Ny Rejowati (IGD) 2.2 Essential HT + cephalgia Ny Kumiatun (IGD) 11.2 Encephalopathy hepaticum + acute viral hepatitis Name : Mrs K Age : 27 y.o Sex : female Adress : Jembel RT1RW5 Sugihwaras Jenu Tuban Date : December, 5th 2014 CHIEF COMPLAINT: decrease of consciousness PRESENT ILLNESS HISTORY : Patients had decrease of consciousness suddenly since 2 days ago, before that she complaint about pain on right upper quadrant with black-bloody vomit 3 days ago, vomit about 10 times a day (a quarter of glass every vomit) without dregs, and Defecation (+) 5 times within 3 day with black-watery stool. Miction (+)N. She also had fever since 1 week ago, fluctuating. Headache (+). Shortness of breath 3 days ago. Her eyes looks yellowish since last night. PAST ILLNESS HISTORY: HT (-), DM (-), never consume diabetic drugs FAMILY ILLNESS HISTORY: the same as the patient's complaints (-) PERSONAL HISTORY, SOCIAL, and ECONOMICS: Patients never drink herbal medicine VITAL SIGN : GCS : 335 BP : 130/70 mmHg PULSE RATE : 130 x / minutes TEMP : 36,9oC RR : 28 x / minutes Head and Neck : Anemic (-/-), Icteric (+/+), Cyanosis (-/-), Dyspneu (-) Pupil isokor 3 mm / 3 mm Thorax : simetric bilaterally, retraction (-/-), Pulmo : ves/ves, rh (-/-), wh (-/-) Cor : S1-S2 single reguler, murmur(-), gallop(-) Abdomen : Abdomen : soepel, meteorismus (-),BU(+N), hepar palpable 1 cm under arcus costae (smooth surface, sharp edge, compound),lien not palpable, epigastrium tenderness (-),shifting dullnes (-), undulasi (-), RUQ tenderness (+), Ascites (-). Extremity : warm, dry, red. Edem (-) Female, 27 years old Decrease of consciousness haematemesis melena RUQ tenderness Takipneu Jaundice Decrease of consciousness Haematemesis melena Jaundice Encephalopathy hepaticum ec susp. Cirrhosis hepatis Haematemesis melena ec susp variceal esophagus rupture CBC ECG LFT RFT Abdominal USG Thorax AP Gastroscopy HCV analyzed Diffcount 0/0/77/20/3 Chloride 98 Hematokrit 38,1 Hemoglobin 13,6 Potassium 4,0 LED 25/52 Natrium 131 Leukosit 11.500 Trombosit 36.000 Bilirubin direct 3,08 SGOT 3649 Billirubin total 4,98 SGPT 1968 Alkali fosfatase 172 Ser creatinin 1,4 Urea 70 HBs-Ag (-) GDA 136 Encephalopathy hepaticum ec cirrochis hepatis DD susp .degenerasi maligna Hematemesis melena ec variceal esophagus rupture Attach O2 nasal 2 lpm Attach NGT Attach DC Inf assering loading 1000 cc Pz 1500 cc/24 h Inj cefotaxime 3x2 gram Inj metamizole 3x 1 g Inj ranitidin 2x50 mg Inj vit K 3x1 amp Inj asam traneksamat 3x1 amp PO : lactulose 4x CI Vital signs Complaint Urinary production Dubia ad bonam Explaine to the family about the disease of the family, about its theraphy and intervention will be done, and also about complication and prognosis.