appendix fix
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APENDISITIS
Stase Ilmu Bedah RSIJ Cempaka Putih
Pembimbing: dr. Winoto, Sp.B
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PANJANGNYA
KIRA-KIRA
ADA
KESAMAAN
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Anatomi
Berasal dari MID GUT
Di fossa iliaka kanan titik
Mc. Burney
Basis di puncak sekum
pertemuan 3 taenia
Bentuk tabung, panjang 3
15 cm
Pangkal lumen sempit,
distal lebar Lokasi : retrosekal (65%),
pelvinal, antesekal, medial,
preileal,postileal, dll
Vaskularisasi A.a endikularis end arteri
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Definition
Appendicitis is a
condition characterized
by inflammation of the
appendix. It is
classified as a medical
emergency and many
cases require removal
of the inflamed
appendix, either bylaparotomy or
laparoscopy.
Untreated,
mortality is high,
mainly because of
the risk of rupture
leading to
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Etiology
Obstruksi
Lumen
HiperplasiaLymphoid
Fecalith
Foreign object
Neoplasma
Parasit
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Patogenesis
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APENDISITIS AKUTSymptoms :- Nyeri visera di epigastrium, sekitar umbilicus- Mungkin Kolik
Patogenesis
tekanan intraluminer tinggi
mukus >>>
gangguandrainase
limfe
edema +ulserasimukosa
Obstruksi
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Patogenesi
s
Appendisitis
APENDISITIS AKUT SUPURATIF / PURULENTASymptoms- Nyeri sentral berpindah ke perut kanan bawah- Nyeri somatik ( peritonitis lokal)
- Mual dan muntah
obstruksivena
Trombosis
Iskemiaedema
semakinberat
invasikuman
TekananIntralumen
Tinggi
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Gejala Klinis
Nyeri samar-samar dan
tumpul
Nyeri pada titikMcburney
Sakit bertambahMual dan
kadang adamuntah
Konstipasi/diare
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Pemeriksaan Fisik
KEADAAN UMUM
Demam ringan 37,5
0
38,50
C(beda 1
0
C rektaldan aksiler sudah
bermakna) Demam tinggi
infiltrat, abses,peritonitis
Nadi cepat infiltrat, abses,peritonitis
Kurang bergerak,paha difleksikan
INSPEKSI
Tidak tampakkelainan
Penonjolan perutkanan bawah
INFILTRAT ATAUABSES
Cembung ikutgerak nafas PERFORASI /PERITONITIS
PALPASI
Nyeri tekan perutkanan bawah (McBurney)
Massa di perut
kanan bawah INFILTRAT ATAUABSES
Defans lokal defans menyeluruh sudahPERITONITIS
BLUMBERG SIGN, ROVSING SIGN
OBTURATORSIGN, PSOASSIGN
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McBurneys Point
McBurneys point (1) appears
about one-third of the distance
along a line starting at the right
ASIS (3) and ending at theumbilicus 2 .
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Anatomic basis for the
psoas sign: inflamedappendix is in a
retroperitoneal location in
contact with the psoas
muscle, which is stretched
by this maneuver.
The psoas sign. Pain on
passive extension of the rightthigh. Patient lies on left side.
Examiner extends patient's
right thigh while applying
counter resistance to the right
hip (asterisk).
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Anatomic basis for the
obturator sign: inflamedappendix in the pelvis is in
contact with the obturator
internus muscle, which is
stretched by this maneuver.
The obturator sign. Pain on
passive internal rotation of theflexed thigh. Examiner moves
lower leg laterally while
applying resistance to the
lateral side of the knee
(asterisk) resulting in internalrotation of the femur.
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Pemeriksaan Fisik
PERKUSI
Nyeri ketokperut kananbawah
Pekak heparhilang PERFORASI
(sering pekakada)
AUSKULTASI
Peristaltiknormal
Bising ususmenghilang PERITONITIS
COLOKDUBUR
Nyeri pukul 10 11 LETAKPELVINAL
Sfingterlonggar bilaPERITONITIS
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Pemeriksaan Penunjang
Laboratorium:
Peningkatanjumlah leukosit
CRP, Urinalisa
Foto polosabdomen
Ultrasonografi
CT-scan Laparoskopi Histopatologi
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In fewer than 5 percent of
patients, an opaque fecalith
may be apparent in the right
lower quadrant. Plainabdominal films generally are
not recommended unless
other conditions(e.g.,
perforation, intestinal
obstruction, ureteral calculus)are suspected.8 Likewise, as
advanced cross-sectional
imaging techniques have
become available, barium
enema is now used
infrequently.
