Problem 3B - Kelompok 18

8/18/2019 Problem 3B - Kelompok 18

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Problem 3B

Kelompok 18


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Tutor : dr. Agus

• Wongso Handoko (Ketua)

• Isaura rans!ska

• Inge Angel!"a

• #ul!a $rl!ne

• Angela #ess!"a

• %!l&!ana Isd!t'a

• Had! Putra and!r!

• %ul!st!o An!ta (%ekretar!s)

• erl'n• o*anna +.,ultom

• #unetta A!rene P.T (Penul!s)

• !t'a -el!ma


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n/am!l!ar Terms

• +bst!pat!on : 0*ron!" 0onst!pat!on

• ump : sensat!on o/ a mass


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Problems

• W*' t*e bo' "ompla!n se&ereabdom!nal p!an on *!s belo2 na&el

• 2*at t*e relat!on o/ t*e s'mptom o/nausea4 &om!t4 and obst!pat!on 2!t**!s pa!n and t*e slump belo2 *!sabdom!nal

• Interpretat!on


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Bra!n %torm!ng

• a'be t*e bo' su5er /rom :

1. Append!"!t!s

6. Ileus

3. As"ar!s ball

7. Per!ton!t!s

. Per/orat!on

9. %trangulate !n"arserata *ern!a

;. Intussus"ept!on

• All o/ t*em 2ere t*e s'mptoms o/ a"ute abdom!nal pa!n

• Interpretat!on : –.e&er (384)

–.euko"'to"'s !n/e"t!on

–.%egment neutro>l a"ute

–.!m/os!t mono"'t


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!nd mapp!ng

Append!"!t!s

Ileus

As"ar!s ball

Per!ton!t!s

Per/orat!on

%trangulate !n"arserata*ern!a

Intussus"ept!on

?ausea+bst!pat!on

@om!te&erPa!n belo2 na&ellump

A0T$

AB-+$?


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earn!ng +be"t!&es

1. $pla!n *!stolog' o/ lo2er ,IT

6. $pla!n about : A"ute Abdomen

1. Append!"!t!s

6. Ileus

3. As"ar!s ball

7. Per!ton!t!s

. Per/orat!on9. %trangulate !n"arserata *ern!a

;. Intussus"ept!on


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Lo 1 : Histology


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Ileum


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0olon

Colon


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H!stolog' o/ Ee"tum

6 parts o/ re"tum :

1.Upper : "olon l!ke stru"ture. Taller"r'ptus and 2alled b' goblet "ells

2.Lower (anal canal) : Ee"tal"ollumn long!tud!nal /olds !n mu"osalend about 61


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H!stolog' o/ Anus

1. 0ollumnar!s Fone

6. Intermed!a Fone

3. 0utanea Fone


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Anal gland

%Guamous to "ollumnarIn l!nea pe"t!nata T*!nn!ng sGuamous ep!t*

%trat!>ed kerat!n!Fed sGuamous ep!t*elW!t* *a!r /oll!"le


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$?$ %+E0$ %B%TEAT$% PE+-0T%


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$?$ %+E0$ %B%TEAT$% PE+-0T%

BE%H B+E-$E%

J-etr!nase %mall !ntest!ne. J-etr!ns. ,lu"ose.

altase %mall !ntest!ne. altose. ,lu"ose.

%u"rase %mall !ntest!ne. %u"rose. ,lu"ose /ru"tose.

a"tase %mall !ntest!ne. a"tose. ,lu"ose gala"tose.

$nterok!nase %mall !ntest!ne. Tr'ps!nogen. Tr'ps!n.

Am!nopept!dase %mall !ntest!ne. Am!no a"!d atam!no end o/pept!des.

Am!no a"!ds pept!des.

-!pept!dase %mall !ntest!ne. -!pept!dases. Am!no a"!ds.

?u"leos!dases

p*osp*atases

%mall !ntest!ne. ?u"leot!des. ?!trogenous

bases4 pentoses p*osp*ates.


