SAK TRAUMA ABDOMEN 2 Perbaikan

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ng mengakibatkan cidera tekanan/}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang105
7 \langnp1057 \langfe1024 \langfenp1024 }{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1024 \langnp1024 \langfe1024 \langfenp1024 tindasan pada isi rongga abdome
n, }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1024 \la
ngfenp1024 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1024 \langnp1024 \langf
e1024 \langfenp1024 terutama organ padat (hati, pancreas, ginjal, limpa) atau be
rongga (lambung, usus halus, usus besar, pembuluh\uc1 \u8211 ?pembuluh darah abd
ominal) dan mengakibatkan ruptur abdomen (}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Nooraini}{\fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 ,}{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 2014
).}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \lan
gfenp1033 \par }\pard \plain \qj \fi872 \li284 \ri0 \sa0 \lisa0 \sl480 \slmult1
\widctlpar \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \
af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Trauma abdomen adalah
trauma yang terjadi pada daerah abdomen yang meliputi daerah retroperitoneal, p
elvis dan organ peritroneal (Saputra,}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \la
ng1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loc
h \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 2012).}{\fs24 \dbch \af3 \
hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \db
ch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tra
uma abdomen adalah cedera pada abdomen, dapat berupa trauma tumpul dan tembus se
rta trauma yang disengaja atau tidak disengaja (Smeltzer}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 ,}{\fs24 \dbch \
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 2001).
}{\i1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1024 \langnp1024 \langfe1024 \l
angfenp1024 \par }\pard \plain \qj \fi872 \li284 \ri0 \sa0 \lisa0 \sl480 \slmult
1 \widctlpar \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch
\af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s41 \qj \li0 \culi0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \l
in0 \rin0 \itap0 \ls0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang105
7 \langnp1057 \langfe1033 \langfenp1033 2. }{\b1 \fs24 \dbch \af3 \hich \af0 \lo
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 ETIOLOGI}{\b1 \fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par
}\pard \plain \qj \fi284 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjus
tright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lang
np1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang105
7 \langnp1057 \langfe1033 \langfenp1033 Menurut }{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Nooraini }{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 (}{\fs
33 2014}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 ) b}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 erdasarkan mekanisme trauma, dibagi menjadi 2 yaitu :}
{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfe
np1033 \par }\pard \plain \s41 \qj \li284 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widc
tlpar \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loc
h \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 1. }{\fs24 \dbch \af3 \hic
h \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Trauma }{\fs24
\dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
tajam}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 (trauma perut dengan penetrasi kedalam rongga peritonium).}{\fs24
\par }\pard \plain \s41 \qj \fi-153 \li720 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \adjustright \lin720 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \lo
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Disebabkan oleh :}{\fs24
\par }\pard \plain \s41 \qj \fi-284 \li851 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \adjustright \lin851 \rin0 \itap0 \ls1 \fs22 \dbch \af3 \hich \af0 \loch
\af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Luka akibat terkena
tembakan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 \par }\pard \plain \s41 \qj \fi-284 \li851 \ri0 \sa0 \lisa0 \sl4
80 \slmult1 \widctlpar \adjustright \lin851 \rin0 \itap0 \ls1 \fs22 \dbch \af3 \
hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbc
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Luka
akibat tikaman benda tajam}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-284 \li851 \r
i0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \lin851 \rin0 \itap0 \ls1
\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langf
enp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Luka akibat tusukan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li360 \ri
0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \lin360 \rin0 \itap0 \fs22
\dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp103
3 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \lang
fenp1033 2. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langf
e1033 \langfenp1033 Trauma tumpul (trauma perut tanpa penetrasi kedalam rongga p
eritonium).}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 \par }\pard \plain \qj \fi567 \li0 \ri0 \sa0 \lisa0 \sl480 \s
lmult1 \widctlpar \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \l
och \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Disebabkan oleh
:}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \lang
fenp1033 \par }\pard \plain \s41 \qj \fi-284 \li851 \ri0 \sa0 \lisa0 \sl480 \slm
ult1 \widctlpar \adjustright \lin851 \rin0 \itap0 \ls2 \fs22 \dbch \af3 \hich \a
f0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Terkena kom
presi atau tekanan dari luar tubuh}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-284 \l
i851 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \lin851 \rin0 \ita
p0 \ls2 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 Hancur (tertabrak mobil)}{\fs24 \dbch \af3 \hich \af0 \loc
h \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \q
j \fi-284 \li851 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \lin85
1 \rin0 \itap0 \ls2 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 Terjepit sabuk pengaman karna terlalu menekan
perut}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \par }\pard \plain \s41 \qj \fi-284 \li851 \ri0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \adjustright \lin851 \rin0 \itap0 \ls2 \fs22 \dbch \af3 \hic
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Cidera
akselerasi/ deserasi karena kecelakaan olah raga}{\fs24 \dbch \af3 \hich \af0 \l
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41
\qj \li567 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \adjustright \lin567 \rin
0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \la
ngfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li0 \ri0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0
\loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 3. }{\b1 \
fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp
1033 MANIFESTASI KLINIS}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi284 \li0 \ri0 \sa0
\lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \it
ngfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1
033 \langfenp1033 Menurut }{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expnd-1
5 \expndtw-15 Smel}{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expnd-15 \expnd
tw-15 \lang1057 \langnp1057 t}{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expn
d-15 \expndtw-15 zer}{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expnd-15 \exp
ndtw-15 \lang1057 \langnp1057 (2001) }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 tanda dan gejala trauma abdomen,
yaitu :}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s41 \qj \fi-207 \li567 \ri0 \sa0 \lisa0 \sl36
0 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin567 \rin0 \itap0 \ls3 \
fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfen
p1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 Nyeri}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li567 \ri0 \sa0 \lisa0 \s
l360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin567 \rin0 \itap0 \fs
033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \la
ngfenp1033 Nyeri dapat terjadi mulai dari nyeri sedang sampai yang berat. Nyeri
dapat timbul di bagian yang luka atau tersebar. Terdapat nyeri saat ditekan dan
nyeri lepas.}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langf
e1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-207 \li567 \ri0 \sa0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin567 \rin0 \itap0 \
ls3 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \la
033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Darah dan cairan}{\fs24 \dbch \af3 \hich \af0 \loch \
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li567
\ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin
567 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \l
angfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp
1033 \langfe1033 \langfenp1033 Adanya penumpukan darah atau cairan dirongga peri
tonium yang disebabkan oleh iritasi.}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lan
g1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-207
\li567 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustrigh
t \lin567 \rin0 \itap0 \ls3 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 Cairan atau udara dibawah diafragma}{\
1033 \par }\pard \plain \qj \li567 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin567 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \
loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hic
h \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Nyeri disebelah
kiri yang disebabkan oleh perdarahan limpa. Tanda ini ada saat pasien dalam pos
isi rekumben.}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-207 \li567 \ri0 \sa0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin567 \rin0 \itap0
\ls3 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \l
angfenp1033 {\fs14 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
3 \langfe1033 \langfenp1033 Mual dan muntah}{\fs24 \dbch \af3 \hich \af0 \loch \
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \
li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
lin0 \rin0 \tql \tx440 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lan
g1057 \langnp1057 \langfe1033 \langfenp1033
e. }{\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Penurunan kesadaran
(malaise, letargi, gelisah) yang disebabkan oleh kehilangan darah }{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab
}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langf
enp1033 \tab }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lang
fe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp
1033 \langfe1033 \langfenp1033 dan tanda-tanda awal syok hemoragi.}{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }
\pard \plain \s41 \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \tql \tx440 \itap0 \fs22 \dbch \af3 \hich \af0
\loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \h
ich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \
plain \qj \li360 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin360 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1057 \langnp1057 \langfe1033 \langfenp1033 Dan}{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 menurut Sjamsuhidayat
enp1033 (2007)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \la
ngfe1033 \langfenp1033 meliputi: nyeri tekan diatas daerah abdomen, distensi ab
domen, demam, anorexia, mual dan muntah, takikardi, peningkatan suhu tubuh, nyer
i spontan}{\fs24 \loch \af3 \hich \af3 \dbch \f3 \lang1033 \langnp1033 \langfe10
33 \langfenp1033 .}{\fs24 \loch \af3 \hich \af3 \dbch \f3 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \qj \li360 \ri0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin360 \rin0 \itap0 \fs22 \d
bch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {
\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfen
p1033 Pada trauma non}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp10
\langnp1033 \langfe1033 \langfenp1033 penetrasi (tumpul) biasanya terdapat adany
a: }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \la
ngfenp1033 \par }\pard \plain \qj \li420 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widct
lpar \aspalpha \adjustright \lin420 \rin0 \itap0 \ls4 \fs22 \dbch \af3 \hich \af
0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Jejas atau r
uftur dibagian dalam abdomen }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li420 \ri0 \sa0 \l
isa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin420 \rin0 \itap0 \ls4
\langfenp1033 Terjadi perdarahan intra abdominal}{\fs24 \dbch \af3 \hich \af0 \

loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj
\fi-221 \cufi-92 \li659 \culi199 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \as
palpha \adjustright \lin659 \rin0 \itap0 \ls4 \fs22 \dbch \af3 \hich \af0 \loch
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Apabila trauma terke
na usus, mortilisasi usus terganggu sehingga fungsi usus tidak normal dan biasan
ya akan mengakibatkan peritonitis dengan gejala mual, muntah, dan BAB hitam (mel
ena).}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \par }\pard \plain \qj \li420 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \adjustright \lin420 \rin0 \itap0 \ls4 \fs22 \dbch \af3 \hich \
af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kemungkina
n bukti klinis tidak tampak sampai beberapa jam setelah trauma}{\fs24 \dbch \af3
d \plain \qj \li420 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjus
tright \lin420 \rin0 \itap0 \ls4 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang103
lang1033 \langnp1033 \langfe1033 \langfenp1033 Cedera serius dapat terjadi walau
pun tak terlihat tanda kontusio pada dinding abdomen. }{\fs24 \dbch \af3 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin0 \
rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \fi439 \cufi183 \li0 \ri0 \sa0 \lis
a0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin0 \rin0 \itap0 \fs22 \d
p1033 Pada trauma penetrasi biasanya terdapat: }{\fs24 \dbch \af3 \hich \af0 \lo
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \f
i-221 \cufi-92 \li659 \culi199 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspa
lpha \adjustright \lin659 \rin0 \itap0 \ls5 \fs22 \dbch \af3 \hich \af0 \loch \a
f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Terdapat luka robekan
pada abdomen }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 \par }\pard \plain \qj \fi-221 \cufi-92 \li659 \culi199 \ri
0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin659 \rin0 \i
tap0 \ls5 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe10
33 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \l
angfe1033 \langfenp1033 Luka tusuk sampai menembus abdomen }{\fs24 \dbch \af3 \h
plain \qj \fi-221 \cufi-92 \li659 \culi199 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \adjustright \lin659 \rin0 \itap0 \ls5 \fs22 \dbch \af3 \hich \
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Penanganan
yang kurang tepat biasanya memperbanyak perdarahan/memperparah keadaan}{\fs24
\par }\pard \plain \qj \fi-221 \cufi-92 \li659 \culi199 \ri0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \aspalpha \adjustright \lin659 \rin0 \itap0 \ls5 \fs22 \dbch
\af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs
33 Biasanya organ yang terkena penetrasi bisa keluar dari dalam andomen.}{\fs24
\par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalph
a \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \
s41 \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adju
stright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \la
ng1057 \langnp1057 \langfe1033 \langfenp1033 4. }{\b1 \fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 KOMPLIKASI}{\fs24 \d
bch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \p
ar }\pard \plain \s41 \qj \fi-283 \li567 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widct
lpar \aspalpha \aspnum \adjustright \lin567 \rin0 \itap0 \ls6 \fs22 \dbch \af3 \
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Sege
ra : hemoragi, syok, dan cedera.}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi-283 \li5
67 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \l
in567 \rin0 \itap0 \ls6 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp
1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Lambat : infeksi }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plai
n \s41 \qj \fi-283 \li567 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin567 \rin0 \itap0 \ls6 \fs22 \dbch \af3 \hich \af0 \loch
\af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\cs26 \fs24 \dbch \af3 \h
ich \af0 \loch \f0 \expnd-15 \expndtw-15 Komplikasi yang dapat muncul dari traum
a abdomen terutama trauma tumpul adalah cedera yang terlewatkan, terlambat dalam
diagnosis, cedera iatrogenic, intra abdomen sepsis dan abses, resusitasi yang t
idak adekuat, rupture spleen yang muncul kemudian. Peritonitis }{\cs27 \fs24 \db
ch \af3 \hich \af0 \loch \f0 \expnd-15 \expndtw-15 merupakan komplikasi terserin
g dari trauma tumpul }{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expnd-15 \ex
pndtw-15 abdomen karena adanya rupture pada organ. Penyebab yang paling serius d
ari peritonitis adalah}{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \expnd-15 \e
xpndtw-15 \lang1057 \langnp1057 }{\cs26 \fs24 \dbch \af3 \hich \af0 \loch \f0 \
expnd-15 \expndtw-15 terjadinya suatu hubungan (viskus) }{\cs28 \fs24 \dbch \af3
\hich \af0 \loch \f0 \expnd-15 \expndtw-15 ke }{\cs29 \fs24 \dbch \af3 \hich \a
f0 \loch \f0 \expnd-15 \expndtw-15 dalam rongga }{\cs30 \fs24 \dbch \af3 \hich \
af0 \loch \f0 \expnd-15 \expndtw-15 peritoneal dari }{\cs28 \fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \expnd-15 \expndtw-15 organ-organ intraabdominal }{\cs26 \fs24
\dbch \af3 \hich \af0 \loch \f0 \expnd-15 \expndtw-15 (esofagus, lambung, duode
num, intestinal, colon, rektum, kandung empedu, apendiks dan saluran kemih), yan
g dapat disebabkan oleh trauma, darah yang menginfeksi peritoneal, benda asing,
obstruksi dari usus yang mengalami strangulasi, pancreatitis }{\cs26 \fs24 \dbch
\af3 \hich \af0 \loch \f0 \expnd-15 \expndtw-15 \lang1057 \langnp1057 .}{\fs24
\par }\pard \plain \s41 \qj \li0 \ri0 \sa0 \lisa0 \pnrnot0 \sl480 \slmult1 \widc
tlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \ls0 \fs22 \dbch \af3 \h
ich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 (Smeltzer, 2001).}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li720 \ri0 \s
a0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin
ngfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \fi0 \cufi0 \li0 \culi0 \ri0
\sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin
ngfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult
1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx220 \itap0 \fs22
3 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \
langfenp1033 6. }{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp103
3 \langfe1033 \langfenp1033 ANATOMI DAN FISIOLOGI }{\b1 \fs24 \dbch \af3 \hich \
\qj \fi718 \li218 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin218 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af
2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \

loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Abdomen ialah rongga te
rbesar dalam tubuh. Bentuk lonjong dan meluas dari atas diafragma sampai pelvis
dibawah. Rongga abdomen dilukiskan menjadi dua bagian}{\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 abdomen ya
ng sebenarnya, yaitu rongga sebelah atas dan yang lebih besar, dan pelvis yaitu
rongga sebelah bawah dan kecil. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi718 \li218 \cu
li99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin218 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp103
3 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 Batasan}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 -}{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 batasan abdomen. Di a
tas, diafragma, Di bawah, pintu masuk panggul dari panggul besar. Di depan dan k
edua sisi, otot}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \la
ngfe1033 \langfenp1033 -}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 otot abdominal, tulang}{\fs24 \dbch \af3 \hich \
af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 -}{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 tulang il
liaka dan iga}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lang
fe1033 \langfenp1033 -}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1
033 \langfe1033 \langfenp1033 iga sebelah bawah. Di belakang, tulang punggung, d
an otot psoas dan quadratrus lumborum. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-2 \li2
20 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjust
right \lin220 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang10
33 \langnp1033 \langfe1033 \langfenp1033 Isi Abdomen. Sebagaian besar dari salur
an pencernaan, yaitu lambung, usus halus, dan usus besar. Hati menempati bagian
atas, terletak di bawah diafragma, dan menutupi lambung dan bagian pertama usus
halus. Kandung empedu terletak dibawah hati. Pankreas terletak dibelakang lambun
g, dan limpa terletak dibagian ujung pancreas. Ginjal dan kelenjar suprarenal be
rada diatas dinding posterior abdomen. Ureter berjalan melalui abdomen dari ginj
al. Aorta abdominalis, vena kava inferior, reseptakulum khili dan sebagaian dari
saluran torasika terletak didalam abdomen. Pembuluh limfe dan kelenjar limfe, u
rat saraf, peritoneum dan lemak juga dijumpai dalam rongga ini}{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 (Noorarin
i, 2014).}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe10
33 \langfenp1033 \par }\pard \plain \qj \fi-2 \li220 \culi99 \ri0 \sa0 \lisa0 \s
ngfenp1033 \par }\pard \plain \qj \fi-2 \li220 \culi99 \ri0 \sa0 \lisa0 \sl480 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin220 \rin0 \itap0 \fs22 \db
ch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\
1033 \par }\pard \plain \qj \fi-2 \li220 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult
1 \widctlpar \aspalpha \aspnum \adjustright \lin220 \rin0 \itap0 \fs22 \dbch \af
3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \
dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \
par }\pard \plain \qj \fi-2 \li220 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \aspnum \adjustright \lin220 \rin0 \itap0 \fs22 \dbch \af3 \hic
af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\
pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspn
um \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-2 \l
i220 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adju
stright \lin220 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \l
angnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang
1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa2
00 \lisa0 \sbauto1 \saauto1 \sl276 \slmult1 \widctlpar \aspalpha \adjustright \l
in0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \l
1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa200 \lisa0 \s
bauto1 \saauto1 \sl276 \slmult1 \widctlpar \aspalpha \adjustright \lin0 \rin0 \i
tap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \l
angfenp1033 {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1024 \langnp1024 \langf
e1024 \langfenp1024 {\shp {\*\shpinst \shpleft1175 \shptop1801 \shpright5765 \sh
pbottom6601 \shpfhdr0 \shpbxpage \shpbxignore \shpbypage \shpbyignore \shpwr3 \s
hpwrk0 \shpfblwtxt0 \shpz1 \shplid1026 {\sp {\sn shapeType}{\sv 75}}{\sp {\sn fF
lipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\s
p {\sn fLockText}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectR
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scaley100 \picw306 \pich320 \picwgoal4590 \pichgoal4800 \pngblip {\*\blipuid 669
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\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \l
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Hypochondrium dextra, ya
itu regio kanan atas:}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp10
\langnp1033 \langfe1033 \langfenp1033 Hepar}{\fs24 \dbch \af3 \hich \af0 \loch \
f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 dan Vesica fellea}{\

