appendicitis - typhoid - peritonitis
TRANSCRIPT
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Dr. WILMAR Y Dr. WILMAR Y LUKMAN,SpB.KBDLUKMAN,SpB.KBD
KOLONEL (PURN.)KOLONEL (PURN.)
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APPENDICITIS
LK > PR
PERADANGAN PADA :
APPENDIX = VERMI
CULARIS = UMBAI
CACING , USUS BUNTU
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ANATOMIANATOMI
APPENDIX = USUS BUNTU APPENDIX = USUS BUNTU UMBAI UMBAI CACINGCACING
VERMICULARISVERMICULARIS LETAK LETAK = CAECUM = CAECUM
TITIK Mc BURNEYTITIK Mc BURNEY
1/3 LATERAL 1/3 LATERAL UMBILICAL UMBILICAL && SIASSIAS
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APPENDICITIS
AKUT KRONIS
-20-30 TAHUN
-LK > PR
-JARANG < 2 THN
-ANAK & ORANGTUA BOCOR BAGIAN PROX SEMPIT
-CAUSA NON OBSTRUKTIF
OBSTRUKTIF
- FIBROSIS DINDING APP
- SUMBATAN LUMEN
- JARINGAN PARUT
- ULKUS LAMA
- INFLAMASI
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APPENDICITIS AKUT
NON OBSTRUKTIF OBSTRUKTIF
INFLAMASI / RADANGMUCOSA APPENDIXRASA SAKIT UMBILICUS & EPIGASTRIUMANOREKSIA, NAUSEA, VOMITINGMc BURNEY SIGNBLUMBERG SIGNROVSING SIGNOBSTURATOR SIGNPSOAS SIGNT.RECTAL > T.AXILLART NYERI JAM 9 – 12LEUCOSIT
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OBSTRUKSI OBSTRUKSI APPENDICITISAPPENDICITIS
SUMBATANSUMBATAN LUMEN LUMEN APPENDIXAPPENDIX
TEK INTRALUMINALTEK INTRALUMINAL
SUMBATAN DARI LENDIR APP KE SUMBATAN DARI LENDIR APP KE CAECUMCAECUM
SUMBATAN SUMBATAN LEPAS KE LEPAS KE CAECUMCAECUM
APPENDIX APPENDIX NORMALNORMAL
SUMBATAN SUMBATAN MENETAPMENETAP
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GANGGUAN VASKULARISASIGANGGUAN VASKULARISASI
NEKROTIK DINDING APPENDIXNEKROTIK DINDING APPENDIX
INVASI BAKTERI ( AEROB & INVASI BAKTERI ( AEROB & ANAEROB )ANAEROB )
PERFORASIPERFORASI
ISI CAECUMISI CAECUM
PERITONITIPERITONITIS DIFFUSAS DIFFUSA
PERITONEAPERITONEALL
UJUNG APPUJUNG APP
WALL ING WALL ING OF OF
OMENTUMOMENTUM
PERITONITIPERITONITIS LOKALS LOKAL
SUPURATIF INFLAMASISUPURATIF INFLAMASI
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GEJALA KLINIK
AKIBAT OBSTRUKSI
AKIBAT IRITASI PERITONEAL
SEMBUH
PERFORASI MIKRO SEMBUH, ABCES
MAKRO PERITONITIS
KONSTRAKSI BAGIAN PROX
DISTENSI
NYERI VISCERAL
RANGSANGAN SISTEMIK
ANOREKSIA NAUSEA VOMITING
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DDDD
RONGGA THORAXRONGGA THORAX : : PNEUMONIA PNEUMONIA PLEURITISPLEURITIS
ABDOMENT ATASABDOMENT ATAS : : PERFORASI PEPTIC PERFORASI PEPTIC ULCERULCER CHOLECYSTITIS ACUTCHOLECYSTITIS ACUT
