APENDISITIS

ANATOMI
APENDIX

PANJANGNYA
KIRA-KIRA

SECARA HISTOLOGIS

10 CM

DINDING APENDIX
= DINDING KOLON
JUMLAH KELENJAR GENTAH BENING (KGB)
PADA APENDIX
SEDIKIT

PADA
BAYI

ADA
KESAMAAN

SANGAT BANYAK

SANGAT SEDIKIT

PADA DEWASA MUDA PADA USIA LANJUT

Anatomi
Berasal dari MID GUT
Di fossa iliaka kanan
titik Mc. Burney
Basis di puncak sekum
pertemuan 3 taenia
Bentuk tabung, panjang
3 15 cm
Pangkal lumen sempit,
distal lebar
Lokasi : retrosekal
(65%), pelvinal,
antesekal, medial,
preileal,postileal, dll
Vaskularisasi

Definitio
n
Appendicitis is a
condition
characterized by
inflammation of
the appendix. It is
classified as a
medical
emergency and
many
cases
Untreated,
require
removal
mortality
is
of
the mainly
inflamed
high,
appendix,
because ofeither
the
by
laparotomy
risk
of rupture or
laparoscopy.

Etiolo
gy

PATOGENESIS

Patogen
esis

APENDISITIS AKUT
Symptoms :
- Nyeri visera di epigastrium, sekitar umbilicus
- Mungkin Kolik

Patogenes
is
Appendisit
is

APENDISITIS AKUT SUPURATIF / PURULENTA

Symptoms
- Nyeri sentral berpindah ke perut kanan bawah
- Nyeri somatik ( peritonitis lokal)
- Mual dan muntah

DIAGNOSIS
APENDISITIS

ANAMNESIS

PEMERIKSAAN
PENUNJANG
PEMERIKSAAN
FISIK

Gejala Klinis
Konstipasi
Mual
Sakit
Nyeri

DIAGNOSIS
PEMERIKSAAN FISIK
STATUS GENERALIS

1. UMUMNYA BAIK
2. SUHU AKSILER DAN
SUHU REKTAL BERBEDA
LEBIH ATAU SAMA DENGAN
1 DERAJAT CELCIUS

STATUS LOKALIS
( ABDOMEN )
SEBELUM PERFORASI
PERFORASI
PERITONITIS LOKAL
PERITONITIS UMUM
1. ROVSING'S SIGN
2. PSOAS SIGN
3. OBTURATOR SIGN
4. TENHORN SIGN

Pemeriksaan Fisik
KEADAAN

MCBURNEYS POINT

McBurneys point (1)

appears about one-third of
the distance along a line
starting at the right ASIS
(3) and ending at the

The psoas sign. Pain on

passive extension of the right
thigh. Patient lies on left side.
Examiner extends patient's
right thigh while applying
counter resistance to the right
hip (asterisk).

ANATOMIC BASIS FOR THE

PSOAS SIGN: INFLAMED
APPENDIX IS IN A
RETROPERITONEAL LOCATION
IN CONTACT WITH THE PSOAS
MUSCLE, WHICH IS STRETCHED
BY THIS MANEUVER.

The obturator sign. Pain on

passive internal rotation of the
flexed thigh. Examiner moves
lower leg laterally while
applying resistance to the
lateral side of the knee
(asterisk) resulting in internal
rotation of the femur.

ANATOMIC BASIS FOR THE

OBTURATOR SIGN: INFLAMED
APPENDIX IN THE PELVIS IS IN
CONTACT WITH THE
OBTURATOR INTERNUS
MUSCLE, WHICH IS STRETCHED
BY THIS MANEUVER.

Pemeriksaan Fisik
PERKUSI

Pemeriksaan
Penunjang
Histopatologi
Laparoskopi
CT-scan
Ultrasonografi
Foto
Laboratorium

COMPUTED
TOMOGRAPHY

In fewer than 5 percent of

patients, an opaque fecalith
may be apparent in the right
lower quadrant. Plain abdominal
films generally are not
recommended unless other
conditions(e.g., perforation,
intestinal obstruction, ureteral
calculus) are suspected.8
Likewise, as advanced crosssectional imaging techniques
have become available, barium
enema is now used infrequently.