1033 \par }\pard \plain \qj \fi-425 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
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e1033 \langfenp1033 HYPERLINK "http://dokteraneh.blogspot.com/2011/11/anatomi-ga
ster.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langnp1
\langnp1033 \langfe1033 \langfenp1033 Gaster}}}{\fs24 \dbch \af3 \hich \af0 \loc
h \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich
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\fldedit {\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1
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2011/11/intestinum-crassum.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \
af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Colon transversum}}}
{\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \langf
enp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 \par }\pard \plain \qj \fi-425 \li425 \ri0 \sa0 \lisa0 \sl480 \s
lmult1 \widctlpar \aspalpha \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls7 \
langfenp1033 Hypochondrium sinistra, regio yang berada di kiri atas:}{\fs24 \dbc
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field \fldedit {\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang
1033 \langnp1033 \langfe1033 \langfenp1033 HYPERLINK "http://dokteraneh.blogspot
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ch \af3 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{
p1033 , Hepar, Colon Transversum}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-425 \li425 \r
i0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin425 \rin0 \
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033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \
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:}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \lang
fenp1033 }{\field \fldedit {\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2
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och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 HYPERLINK "http://dokter
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lon ascendens}}}{\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langnp1033 \l
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gfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 Umbilicalis, regio tengah:}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\field \fldedi
t {\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1
033 \langfe1033 \langfenp1033 HYPERLINK "http://dokteraneh.blogspot.com/2011/11/
intestinum-tenue.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Intestinum tenue}}}{\fs24 \dbc
h \af3 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\
1033 , Colon transversum}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-425 \li425 \ri0 \sa0
\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin425 \rin0 \tql \tx4
33 \langfe1033 \langfenp1033 Lumbaris sinistra, regio sebelah kiri umbilikalis:}
np1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 Intestinum tenue}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang105
7 \langnp1057 \langfe1033 \langfenp1033 (usus halus)}{\fs24 \dbch \af3 \hich \a
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{\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 HYPERLINK "http://dokteraneh.blogspot.com/2011/11/i
ntestinum-crassum.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang
1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \
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dctlpar \aspalpha \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls7 \fs22 \dbch
33 Inguinalis dextra, regio kanan bawah:}{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\field \fldedit {\*\fldinst {
\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfe
\langfenp1033 HYPERLINK "http://dokteraneh.blogspot.com/2011/11/intestinum-cras
sum.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \
langnp1057 \langfe1033 \langfenp1033 S}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \l
ang1033 \langnp1033 \langfe1033 \langfenp1033 ecum}}}{\fs24 \dbch \af3 \hich \af
0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 , }{\field
\fldedit {\*\fldinst {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp10
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011/11/intestinum-crassum.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \a
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Appendix vermiformis}
}}{\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \lan
gfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1
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\slmult1 \widctlpar \aspalpha \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls7
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\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs
33 Appendix vermiformis, Intestinum tenue}{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 (usus halus)}{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 , Vesica u
rinaria}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
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s22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp
1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \l
angfenp1033 Inguinalis sinistra, regio kiri bawah:}{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \h
ich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Intestinum te
nue}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \la
ngfenp1033 (usus halus)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 , Colon descendens, }{\field \fldedit {\*\fldins
t {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \lan
033 \langfenp1033 HYPERLINK "http://dokteraneh.blogspot.com/2011/11/intestinum-c
rassum.html"}}{\fldrslt {\fs24 \dbch \af3 \hich \af0 \loch \af0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 Colon sigmoideum}}}{\fs24 \dbch \af3 \hi
ch \af0 \loch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch
}\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \ad
justright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \l
\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \lin0 \rin0 \itap0 \fs
ngfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlp
ar \aspalpha \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kuadran abdomen}{\fs2
3 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspal
pha \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang
1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Selain dibagi menjadi regio-re
gio, dinding abdomen juga dibagi menjadi kuadran-kuadran yang ditentukan oleh du
a garis:}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
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h \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\f
s24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1
033 Sehingga tercipta regio kanan atas, kanan bawah, kiri atas, dan kiri bawah.
Kuadran-kuadran ini digunakan secara klinis.}{\fs24 \dbch \af3 \hich \af0 \loch
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eb78cfe5bb8855bb885cf87ff07d824f84e4e923b8d0000000049454e44ae426082}}}}}{\fs24 \
loch \af3 \hich \af0 \dbch \af3 \lang1033 \langnp1033 \langfe1033 \langfenp1033
}}}{\fs24 \loch \af3 \hich \af0 \dbch \af3 \lang1033 \langnp1033 \langfe1033 \la
ngfenp1033 }{\fs24 \loch \af3 \hich \af3 \dbch \f3 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1
\widctlpar \aspalpha \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0
plain \qj \fi-2 \li220 \culi99 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspa
lpha \aspnum \adjustright \lin220 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch
\qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustri
ght \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1
langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li0 \ri0 \sa0
\lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tq
l \tx220 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \la
ngfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \lan
gnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \s41 \qj \li0 \ri0 \sa0 \li
sa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \
tx220 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langf
e1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp
1057 \langfe1033 \langfenp1033 7. }{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \l
ang1033 \langnp1033 \langfe1033 \langfenp1033 PATOFISIOLOGI}{\b1 \fs24 \dbch \af
rd \plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li
284 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033
gnp1033 \langfe1033 \langfenp1033 Jika terjadi trauma pe}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 netrasi }{\fs24
\cf0 atau non}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lang
fe1033 \langfenp1033 \cf0 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 \cf0 p}{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 \cf0 e}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf0 netrasi k}{\
1033 emun}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe10
33 \langfenp1033 gkinan terjadi pendarahan intra abdomen yang serius, pasien aka
n memperlihatkan tanda-tanda iritasi yang disertai penurunan hitung sel darah me
rah yang akhirnya gambaran klasik syok hemoragik. }{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1024 \langnp1024 \langfe1033 \langfenp1033 Bila suatu organ viser
al mengalami perforasi, maka tanda-tanda perforasi, tanda-tanda iritasi peritoni
um cepat tampak. Tanda-tanda dalam trauma abdomen tersebut meliputi nyeri tekan,
nyeri spontan, nyeri lepas dan distensi abdomen tanpa bising usus bila telah te
rjadi peritonitis umum. Bila syok telah lanjut pasien akan mengalami takikardi d
an peningkatan suhu tubuh, juga terdapat leukositosis. Biasanya tanda-tanda peri
tonitis mungkin belum tampak. Pada fase awal perforasi kecil hanya tanda-tanda t
idak khas yang muncul. Bila terdapat kecurigaan bahwa masuk rongga abdomen, maka
operasi harus dilakukan (Mansjoer, 2001).}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1024 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720
t \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1
langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \
sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \ri
n0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe10
angfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \s
ngfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3
\hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \d
ar }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \
h \af0 \loch \f0 \lang1024 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \pl
ain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \asp
num \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \la
ng1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch
\f0 \lang1024 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi72
0 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustri
ght \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1024
\langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0
\sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0
langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmul
t1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \a
f3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24
\par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0
plain \qj \fi720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \a
spnum \adjustright \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \
h \f0 \lang1024 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi
720 \li284 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjust
right \lin284 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lan
24 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \r
i0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284
fe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1024 \langnp102
4 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li284 \ri0 \sa0 \lisa
0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0
\langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \wid
rd \plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \tql \tx220 \itap0 \ls9 \fs22 \dbch \af3 \hich \af0 \l
och \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \
hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 PATOFLOW DIA
GRAM}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe103
3 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \wi
dctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx220 \itap0 \fs22 \dbc
1024 {\shp {\*\shpinst \shpleft3331 \shptop287 \shpright6016 \shpbottom1100 \shp
fhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfbl
wtxt0 \shpz2 \shplid1028 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\
sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockTex
t}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv 0}}{\
sp {\sn fLockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fShadowOK}{\s
v 1}}{\sp {\sn fillType}{\sv 4}}{\sp {\sn fillColor}{\sv 14728860}}{\sp {\sn fil
lBackColor}{\sv 15783355}}{\sp {\sn lineColor}{\sv 12819571}}{\sp {\sn lineWidth
}{\sv 15875}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}{\shptx
t \pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \a
spnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \la
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Trauma }{\fs24 \dbch \af3 \h
plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \ad
1033 \langnp1033 \langfe1033 \langfenp1033 (kecelakaan) }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \pla
in \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adj
ustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \la
033 \langnp1033 \langfe1033 \langfenp1033 \par }}}{\shprslt {\pict }}}}{\b1 \fs2
3 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspal
pha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \a
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qc
\li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
gnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \
sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs2
33 {\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1024 \langnp1024 \langfe1024 \la
ngfenp1024 {\shp {\*\shpinst \shpleft6252 \shptop195 \shpright8008 \shpbottom809
\shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \s
hpfblwtxt0 \shpz4 \shplid1029 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv
0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLo
ckText}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv
0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fShadowO
K}{\sv 1}}{\sp {\sn fillType}{\sv 4}}{\sp {\sn fillColor}{\sv 14728860}}{\sp {\s
n fillBackColor}{\sv 15783355}}{\sp {\sn lineColor}{\sv 12819571}}{\sp {\sn line
Width}{\sv 15875}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}{\
shptxt \pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalp
ha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hic
h \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \
qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustrig
ht \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \l
angnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lan
g1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \
lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \ita
p0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \lan
gfenp1033 {\fs22 \dbch \af3 \hich \af0 \loch \f2 \lang1033 \langnp1033 \langfe10
33 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpa
r \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0
\loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af3 \hi
ch \af0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain
\qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustri
langnp1033 \langfe1033 \langfenp1033 Non-Penetrasi}{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \li
lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \
langfe1033 \langfenp1033 {\fs22 \dbch \af3 \hich \af0 \loch \f2 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }}}{\shprslt {\pict }}}}{\fs22 \dbch \af3 \
hich \af0 \loch \af2 \lang1024 \langnp1024 \langfe1024 \langfenp1024 {\shp {\*\s
hpinst \shpleft1720 \shptop188 \shpright3038 \shpbottom794 \shpfhdr0 \shpbxcolum
n \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz6 \shp
lid1030 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\
sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}{\sp {\
sn fLockVerticies}{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv 0}}{\sp {\sn fLockRota
tion}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fi
llType}{\sv 4}}{\sp {\sn fillColor}{\sv 14728860}}{\sp {\sn fillBackColor}{\sv 1
5783355}}{\sp {\sn lineColor}{\sv 12819571}}{\sp {\sn lineWidth}{\sv 15875}}{\sp
{\sn lineStyle}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}{\shptxt \pard \plain \q
c \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustrigh
1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lis
a0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0
np1033 {\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1
\af3 \hich \af0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\par
d \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \a
djustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \
g1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \li
sa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0
\langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \la
ngfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \wi
dctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich
\af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \a
f3 \hich \af0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \
plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adju
33 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0
\sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \f
angfenp1033 Penetrasi}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch
33 \par }}}{\shprslt {\pict }}}}{\fs22 \dbch \af3 \hich \af0 \loch \af2 \lang102
4 \langnp1024 \langfe1024 \langfenp1024 {\shp {\*\shpinst \shpleft3082 \shptop22
3 \shpright6217 \shpbottom703 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \sh
pbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz19 \shplid1031 {\sp {\sn shapeType}
{\sv 69}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgains
tGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{
\sp {\sn fLockAspectRatio}{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn Wrap
Text}{\sv 0}}{\sp {\sn adjustValue}{\sv 4320}}{\sp {\sn adjust2Value}{\sv 5400}}
{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fillType}{\sv 4}}{\sp {\sn fillColor}{\sv
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gfe1033 \langfenp1033 otilitas usus}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang
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pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspn
\lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \

