Hasil Kolonoskopi Pasien dengan Perdarahan Saluran Cerna Bagian Bawah di Rumah Sakit Umum Pusat Haji Adam Malik Medan Tahun 2012
54
LAMPIRAN
NO. REKAM MEDIS :
FORMULIR PENELITIAN
NAMA
:
JENIS KELAMIN
:
USIA/TANGGAL LAHIR
:
AGAMA
:
SUKU
:
PENDIDIKAN
:
KELUHAN
:
HASIL PEMERIKSAAN
:
1. ANUS
2.REKTUM
3.KOLON SIGMOID
4.KOLON DESENDENS
5.KOLON TRANSVERSUM
6.KOLON ASENDENS
7. SEKUM
RIWAYAT PENYAKIT
:
Hb
:
RDW :
B
:
Ureum
:
PT
RBC
:
MPV :
NA
:
Kreatinin
:
Kontrol
:
WBC :
PCT
:
LA
:
Asam Urat
:
Pasien
:
HT
:
PDW :
MA
:
Natrium
:
APTT
PLT
:
N
:
EA
:
Kalium
:
Kontrol
:
MCV :
L
:
BA
:
Chloride
:
Pasien
:
MCH :
M
:
AST
:
CEA
:
INR
:
MCHC :
E
:
ALT
:
CA125
:
TT
:
Universitas Sumatera Utara
55
LAMPIRAN
Jeniskelamin
Cumulative
Frequency Percent Valid Percent
Percent
Valid Laki-laki
22
52.4
52.4
52.4
Perempuan
20
47.6
47.6
100.0
Total
42
100.0
100.0
Umur
Cumulative
Frequency Percent Valid Percent
Percent
Valid 1
3
7.1
7.1
7.1
2
11
26.2
26.2
33.3
3
8
19.0
19.0
52.4
4
6
14.3
14.3
66.7
5
9
21.4
21.4
88.1
6
5
11.9
11.9
100.0
42
100.0
100.0
Total
Agama
Cumulative
Frequency Percent Valid Percent
Percent
Valid Islam
22
52.4
52.4
52.4
Protestan
20
47.6
47.6
100.0
Total
42
100.0
100.0
Universitas Sumatera Utara
56
Suku
Cumulative
Frequency Percent Valid Percent
Percent
Valid Jawa
5
11.9
11.9
11.9
Batak
23
54.8
54.8
66.7
Karo
1
2.4
2.4
69.0
Nias
1
2.4
2.4
71.4
Lain-lain
12
28.6
28.6
100.0
Total
42
100.0
100.0
Pekerjaan
Cumulative
Frequency Percent Valid Percent
Percent
Valid IbuRumahTangga
10
23.8
23.8
23.8
Pegawai
6
14.3
14.3
38.1
wiraswasta
8
19.0
19.0
57.1
pesiunan
6
14.3
14.3
71.4
Lain-lain
12
28.6
28.6
100.0
Total
42
100.0
100.0
Pendidikan
Cumulative
Frequency Percent Valid Percent
Percent
Valid Tidaksekolah
2
4.8
4.8
4.8
5
11.9
11.9
16.7
SMP
10
23.8
23.8
40.5
SMA
19
45.2
45.2
85.7
6
14.3
14.3
100.0
42
100.0
100.0
SD
Sarjana
Total
Universitas Sumatera Utara
57
Anus
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
32
76.2
76.2
76.2
hemoroid
10
23.8
23.8
100.0
Total
42
100.0
100.0
Rektum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
33
78.6
78.6
78.6
Hemoroid
2
4.8
4.8
83.3
Massa protruded
4
9.5
9.5
92.9
edema
1
2.4
2.4
95.2
Hiperemis
2
4.8
4.8
100.0
42
100.0
100.0
Total
Sigmoid
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
29
69.0
69.0
69.0
Massa protruded
3
7.1
7.1
76.2
Edema
2
4.8
4.8
81.0
Scope tidakdilanjutkan
5
11.9
11.9
92.9
Hiperemis
2
4.8
4.8
97.6
granuloma, divertikel,
polip
1
2.4
2.4
100.0
42
100.0
100.0
Total
Universitas Sumatera Utara
58
Desendens
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
24
57.1
57.1
57.1
Massa protruded
2
4.8
4.8
61.9
Edema
2
4.8
4.8
66.7
Scope tidakdilanjutkan
9
21.4
21.4
88.1
Hiperemis
2
4.8
4.8
92.9
Granuloma,polip,
divertikel
3
7.1
7.1
100.0
42
100.0
100.0
Total
Transversum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
25
59.5
59.5
59.5
Massa protruded
1
2.4
2.4
61.9
Edema
2
4.8
4.8
66.7
11
26.2
26.2
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Universitas Sumatera Utara
59
Asendens
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
24
57.1
57.1
57.1
Massa protruded
2
4.8
4.8
61.9
Edema
1
2.4
2.4
64.3
12
28.6
28.6
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Sekum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
21
50.0
50.0
50.0
Massa protruded
2
4.8
4.8
54.8
Edema
2
4.8
4.8
59.5
14
33.3
33.3
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Universitas Sumatera Utara
