ekspertise usg abdomen appendicitis
DESCRIPTION
USG appendisitisTRANSCRIPT
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Ekspertise USG ABDOMEN
Pembimbing :dr. Rachmat Mulyana Memet, Sp.
Rad
Oleh :Jayyidah Afifah
2010730055
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Kandung empedu - Kontur : normal - Ukuran : normal- Dinding : normal- Batu : -- Sludge : -- Saluran empedu
intrahep/CBD : Tak melebar
Hati- Permukaan : rata- Vaskuler intrahepatik :
normal - Ekostruktur : homogen - Lesi-lesi fokal : -
Aorta : normalKGB para Aorta/Parailiacal : tak membesar
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Ginjal - Kontur : normal- Besar : normal- Batas : tegas- Kortises : normal- Sistem kolekting :
normal- Batu/SOL/bendungan
: (-)
Pankreas : normal
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Limpa : normal
Ginjal - Kontur : normal- Besar : normal- Batas : tegas- Kortises : normal- Sistem kolekting :
normal- Batu/SOL/bendungan :
(-)
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VU normal, uterus & adneksa tak membesar, Appendiks tak membesar.
Kesan :
- Uterus & adnexa tak membesar
- Appendiks tak membesar
- Organ abdomen lainnya normal.
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Tinjauan pustaka
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Apendisitis adalah peradangan pada apendix vermiformis.
Diagnosis dini penting untuk menimalkan angka kesakitan
PENDAHULUAN
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Appendicitis
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Peradangan Pada
Apendiks
Berakibat peradang
an dan pecah
Perforasi dan
peritonitis
Definisi Apendisitis
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Infeksi
• Bakteri Escherichia coli dan Streptococcus• Parasit E.histolytica dan cacing askaris
Sumbatan lumen
• hyperplasia jaringan limf, • fekalit, • tumor apendiks
Gaya hidup
• Pola makan kurang serat• Lingkungan
Etiologi
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Appendiks obstruksi Merupakan kejadian awal yang paling sering pada appendisitis.
Tekanan IntraluminalMeningkatnya tekanan intraluminal akibat obstruksi lumen appendiks sekresi mukosa meningkat, pertumbuhan bakteri yang berlebihan, dinding appendiks menipis karna terjadi distensi dan terjadi obstruksi limfatik dan vena.
Nekrosis dan Perforasi Nekrosis dan perforasi terjadi ketika aliran arteri terganggu.
Patogenesis
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tekanan intra luminer tinggi
mukus >>>
gangguan drainase
limfe
edema +
ulserasi mukosa
Obstruksi
Apendisitis Akut
Gejala : Nyeri visera di
epigastrium, sekitar umbilicus
Mungkin Kolik
Patogenesis
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obstruksi vena
Trombosis
Iskemia
edema semakin berat
invasi kuman
Tekanan
Intralumen
Tinggi
Apendisitis akut supuratif / purulenta
Gejala: Nyeri sentral
berpindah ke perut kanan bawah
Nyeri somatik (peritonitis lokal)
Mual dan muntah
Continue...
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Tekanan Intralumen
Semakin Tinggi
Gangguan Arteri
Nekrosis Apendisitis gangrenosa
Perforasi
Peritonitis generalisata
Apendisitis gangrenosa
Peritonitis generalisata
Continue...
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Apendisitis
Nyeri epigastriu
m Nyeri perut kanan bawah
Nyeri progresif
AnoreksiaMual dan
muntah
Demam
Nyeri tekan , nyeri lepas, nyeri alih, (Direct rebound
tenderness (jam 9-11) (Mc.Burney’s point),
Rovsing’s sign, Iliopsoas sign, Obturator sign,
Dunphy sign, colok dubur
Leukositosis
Tanda dan gejala
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The Modified Alvarado Scale for the Diagnosis of Appendicitis
The Modified Alvarado Score Skor
GejalaPerpindahan nyeri dari ulu hati ke
perut kanan bawah1
Mual-Muntah 1Anoreksia 1
TandaNyeri di perut kanan bawah 2Nyeri lepas 1Demam diatas 37,5 ° C 1
Pemeriksaan Lab
Leukositosis 2Hitung jenis leukosit shift to the left 1
Total 10Interpretasi dari Modified Alvarado Score: 1-4 : sangat mungkin bukan apendisitis akut 5-7 : sangat mungkin apendisitis akut 8-10 : pasti apendisitis akut
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Abdominal X Ray (AXR) terlihat Appendicolith/fecalith Appendicogram (kontras) USG terutama wanita menyingkirkan DD CT scan abdominal
(+) Bila ditemukan dilatasi appendix > 6 mm, penebalan appendix
(+) palsu jika terlihat inflamasi periappendix, dilatasi tuba fallopi, insipissated stool, overlying fat
(-) palsu jika inflamasi terbatas diatas appendix, retrocecal ceacum, appendix besar, perforasi (appendix compressible)
Pemeriksaan Radiologi
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Diagnosis BandingGastritis
konstipasi
PIDRuptur kista ovarium
KET
ISKUrolithiasis
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1. Foto Polos Abdomen (Sinar-X)
Pencitraan Radiologi
Tidak direkomendasikan
Tanda spesifik berupa Apendikholith/fekolith
tidak membantu untuk diagnostik apendisitis
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Foto polos abdomen tampak apendikolith (panah)
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KontrasBarium sulfat
Secara Anal
Secara Oral
2. Appendikogram
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48 jam : makanan lunak
12-24 jam : 2 tab dulcolax dan supp anal
4 jam : puasa, tidak merokok dan tidak banyak bicara
Persiapan pasien Apendikogram
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PA/APRPOLPO
Posisi
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Hasil proyeksi PA/AP
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contrast-filled appendix on barium study (normal)
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Temuan appendikogram pada appendisitis
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