Diabetic Ulcus Pedis Sinistra: Maulina Analita, S.Ked
Diabetic Ulcus Pedis Sinistra: Maulina Analita, S.Ked
Diabetic Ulcus Pedis Sinistra: Maulina Analita, S.Ked
Advisor:
dr. Amran Sinaga, Sp.B
introduce
Diabetes Mellitus (DM) is often called the great imitator because this disease can af-
fect all organs of the body such as the brain (stroke), kidneys (kidney failure), heart,
eyes, and feet (diabetic gangrene).
Neck :
Enlargement KGB (-)
Heart
Inspection: IC nokseen
Palpation: IC palpable at ICS IV
Pulmo linea midclavicular sinistra
Inspection: symmetrical Right and left
Percussion: L imitheart DBN
Palpation:Right tactile fremitus is the same as left
Percussion : Sonors whole lung field Auscultation: heart sound I/II
Auscultation: Vesicular(+/+),rh (-/-),wh(-/-) regular, murmurs (-),gallops (-)
Abdomen
inspection: Symmetrical, surgical scars (-), scar in
inguinal regio (-), groin lump in inguinal regio
Auscultation : Bowel noise (+)
Palpation: tenderness (+)
liver : not palpable, hepatomegaly (-)
Lien: not palpable
Kidneys: not palpable Extremities :
Percussion : tympani Superior
Dextra:Warm acral, CRT < 2 seconds, edema (-)
Sinistra :Warm acral, CRT < 2 seconds, edema (-)
Inferior
Dextra:Warm Akral, CRT < 2 seconds
Sinistra : Warm accral, CRT < 2 seconds,edema(-)
Supporting investigasion
result Reference value
Hematologi
Hemoglobin 10,6 g/dL 13,4 – 15,5
Hematokrit 31,5 % 34,5 - 54
Eritrosit 3,96 10^6/uL 12,9 – 14.2
Trombosit 461 10^3/uL 150 – 450
Leukosit 12,0 10^3/uL 4,0 – 10,0
GDS 280 Mg/dl <200
Elektrolit
Natrium (Na) 129,3 mmol/L 135 – 148
Kalium (K) 4,58 mmol/L 3,5 – 5,3
Chlorida (Cl) 94,1 mmol/L 98 – 110
Kalsium (Ka) 1,19 mmol/L 1,10-1,35
Ur 24 Mg/dl 15-39
Kr 0,77 Mg/dl 0,55-1,3
HbA1C 8,1 % <6,5
TREAT
Physical Ex- history
amination
Non Farmakologi
1. Bed Rest
2. Wound Toilet
Supporting
investigasion Farmakologis:
1. IVFD NaCl 0,9 % 20 tpm
2. Inj Ceftriaxone 1x2gr
3. Inj Metronidazole 3x500mg
4. Inj Ketorolac 3x1
5. Inj Ranitidin 2x1
6. Inj Novorapid 3x12 IU
7. Inj Lontus 1x8 IU
Diagnosis: 8. Transfusi PRC 2 kantong
9. Pro Debridement
Ulkus Diabetikum Pedis Sinistra
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Literatur review
Diabetic ulcers
Diabetic
Metabolic
ulcer
control
management
Metabolic Control
Non-pharmacological therapy
Pharmacological therapy
1) Sulfonylureas
2) Glinide
3) Thiazolidinediones
4) Glucosidase Inhibitors
5) Biguanid
• 6) Combination drugs from the above groups
Diabetic Ulcer Management
Debridement
• attempts to remove foreign bodies and necrotic tissue from the wound
• There are several options for debridement, namely: mechanical, enzy-
matic, autolytic, biologic debridement
Wound Management
Infection Control
Amputation
Complication
Analysis
After taking the history and physical examination to confirm the
diagnosis, supporting examinations were carried out in the form
of a laboratory, chest radiographs and left pedis.
The results of laboratory examinations showed the presence of
leukocytosis, anemia, and hyperglycemia.
This identifies that there is an infectious process in the patient
which is most likely due to the patient's high glucose level. On
the left pedis photo, osteomyelitis is found
From this history, several important things were obtained that
lead to Diabetic Ulcers on the left foot, namely there was a
wound on the left leg that felt painful and hot. In addition, the
patient also has a history of diabetes mellitus since 5 years and
regularly uses insulin.
Diabetic ulcers are the 2nd most common combined atherosclerosis after
coronary artery atherosclerosis and those affected by lower leg blood
vessels.