AKUT ABDOMEN

DIVISI BEDAH DIGESTIF

BAGIAN ILMU BEDAH
FK. UNAIR SURABAYA
AKUT ABDOMEN
NON TRAUMATIK
AKUT PER AKUT
NYERI ABDOMEN
KEADAAN UMUM
6 JAM
SURGERY

DO IT RIGHT FROM THE START
PENYEBAB AKUT ABDOMEN
GARIS BESAR

1. NON SURGICAL (TERMASUK KELAINAN
DILUAR ABDOMEN)
2. PERITONITIS LOKAL / GENERAL
3. OBSTRUKSI GASTRO INTESTINAL
4. PERDARAHAN INTRA / RETROPERITONEAL
5. ISKEMIA / INFARK
6. UROLOGIS - GINEKOLOGIS
PENYEBAB AKUT ABDOMEN
SEGALA USIA ANAK-ANAK
APENDISITIS INVAGINASI
PERFORASI USUS/LAMBUNG RADANG SALURAN KEMIH
NYERI ABDOMEN NON SPESIFIK HERNIA
(NON BEDAH) RADANG SALURAN NAPAS ATAS
OBSTRUKSI USUS
PANKREATITIS AKUT WANITA
KOLIK GINJAL/ URETER RADANG PELVIS
DYSPEPSIA RADANG SALURAN KEMIH
HERNIA KEHAMILAN EKTOPIK
KOLESISTITIS AKUT/BILIER KISTA OVARIUM

USIA TUA
KANKER
VASKULAR
SEBAB-SEBAB MEDIK

WORLD ORGANIZATION OF GASTROENTEROLOGY
RESEARCH COMMITTEE ON ACUTE ABDOMINAL
PAIN (1979)
N %
NON SPECIFIC ABDOMINAL PAIN 2623 43.0
ACUTE APPENDICITIS 1476 24.2
ACUTE CHOLECYSTITIS 541 8.9
SMALL BOWEL OBSTRUCTION 292 4.0
RENAL COLIC 209 3.4
PERFORATED PEPTIC ULCER 172 2.8
ACUTE PANCREATITIS 138 2.3
ACUTE DIVERTICULAR DISEASE 128 2.1
ALL OTHER CASES 568 9.8
(GYNAEC + CA COLON)

TOTAL 6097
NYERI ABDOMEN
SARAF RESEPTOR SPESIFIKASI
NYERI
LOKASI RANGSANGAN
VISCERAL S.OTONOM PERITONEUM
VISCERALIS
TAK JELAS (SUKAR
DIJELASKAN)
SUKAR KEJANG TARIK
DISTENSI
SOMATIK S. SENTRAL PERITONEUM
PARIETALIS
JELAS
TAJAM
MENUSUK
JELAS
(MENUNJUK)
SENTUH
TEKANAN
PANAS
RADANG
REVERSED PAIN
NYERI YANG DIALIRKAN KARENA KONFERGENSI SARAF PADA
TRAKTUS SPINOTALAMIK (EMBRIOLOGIS)
Appendix
Ileum Perforation
Liver Abscess
Gaster Perforation
Others
FORE GUT
MID GUT
HIND GUT
CAUSES OF HEMOPERITONEUM
GASTROINTESTINAL
TRAUMATIC LACERATION OF LIVER, SPLEEN, PANCREAS,
MESENTERY, BOWEL
GYNECOLOGIC
RUPTURED ECTOPIC PREGNANCY
RUPTURED GRAAFIAN FOLLICLE
RUPTURED UTERUS
VASCULAR
RUPTURED ANEURYSM : AORTOILIAC, HEPATIC, RENAL,
AND SPLENIC ARTERY
UROLOGIC
RUPTURED BLADDER
HEMATOLOGIC
RUPTURED SPLEEN


Z. COPE :

MANY EXAMINATION OF THE ABDOMEN ARE
IMPERFECT BECAUSE THE PRACTITIONER
DOES NOT ACT UPON THE IMPORTANT
PRINCIPLE OF APPLYING HIS KNOWLEDGE OF
ANATOMY
NYERI KLINIS
KOLIK : RENAL
BILIER
INTESTINAL

RADANG : SEPTIK
KIMIAWI

ISKEMIA
PROGRES PENYAKIT
PROSES > GEJALA
WAKTU : MIGRATORY PAIN (apendisitis)
EMOSI OBJEKTIF > SUBJEKTIF
OBAT KOSTIKOSTEROID STEROID
ANALGETIKA SPASMOLITIK
DIAGNOSA BELUM PASTI JANGAN ANALGETIKA
WANITA 24 TAHUN IBU 2 ANAK KECIL
NYERI ABDOMEN 24 JAM
MULAI PUSAT SAMPAI ILIAKA KANAN
TEGANG RLQ + REBOUND PHEN
LEKO 17.000
OPERASI ?


WANITA 18 TAHUN PELAJAR SMU
DIBAWA KE RS DENGAN DUGAAN APENDISITIS AKUT
KELUHAN NYERI PERUT KANAN BAWAH
DEFANS MUSKULER REBOUND PHEN LEKO 7.600
APENDEKTOMI ?
GEJALA KLINIS (PENUNJANG)

MUNTAH
NYERI MUNTAH : APENDISITIS
MUNTAH NYERI : GASTRO ENTERITIS
IKTERUS - HEPATOBILIER
HEMATURIA UROLOGI
OBSTIPASI G I
HAID
DIAGNOSA
DIAGNOSE MUST BE ESTABLISHED IN THE
EARLIEST POSSIBLE STAGE

KLINIS
SOAP

LABORATORIUM - STANDAR
Hb LEKOSIT, HCT,TROMBOSIT FAAL
HEMOSTASIS

BIOKIMIA DARAH (INDIKASI)
AMYLASE
GLUKOSA
KREATININ
FAAL HEPAR
URINE
LENGKAP

RADIOLOGI
ABDOMEN POLOS BERBARING
ABDOMEN POLOS TEGAK/DEKUBITUS
DIAFRAGMA
THORAX

ULTRASONOGRAFI

ELEKTRO KARDIOGRAFI
WAKTU OPTIMAL PEMBEDAHAN

1. TEKANAN VENA SENTRAL STABIL 80 120
mm H2O
2. MINIMAL CAIRAN DEFISIT SUDAH DIGANTI
KOREKSI ELEKTROLIT ABNORMAL
3. URINE 30 50 ml/JAM
4. HCT 36%
5. NASOGASTRIC TUBE
6. OBAT-OBAT