ABDOMEN BAWAHABDOMEN BAWAH : : REGIONAL ENTERITISREGIONAL ENTERITIS PELVISPELVIS : : SALPINGITISSALPINGITIS
KETKET TORSIO KISTA TORSIO KISTA
OVARIIOVARII PIDPID
RETROPERITONEALRETROPERITONEAL: : KOLIK URETER KOLIK URETER
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APPENDICECTOMYAPPENDICECTOMYAPPENDECTOMYAPPENDECTOMY
SEGERASEGERA
KECUALIKECUALIADVANCE ADVANCE PERITONITIS PERITONITISKELUHAN KELUHAN APP KRONIS APP KRONISKONDISI TDK MUNGKIN BILAKONDISI TDK MUNGKIN BILADILAKUKAN OPERASIDILAKUKAN OPERASI
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PERIAPPENDICULAR MASSPERIAPPENDICULAR MASS : : TIDAK OPERASITIDAK OPERASI KONSERVATIFKONSERVATIF ADA MASSA PERUT KANAN BAWAHADA MASSA PERUT KANAN BAWAH DIET LUNAKDIET LUNAK ANTIBIOTIKA AMINOGLIKOSIDA + ANTIBIOTIKA AMINOGLIKOSIDA +
METRONIDAZOLEMETRONIDAZOLE 2-3 BULAN 2-3 BULAN APPENDECTOMY APPENDECTOMY TIDAK ADA KELUHAN TIDAK ADA KELUHAN APPENDIX SEMBUH APPENDIX SEMBUH
FIBROSISFIBROSIS TIDAK APPENDECTOMYTIDAK APPENDECTOMY
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PERIAPPENDICULAS MASSPERIAPPENDICULAS MASS
PERIAPPENDICULAR ABSCESPERIAPPENDICULAR ABSCES
MASSA PADAT MASSA PADAT LUNAK, FLUKTUASI (+) LUNAK, FLUKTUASI (+)SUHU 40 C. MENGGIGIL,SUHU 40 C. MENGGIGIL,
LEUKOSIT > 15.000LEUKOSIT > 15.000
INCISI DRAINAGEINCISI DRAINAGE
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Dr. WILMAR Y LUKMAN SpB.KBDDr. WILMAR Y LUKMAN SpB.KBD
KOLONEL (Purn.)KOLONEL (Purn.)
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PERFORASI TYPHOIDPERFORASI TYPHOID
MERUPAKAN KOMPLIKASI MERUPAKAN KOMPLIKASI DARI PENYAKIT TYPHOID DARI PENYAKIT TYPHOID FEVER / TYPHUS FEVER / TYPHUS ABDOMINALIS, SUATU ABDOMINALIS, SUATU PENYAKIT INFEKSI YANG PENYAKIT INFEKSI YANG BIASA DITEMUKAN DI DAERAH BIASA DITEMUKAN DI DAERAH TROPISTROPIS
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PATOLOGI / PATOLOGI / PATOGENESISPATOGENESIS
PATOLOGI / PATOLOGI / PATOGENESISPATOGENESIS
SALMONELLA TYPHISALMONELLA TYPHI
MELALUI MAKANAN TERTELANMELALUI MAKANAN TERTELAN
ASAM LAMBUNG CUKUPASAM LAMBUNG CUKUPKUMAN SEDIKITKUMAN SEDIKIT
BAKTERI MATIBAKTERI MATI
ASAM LAMBUNG KURANGASAM LAMBUNG KURANGKUMAN MASIFKUMAN MASIF
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USUSUSUS HALUSHALUS
ILEUM ( PEYER PATCH ) BERKEMBANG BIAKILEUM ( PEYER PATCH ) BERKEMBANG BIAK
KELKEL MESENTERICMESENTERIC
BAKTEREMIABAKTEREMIA FASEFASE I I BAKTERI DIBERSIHKANBAKTERI DIBERSIHKANDI REST HATI, LIMPA DI REST HATI, LIMPA
OLEH SEL FAGOSITOLEH SEL FAGOSIT