h \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard
\plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \a
g1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa
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af0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc
np1033 \langfe1033 \langfenp1033 Terjadi perforasi lapisan abdomen }{\fs24 \dbch
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\lang1057 \langnp1057 \langfe1033 \langfenp1033 Anoeksia}{\fs22 \dbch \af3 \hich
\af0 \loch \f2 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }}}{\shprsl
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{\shp {\*\shpinst \shpleft-1146 \shptop367 \shpright709 \shpbottom1219 \shpfhdr
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ard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnu
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qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustrig

33 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \
gnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276
h \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \s
np1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \asp
langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl
3 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlp
1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspal
ngnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl
enp1033 MK: }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 Resiko infeksi }{\fs22 \dbch \af3 \hich \af0 \loch \f2 \lan
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{\shp {\*\shpinst \shpleft4430 \shptop361 \shpright4850 \shpbottom961 \shpfhdr0
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tGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}{\sp {\sn fLockVerticies}{\sv 0}}{
\sp {\sn fLockAspectRatio}{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn Wrap
Text}{\sv 0}}{\sp {\sn txflTextFlow}{\sv 1}}{\sp {\sn adjustValue}{\sv 16200}}{\
sp {\sn adjust2Value}{\sv 5400}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fillType}{
\sv 4}}{\sp {\sn fillColor}{\sv 14728860}}{\sp {\sn fillBackColor}{\sv 15783355}
}{\sp {\sn lineColor}{\sv 12819571}}{\sp {\sn lineWidth}{\sv 15875}}{\sp {\sn li
neStyle}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\b1 \fs24
\par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalp
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left3397 \shptop424 \shpright5851 \shpbottom1202 \shpfhdr0 \shpbxcolumn \shpbxig
nore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz14 \shplid1066 {
\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\s
p {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}{\sp {\sn fLockV
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{\sp {\sn lineColor}{\sv 12819571}}{\sp {\sn lineWidth}{\sv 15875}}{\sp {\sn lin
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p1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \
33 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slm
in \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjus
3 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \s
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\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \
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f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \
lain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjus
ain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \ad
Gangguan cairan dan el}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp
1057 \langfe1033 \langfenp1033 e}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 ktrolit }{\fs22 \dbch \af3 \hich \af0 \l
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langfenp1024 {\shp {\*\shpinst \shpleft8104 \shptop477 \shpright10558 \shpbottom
1991 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk
0 \shpfblwtxt0 \shpz16 \shplid1067 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}
{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\s
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{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn dxTextLeft}{\sv 91439}}{\sp {\
sn dyTextTop}{\sv 45719}}{\sp {\sn dxTextRight}{\sv 91439}}{\sp {\sn dyTextBotto
m}{\sv 45719}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn f
illColor}{\sv 16764057}}{\sp {\sn fillBackColor}{\sv 15783355}}{\sp {\sn fHitTes
tFill}{\sv 1}}{\sp {\sn fFilled}{\sv 1}}{\sp {\sn lineColor}{\sv 16764057}}{\sp
{\sn lineWidth}{\sv 15875}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 1}}{

\sp {\sn fUseShapeAnchor}{\sv 0}}{\sp {\sn fRecolorFillAsPicture}{\sv 0}}{\sp {\
sn fLayoutInCell}{\sv 1}}{\shptxt \pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276
lain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \a
033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \sl
d \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum
ang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs22 \dbch \af3 \hich \af0 \loc
\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \asp

lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0
ain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \ad
e1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \w
33 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slm
033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \wid
p1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspa
ich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch
langfe1033 \langfenp1033 MK: Ketidakseimbangan nutrisi kurang dari kebutuhan tub
uh}{\fs22 \dbch \af3 \hich \af0 \loch \f2 \lang1057 \langnp1057 \langfe1033 \lan
gfenp1033 \par }}}{\shprslt {\pict }}}}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f
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057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl48
np1024 {\shp {\*\shpinst \shpleft-70 \shptop73 \shpright2278 \shpbottom961 \shpf
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sp {\sn fLockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fShadowOK}{\s
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\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af
\langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0
pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspn
\qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustr
lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0
angnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl2
\langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpa
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \a
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n \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adju
\qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjust
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e1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \w
fe1033 \langfenp1033 Terputusnya kontinuitas jaringan}{\fs24 \dbch \af3 \hich \a
ngnp1033 \langfe1033 \langfenp1033 \par }}}{\shprslt {\pict }}}}{\fs22 \dbch \af
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}{\shprslt {\pict }}}}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \lang
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shptop189 \shpright5520 \shpbottom967 \shpfhdr0 \shpbxcolumn \shpbxignore \shpby
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}\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha
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\loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kelemahan