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o 6 : A"ute AB-+I?A

PAI?


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Source Of Abdominal Pain

ABDOMINALABDOMINAL

EXTRA

ABDOMINAL

EXTRA

ABDOMINAL

$bdominal wall % intra&peritoneal organ#

Retroperitoneal organ#

'elic organ#

Intra&thoracicorgan#

*#temic+*#,unction

-unctionalabdominal pain


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*pe# o, $bdominal

'ain

IC!R$L'$I/

0M$IC'$I/

1 2

• 0ol!" pa!n • Is"*em!"pa!n• Per!ton!t!s

Somatic Pain Visceral Pain


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Somatic Pain Visceral Pain

Receptor Pain stimuli start in the parietalperitoneum, which isinnervated by peripheralnerves

Visceral peritoneum

Stimulus ouch, pressure, heat,inflammation

raction, distention, ! spasm

"ediation #$S ! interpreted at aspecific cortical location

Autonomic $ervous Systeminterpreted at the thalamic level of the brain

Specifity Precisely described as sharp,

%nifeli%e, cuttin&

Va&ue, often dull, poorly

described

'ocali(ation he pain is locali(ed with &reataccuracy by the patient, whocan often point to the site with

one fin&er

Poor and the patien is placin&the entire hand over theinvolved re&ion


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$t!olog'


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0auses o/ A"ute Abdom!nalemergen"!es !n Bab' and !n/ants


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*ttp:


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APP)$*+#++S


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Appendi

• he adult appendi avera&es - cm in len&th

• he appendi has the same layers as the remainder ofthe &ut and possesses a colonic/type mucosa

• Rich lymphoid tissue of the mucosa ! submucosa, whichin young indiiduals forms an entire layer of &erminalfollicles ! lymphoid pulp

• his lymphoid tissue under&oes pro&ressive atrophy durin& life to the point of complete disappearance inadvanced a&e.


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T*e append! !s a 3 to 9J"m long tubeJl!ke stru"ture t*at proe"ts /rom t*e

un"t!on o/ t*e small and large !ntest!nes. ?o one kno2s 2*at t*e /un"t!ono/ t*e append! !s. Ho2e&er4 on"e t*e append! be"omes !n/e"ted or


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• De!inition – Appendicitis is inflammation of the

appendi. he appendi is a small pouch

attached to the be&innin& of your lar&eintestine.

Appendicitis


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• Also called periappendiceal abscess

• An abscess in the peritoneal cavity

– resultin& from the spread of infection in acute appendicitis,especially with perforation of the appendi

• #an be mana&ed by either sur&ical draina&e or by

ima&e &uided percutaneous draina&e

$ppendiceal $b#ce##


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$ppendiciti# /umber and $ge&$du#ted Rate# o, $mbulator*Care i#it# and 3o#pital +i#charge# 4ith -ir#t&Li#ted and $ll&

Li#ted +iagno#e# o, b* $ge5 Race5 and e" in the Unitedtate#5 2667

%+E0$: ?at!onal Ambulator' ed!"al 0are %ur&e' (?A0%) and ?at!onal Hosp!talAmbulator' ed!"al 0are %ur&e' (?HA0%) (3J'ear a&erage4 63J6)4 and Healt*"are

0ost and t!l!Fat!on Proe"t ?at!on2!de Inpat!ent %ample (H0P ?I%)


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RIS" #A$TORS

• "ost cases of appendicitis occur between

the a&es of 01 and 21 years.

• 3avin& a family history of appendicitis may

increase a child4s ris% for the illness

• 3avin& cystic fibrosis also seems to put a

child at hi&her ris%.


