bedah digestive (abdomen akut)
TRANSCRIPT
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BEDAH DIGESTIV
KEPANITERAAN KLINIK STASE ILMU BEDAH
RUMAH SAKIT ISLAM PONDOK KOPI
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH JAKARTA
2015
FITRI LARASATI (2010730136)
DR.H.SALEH SETIAAN! SP.B
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Abdomen Akut
Kondisi dimana gejala utamanya nyeri d
terjadi seara tiba!tiba dan
penanggulangannya biasanya ti
pembeda"an diperlukan#
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$%E&I 'E&(T
K"#$%&' &' *"'+',+# -&/ &/"'&-+*"' &$4 /&% '"/ "$4. R&"$4 -&&4 -/"&&' +#"% "#&/'&'-/ &-+*"' &4&$ -/ #$& &-+*"'
+&'+&' -/ +'& 4+&.
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Diagnosis Banding
KolesistitisAkut,'ankreatitisAkut
'er)orasiTukak'eptik,HepatitisAkut
Kongesti)HepatomegaliAkut,Abses"ati,'neumoniadenganreaksi
pleura,'ielone)ritisAkut,
Angina'ektoris
&uptur limpa, 'er)o'ankreatitis akutaorta pea", 'er)
'neumonia dengan pielone)ritis a
Apendisitis, adneksitis,endometriosis, KET, Kista
oarium terpuntir, 'untiranapendises, epiploiae, "ernia
inkarserata, diertikulitis, ileitisregional, per)orasi aeum,abses psoas, batu ureter,
adenitis mesenterik
s,adneksitis,KET,
riumterpuntir,
serata,per)orasi
oid,absespsoas,
uureter#
.bstruksi usus,apendisitis, pankreatitisakut, oklusi pemb#dara"
mesenterial, "erniastrangulasi, ruptur
aneurisma aorta,diertikulitis
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T",&-/ &"'& &-&'& &'&'&'
"/4+'"$* &' *"#/$4/ +'&"/4+'"$*
D/"&& +#"% $$'&' && +4+' L+&/ '"/ $#/4 $'4$ -/&*&& P&/"' /&&'& ""& &4/ 4&'
*"'"&&' "4&*&%'& &&
N"/V/"
T",&-/ &"'& &'&'&' "/4+'"&/"4"
D/"&& +#"% $$'&' && 4"/$$'&' && $&4.
R&& '"/ ""4/ -/4$$4$$8-/ D&&4 -/4$',$&' "9&& 4"&4 +#"
N"/S+*&4/
/enis $yeri 'erut
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0okalisasi $yeri
Asal .rgan
F+"$4
M/-$4 H/'-$4 R"4+"/4+'" P"#:/
.rgan
E+&$! #&*$'!-$+-"'$*! $&'
&*"-$ J",$'$* K+#+' -/4 ;/',! $"4" A-'"&
0ok
E/&
P"/$* I'&$* P/'& P/'&
ViseralN"/ &' 4/*$# /&&'& "$&/ -"'&' #"4& +&'+'& "$4 -&' & +&' "9&& "*/+#+/
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0okalisasi $yeri
L+&/ O&'
A-+*"' K&'&' A4&
E/&4/$*
A-+*"' K// A4&A-+*"' K&'&' B&
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N"/ S+*&4/= &'&'&' "/4+'"$*"#&'$' terus!menerus.
N"/ V/"= '"/ kolik &/&4 &:/"
S/&4 R&& N"/
N"/ "9&& "4&%& "4&*&%-/"&&' +#"% +" /'>&*&/! +#"/4/4/ &$4 &4&$ &'"&4/4/ &$4.