fisik }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
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1024 {\shp {\*\shpinst \shpleft-222 \shptop503 \shpright2381 \shpbottom1290 \shp
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tInCell}{\sv 1}}{\shptxt \pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1
}\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \a
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af
\langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult
langnp1057 \langfe1033 \langfenp1033 }{\fs22 \dbch \af3 \hich \af0 \loch \f2 \la
ng1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lis
\langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \
ngfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \a
ain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adju
\loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li
0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \li
\langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \s
ngfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar

e1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \wid
lain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjus
fenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \a
ard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \asp
1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \l
\plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \a
d \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnu
\lang1057 \langnp1057 \langfe1033 \langfenp1033 MK: Kerusakan integritas jaringa
n}{\fs22 \dbch \af3 \hich \af0 \loch \f2 \lang1057 \langnp1057 \langfe1033 \lang
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{\sn fillBackColor}{\sv 15783355}}{\sp {\sn fHitTestFill}{\sv 1}}{\sp {\sn fFill
ed}{\sv 1}}{\sp {\sn lineColor}{\sv 16764057}}{\sp {\sn lineWidth}{\sv 15875}}{\
sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 1}}{\sp {\sn fUseShapeAnchor}{\sv
0}}{\sp {\sn fRecolorFillAsPicture}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}{\sh
ptxt \pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha
033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \li
f0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \
\loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0
}\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \a
\lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \s
\langnp1033 \langfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \
033 \langfenp1033 }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widct
np1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalph
lain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \a
fe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \wi
}\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \as
e1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \widct
1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \wi
ang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs22 \dbch \af3 \hich \af0 \loc
ngfe1033 \langfenp1033 }\pard \plain \qc \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1
och \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 MK: Intoleransi aktivita
s}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \lang
033 \langfenp1033 \par }\pard \plain \li0 \ri0 \sa200 \lisa0 \sl276 \slmult1 \wi
f3 \hich \af0 \loch \f2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }}}
{\shprslt {\pict }}}}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langn
p1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl
{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \l
angfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctl
0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \a
f3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\p
33 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch
fe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langn
p1057 \langfe1033 \langfenp1033 9. }{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 PEMERIKSAAN DIAGNOSTIK}{\b1 \fs24
\par }\pard \plain \qj \fi218 \cufi91 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wi
f3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 Menurut
enp1033 Nooraini, }{\fs22 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 (}{\fs22 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 2014)}{\fs22 \dbch \af3 \hich \af0 \loch \f0
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 pemeriksaan di
agnostik pada kasus trauma abdomen antaralain: }{\fs24 \dbch \af3 \hich \af0 \lo
i-205 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adju
stright \lin425 \rin0 \tql \tx425 \itap0 \ls10 \fs22 \dbch \af3 \hich \af0 \loch
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Foto thoraks }{\fs2
3 \par }\pard \plain \qj \fi439 \cufi183 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \
\af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Untuk
melihat adanya trauma pada thorak. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang
1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-205 \li425
425 \rin0 \tql \tx425 \itap0 \ls10 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemeriksaan darah rutin }{\fs24
\par }\pard \plain \qj \li438 \culi199 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctl
par \aspalpha \aspnum \adjustright \lin438 \rin0 \itap0 \fs22 \dbch \af3 \hich \
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemeriksaa
n Hb diperlukan untuk }{\i1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 base-line data }{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 bila terjadi perdarahan
terus menerus. Demikian pula dengan pemeriksaan hematokrit. Pemeriksaan leukosi
t yang melebihi 20.000/mm tanpa terdapatnya infeksi menunjukkan adanya perdaraha
n cukup banyak kemungkinan ruptura lienalis. Serum amilase yang meninggi menunju
kkan kemungkinan adanya trauma pankreas atau perforasi usus halus. Kenaikan tran
saminase menunjukkan kemungkinan trauma pada hepar. }{\fs24 \dbch \af3 \hich \af
qj \fi-205 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls10 \fs22 \dbch \af3 \hich \af0
ch \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Plain abdomen
foto tegak }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 \par }\pard \plain \qj \li438 \culi199 \ri0 \sa0 \lisa0 \sl48
enp1033 Memperlihatkan udara bebas dalam rongga peritoneum, udara bebas retroper
ineal dekat duodenum, corpus alineum dan perubahan gambaran usus. }{\fs24 \dbch
\pard \plain \qj \fi-205 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \asp
alpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls10 \fs22 \dbch \a
Pemeriksaan urine rutin }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li438 \culi199 \ri0 \sa0
\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin438 \rin0
fe1033 \langfenp1033 Menunjukkan adanya trauma pada saluran kemih bila dijumpai
hematuri. Urine yang jernih belum dapat menyingkirkan adanya trauma pada saluran
urogenital. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 \par }\pard \plain \qj \fi-205 \li425 \ri0 \sa0 \lisa0 \sl4
80 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql \tx425
\itap0 \ls10 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langf
\langfe1033 \langfenp1033 Diagnostik Peritoneal Lavage (DPL) }{\fs24 \dbch \af3
d \plain \qj \fi720 \li720 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Diagnostik peritoneal lavage me
rupakan salah satu test yang paling akurat dan memiliki sensitivitas yang tinggi
yaitu berkisar 98% dalam mendeteksi perdarahan intraperitoneal maupun ruptur or
gan yang terjadi akibat trauma tumpul abdomen }{\fs24 \dbch \af3 \hich \af0 \loc
720 \li720 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \adjustright \l
in720 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033
np1033 \langfe1033 \langfenp1033 Diagnostik peritoneal lavage pada trauma penest
rasi adalah difokuskan pada pasien dengan luka tusuk di anterior abdominal asimp
tomatik, memiliki status hemodinamik yang stabil, tidak ada tanda- tanda periton
itis dan hasil eksplorasi luka menunjukkan positif. Lavase peritoneal berguna un
tuk mengetahui adanya perdarahan intra abdomen pada suatu trauma tumpul bila den
gan pemeriksaan fisik dan radiologi seperti foto sinar X, hasilnya masih diraguk
an}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \lan
gfenp1033 \par }\pard \plain \qj \fi720 \li720 \ri0 \sa0 \lisa0 \sl480 \slmult1
\widctlpar \aspalpha \adjustright \lin720 \rin0 \itap0 \fs22 \dbch \af3 \hich \a
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 DPL merupak
an tindakan yang invasif dan dapat dilakukan dengan menggunakan pendekatan tertu
tup maupun semiterbuka. Pada teknik tertutup, kateter dimasukkan secara perkuta
n}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \lang
033 \langfenp1033 sedangkan pada pendekatan semi terbuka}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 dengan}
3 \langfenp1033 melibatkan insisi kecil dan diseksi pada rectus fascia. Kateter
kemudian dimasukkan melalui peritoneum ke dalam rongga}{\fs24 \dbch \af3 \hich \
af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 peritoneu
m.}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \lan
gfenp1033 }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 Pada aspirasi pertama bila ditemukan darah maka tindakan lapa
rotomi harus segera dilakukan. Namun bila tidak ada maka cairan ringer laktat ya
ng dihangatkan dimasukkan kedalam sebanyak 1000 cc sambil dilakukan penekanan ab
domen untuk menyakinkan pencampuran cairan dengan isi abdomen setelah itu dikelu
arkan kembali. Hasil cairan tersebut akan diperiksa secara makroskopis untuk mel
ihat apakah ada isi pencernaan, sel darah merah, sel darah putih dan cairan empe
du. Tes dikatakan positif bila ditemukan kadar sel darah merah lebih dari 100.00
0 ml, kadar sel darah putih lebih dari 500 cc atau pada pewarnaan gram postif di
temukan bakter}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lan
gfe1033 \langfenp1033 i}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp
1033 \langfe1033 \langfenp1033 pencernaan (Majewski}{\fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 , }{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 2000). }{\
1033 \par }\pard \plain \qj \fi660 \cufi275 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult
ch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 1)
Indikasi untuk melakukan DPL adalah sebagai berikut : }{\fs24 \dbch \af3 \hich \
\qj \fi218 \cufi91 \li660 \culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin660 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0
ch \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 a. }{\fs24 \db
ch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Nye
ri abdomen yang tidak bisa diterangkan sebabnya }{\fs24 \dbch \af3 \hich \af0 \l
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \
fi218 \cufi91 \li660 \culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspal
pha \aspnum \adjustright \lin660 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch
0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 b. }{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Trauma pa
da bagian bawah dari dada }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi218 \cufi91 \li660 \
culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustrig
ht \lin660 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp
\langnp1057 \langfe1033 \langfenp1033 c. }{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Hipotensi, hematokrit turun tan
pa alasan yang jelas }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi218 \cufi91 \li660 \culi3
00 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \l
in660 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033
np1057 \langfe1033 \langfenp1033 d. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lan
g1033 \langnp1033 \langfe1033 \langfenp1033 Pasien cedera abdominal dengan gangg
uan kesadaran (obat, alkohol, cedera otak) }{\fs24 \dbch \af3 \hich \af0 \loch \
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi218
\cufi91 \li660 \culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \
aspnum \adjustright \lin660 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2
ch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 e. }{\fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pasien cedera
abdominal dan cedera medula spinalis (sumsum tulang belakang) }{\fs24 \dbch \af3
d \plain \qj \fi218 \cufi91 \li660 \culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wi
dctlpar \aspalpha \aspnum \adjustright \lin660 \rin0 \itap0 \fs22 \dbch \af3 \hi
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 f. }{\
1033 Patah tulang pelvis }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lang
np1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi221 \cufi92 \li436 \c
uli198 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustrigh
t \lin436 \rin0 \itap0 \ls11 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \l
1033 \langnp1033 \langfe1033 \langfenp1033 Kontra indikasi relatif melakukan DPL
adalah sebagai berikut : }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-218 \cufi-91 \li109
4 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjust
right \lin1094 \rin0 \tql \tx425 \itap0 \ls12 \fs22 \dbch \af3 \hich \af0 \loch
0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Hamil }{\fs24 \dbch
\pard \plain \qj \fi-218 \cufi-91 \li1094 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmu
lt1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin1094 \rin0 \tql
\tx425 \itap0 \ls12 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp103
ngnp1033 \langfe1033 \langfenp1033 Pernah operasi abdominal }{\fs24 \dbch \af3 \
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \qj \fi-218 \cufi-91 \li1094 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmult1 \w
idctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin1094 \rin0 \tql \tx42
33 \langfe1033 \langfenp1033 Operator tidak berpengalaman }{\fs24 \dbch \af3 \hi
lain \qj \fi-218 \cufi-91 \li1094 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin1094 \rin0 \tql \tx425
\itap0 \ls12 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langf
\langfe1033 \langfenp1033 Bila hasilnya tidak akan merubah penatalaksanaan }{\f
033 \par }\pard \plain \qj \fi-235 \cufi-98 \li895 \culi300 \ri0 \sa0 \lisa0 \sl
480 \slmult1 \widctlpar \aspalpha \toplinepunct1 \adjustright \lin895 \rin0 \ita
p0 \ls13 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe103
ngfe1033 \langfenp1033 Menurut Warsinggih (2009) }{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Indikasi DPL}{\fs24 \db
ch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \li
ne }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \la
ngfenp1033 a. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 \uc1 \u8220 ?Equivocal\uc1 \u8221 ?, yaitu pada keadaan ge
jala klinik yang meragukan misalnya trauma}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-238
\cufi-99 \li1114 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha
\toplinepunct1 \adjustright \lin1114 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \
h \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 b. }{\fs24 \dbc
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \uc1
\u8220 ?Unreliable\uc1 \u8221 ?, yaitu jika kesadaran pasien menurun setelah tr
auma kepala ata}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \la
ngfe1033 \langfenp1033 u }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 intoksikasi}{\fs24 \dbch \af3 \hich \af0 \loc
-238 \cufi-99 \li1114 \culi398 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspa
lpha \toplinepunct1 \adjustright \lin1114 \rin0 \tql \tx660 \itap0 \fs22 \dbch \
c. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \l
angfenp1033 \uc1 \u8220 ?Impractical\uc1 \u8221 ?, yaitu untuk mengantisipasi ke
mungkinan pasien membutuhkan anestesia umum yang lama untuk trauma lainnya}{\fs2
3 \par }\pard \plain \qj \fi-238 \cufi-99 \li1114 \culi398 \ri0 \sa0 \lisa0 \sl4
80 \slmult1 \widctlpar \aspalpha \toplinepunct1 \adjustright \lin1114 \rin0 \tql
ngnp1033 \langfe1033 \langfenp1033 Kontra}{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 indikasi DPL}{\fs24 \d
bch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \l
ine }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \l
angfenp1033 a. \uc1 \u8220 ?}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \l
angnp1033 \langfe1033 \langfenp1033 Absolute\uc1 \u8221 ?: indikasi yang jelas u
ntuk tindakan laparotomi}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-218 \cufi-91 \li1314
\culi498 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \toplinepunct1 \a
djustright \lin1314 \rin0 \tql \tx1320 \itap0 \fs22 \dbch \af3 \hich \af0 \loch
0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 b. }{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \uc1 \u82
20 ?Relative\uc1 \u8221 ?: secara teknik sulit dilakukan seperti kegemukan (morb
id obesity), pembedahan abdominal sebelumnya, kehamilan lanjut}{\fs24 \dbch \af3
d \plain \qj \li675 \culi307 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalp
ha \aspnum \adjustright \lin675 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \q
j \fi3 \li436 \culi198 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \as
pnum \adjustright \lin436 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \l
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 g. }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Ultrasonografi d
an CT Scan }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 \par }\pard \plain \qj \fi3 \li651 \culi296 \ri0 \sa0 \lisa0
langfenp1033 Sebagai pemeriksaan tambahan pada penderita yang belum dioperasi da
n disangsikan adanya trauma pada hepar dan retroperitoneum. }{\fs24 \dbch \af3 \
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \qj \fi3 \li651 \culi296 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \asp
alpha \aspnum \toplinepunct1 \adjustright \lin651 \rin0 \itap0 \ls15 \fs22 \dbch
33 Ultrasound (USG)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi8 \li869 \culi395 \ri0 \sa0
\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright
\lin869 \rin0 \tql \tx880 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang10
\lang1033 \langnp1033 \langfe1033 \langfenp1033 USG digunakan secara luas untuk
evaluasi trauma abdomen terutama trauma pediatrik}{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \line }{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Dengan pe
ningkatan resolusi ultrasound, prosedure jadi lebih cepat, modern, murah, dan ev
aluasi bersifat \uc1 \u8220 ?relatively organ specific\uc1 \u8221 ? . Alat yang
\uc1 \u8220 ?portable\uc1 \u8221 ? dan dapat digunakan di ruang resusitasi untuk
evaluasi yang cepat}{\fs24 \loch \af3 \hich \af0 \dbch \f3 \lang1033 \langnp103
3 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li653 \culi297 \ri0 \sa0 \li
sa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \li
n653 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \
p1057 \langfe1033 \langfenp1033 2) Menurut Warsinggih (2009), }{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 indikasi C
omputerized tomography (CT)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \la
ngnp1057 \langfe1033 \langfenp1033 adalah}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \line }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs24 \db
ch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
a. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \la
ngfenp1033 \uc1 \u8220 ?Delayed presentation\uc1 \u8221 ?}{\fs24 \dbch \af3 \hic
h \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 gejala
muncul lebih dari 24 jam setelah trauma}{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi878 \c
ufi366 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \topli
nepunct1 \adjustright \lin0 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2
ch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 b. }{\fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Hasil DPL yang
meragukan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1
033 \langfenp1033 \par }\pard \plain \qj \fi878 \cufi366 \li0 \ri0 \sa0 \lisa0 \
sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin0 \r
langfe1033 \langfenp1033 c. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \l
angnp1033 \langfe1033 \langfenp1033 Adanya kontra}{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hi
ch \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 indikasi relat
ive untuk DPL}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lang
fe1033 \langfenp1033 \par }\pard \plain \qj \fi-221 \cufi-92 \li1099 \culi399 \r
i0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adju
stright \lin1099 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \
g1057 \langnp1057 \langfe1033 \langfenp1033 d. }{\fs24 \dbch \af3 \hich \af0 \lo
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kecurigaan trauma retrope
ritoneal seperti adanya hematuria tanpa trauma urethra}{\fs24 \dbch \af3 \hich \
af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 atau buli
-buli }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \qj \fi-233 \cufi-97 \li893 \culi300 \ri0 \sa0
\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright

