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.
2.

3.
4. 5.

6.

NON SURGICAL (TERMASUK KELAINAN DILUAR ABDOMEN) PERITONITIS LOKAL / GENERAL OBSTRUKSI GASTRO INTESTINAL PERDARAHAN INTRA / RETROPERITONEAL ISKEMIA / INFARK UROLOGIS - GINEKOLOGIS

PENYEBAB AKUT ABDOMEN

SEGALA USIA APENDISITIS PERFORASI USUS/LAMBUNG NYERI ABDOMEN NON SPESIFIK (NON BEDAH) OBSTRUKSI USUS PANKREATITIS AKUT KOLIK GINJAL/ URETER DYSPEPSIA HERNIA KOLESISTITIS AKUT/BILIER ANAK-ANAK INVAGINASI RADANG SALURAN KEMIH HERNIA RADANG SALURAN NAPAS ATAS WANITA RADANG PELVIS RADANG SALURAN KEMIH KEHAMILAN EKTOPIK KISTA OVARIUM

USIA TUA KANKER VASKULAR SEBAB-SEBAB MEDIK

WORLD ORGANIZATION OF GASTROENTEROLOGY RESEARCH COMMITTEE ON ACUTE ABDOMINAL PAIN (1979)

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

6097

NYERI ABDOMEN
SARAF
VISCERAL S.OTONOM

RESEPTOR
PERITONEUM VISCERALIS PERITONEUM PARIETALIS

SPESIFIKASI NYERI
TAK JELAS (SUKAR DIJELASKAN) JELAS TAJAM MENUSUK

LOKASI
SUKAR

RANGSANGAN
KEJANG TARIK DISTENSI SENTUH TEKANAN PANAS RADANG

SOMATIK

S. SENTRAL

JELAS (MENUNJUK)

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 RUPTURED SPLEEN

HEMATOLOGIC

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 : SEPTIK KIMIAWI

RADANG

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. 2.

3.
4. 5.

6.

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