O'"4 -&'I'4"'/4& N"/
N"/ "$4 &' -/"4&/ *$'4&% &'*"'"$ "#$ -///&' "*$'
&$4! &'"&4/4/ &$4 8 $*&4&'&/&' &4&.M$'4&%
U*$! +// &/"'! R/
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U*$ = "#&/'&' $&' "*"-$ ,&&304%'! /':&/'&/ #"/% "/' &-&&/'+*& +#+' -&' "4$* $/& 0604
P+// &/"' = P&'"&4/4/ &$4 "
""#&% // -' >"/ &-& 4$#&' -&' #$4$4. A-+*"' &$4 -"'&' //4&/ &/"' &&' #"/% '&*&' -&* +// &"'& "'&& *"',&-/ #"/% *$-&%.
R/
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'emeriksaan Abdomen
I'"/ P&/ P"$/A$
J&/'&' &$4 "&+"&/("*$'/'&'&-&'& &-%"/).P"$4 *"*$'9/4;&*&&'$$8"&&' $$.
N"/ 4"&'D"&' *$$#& (/'>&*&/"/4+'"$* &/"4")4&'-& -&/ Murphy("&-&'&' &'-$'"*"-$)'"/ 4"&' /'4"+4 &'&'
&4& (&" %&4/)
'"/ "4+ (//4&/"/4+'"$*)P"& %"& -&'%/4/' -$##'"(4"-&&4 $-&&"& &4&$ 9&/&'"&)
//' $$*"'%/#&' ("/4+'/4/ $B//' $$ metalic soun+4$/)B//' $$ &*& "/
+#"% &//
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M"*"-&&' &'4&& +4$/ (+#&) -"'&' &// $$(&*$#& *"#"&)P"*"/&&'
R"4
H8H4 ("-&&%&'8-"%/-&/) P"*. R&-/+#+/ +4+ &-+*"' 3 US; ("#&/'&' H&4/! $&' "*
-&' &'"&)
P"*"/&&'P"'$',&'
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12 0angka" $yeri 'erut Kanan Atas
1
O4&!".'&&&'!&.-/+:&$#".)
2
'-/'(A'&*'"/!PF!PP)
3
'"*"-&%&'&4&$4/-&
&&.+4+*/-"'&'&&4&'*"-/&'&4&
5
/O".&/
6
&'"*"-&%&'
7
"-&%
*&"*"-&%&'
C
9&"-&%
10
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K.0ESISTISIS AK(T
R&-&' &'-$' "*"-$ C5 -/"&$*&4&' -$4$ /4/$ 4"$4&*& +#"*"-$.
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Kolesistitis Akut
Subjekti)
N"/ "$4 &$4 -/&."$4 &'&' &4&(+#/ &4&$ 4"$*"'"$)
N"/ *"'"& "$'$' -&' "
&$#& M$! *$'4&% -"*&*
.bjekti)
S"/' &-&
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'enatalaksanaan O":&/ "#&*& 2 G 2 ,&
4&'-& "/4+'/4/'&. B/#& *"*&/ -/"'9&'
+#"/4"4+*/ (12 "*$-/&')
N+'+"&4/
S"#&*& +":&/ /#& 4"-&&4 E*"*& &'-$' "*"-$ P"/4+'/4/ *"#$&8$*$* T/-& &-& "&/&' "4"#&%
2G2,&*! -/#&$&' 4/'-&&'+#"/4"4+*/ ""&.
O"&4/
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'A$K&EATITIS AK(T
S$*&4&' &-& $&' &'"&*"'"&&' "4&:&&/ -&/ ",&/'&' &"'/* &'"&.