ngnp1057 \langfe1033 \langfenp1033 3) }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \l
ang1033 \langnp1033 \langfe1033 \langfenp1033 Kontra indikasi CT scan}{\fs24 \db
ngfenp1033 a. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 \uc1 \u8220 ?Absolute\uc1 \u8221 ?; adanya indikasi untuk
laparotomi dan kehamilan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \line }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \l
ang1057 \langnp1057 \langfe1033 \langfenp1033 b. }{\fs24 \dbch \af3 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \uc1 \u8220 ?Relative\u
c1 \u8221 ?; allergy terhadap media kontras, pediatric trauma}{\fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard
\plain \qj \li0 \ri0 \sa0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin0 \rin0 \tql \tx220 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af
2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \a
ght \lin0 \rin0 \tql \tx220 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 10. }{\b1 \fs24 \dbch \af3
\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 PENANGANAN
TRAUMA ABDOMEN}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-205 \li425 \ri0 \sa0 \lisa0
\sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql \t
x425 \itap0 \ls16 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \
p1033 \langfe1033 \langfenp1033 Airway dan Breathing}{\fs24 \dbch \af3 \hich \af
qj \li440 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustr
ight \lin440 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lang
3 \langnp1033 \langfe1033 \langfenp1033 Ini diatasi terlbih dahulu. Selalu ingat
bahwa cedera bisa lebih daris atu area tubuh, dan apapun yang ditemukan, ingat
untuk memprioritaskan airway dan breathing terlebih dahulu.}{\fs24 \dbch \af3 \h
plain \qj \fi-205 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \
aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls16 \fs22 \dbch \af3 \hic
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Circula
tion }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \par }\pard \plain \qj \li438 \culi199 \ri0 \sa0 \lisa0 \sl480 \slm
ult1 \widctlpar \aspalpha \aspnum \adjustright \lin438 \rin0 \itap0 \fs22 \dbch
3 Kebanyak trauma abdomen tidak dapat dilakukan tindakan apa-apa pada fase pra-R
S, namun terhadap syok yang menyertainya perlu penanganan yang agresif. Seharusn
ya monitoring urin dilakukan dengan pemasangan DC, namun umumnya tidak diperluka
n pada fase pra-RS karena masa transportasi yang pendek}{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 .}{\fs24 \dbch \a
f3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\p
ard \plain \qj \fi-205 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspal
pha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls16 \fs22 \dbch \af3
bch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Di
sability}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 \par }\pard \plain \qj \li438 \culi199 \ri0 \sa0 \lisa0 \sl480 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin438 \rin0 \itap0 \fs22 \db