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)+O'O56• Obstruction caused by fecalith, which is accumulation

and inspissation of fecal matter around ve&etable fiber • )nlar&ed lymphoid follicles associated with viral infection• +nspissated barium• umor • Appendiccal ulceration• In!ectie

– 7acterial 8uberculosis, yphus, Actinomycosis, E.coli and B. fragilis, Pseudomonas, Yersinia, Eikenellacorrodens infections9

– Viral 8Adenovirus, #ytome&alovirus infections

– :un&al 8Asper&illosis, 3istoplasmosis9 – Parasitic 8Enterobius vermicularis, Strongyloides

stercoralis, Entamoeba histolytica infections, Ascariasis, Schistosomiasis, #ryptosporidiosis,aeniasis9


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#lassification

– Acute appendicitis

• ipi%al

• Atipi%al

– #hronic appendicitis


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Acute appendicitis

• Ti%i&al

– :irst, the pain is located in periumbilcal ; epi&astric

and then, the pain relocated in fossa illiaca deter

8R'


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-!agnost!" %"or!ng

(A?TE$% %"ore)

• %"ore J3

– d!s"*arged 2!t*out!mag!ng

– 3.9L !n"!den"e o/

append!"!t!s• %"ore 7J9

– 0T e&aluat!on

– 36L !n"!den"e o/append!"!t!s

• %"ore ;J1 – %urg!"al

"onsultat!on

– ;8L !n"!den"e o/append!"!t!s

* i ti *i i ; diti


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Si&n *escription *ia&nosis;condition

Aaron si&n Pain or pressure inepi&astrium or anteriorchest with persistent firm

pressure applied to"c7urney>s point

Aute appendicitis

7assler si&n Sharp pain created bycompresin& appendibetween abdominal walland iliacus

#hronic appendicitis

7lumber&>s si&n ransient abdominal wallrebound tenderness

Peritoneal inflammation

+liopsoas si&n )levation and etensionof le& a&aints resistancecreates pain

Appendicitis withretrocecal abcess

Rovsin&>s si&n Pain at "c7urney>s pointwhen compressin& theleft lower abdomen

Acute appendicitis

en 3orn si&n Pain caused ny &entletraction of ri&httesticle

Acute appendicitis


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"ana&ement

• Appendoctomy

– 'aparoscopy

– Open abdominal sur&ical

A%%endectomy


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A%%endectomy

UR9!R:


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UR9!R:

• %urger' to remo&e t*e append! !s

"alled an appende"tom'• T*e t2o t'pes o/ appende"tom'

!n"lude:

– +pen appende"tom':• An !n"!s!on !s made !n t*e r!g*t lo2er abdomen

and t*e append! !s remo&ed t*roug* t*e!n"!s!on.

– aparos"op!" appende"tom':• A small !n"!s!on !s made !n t*e umb!l!"us and

t*e surgeon uses a =e!ble >beropt!" s"ope toremo&e t*e append! t*roug* t*e small

!n"!s!on.•

0ompl!"at!o


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0ompl!"at!on

Intraperitoneal complication#$arl'Append! stump blo2outJsp!llage

o/ "olon!" "ontents !nto t*eper!toneal "a&!t'.,eneral!sed per!ton!t!sJper/orated

or gangrenous append! 4 &!rulentorgan!sms4 late presentat!on or

d!agnos!sAbs"essesJlo"al4 pel&!"4

sub*epat!"4 subp*ren!"Eeta!ned /e"ol!t* "aus!ng "*ron!"

lo"al !n/e"t!onHaematoma due to sl!ppage o/ a

&as"ular l!gature or a mesenter!"or omental tear$arl' or late (e&en man' 'ears later)Intest!nal obstr!"t!on due to

ad*es!onateIn/ert!l!t' due to tubal o""lus!on

/ollo2!ng pel&!" !n/e"t!on

$bdominal wallcomplication#

• $arl'

– %uper>"!al 2ound!n/e"t!on

– -eep 2ound !n/e"t!on

– -e*!s"en"e• ate

– In"!s!onal *ern!a


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PE+,?+%I%

• he progno#i# i# e"cellent.

• W!t* un"ompl!"ated append!"!t!s4most people re"o&er 2!t* no longJ

term "ompl!"at!ons.• I/ t*e append! ruptures4 t*ere !s a

greater r!sk o/ "ompl!"at!ons4

!n"lud!ng deat*. T*!s !n"rease !n r!skgenerall' !s /ound !n t*e &er' 'oung4elderl'4 and t*ose 2!t* 2eakened!mmune s'stems4 !n"lud!ng people

2!t* d!abetes.