R">$ "*"-$ " -$4$ &'"&
"'"& &'"&4/4/ &$4 %"*+&/
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'ankreatitis Akut
A#+%+#B&4$ "*"-$
T&$*&
T$& "4/
V/$
O&4//4&' /'&4&
"/&
%/""*/
/-/+&4/
ETI.0.GI
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'ankreatitis AkutSubjekti)
N"/ "$4 *"'"*$ "
&&% "#&&' (4"$*"'$$)
N"/ "$4 "$&' &-&+// "&/' *//'
M$! *$'4&% R/
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Tindakan segera yang "adilakukan
P$&&
D"+*"/ #&*$'
T"&/ 9&/&' $'4$ "&/&' /
P"*"/&' &'4/+#/'"/ $#& &
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'E&3.&ASI T(KAK 'E'TIK
P"+&/ 4$& "4/ 4"$4&*&-$+"-"'$* *"$&&' "'"& '"/ "$4 %"&4 4/&4/& &-&-"'&' /
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'er)orasi Tukak 'eptik
Subjekti)
P&/"' -"'&'/
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Tindakan
P"*&&'&' P/& #&*$' $'4$ -"-&' "'/&&' 9&/&' #&*$'
R"$/4&/ 9&/&'
A'"4/& $'4$ *"'$&'/ '
*"*"&// /&' / :"'& -&' &$.
P"*"-&%&' -/#&$&'
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Trauma 'erut
L$& &-& // +'& "$4 -&-"'&' &4&$ 4&'& 4"*$&''& -/'
B"-&&&' "'"&'&! 4&$*& &4& 2 &/&' "&! &/4$=
T&$*& "$4 -"'&' "'"4&/ " -&"/4+'"$* (4&$*& 4"*$)
T&$*& "$4 4&'& "'"4&/ "/4+'"$* (4&$*& 4$*$#)
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A'&*'"/ P"*"/&&' F// P"*"' P"'
Diagnosis
A&% 4$$&' S"',&4& && &'
-/&&/ B&&/*&'&
4",&-/'&"9"#&&&'
B"'4$&' &'%"&4 &-& "$4
J",& &-& -/'-/' "$4P&-& #$& 4"*&84$$ -"'&' // "$4
&' "#$& ;",& &-& 4&$*& 4$*$# "$4 &/&4
"%/#&'&' -&&%! *"*&8 "$&&'&-& +&'8 //4&/ 9&/&' $$
R//-/4 &/&4 %"*&4+*& &-& -/'-/'"$4.
H"*&4*"'$
,/& &100 $9&/&'
(4&$ P&& L&:
Akibat Trauma Ter"adap .rgan
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L$& T$$ =
P"-&&%&'
I/4&/ "/4+'"$*
(+&' "+'&)
L$& T"*& =
K"$&&' O&' &'-/#$/ "#$$
T&$*
K"$&&'4","/-/&'4&
-"'&' 4$
Akibat Trauma Ter"adap .rgandalam 'erut
' l k
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'enatalaksanaan S+ ("-&&%&') ;&'$&' ,&' '&& P"*&&'&' /& #&*$'
P"*&&'&' &4"4"
T&$*& P"$4
L&&+4+*/ -/#&$&' =T&'-&4&'-& &'&' "/4+'"! +
$$ 4& 4"-"'&! -&&% -&* #&*$#/! "4$*! &-& $-&& "& /'4&"
L$& T$$
D/&',$&' L&&+4+*/L$& T"*&
L&&+4+*/T&$*& T$*$#
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GA$GG(A$ 'ASASE (S(S
S"/' -/"$4 ,$& /#"$! -&&4 -/"&'$&' "/4/ $$ &/&4 "*&+&4&' &4&$ "#&/'&' /4"*/ ""4/ -"'&' $"*/& "%/'& 4",&-/ &/
P"'"& #&/' /&% &-&'& $*&4&
#$*"' $$ &/&4 "#"&4&' &4&$ *A&' 4",&-/ "'/'&4&' "/4/ $$&%& $'4$ *"'&4&/ %&*&4&'.
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Gangguan 'asase (sus
Subjekti)
P"$4 "*$' M$'4&% T/-& /& >&4$ T/-& /& BAB R/
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Tindakan
P"*&&'&' I'$ $'4$ "%/-+"/ "#"4+#/4
K&4"4" $/'
P"*&&'&' /& #&*$'*"'$&'/ 4"&'&' I'4& &-+**"'"&' -/&&*&! "%/'& *"'&&&'
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Tinjauan 'ustaka
TE&I*A KASIH