1033 Tidak jarang trauma abdomen disertai dengan trauma kapitis. Selalu periksa
tingkat kesadaran (dengan GCS) dan adanya lateralisasi (pupil anisokor dan motor
ik yang lebih lemah satu sisi)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-205 \li425 \ri0
rin0 \tql \tx425 \itap0 \ls16 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \
g1033 \langnp1033 \langfe1033 \langfenp1033 Apabila ditemukan usus yang menonjol
keluar, cukup dengan menutupnya dengan kasa steril yang lembab supaya usus tida
k kering. Apabila ada benda menancap, jangan dicabut, tetapi dilakukan fiksasi b
enda tersebut terhadap dinding perut}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lan
g1057 \langnp1057 \langfe1033 \langfenp1033 (Rachmadi, 2011).}{\fs24 \dbch \af3
d \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum
ang1024 \langnp1024 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \
\langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 11. }{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 PENATALAKSANAAN MEDIS }{\b1 \fs24 \dbc
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par
}\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \asp
alpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls17 \fs22 \dbch \a
Abdominal paracentesis }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp
1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi720 \li0 \ri0 \sa0 \lis
\langfenp1033 Menentukan adanya perdarahan dalam rongga peritonium, merupakan in
dikasi untuk }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lang
fe1033 \langfenp1033 \tab }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 laparotomi. }{\fs24 \dbch \af3 \hich \af0 \loc
15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustr
ight \lin425 \rin0 \tql \tx425 \itap0 \ls17 \fs22 \dbch \af3 \hich \af0 \loch \a
\loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemeriksaan laparoskop
i }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \lan
gfenp1033 \par }\pard \plain \qj \fi720 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \w
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Mengeta
hui secara langsung penyebab abdomen akut. }{\fs24 \dbch \af3 \hich \af0 \loch \
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15
t \lin425 \rin0 \tql \tx425 \itap0 \ls17 \fs22 \dbch \af3 \hich \af0 \loch \af2
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemasangan NGT }{\fs24 \d
ar }\pard \plain \qj \fi720 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \as
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Memeriksa cairan ya
ng keluar dari lambung pada trauma abdomen. }{\fs24 \dbch \af3 \hich \af0 \loch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15
ht \lin425 \rin0 \tql \tx425 \itap0 \ls17 \fs22 \dbch \af3 \hich \af0 \loch \af2
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pemberian antibiotik }{\
1033 \par }\pard \plain \qj \fi720 \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctl
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Mencegah inf
eksi. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmul
t1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \l
s17 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \la
033 \langfenp1033 Laparotomi }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \
langnp1057 \langfe1033 \langfenp1033 (Noorarini, 2014).}{\fs24 \dbch \af3 \hich
n \qj \li440 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adju
1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li440 \ri0 \s
ngfe1033 \langfenp1033 \par }\pard \plain \qj \li440 \ri0 \sa0 \lisa0 \sl480 \sl
mult1 \widctlpar \aspalpha \aspnum \adjustright \lin440 \rin0 \itap0 \fs22 \dbch
33 \par }\pard \plain \qj \li440 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \as
palpha \aspnum \adjustright \lin440 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \lo
n \qj \li440 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adju
\lisa0 \pnrnot0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0
\rin0 \itap0 \ls18 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 PENATALAKSANAAN KEPERAWATAN}{\b1 \fs24 \db
r }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \pnrnot0 \sl480 \slmult1 \widctlpar \a
spalpha \aspnum \adjustright \lin0 \rin0 \itap0 \ls0 \fs22 \dbch \af3 \hich \af0
\loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b0 \fs24 \dbch \af
3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
Men
urut (Noorarini, 2014) penatalaksanaan pada trauma abdomen adalah}{\b0 \fs24 \db
r }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \as
palpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls19 \fs22 \dbch \
Mulai prosedur resusitasi (memperbaiki jalan napas, pernapasan, sirkulasi) sesu
ai }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \la
ngfenp1033 \tab }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \l
angfe1033 \langfenp1033 indikasi. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1
033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li425 \r
\rin0 \tql \tx660 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033
ang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \lo
ch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pertahankan pasien pada b
rankar atau tandu papan ; gerakkan dapat menyebabkan }{\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }
np1033 \tab }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langf
e1033 \langfenp1033 fragmentasi bekuan pada pada pembuluh darah besar dan menimb
ulkan hemoragi masif. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1
033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lis
a0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql
gnp1033 \langfe1033 \langfenp1033 Pastikan kepatenan jalan napas dan kestabilan
pernapasan serta sistem saraf. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li425 \ri0
in0 \tql \tx425 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \l
1033 \langnp1033 \langfe1033 \langfenp1033 Gunting baju dari luka. }{\fs24 \dbch
}\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspa
lpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls19 \fs22 \dbch \af
dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 H
itung jumlah luka. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0
\sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql \tx
425 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \l
1033 \langfe1033 \langfenp1033 Kontrol perdarahan dan pertahanan volume darah sa
mpai pembedahan dilakukan. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-205 \li645 \ri0 \s
0 \tql \tx425 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lan
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Aspirasi lambung dengan selang
nasogastrik. Prosedur ini membantu mendeteksi luka }{\fs24 \dbch \af3 \hich \af
0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs24 \dbch \
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 lambung
, mengurangi kontaminasi terhadap rongga peritonium, dan mencegah }{\fs24 \dbch
\af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }
np1033 komplikasi paru karena aspirasi. }{\fs24 \dbch \af3 \hich \af0 \loch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li
lin425 \rin0 \tql \tx425 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \la
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tutupi visera abdomen yang k
eluar dengan balutan steril, balutan salin basah untuk }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs24 \dbc
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 menc
egah kekeringan visera. }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \l
isa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tq
l \tx425 \itap0 \ls19 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp10
angnp1033 \langfe1033 \langfenp1033 Pasang kateter uretra menetap untuk mendapat
kan kepastian adanya hematuria dan }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang
1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs24 \dbch \af3 \hich \af0 \l
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 pantau haluaran urine. }
np1033 \par }\pard \plain \qj \fi15 \li425 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \aspnum \adjustright \lin425 \rin0 \tql \tx425 \itap0 \ls17 \fs
ngfenp1033 Siapkan pasien untuk pembedahan jika terdapat bukti adanya syok, kehi
langan darah, }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \lan
gfe1033 \langfenp1033 \tab }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \la
ngnp1033 \langfe1033 \langfenp1033 adanya udara bebas dibawah diafragma, evisera
si, atau hematuria}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057
ngnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li440 \ri0 \sa0 \lisa
0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin440 \rin0 \itap0
\langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
\af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch
}\pard \plain \qj \li0 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \as
g1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \dbch \af3 \hich \af0 \lo
i-439 \cufi-182 \li439 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \as
pnum \toplinepunct1 \adjustright \lin439 \rin0 \itap0 \ls20 \fs22 \dbch \af3 \hi
ch \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs24 \d
bch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 PE
NANGANAN NON OPERATIF}{\b1 \fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lang
np1033 \langfe1033 \langfenp1033 \line }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1057 \langnp1057 \langfe1033 \langfenp1033 Menurut Warsinggih (2009), }{\fs2
3 keuntungan penanganan non operatif yaitu; lebih murah, komplikasi postoperatif
tidak ada, dan nyeri}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp10
57 \langfe1033 \langfenp1033 relatif berkurang, dengan }{\fs24 \dbch \af3 \hich
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 CT scan dapat me
ningkatkan kemampuan kita dalam mendeteksi kelainan terutama organ padat pada tr
auma tumpul abdomen, begitu juga pada trauma tembus abdomen}{\fs24 \dbch \af3 \h
ich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 .}{\fs24 \dbc
h \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par
}\pard \plain \qj \fi-215 \li653 \culi199 \ri0 \sa0 \lisa0 \sl480 \slmult1 \wid
ctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin653 \rin0 \itap0 \ls21
\langfenp1033 Pada pasien hemodinamik stabil}{\fs24 \dbch \af3 \hich \af0 \loch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 60 \uc1 \u8211 ? 70
% trauma tumpul organ padat dapat ditangani secara non operatif, angka kesuksesa
n lebih dari 90%}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \l
angfe1033 \langfenp1033 . }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lan
gnp1033 \langfe1033 \langfenp1033 \uc1 \u8220 ?Screening\uc1 \u8221 ? pasien den
gan CT scan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe
1033 \langfenp1033 \line }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \lang
np1033 \langfe1033 \langfenp1033 Penanganan non operatif trauma limpa}{\fs24 \db
ch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 , }
np1033 trauma tumpul limpa ditangani secara non operatif pada 60 \uc1 \u8211 ? 7
0% kasus, angka kegagalan 10%}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \
langnp1057 \langfe1033 \langfenp1033 . }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 Kunci sukses adalah seleksi pasie