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Intest!nal Per/orat!on


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-e>n!t!on

• a *ole t*at de&elops t*roug*t*e 2*ole 2all o/ !ntest!ne.


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%'mptoms

• Per/orat!on o/ t*e !ntest!ne "auses t*e"ontents o/ t*e !ntest!nes to leak !nto t*eabdom!nal "a&!t'. T*!s "auses a ser!ous

!n/e"t!on "alled per!ton!t!s.• %'mptoms ma' !n"lude:

– Abdom!nal pa!n J se&ere

– 0*!lls

– e&er

– ?ausea

– @om!t!ng

http://www.nlm.nih.gov/medlineplus/ency/article/001335.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001335.htm


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Test

• NJra's o/ t*e "*est or abdomen ma's*o2 a!r !n t*e abdom!nal "a&!t'4"alled /ree a!r. T*!s !s a s!gn o/ a tear

(per/orat!on).• A 0T s"an o/ t*e abdomen o/ten

s*o2s t*e lo"at!on o/ t*e per/orat!on.

T*e 2*!te blood "ell "ount !s o/ten*!g*er t*an normal.

http://www.nlm.nih.gov/medlineplus/ency/article/003789.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003643.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003789.htm


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Treatment

• Treatment usuall' !n&ol&es surger' torepa!r t*e *ole (per/orat!on).%omet!mes4 a small part o/ t*e

!ntest!ne must be remo&ed. Atemporar' "olostom' or !leostom'(to dra!n t*e small or large !ntest!ne)

ma' be needed.



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0ompl!"at!ons

• T*e most "ommon ser!ous"ompl!"at!on o/ per/orat!on4 e&en2!t* surger'4 !s !n/e"t!on. In/e"t!ons

"an be e!t*er !ns!de t*e abdomen(abdom!nal abs"ess)4 or t*roug*outt*e 2*ole bod'. Bod'J2!de !n/e"t!on

!s "alled seps!s. It "an be &er'ser!ous and "an lead to deat*.



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Prognos!s

• %urger' !s usuall' su""ess/ul.Ho2e&er4 t*e su""ess o/ surger'depends on *o2 se&ere t*e

per/orat!on !s4 and /or *o2 long !t2as present be/ore treatment.


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IL!U 0;RUCI0/


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+e


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ign# and *mptom#

• Interm!ttent "ramp' abdom!nal pa!n

• ?ausea

• @om!t!ng or d!arr*ea

• 0onst!pat!on

• Inab!l!t' to *a&e a bo2el mo&ement or pass gas

• %2ell!ng o/ t*e abdomen (d!stent!on)

• Abdom!nal tenderness

• e&er


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>&ra* -inding

A!r =u!d le&el%tepladderAbsent "olon!" gases


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Complication

• Bo2el ne"ros!s• Bo2el per/orat!on

• %eps!s

• %*o"k *!po&olem!"

• Abs"ess

• %*ort bo2el s'ndrome 2!t* malabsorpt!on andmalnutr!t!on

• -e"reased absorpt!on

• -e*'drat!on

• K!dne' /a!lure.

• -eat*


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reatment

Based on t*e "ause :

• +perat!/

• ed!"amentosa

• Ee*'drat!on and nutr!t!on• T*e person !s not allo2ed to eat or dr!nk

an't*!ng unt!l !ntest!nal /un"t!onnormal!Fes (or returns).

• lu!ds and ele"trol'tes (su"* as sod!um4"*lor!de4 and potass!um) are g!&en!ntra&enousl'.


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Ileu# 0b#truction e.c.

