Akut Abdomen Belajar Bb Fix

8/17/2019 Akut Abdomen Belajar Bb Fix

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ACUTE ABDOMEN

Nama : Herda UtamaLuthviani Sari

Nim : 201173003

!em"im"in# : dr$ %at&t Su#iart

S'B


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Anat&miA"d&men

• Abdomen dibagi

menjadi 4

kuadran oleh garistengah tubuh dan

garis horizontal

yang membentangmelalui umbilicus

Right UpperQuadrant(RUP)

• Hati• (andun#

em'edu• %in)a* +anan• (&*&n

a,-enden,• (&*&n

tran,ver,um

Left LowerQuadrant (LLQ)

(&*&nde,-enden,

(&*&n ,i#m&idOvarium +iri./anita Tu"a a**&'i +iri./anita

Left UpperQuadrant (LUQ)•Lien•Lam"un#•!an+rea,•%in)a* +iri•(&*&n

tran,ver,um•(&*&nde,-enden,

Right LowerQuadrant (RLQ)

•(&*&n a,-eden,•A''endi•Ovarium +anan./anita• Tu"a a**&'i+anan ./anita

Periumbilical area• Ter*eta+di,e+itar

um"i*i-u,•U,u, ha*u,"eradadi,e'an)an#'erium"i*i+a*

Suprapubicarea•Ber*&+a,idi"a/ah daritu*an# 'u"i,• Terda'at uteru,dan ve,i-a

urinaria


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DindingAbdomen

Ot&t 'enu,un dindin# a"d&men: .dari da*am+e *uar

•De'an45entra*6M re-tu, a"d&mini,

.+iri6+anan *inea mediana•Latera*6M tran,ver,u, a"d&mini,6M &"*iuu, internu, a"d&mini,6M &"*iuu, e+,ternu, a"d&mini,

•Be*a+an#4d&r,a*- M ',&a, ma)&r dan m ',&a, min&r6M uadratu, *um"&rum6M ere-t&r trun-i6M *ati,,imu, d&r,i


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Anatomi Dalam Abdomen

8&n##a !erit&nea*

• !erit&neum ada*ah mem"ran,er&,a ti'i, dan *i-in an# me*a'i,i"a#ian da*am dindin# -avuma"d&mini, dan mem"un#+u,,e"a#ian atau ,e*uruh vi,-eraa"d&men$

• !erit&neum 'arieta*e .me*a'i,i"a#ian da*am dindin# -avum

a"d&men

• !erit&neum vi,-era*e .mem"un#+u,,e"a#ian4,e*uruh &r#an vi,-eraa"d&mini,$

• Da*am +eadaan n&rma*9 -avum inihana "eri,i ,edi+it -airan ,er&,a


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Or#an retr&'erit&nea*


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vi,-era a"d&men


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!E8TONTS


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De;ni,i

!erit&niti, ada*ah +eadaan a+uta"d&men a+i"at 'eradan#an ,e"a#ian

atau ,e*uruh ,e*a'ut 'erit&neum'arieta*e atau vi,-era* 'ada r&n##aa"d&men$ !ene"a" ter,erin# ada*ah'er&ra,i dari &r#an *am"un#9 -&*&n9+andun# em'edu dan a'endi+,$ ne+,i

da'at )u#a mene"ar dari &r#an *ainan# men)a*ar me*a*ui darah$


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Eti&*i

!ene"a" an# 'a*in# ,eriu, dari'erit&niti, ada*ah ter)adina ,uatuhu"un#an .vi,+u, +eda*am r&n##a'erit&nea* dari &r#an6&r#anintraa"d&mina* .e,&'ha#u,9 *am"un#9du&denum9 inte,tina*9 -&*&n9 re-tum9+andun# em'edu9 a'endi+, dan ,a*uran+emih9 an# da'at di,e"a"+an &*ehtrauma9 darah an# men#ine+,i

'erit&nea*9 "enda a,in#9 u,u, an#men#a*ami ,tran#u*a,i .v&*vu*u,9'an+reatiti,9 !D .!e*vi- n


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(*a,i;+a,i

!ene"a" ter"ana+ dari'erit&niti, 'rimer ada*ah'erit&niti, an# di,e"a"+an+arena "a+teri an# mun-u*,e-ara ,'&ntan.,'&ntane&u, "a-teria*'erit&niti, an# ,erin#ter)adi +arena 'ena+it+r&ni,$ !erit&niti, 'rimerdi"eda+an men)adi

.1 ,'e,i;+ aitu 'erit&niti,an# di,e"a"+an &*ehine+,i +uman an# ,'e,i;+,e'erti +uman TB$