LAMPIRAN
NO. REKAM MEDIS :
FORMULIR PENELITIAN
NAMA
:
JENIS KELAMIN
:
USIA/TANGGAL LAHIR
:
AGAMA
:
SUKU
:
PENDIDIKAN
:
KELUHAN
:
HASIL PEMERIKSAAN
:
1. ANUS
2.REKTUM
3.KOLON SIGMOID
4.KOLON DESENDENS
5.KOLON TRANSVERSUM
6.KOLON ASENDENS
7. SEKUM
RIWAYAT PENYAKIT
:
Hb
:
RDW :
B
:
Ureum
:
PT
RBC
:
MPV :
NA
:
Kreatinin
:
Kontrol
:
WBC :
PCT
:
LA
:
Asam Urat
:
Pasien
:
HT
:
PDW :
MA
:
Natrium
:
APTT
PLT
:
N
:
EA
:
Kalium
:
Kontrol
:
MCV :
L
:
BA
:
Chloride
:
Pasien
:
MCH :
M
:
AST
:
CEA
:
INR
:
MCHC :
E
:
ALT
:
CA125
:
TT
:
Universitas Sumatera Utara
55
LAMPIRAN
Jeniskelamin
Cumulative
Frequency Percent Valid Percent
Percent
Valid Laki-laki
22
52.4
52.4
52.4
Perempuan
20
47.6
47.6
100.0
Total
42
100.0
100.0
Umur
Cumulative
Frequency Percent Valid Percent
Percent
Valid 1
3
7.1
7.1
7.1
2
11
26.2
26.2
33.3
3
8
19.0
19.0
52.4
4
6
14.3
14.3
66.7
5
9
21.4
21.4
88.1
6
5
11.9
11.9
100.0
42
100.0
100.0
Total
Agama
Cumulative
Frequency Percent Valid Percent
Percent
Valid Islam
22
52.4
52.4
52.4
Protestan
20
47.6
47.6
100.0
Total
42
100.0
100.0
Universitas Sumatera Utara
56
Suku
Cumulative
Frequency Percent Valid Percent
Percent
Valid Jawa
5
11.9
11.9
11.9
Batak
23
54.8
54.8
66.7
Karo
1
2.4
2.4
69.0
Nias
1
2.4
2.4
71.4
Lain-lain
12
28.6
28.6
100.0
Total
42
100.0
100.0
Pekerjaan
Cumulative
Frequency Percent Valid Percent
Percent
Valid IbuRumahTangga
10
23.8
23.8
23.8
Pegawai
6
14.3
14.3
38.1
wiraswasta
8
19.0
19.0
57.1
pesiunan
6
14.3
14.3
71.4
Lain-lain
12
28.6
28.6
100.0
Total
42
100.0
100.0
Pendidikan
Cumulative
Frequency Percent Valid Percent
Percent
Valid Tidaksekolah
2
4.8
4.8
4.8
5
11.9
11.9
16.7
SMP
10
23.8
23.8
40.5
SMA
19
45.2
45.2
85.7
6
14.3
14.3
100.0
42
100.0
100.0
SD
Sarjana
Total
Universitas Sumatera Utara
57
Anus
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
32
76.2
76.2
76.2
hemoroid
10
23.8
23.8
100.0
Total
42
100.0
100.0
Rektum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
33
78.6
78.6
78.6
Hemoroid
2
4.8
4.8
83.3
Massa protruded
4
9.5
9.5
92.9
edema
1
2.4
2.4
95.2
Hiperemis
2
4.8
4.8
100.0
42
100.0
100.0
Total
Sigmoid
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
29
69.0
69.0
69.0
Massa protruded
3
7.1
7.1
76.2
Edema
2
4.8
4.8
81.0
Scope tidakdilanjutkan
5
11.9
11.9
92.9
Hiperemis
2
4.8
4.8
97.6
granuloma, divertikel,
polip
1
2.4
2.4
100.0
42
100.0
100.0
Total
Universitas Sumatera Utara
58
Desendens
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
24
57.1
57.1
57.1
Massa protruded
2
4.8
4.8
61.9
Edema
2
4.8
4.8
66.7
Scope tidakdilanjutkan
9
21.4
21.4
88.1
Hiperemis
2
4.8
4.8
92.9
Granuloma,polip,
divertikel
3
7.1
7.1
100.0
42
100.0
100.0
Total
Transversum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
25
59.5
59.5
59.5
Massa protruded
1
2.4
2.4
61.9
Edema
2
4.8
4.8
66.7
11
26.2
26.2
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Universitas Sumatera Utara
59
Asendens
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
24
57.1
57.1
57.1
Massa protruded
2
4.8
4.8
61.9
Edema
1
2.4
2.4
64.3
12
28.6
28.6
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Sekum
Cumulative
Frequency Percent Valid Percent
Percent
Valid Normal
21
50.0
50.0
50.0
Massa protruded
2
4.8
4.8
54.8
Edema
2
4.8
4.8
59.5
14
33.3
33.3
92.9
Hiperemis
1
2.4
2.4
95.2
Granuloma,polip,
divertikel
2
4.8
4.8
100.0
42
100.0
100.0
Scope tidakdilanjutkan
Total
Universitas Sumatera Utara