3elminth In,ection


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Helm!nt* In/e"t!on t*at0ause Ileus +bstru"t!on

• Ascaris lumcbricoides

• Taenia saginata

• Diphyllobotrium latum• Fasciola buski


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scaris lumbricoide


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Ascaris lumbricoides

• ature /emale !s 6J7 "m .Q.9"m

• ature male !s 16J6 "m .3J.7

"m.• 67. eggs< da'

• T*e lar&ae t*en m!grate &!a t*e

&enous "!r"ulat!on to t*e pulmonar'"!r"ulat!on and to t*e lungs.


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Pat*op*'s!olog' As"ar!s


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p ' g'In/e"t!on


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-!agnos!s

• -!agnos!s !s b' m!"ros"op!" dete"t!on o/eggs !n stools.

• +""as!onall'4 lar&ae "an be /ound !n t*e

sputum dur!ng t*e pulmonar' p*ase.• $os!nop*!l!a "an be marked 2*!le lar&aem!grate t*oug* t*e lungs but usuall'subs!des later !n !n/e"t!on 2*en adult

2orms res!de !n t*e !ntest!ne.• 0*est Jra' dur!ng t*e pulmonar' p*ase

ma' s*o2 !n>ltrates (RSerOs pneumon!a).


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Treatment

• ebendaFole

• P!peraF!ne

• P'rantel pamoate

• AlbendaFole

• T*!abendaFole


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Treatment

• Pre&ent!onPre&ent!on and 0ontrol $5orts on to t*e "'"le o/l!/e and t*e nature o/ t*!s 2orm eggs4 /ollo2!ngsteps: *ealt* "ounsel!ng on good san!tat!on4

am!l' *'g!ene and personal *'g!ene su"* as:?ot us!ng /e"es as a /ert!l!Fer plant.Preparat!on o/ /ood and to eat4 2as* *ands us!ngt*e soap.

or t*ose 2*o "onsume /res* &egetables (ra2) asalapan4 2as*ed aga!n 2!t* =o2 2ater.


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+perat!/ Bolus As"ar!s


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P$EIT+?ITI%


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-$I?ITI+?

Per!ton!t!s !s an !n=ammat!on o/ t*eper!toneum.

0an be :

/ o"al!Fed or d!5use !n lo"at!on

/ A"ute or "*ron!"

/ In/e"t!ous or asept!"

+ +,


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$TI++,

'er,oration# o, bowel

• Trauma4 blunt or penetrat!ng

• In=ammat!on

• Append!"!t!s• -!&ert!"ul!t!s

• Pept!" ul"er d!sease

• In=ammator' bo2el d!sease

• Iatrogen!"

• $ndos"op!" per/orat!on

• Ingested /ore!gn bod'4 toot*p!"k4 >s* bone

• 'er,oration# or lea=ing o, other


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• 'er,oration# or lea=ing o, otherorgan#

• Pan"reaspan"reat!t!s• ,all bladder"*ole"'st!t!s

• r!nar' bladdertrauma4 rupture

• !&erb!le leak a/ter b!ops'

• allop!an tubessalp!ng!t!s

• Bleed!ng !nto t*e per!toneal "a&!t'

0I?I0A A?I$%TATI+?


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0I?I0A A?I$%TATI+?

0ard!nal man!/estat!on :

/ A"ute abom!nal pa!n and tenderness

/ e&er

/ Ta"*'"ard!a

/ -e*'drat!on

/euko"'tos!s

TH$EAP


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TH$EAP

• Ee*'drat!on• "orre"t!on o/ ele"trol'te

abnormal!t!es

• Ant!b!ot!"s• %urg!"al "orre"t!on o/ t*e underl'!ng

de/e"t.

PE+,?+%I%


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PE+,?+%I%

• ortal!t' rates are 1L /orun"ompl!"ated per!ton!t!s asso"!ated2!t* a per/orated ul"er or ruptured

append! or d!&ert!"ulum !n anot*er2!se *ealt*' person.

• ortal!t' rates o/ 7L *a&e been

reported /or elderl' people4 t*ose2!t* underl'!ng !llnesses4 and 2*enper!ton!t!s *as been present /or U78

*.

Intussus"ept!on


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p


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I t t!