.2 N&n S'e,i;+ aitu

'erit&niti, an# di,e"a"+an&*eh ine+,i +uman an# n&n,'e,i;+ ,e'erti 'neum&nia

'erit&niti, ,e+undermeru'a+an "entu+'erit&niti, an# 'a*in#,erin# ter)adi9 di,e"a"+an&*eh 'er&ra,i ataune+r&,i, .ine+,i

tran,mura* &r#an6&r#anda*am den#an in&+u*a,i"a+teri r&n##a 'erit&nea*$Ber"eda den#an SB!9'erit&niti, ,e+under *e"ih"ana+ di,e"a"+an"a+teri #ram '&,iti an#

"era,a* dari ,a*uran -erna"a#ian ata,$

1 primer (!pontan)" !e#under (berhubungandengan pro!e! patologi $angberlang!ung di organ dalam)%

Infeksi peritoneal diklasifikasikan menjadi:


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%e)a*a+*ini,

•

Anamne,i, :

n3eri 'ada ,e*uruh

*a'an#an 'erut +adan#

di,ertai den#an :

6 Demam

6 Mua* 4 Muntah6 BAB tida+ ada +

ha,

6 +adan# men-ret


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!emeri+,aan ;,i+

&n!pe#!i!ada in,'e+,i9 'emeri+,a men#amatiada+ah )arin#an 'arut "e+a, &'era,imenun)u++an +emun#+inan adana adhe,i9'erut mem"un-it den#an #am"aran u,u,atau #era+an u,u, an# di,e"a"+an &*eh#an##uan 'a,a,e$ !ada 'erit&niti,

"ia,ana a+an ditemu+an 'erut an#mem"un-it dan te#an# atau di,tended

Per#u!i

!er+u,i$ Neri +et&+ menun)u++an adanairita,i 'ada 'erit&neum9 adana udara

"e"a, atau -airan "e"a, )u#a da'atditentu+an den#an 'er+u,i me*a*ui'emeri+,aan 'e+a+ hati dan ,hitin#du*ne,,,$ !ada 'a,ien den#an 'erit&niti,9'e+a+ he'ar a+an men#hi*an#9 a+i"at dari'er&ra,i u,u, an# "eri,i udara ,ehin##audara a+an men#i,i -avum 'erit&neum,ehin##a 'ada 'er+u,i he'ar ter)adi'eru"ahan redu' men)adi tim'ani dan'er+u,i a"d&men hi'ertim'ani +arena

Au!#ulta!i

Au,+u*ta,i di*a+u+an untu+ meni*aia'a+ah ter)adi 'enurunan ,uara

"i,in# u,u,$ !a,ien den#an'erit&niti, umum9"i,in# u,u, a+anme*emah atau men#hi*an# ,ama,e+a*i9 ha* ini di,e"a"+an +arena'erit&nea* an# *um'uh ,ehin##amene"a"+an u,u, i+ut

*um'uh4tida+ "er#era+=.i*eu,'ara*iti+$

Palpa!i

6Dean, mu,+u*ar .'erut mema'an6Neri te+an 'ada ,e*uruh *a'an#an 'erut


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Penatala#!anaan

!rin,i' umum 'en#&"atan:1$Men#i,tirahat+an ,a*uran-erna den#an memua,a+an'a,ien92$!em"erian anti"i&ti- an#,e,uai93$De+&m're,i ,a*uran -ernaden#an 'en#hi,a'anna,a,tri+ atau inte,tina*9>$!en##antian -airan dane*e+rt&*it an# hi*an# an#

di*a+u+an ,e-ara intravena $$!ada 'a,ien den#an a+ut'erit&niti, e+,'*&ra,i*a'arat&mi 'er*u ,e#eradi*a+u+an$

Progno!i!

An#+a m&rta*ita, umumna ada*ah>0?$ @a+t&r6a+t&r an#

mem'en#aruhi 'rn&,i,9 antara*ain :

• eni, ine+,ina4'ena+it 'rimer

• Dura,i4*ama ,a+it ,e"e*um ine+,i

• (e#ana,an

• %a#a* &r#an ,e"e*um tera'i

• %an##uan imun&*i,

• U,ia dan +eadaan umum 'enderita

(eter*am"atan 'enan#anan )ammenin#+at+an an#+am&rta*ita,

,e"ana+ 10630?$ !a,ien den#anmu*ti'*e trauma 0? "erah+irden#an +ematian$ !erit&niti, an#"er*an)ut9 a",e, a"d&men an#'er,i,ten9 ana,t&m&,i, an# "&-&r9;,tu*a inte,tina* men#a+i"at+an'rn&,i, an# )e*e+$


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LEUSOBST8U(T@


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D'&&S&

• &leu!