n dengan ketat}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \lan
gfe1033 \langfenp1033 \par }\pard \plain \qj \fi-215 \li653 \culi199 \ri0 \sa0 \
lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \
lin653 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \lang
3 \langnp1033 \langfe1033 \langfenp1033 Hemodinamik stabil, volume urine >40 \uc
1 \u8211 ? 50 ml/jam, respon baik dengan pemberian kristaloid 1 \uc1 \u8211 ? 2
liter saat resusitasi}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-215 \li653 \culi199 \ri0
\sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjust
right \lin653 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang103
lang1033 \langnp1033 \langfe1033 \langfenp1033 Pada pemeriksaan ulangan; tidak a
da tanda -tanda rangsangan peritoneal}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \la
ng1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-435 \li8
66 \culi196 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \topli
nepunct1 \adjustright \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \lo
\af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Harus dirawat di
ICU dan tersedia fasilitas untuk CT serial}{\fs24 \dbch \af3 \hich \af0 \loch \f
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-435
\li866 \culi196 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \
toplinepunct1 \adjustright \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pasien diraw
at di ICU dan dipuasakan}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langn
p1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-435 \li866 \culi196 \
ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adj
ustright \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang
0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Monitor: tanda-tanda vital, se
rial hematokrit, pemeriksaan fisik setiap 4 jam}{\fs24 \dbch \af3 \hich \af0 \lo
i-435 \li866 \culi196 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \asp
num \toplinepunct1 \adjustright \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hic
af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 CT scan
serial setiap 24 jam}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-435 \li866 \culi196 \ri0
\sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjust
right \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang103
lang1033 \langnp1033 \langfe1033 \langfenp1033 Kegagalan terjadi dalam waktu 72
jam pertama; harus diawasi secara ketat}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-435 \l
i866 \culi196 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \top
linepunct1 \adjustright \lin866 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \
h \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Harus istirahat
ditempat tidur selama 10 hari}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-235 \li664 \cul
i195 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct
1 \adjustright \lin664 \rin0 \itap0 \ls21 \fs22 \dbch \af3 \hich \af0 \loch \af2
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kegagalan penanganan non
operatif trauma limpa}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1057 \langnp1
057 \langfe1033 \langfenp1033 . }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang103
3 \langnp1033 \langfe1033 \langfenp1033 Perdarahan akibat; lisis hematoma, perpi
ndahan cairan akibat perubahan osmotik cairan 4 minggu}{\fs24 \dbch \af3 \hich \
af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 . }{\fs24 \dbch \a

f3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Mandat u
ntuk laparotomi (splenektomi)}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-12 \li663 \culi2
96 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1
\adjustright \lin663 \rin0 \itap0 \ls22 \fs22 \dbch \af3 \hich \af0 \loch \af2 \
h \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Derajat trauma limpa}{\fs2
3 \par }\pard \plain \qj \fi228 \cufi95 \li649 \culi295 \ri0 \sa0 \lisa0 \sl480
\slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin649 \rin0
fe1033 \langfenp1033 Grade I: ruptur kapsul yang minor, hematoma subkapsuler tan
pa kerusakan parenkim}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp10
33 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi8 \li869 \culi395 \ri0 \s
a0 \lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustrig
ht \lin869 \rin0 \itap0 \fs22 \dbch \af3 \hich \af0 \loch \af2 \lang1033 \langnp
\langnp1033 \langfe1033 \langfenp1033 Grade II: ruptur kapsul yang soliter atau
multipel dg kerusakan parenkim yg tidak}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \l
och \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 mencapai hilus}{\fs24 \d
bch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \l
ine }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \l
angfenp1033 Grade III: trauma parenkim mayor, pembuluh darah dan atau hilus}{\fs
33 \line }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe10
33 \langfenp1033 Grade IV: limpa pecah (berkeping-keping) }{\fs24 \dbch \af3 \hi
lain \qj \fi-218 \cufi-91 \li878 \culi300 \ri0 \sa0 \lisa0 \sl480 \slmult1 \widc
tlpar \aspalpha \aspnum \toplinepunct1 \adjustright \lin878 \rin0 \itap0 \fs22 \
np1033 2) }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1
033 \langfenp1033 Kandidat untuk penanganan non operatif trauma limpa}{\fs24 \db
ngfenp1033 Orang dewasa: grade I dan II}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \line }{\fs24 \dbch \af3 \hich \a
f0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Anak-anak; sampai g
rade III}{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe103
3 \langfenp1033 \line }{\fs24 \dbch \af3 \hich \af0 \loch \f0 \lang1033 \langnp1
033 \langfe1033 \langfenp1033 \par }}

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SAK TRAUMA ABDOMEN 2 Perbaikan

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{\rtf \ansi \ansicpg1252 \deff0 \stshfdbch3 \stshfloch0 \stshfhich0 \deflang1057

\deflangfe1057 {\fonttbl {\f0 \froman \fcharset0 \fprq2 {\*\panose 020206030504

li2160 \lin2160 \fi-180 }{\listlevel \levelnfc0 \levelnfcn0 \leveljc0 \leveljcn0

art0 {\leveltext \'02\'03.;}{\levelnumbers \'01;}\dbch \af3 \hich \af0 \loch \f0

\ulc0 }{\listlevel \levelnfc0 \levelnfcn0 \leveljc0 \leveljcn0 \levelstartat1 \l

artat1 \levelfollow0 \levelspace0 \levelindent0 \levellegal0 \levelnorestart0 {\

elfollow0 \levelspace0 \levelindent0 \levellegal0 \levelnorestart0 {\levelnumber

\f0 \ulc0 }{\listlevel \levelnfc0 \levelnfcn0 \leveljc0 \leveljcn0 \levelstartat

t \'02\'06.;}{\levelnumbers \'01;}\dbch \af3 \hich \af0 \loch \f0 \ulc0 \li5760

pace0 \levelindent0 \levellegal0 \levelnorestart0 {\levelnumbers ;}}{\listlevel

level \levelnfc0 \levelnfcn0 \leveljc0 \leveljcn0 \levelstartat1 \levelfollow0 \

el \levelnfc0 \levelnfcn0 \leveljc0 \leveljcn0 \levelstartat1 \levelfollow0 \lev

\langfenp1033 Terjadi perdarahan intra abdominal}{\fs24 \dbch \af3 \hich \af0 \

2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch \af3 \hich \af0 \

0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 dan Vesica fellea}{\

f3 \dbch \af3 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cf13 \ul1 }{\fiel

}{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn tx

\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0

\lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs24 \dbch \af3 \hich \af0 \

0}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs22 \dbch \af3 \hic

ation}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn txflTextFlow}{\sv 1}}{\sp {\s

ch \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs24 \dbch

0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 }\pard \plain \li0 \ri0 \sa200

{\*\shpinst \shpleft2435 \shptop260 \shpright3695 \shpbottom530 \shpfhdr0 \shpb

i0 \sa200 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0

h \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af3 \hich \

p {\sn lineWidth}{\sv 15875}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLayoutInCell

{\sn lineWidth}{\sv 15875}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 1}}{

0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \dbch \af3 \

\hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kelemahan

f3 \hich \af0 \loch \f2 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }\pard \

\lisa0 \sl480 \slmult1 \widctlpar \aspalpha \aspnum \toplinepunct1 \adjustright

ch \af3 \hich \af0 \loch \af2 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\

lang1033 \langnp1033 \langfe1033 \langfenp1033 Kunci sukses adalah seleksi pasie

af0 \loch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 . }{\fs24 \dbch \a

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