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Intussus"ept!on

one part o/ t*e !ntest!ne !n&ag!nat!on!nto t*e net bo2el

T*e pla"e o/ Intususpe"t!on:Ileokol!k4 !leoleal4 kolokol!k


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$t! l


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$t!olog'

• Intussus"ept!on ma' result /rom a lead po!ntsu"* as a pol'p or d!&ert!"ulum t*at !s pulledd!stall' b' per!stalt!" a"t!&!t'4 but VL are!d!opat*!"

• Id!opat*!" !ntussus"ept!on usuall' or!g!natesnear t*e !leo"e"al un"t!on4 and !t l!kel' results/rom s2ollen *'pertrop*!ed Pe'er pat"*es !nt*e !leum ser&!ng as a lead po!nt

• Heno"*J%"*onle!n purpura and me"on!um !leuseGu!&alent ma' be asso"!ated 2!t*!ntussus"ept!on4 usuall' !n t*e small bo2el


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P* s!"al $ am!nat!on


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P*'s!"al $am!nat!on

• ,enerall' re&eals a so/t and nontenderabdomen bet2een ep!sodes o/ pa!n

• 2!t* t!me4 t*e abdomen 2!ll be"omed!stended and t*e eam!nat!on mored!D"ult

• In ;L pat!ents4 re"tal eam!nat!on re&ealso""ult blood or ma' pre"!p!tate passage o/

a blood' bo2el mo&ement• +""as!onall'4 t*e !ntussus"eptum ma' be

palpable !n t*e re"tum


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Prognos!s


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Prognos!s

– Eelates d!re"tl' to t*e durat!on o/!ntussus"ept!on be/ore redu"t!on

– ortal!t' rate 2!t* treatment !s 1J6 L


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Hern!a

-e>n!t!on


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-e>n!t!on

• a *ern!a *as a p!e"e o/ !ntest!ne t*atprotrudes t*roug* an abnormalopen!ng !n t*e abdom!nal 2all. In a

person 2!t* an !n"ar"erated *ern!a4t*e !ntest!ne *as be"ome stu"k !n t*eabnormal open!ng.

• W*en t*!s *appens4 t*e blood suppl'to t*e !ntest!ne !s redu"ed4 and t*e!ntest!nal t!ssue starts to d!e.

http://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htm


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In"ar"erated *ern!a

• Pa!n/ul enlargement o/ a pre&!ous*ern!a or de/e"t

• 0annot be man!pulated (e!t*erspontaneousl' or manuall') t*roug*t*e /as"!al de/e"t

• ?ausea4 &om!t!ng4 and s'mptoms o/bo2el obstru"t!on (poss!ble)


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%trangulated *ern!a• %'mptoms o/ an !n"ar"erated *ern!a present

"omb!ned 2!t* a to!" appearan"e

• %'stem!" to!"!t' se"ondar' to !s"*em!" bo2el

!s poss!ble

• %trangulat!on !s probable !/ pa!n and tendernesso/ an !n"ar"erated *ern!a pers!st a/ter redu"t!on

• %uspe"t an alternat!&e d!agnos!s !n pat!ents 2*o*a&e a substant!al amount o/ pa!n 2!t*oute&!den"e o/ !n"ar"erat!on or strangulat!on

%PT+%


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%PT+%

• %'mptoms o/ an !n"ar"erated *ern!a depend on 2*ere t*e *ern!a !slo"ated. All !n"ar"erated *ern!as

"ause a pa!n/ul4 s2ollen4 and tenderbulge under t*e sk!n. Add!t!onals'mptoms ma' !n"lude anore!a4

nausea4 &om!t!ng4 and /e&er

http://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/anorexia/overview.htmhttp://www.freemd.com/nausea/overview.htmhttp://www.freemd.com/nausea-and-vomiting/overview.htmhttp://www.freemd.com/fever/overview.htmhttp://www.freemd.com/fever/overview.htmhttp://www.freemd.com/nausea-and-vomiting/overview.htmhttp://www.freemd.com/nausea/overview.htmhttp://www.freemd.com/anorexia/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/hernias/overview.htm