Suatu +&ndi,i di mana terda'at #an##uan'a,a,e4 )a*anna ma+anan di u,u,

• &leu! *b!tru#tif

*eu, # ter)adi a+i"at #an##uan me+ani,9

"eru'a &",tru+,i4,um"atan 'd u,u,Di,e"ut )u#a &leu! +e#ani#

Meru'a+an )eni, i*eu, ter"ana+


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'P&D'+&*L*,&

• *eu, &",tru+ti ada*ah ,uatu 'enum"atanme+ani, 'ada u,u, dimana meru'a+an'enum"atan an# ,ama ,e+a*i menutu' atau

men#an##u )a*anna i,i u,u,$• Setia' tahunna 1 dari 1000 'endudu+ dari,e#a*a u,ia didia#n&,a i*eu,$

• Di Ameri+a di'er+ira+an ,e+itar 300$0006>00$000menderita i*eu, ,etia' tahunna$

• Di nd&ne,ia ter-atat ada 7$0 +a,u, i*eu,'ara*iti+ dan &",tru+ti tan'a hernia an#dira/at ina' dan 7$02> 'a,ien ra/at )a*an 'adatahun 200> menurut Ban+ data De'artemen(e,ehatan nd&ne,ia$


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PA*&S&*L*,&

O",tru+,i4,um"atan 'd u,u,.

Ma+anan tertum'u+ di *umen u,u,

.

Te+anan intra*umina* meF

. Te+anan terhada' dindin# u,u, ,ema+in meF

. .

O",tru+,i va,a *imati+a G vena2 O",tru+,i Arteri

'd dindin# u,u, 'd dindin# u,u,

. .

Edema nar+

. .

Tran,*&+a,i "a+teri %an#ren

.

Ne+r&,i,

.


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neri +&*i+a"d&men9

mua*9 muntah9 'erut di,ten,i dan

tida+ "i,a "uan#

air "e,ar.&",ti'a,i$

'emeri+,aan ;,i+ :• demam9 ta+i+ardi9 hi'&ten,i dan

#e)a*a dehidra,i an# "erat$• !ada 'emeri+,aan a"d&men

dida'at+an a"d&men tam'a+ di,ten,idan 'eri,ta*ti- menin#+at ."uniB&r"&ri#mi$ !ada taha' *an)ut

dimana &",tru+,i teru, "er*an)ut9'eri,ta*ti- a+an me*emah dan hi*an#$• Adana e-e, "er-am'ur darah 'ada

'emeri+,aan re-ta* t&u-her da'atdi-uri#ai adana +e#ana,an danintu,e',i$

Laboratorium• !enin#+atan ,erum ami*a,e• Leu+&,it&,i,• Hemat&+rit• #an##uan e*e+tr&*it$• a*+a*&,i, meta"&*i+ "i*a muntah "erat9

dan meta"&*i+ a,id&,i, "i*a ada

tanda6tanda ,h&-+9 dehidra,i dan+et&,i,$

,e/ala #lini! Diagno!i!


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0 Stadium &leu!*b!tru#tif


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LAS&&AS&(2erda!ar#an Leta#)


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LAS&&AS&(2erda!ar#an Leta#)

o

la!i3# a!i

Leta# 'tiologi lini!

1$ &leu!Leta#

inggi

• Du&denum

• e)unum• *eum

• Adhe,i.ri/$&'era,i,e"e*umna

• Hernia• ntu,u,e',

i• 5&*vu*u,• %a**,t&ne

i*eu,• Ne&'*a,ma

• Terutama ditandaid#n muntah teru,6meneru,

• !erut "ia,ana td++em"un#

2$ &leu!

Leta#Rendah

• C&*&n

• 8e-tum

• Ne&'*a,ma

• Hernia• 5&*vu*u,

• Terutama ditandai

d#n +em"un#• Muntah "ia,an a


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,A+2ARA

RAD&*L*,&SLeta# inggi Leta# Rendah

• Di*ata,i u,u, di 'r&+,ima*,um"atan .,um"atan 'a*in#di,ta* di ileocecal juntion

• (&*a', u,u, di di,ta*,um"atan

•

Herring bone appearance:6 2 dindin# u,u, ha*u, #terdi*ata,i mene"a* Gmenem'e* mem"entu+#am"aran verte"ra i+an