KEMBANG BIAK HATI, KEMBANG BIAK HATI, LIMPA LIMPA BAKTERIMIA FASE II BAKTERIMIA FASE II
ILEUM ( PAYER PATCH ) BERKEMBANG BIAKILEUM ( PAYER PATCH ) BERKEMBANG BIAK
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CAIRAN EMPEDU, KUMAN MASIFCAIRAN EMPEDU, KUMAN MASIF
DOUDENUMDOUDENUM
ILEUM TERMINALEILEUM TERMINALE
REAKSI KEL .PAYER ,REAKSI KEL .PAYER ,NEKROSIS KELENJARNEKROSIS KELENJAR
ULKUS DALAMULKUS DALAM ULKUS DANGKAL ULKUS DANGKAL
PENDARAHAN USUSPENDARAHAN USUSPERFORASIPERFORASI
SERING MINGGU II / III;SERING MINGGU II / III;LOKASI ILEUM TERMINALELOKASI ILEUM TERMINALE
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KELUHAN DEMAMKELUHAN DEMAM ± ± 2 2 MINGGU MINGGU TIDAK PERNAH TIDAK PERNAH NORMALNORMALMUNTAH HIJAUMUNTAH HIJAU
BAB ( - )BAB ( - )
SUBJECTIVE
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OBJECTIVEOBJECTIVE GELISAH, KESADARAN GELISAH, KESADARAN SHOCK TAKIKARDISHOCK TAKIKARDI DEMAM TINGGIDEMAM TINGGI GEJALA SEPTIK SHOCKGEJALA SEPTIK SHOCK GEJALA GANGGUAN PERNAFASANGEJALA GANGGUAN PERNAFASAN GEJALA GANGGUAN FUNGSI GINJALGEJALA GANGGUAN FUNGSI GINJAL
ABDOMENTEGANG
DEFANCE MUSCULAR (+)
LIVER DUMPING (-)
PERISTALTIK LEMAH (-)
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PLAIN ABDOMINAL FOTOPLAIN ABDOMINAL FOTO DISTENSI UDARA USUS HALUS / BESAR DISTENSI UDARA USUS HALUS / BESAR DINDING USUS MENEBAL OK CAIRAN & DINDING USUS MENEBAL OK CAIRAN &
EXUDATEXUDAT PNEUMO PERITONEUM PNEUMO PERITONEUM AIR FLUID LEVELAIR FLUID LEVEL
LABORATORIUMLABORATORIUM LEUKOPENIA SEBELUM PERFORASILEUKOPENIA SEBELUM PERFORASI LEUKOSITOSIS SESUDAH PERFORASILEUKOSITOSIS SESUDAH PERFORASI
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A ( ASSESMENT )A ( ASSESMENT ) PERITONITIS DIFFUSA EC PERITONITIS DIFFUSA EC TYPHOID PERFORASI TYPHOID PERFORASI
P ( PLANNING )P ( PLANNING ) PUASA PUASA DEKOMPRESSI DEKOMPRESSI PSG NGT, PSG NGT, PSG FOLEY CATHETER PSG FOLEY CATHETER IVFD ( CAIRAN + ELETROLIT ) IVFD ( CAIRAN + ELETROLIT ) ANTIBIOTIKA ANTIBIOTIKA EXPLORASI LAPARATOMI EXPLORASI LAPARATOMI
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Dr WILMAR Y LUKMAN, Dr WILMAR Y LUKMAN, SpB.KBDSpB.KBD
KOLONEL (PURN.)KOLONEL (PURN.)
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ANAMNESIS
GEJALA KLINIK
PERITONITIS
-NUCHTER-IVFD-DECOMPRESI (NGT & FOLEY CATHETER-ANTIBIOTIKA
EXPLORASI LAPARATOMI
-STOP KONTAMINASI-EKSISI PINGGIR PERFORASI-TUTUP PERFORASI -CUCI RONGGA PERUT-DRAINAGE CAIRAN
-LABORATORIUM LEUKOSIT- PLAIN ABDOMINAL FOTO 2 POSISI
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