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• Abdom!nal s2ell!ng

• Abdom!nal tenderness: – E!g*t lo2er abdom!nal tenderness

– e/t lo2er abdom!nal tenderness – E!g*t upper abdom!nal tenderness

– e/t upper abdom!nal tenderness

– pper abdom!nal tenderness – o2er abdom!nal tenderness

http://www.freemd.com/abdominal-swelling/overview.htmhttp://www.freemd.com/abdominal-tenderness/overview.htmhttp://www.freemd.com/right-lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/left-lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/right-upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/left-upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/left-upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/right-upper-abdominal-tenderness/overview.htmhttp://www.freemd.com/left-lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/right-lower-abdominal-tenderness/overview.htmhttp://www.freemd.com/abdominal-tenderness/overview.htmhttp://www.freemd.com/abdominal-swelling/overview.htm


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• ,ro!n pa!n• %k!n redness o&erl'!ng t*e *ern!a

• e&er

• Anore!a

• 0onst!pat!on

• ?ausea

• @om!t!ng

• ala!se

In"ar"erated Hern!a T'pes

http://www.freemd.com/groin-pain/overview.htmhttp://www.freemd.com/skin-redness/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/fever/overview.htmhttp://www.freemd.com/anorexia/overview.htmhttp://www.freemd.com/constipation/overview.htmhttp://www.freemd.com/nausea/overview.htmhttp://www.freemd.com/nausea-and-vomiting/overview.htmhttp://www.freemd.com/malaise/overview.htmhttp://www.freemd.com/malaise/overview.htmhttp://www.freemd.com/nausea-and-vomiting/overview.htmhttp://www.freemd.com/nausea/overview.htmhttp://www.freemd.com/constipation/overview.htmhttp://www.freemd.com/anorexia/overview.htmhttp://www.freemd.com/fever/overview.htmhttp://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/skin-redness/overview.htmhttp://www.freemd.com/groin-pain/overview.htm


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• T'pes o/ !n"ar"erated *ern!as !n"lude:

• In"ar"erated !ngu!nal *ern!a• In"ar"erated umb!l!"al *ern!a

• In"ar"erated &entral *ern!a

• In"ar"erated !n"!s!onal *ern!a

• In"ar"erated /emoral *ern!a

http://www.freemd.com/hernias/overview.htmhttp://www.freemd.com/incarcerated-inguinal-hernia/overview.htmhttp://www.freemd.com/umbilical-hernia/overview.htmhttp://www.freemd.com/incarcerated-ventral-hernia/overview.htmhttp://www.freemd.com/incisional-hernia/overview.htmhttp://www.freemd.com/femoral-hernia/overview.htmhttp://www.freemd.com/femoral-hernia/overview.htmhttp://www.freemd.com/incisional-hernia/overview.htmhttp://www.freemd.com/incarcerated-ventral-hernia/overview.htmhttp://www.freemd.com/umbilical-hernia/overview.htmhttp://www.freemd.com/incarcerated-inguinal-hernia/overview.htmhttp://www.freemd.com/hernias/overview.htm


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• Umbilical hernia• T*e umb!l!"al *ern!a o""urs t*roug*

t*e umb!l!"al >bromus"ular r!ng4

2*!"* usuall' obl!terates b' 6 'earso/ age. T*e' are "ongen!tal !n or!g!nand are repa!red !/ t*e' pers!st !n

"*!ldren older t*an age 6J7 'ears.