6 mu,+u*u, # ,ir+u*er meneru'ai -&,ta i+an

• Step-ladder appearance:%am"aran air-fuid level #

'ende+2 "er"entu+ ,e'ertitan##a +arena -airan

tran,uda,i "erada da*am u,u,

• Di*ata,i u,u, di 'r&+,ima*,um"atan .,um"atan di-&*&n

• (&*a', u,u, di di,ta*

,um"atan• !ene"a*an dindin# u,u,

# men#a*ami di*ata,i: Di u,u, ha*u, herring

bone appearance Di u,u, "e,ar tam'a+

'd te'i a"d&men• %am"aran air-fuid level: Di u,u, ha*u, 'ende+29

"er"entu+ ,e'erti tan##a .step-ladder appearance

Di -&*&n 'an)an#2


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*b!tru#!i U!u! 4alu!a#ibat adhe!i

25

Multiple dilated loops of small bowel Multiple fluid levels on erect film


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*b!tru#!i U!u!

4alu!a#ibat ileu! batuempedu

26

Multiple dilated loops of small

bowel are seen. A band of gas in the right

hypochondrium lies within the

common bile duct.


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*b!tru#!i U!u! 4alu!a#ibat intu!u!ep!i

27

A crescent of air at the apex of an

intussusception

Stepladder


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Stepladderappearance pd*b!tru#!i u!u!halu!

28

Step-ladderappearance5

%am"aran air-fuid level # 'ende+2 "er"entu+,e'erti tan##a +arena -airantran,uda,i "eradada*am u,u, ha*u, #men#a*ami di,ten,i


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String of beads signpd *b!tru#!i U!u! 4alu!

29

‘String of beads’ sign

Gelembung2 kecil udara

yang terperangkap dikolom2 di antara valvulae

conniventes.


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*b!tru#!i U!u! 2e!ar30

%am"aran radi&*i, ter#antun#,tatu, +&m'eten,i +atu' i*e&,e+a*.ileocaecal valve

$pe &A 5(atu' i*e&,e+a* +&m'eten di,ten,iu,u, "e,ar .t$u -&*&n a,enden,9 td+ada di,ten,i u,u, ha*u,

T'e B:Di,ten,i ,e+um G u,u, ha*u,

T'e :(atu' i*e&,e+a* in+&m'eten ,e+um G -&*&n a,enden, td+

di,ten,i9 ta'i u,u, ha*u, di,ten,i


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*b!tru#!i U!u!2e!ara#ibat 6ol6ulu!

!e#um

31

Sekum yg terdistensi dgn

haustrasinya, di abdomen

tengah baah

!idak ada distensi usus halus yg

signifikan


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*b!tru#!i U!u!2e!ara#ibat 6ol6ulu!

!igmoid

32

"oop sigmoid tanpa haustrasi yg

sangat terdistensi terlihat di pelvis

dalam bentuk # terbalik

$olon asendens % desendens yg

berhaustrasi terpisah dari loop

sigmoid yg mengalami volvulus


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Obstruksi Usus Besar

Supine Prone


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!ENATALA(SANAAN

R'SUS&AS&

Da*am re,u,ita,i an# 'er*udi'erhati+an ada*ah men#a/a,itanda6tanda vita*9 dehidra,i dan,&+$ !a,ien an# men#a*ami i*eu,

&",tru+,i men#a*ami dehidra,i dan#an##uan +e,eim"an#an e+tr&*it,ehin##a 'er*u di"eri+an -airanintravena ,e'erti rin#er *a+tat$8e,'&n terhada' tera'i da'atdi*ihat den#an mem&nit&r tanda6

tanda vita* dan )um*ah urin an#+e*uar$ Se*ain 'em"erian -airanintravena9 di'er*u+an )u#a'ema,an#an na,a,tri- tu"e.N%T$ N%T di#una+an untu+men#&,&n#+an *am"un#9men-e#ah a,'ira,i 'u*m&num "i*a

arma#ologi!

!em"erian &"at6&"atanti"i&ti+ ,'e+trum *ua,da'at di"eri+an ,e"a#ai'r&;*a+,i,$ Antiemeti+da'at di"eri+an untu+men#uran#i #e)a*a mua*muntah$

*peratif

O'era,i di*a+u+an ,ete*ahrehidra,i dan de+&m're,ina,a,tri+ untu+men-e#ah ,e',i, ,e+under$O'era,i dia/a*i den#an*a'ar&t&mi +emudiandi,u,u* den#an te+ni+"edah an# di,e,uai+an

den#an ha,i* e+,'*&ra,i,e*ama *a'ar&t&mi$


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Akut Abdomen Belajar Bb Fix

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