ULTRASONOGRAPHY

Ultrasonogram
showing
longitudinal
section (arrows)
of inflamed
appendix.

COMPUTED TOMOGRAPHY

Computed
tomographic
scan showing
cross-section of
inflamed
appendix (A)
with
appendicolith
(a).
Computed
tomographic
scan showing
enlarged and
inflamed
appendix (A)
extending
from the

Alvarado Scale for the Diagnosis of

Appendicitis

Manifestations
Symptoms

Signs

Laboratory values

Value

Migration of pain

Anorexia

Nausea and/or vomiting

Right lower quadrant tenderness (Nyeri

fossa iliaca kanan)

Rebound (Nyeri lepas)

Elevated temperature (>37,30C)

Leukocytosis (>10103/L)

Left shift in leukocyte count

(neutrofil >75%)

1
Total points 10

>7 : Appendiksitis akut

Modified Alvarado score (Kalan et al) tanpa observasi of

Hematogram

Skor 1 4 :dipertimbangkan appendicitis

akut
: Observasi
Skor 5 6 : possible appendicitis tidak perlu
operasi : Antibiotik
Skor 7 9 : appendicitis akut perlu
pembedahan
: Operasi dini

DIANGNOSIS BANDING

Gastroenteritis
Demam Dengue
Limfadenitis Mesenterika
Kelainan Ovulasi
Infeksi Panggul
Kehamilan di Luar Kandungan
Kista Ovarium Terpuntir
Endometriosis Eksterna
Urolitiasis Pielum/Ureter Kanan
Penyakit Saluran Cerna Lainnya

Penatalaksanaan
Apendectomy

APPENDECTOMY

DRAINAGE

Drainage
PAD
is performed
involvesusing
placing
standard
a needle
ase
t

CONSERVATIVE

Posisi Fowler

Posisi duduk atau setengah duduk, bagian kepala

tempat tidur lebih tinggi atau dinaikkan.
Fowler (45o-90o) dan semi fowler (15o-45o).
Dilakukan untuk mempertahankan kenyamanan,
memfasilitasi fungsi pernapasan, dan pasien

PROGNOSIS
PROGNOSIS APENDISITIS
MORBIDITAS

INFEKSI
LUKA

0-10%

MORTALITAS

PERFORASI
/ GANGREN

50%

SEBELUM
PERFORASI

0.05 %

PERFORASI

2%

REFERENSI

1.

De Jong, W. & Sjamsuhidajat, R.,2004. Buku Ajar Ilmu Bedah

Edisi 2. EGC. Jakarta.

2.

Reksoprodjo, S., dkk. 1995. Kumpulan Kuliah Ilmu Bedah.

Bagian Bedah Staf Pengajar Fakultas Kedokteran Universitas
Indonesia. Bina Rupa Aksara. Jakarta.

3.

Mansjoer, A., dkk. 2000. Kapita Selekta Kedokteran Edisi

Ketiga Jilid Kedua. Penerbit Media Aesculapius Fakultas
Kedokteran Universitas Indonesia. Jakarta.

4.

Bagian Ilmu bedah Fakultas Kedokteran Universitas Sumatra

Utara.
http://library.usu.ac.id/
download/fk/bedah-emir
%20jehan.pdf

5.

Mubin, Halim. Buku Panduan Praktis : Ilmu Penyakit Dalam

Diagnosis dan Terapi Edisi 2. Jakarta : Penerbit Buku
Kedokteran EGC. 2007.

6.

Price, Sylvia A. Patofisiologi : Konsep Klinis Proses-Proses

Penyakit, Edisi 4. Jakarta: Penerbit Buku Kedokteran EGC.
1995.

7.

Schwartz, Spencer, S., Fisher, D.G., 1999. Principles of

Surgery Sevent Edition. Mc-Graw Hill a Division of The
McGraw-Hill Companies. Enigma an Enigma Electronic

. . .TERIMA
KASIH. . .