COMPUTED TOMOGRAPHY
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Ultrasonogram
showing longitudinal
section (arrows) of
inflamed appendix.
ULTRASONOGRAPHY
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Computed
tomographicscan showing
enlarged and
inflamed
appendix (A)
extending fromthe cecum (C).
Computed
tomographic scan
showing cross-
section of
inflamed
appendix (A) with
appendicolith (a).
COMPUTED TOMOGRAPHY
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Alvarado Scale for the Diagnosis of Appendicitis
Manifestations
Value
Symptoms Migration of pain 1
Anorexia 1
Nausea and/or vomiting 1
Signs Right lower quadrant tenderness (Nyerifossa iliaca kanan)
2
Rebound (Nyeri lepas) 1
Elevated temperature (> 37,30C ) 1
Laboratory values Leukocytosis (> 10103/L ) 2
Left shift in leukocyte count
(neutrofil > 75% )
1
Total points 10
>7 : Appendiksitis akut
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Skor 1 4 : dipertimbangkan appendicitis
akut : Observasi
Skor 5
6 : possible appendicitis tidak
perlu operasi : Antibiotik
Skor 7 9 : appendicitis akut perlu
pembedahan : Operasi dini
Modified Alvarado score (Kalan et al) tanpa observasi of
Hematogram
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DIANGNOSIS BANDING
Gastroenteritis Demam Dengue
Limfadenitis Mesenterika
Kelainan Ovulasi Infeksi Panggul
Kehamilan di Luar Kandungan
Kista Ovarium Terpuntir
Endometriosis Eksterna Urolitiasis Pielum/Ureter Kanan
Penyakit Saluran Cerna Lainnya
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Penatalaksanaan
Apendectomy Drainage Conservative
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Appendectomy
An appendectomy (sometimescalled appendisectomy or
appendicectomy (British English))is the surgical removal of the
vermiform appendix
An appendectomy may belaparoscopic or traditional.
Laparoscopic surgery uses a fewsmall incisions.
The various layers of the abdominalwall are then opened,
On entering the peritoneum, theappendix is identified, mobilized andthen ligated and divided at its base
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Drainage involves placing aneedle through the skin in
the abscess, usually under x-ray guidance. The drain is
then left in place for days or
weeks until the abscess goesaway.
PAD is performed usingstandard aseptic technique
and local lidocaineanesthesia. Begin with adiagnostic aspiration,followed by catheter
placement if fluid is purulent
Drainage
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Pada InfiltratAppendikularis
Prosedur Oshner-Shener
1. Istirahat total
2. Posisi fowler
3. Antibiotika
4. Monitoring suhu ,ukuran tumor,
Laju endap darah (led) &leukosit
Appendectomy elektifsetelah 12 minggu
Conservative
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Posisi duduk atau setengah duduk, bagian kepala tempat
tidur lebih tinggi atau dinaikkan.
Fowler (45o-90o) dan semi fowler (15o-45o).
Dilakukan untuk mempertahankan kenyamanan,memfasilitasi fungsi pernapasan, dan pasien pasca bedah.
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REFERENSI
1. De Jong, W. & Sjamsuhidajat, R.,2004. Buku Ajar Ilmu Bedah Edisi 2. EGC.Jakarta.
2. Reksoprodjo, S., dkk. 1995. Kumpulan Kuliah Ilmu Bedah. Bagian Bedah Staf
Pengajar Fakultas Kedokteran Universitas Indonesia. Bina Rupa Aksara. Jakarta.
3. Mansjoer, A., dkk. 2000. Kapita Selekta Kedokteran Edisi Ketiga Jilid Kedua.
Penerbit Media Aesculapius Fakultas Kedokteran Universitas Indonesia. Jakarta.
4. Bagian Ilmu bedah Fakultas Kedokteran Universitas Sumatra Utara.
http://library.usu.ac.id/ download/fk/bedah-emir%20jehan.pdf
5. Mubin, Halim. Buku Panduan Praktis : Ilmu Penyakit Dalam Diagnosis dan
Terapi Edisi 2. Jakarta : Penerbit Buku Kedokteran EGC. 2007.
6. Price, Sylvia A. Patofisiologi : Konsep Klinis Proses-Proses Penyakit, Edisi 4.
Jakarta: Penerbit Buku Kedokteran EGC. 1995.
7. Schwartz, Spencer, S., Fisher, D.G., 1999. Principles of Surgery Sevent Edition.
Mc-Graw Hill a Division of The McGraw-Hill Companies. Enigma an Enigma
Electronic Publication.
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. . .TERIMAKASIH. . .