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• Inci#ional hernia• T*!s !atrogen!" *ern!a o""urs !n 6J

1L o/ all abdom!nal operat!ons

se"ondar' to breakdo2n o/ t*e/as"!al "losure o/ pr!or surger'. $&ena/ter repa!r4 re"urren"e rates

approa"* 6J7L


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• -emoral hernia• T*e /emoral *ern!a /ollo2s t*e tra"t

belo2 t*e !ngu!nal l!gament t*roug*

t*e /emoral "anal. T*e "anal l!esmed!al to t*e /emoral &e!n andlateral to t*e la"unar (,!mbernat)

l!gament. Be"ause /emoral *ern!asprotrude t*roug* su"* a smallde>ned spa"e4 t*e' /reGuentl'be"ome !n"ar"erated or


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• In"ar"erated *ern!a: An !n"ar"erated*ern!a !s no longer redu"!ble. T*e&as"ular suppl' o/ t*e bo2el !s not

"omprom!sed *o2e&er4 bo2elobstru"t!on !s "ommon.

• %trangulated *ern!a: A strangulated

*ern!a o""urs 2*en t*e &as"ularsuppl' o/ t*e bo2el !s "omprom!sedse"ondar' to !n"ar"erat!on o/ *ern!a"ontents.


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• ltrasonograp*' "an be used !n d!5erent!at!ngmasses !n t*e gro!n or abdom!nal 2all or !nd!5erent!at!ng test!"ular sour"es o/ s2ell!ng.

• I/ an !n"ar"erated or strangulated *ern!a !s

suspe"ted4 t*e /ollo2!ng !mag!ng stud!es "an beper/ormed:

• pr!g*t "*est rad!ograp* to e"lude /ree a!r(etremel' rare)

• lat and upr!g*t abdom!nal >lms to d!agnose a small

bo2el obstru"t!on (ne!t*er sens!t!&e or spe"!>") or to!dent!/' areas o/ bo2el outs!de t*e abdom!nal "a&!t'

reatment


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reatment

• Expectant management • Surgical repair

– Mesh

– Open

– Laparoscopic• TEP totally extra!peritoneal"

• TAPP transabdominal pre!peritoneal"

Complication#


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Complication#

• Ee"urren"e• ?euralg!a

– Il!o!ngu!nal

– Il!o*'pogastr!"

– ,en!to/emoral – ateral "utaneous

• Is"*em!" or"*!t!s

• Inur' to &as de/eren"e

• Wound !n/e"t!on• Bleed!ng

0on"lus!on


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0on"lus!on

We *a&e learned about : de>n!t!on4 et!olog'4pat*op*'s!olog'4 ep!dem!olog'4 s!gn s'mptoms4 r!sk/a"tor4 "lass!>"at!on4 d!agnose4 treatment4 KI$40ompl!"at!on4 --4 prognos!s pre&entat!on A"uteAbdomen :

1. Append!"!t!s

6. Ileus

3. As"ar!s ball

7. Per!ton!t!s

. Per/orat!on

9. %trangulate !n"arserata *ern!a

;. Intussus"ept!on

0on"lus!on


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0on"lus!on

• A""ord!ng to t*e s!gns ands'mptoms4 t*!s bab' m!g*t su5er

/rom a"ute abdom!nal probabl'be"ause o/ Hern!a

%uggest!on


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%uggest!on

• or de>n!t!&e d!agnos!sre"ommended /urt*er !n&est!gat!on

Re,erence


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Re,erence

• ?etter H. Atlas o/ anatom'. 6nd ed.0anada: I"on earn!ng %'stem41VV;

• au"! A%4 Braun2ald $4 Kasper -4

Hauser %4 ongo -4 #ameson #4 etal4 ed!tors. Harr!sonXs pr!n"!ple o/!nternal med!"!ne. 1;t* ed. %A:

".,ra2 H!ll med!"al4 68.


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Ee/eren"es


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Ee/eren"es

• Be*rman E!"*ard.$4 @aug*an@!"tor.0.?elson Ilmu Kese*atan Anak.$d!s! 16.#akarta : $,04 1VV6.

• %udo'o4 Aru W. Buku Aar IlmuPen'ak!t -alam. 69. #akarta: KI

• 222.emed!"!ne."om

• 222.med!"!nenet."om
http://www.emedicine.com/http://www.medicinenet.com/http://www.medicinenet.com/http://www.emedicine.com/

Problem 3B - Kelompok 18

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