Oleh : Dr.

Akhmad Makhmudi, Sp BA
Mata kuliah: Ilmu Bedah III (Smt VIII)
Jumat, 31 Desember 2004

KASUS BEDAH ANAK

(KONGENITAL)

ILEUS MEGAKOLON
HIGROMA COLLI

A.OMPHALOCELE B. GASTROSCHIZIS
C.TUMOR D. ATRESIA ANI

RESPIRATORY DISTRESS
SYNDROME (RDS)
ANATOMI : Diameter lumen

kecil, kosta lebih horisontalthorak kecil dan sempit,

pernapasan abdominal, O2
50% lebih tinggi.

TANDA RDS ; Tachypnea,

cyanosis, dyspnea

AKUT ABDOMEN
ILEUS
STRANGULASI
PERITONITIS
PERDARAHAN
KOMBINASI-TRAUMA
ILEUS: PROBLEM
KOMPRESI-DEHIDRASI
DAN INFEKSI

SIMPTOM AND SIGN

SAKIT PERUT
OBSTIPASI
KEMBUNG
MUNTAH
ABDOMINAL SIGN

KAUSA SAKIT PERUT

(ABDOMINAL PAIN)
NONORGANIK: EMOSINAL,

KELAINAN SUSUNAN SARAFPUSAT,

ORGAN INTRA ABDOMINALNORMAL
ORGANIK: KELAINAN ORGAN
INTRAABDOMINAL DAN DINDING
ABDOMEN

SAKIT PERUT-MANIFEST KELAINAN

ORGANIK INTRAPERITONEUM
SAKIT KOLIK (COLICKY/
CRAMPING PAIN- SIMPLE
OBSTRUCTION) -

SAKIT TERUS-

MENERUS (CONSTANS
PAIN- ISCHEMIC TISSUE)
REFERRED PAIN NERVUS TH X

NYERI RANGSANGAN

PERITONEAL ( DEFANS
MUSCULER)

OBSTRUKSI USUS STRANGULASIVOLVULUS JEJUNUM

APPENDICOGRAM
APPENDICITIS 5

GRADE:
I SIMPLE
OBSTRUCTION
II SUPPURATIVE
III GANGREN
IV RUPTURE
V ABSCES

CECAL ILEUS

RETENSI SISA BARIUM DIDALAM SEKUM

DAN LUMEN APPENDIKS

OBSTRUCTION
DEFINITION: SINDROME GANGGUAN PASASE
ORGAN BERSALURAN
ORGAN BERSALURAN:

1. INTESTINUM
2. DUCTUS BILIARIS
3. DUCTUS PANCREATICUS
4. URINARY TRACT
5. TUBA FALLOPII

ILEUS

ILEUS
( INTESTINAL OBSTRUCTION )
OBSTRUCTION : YES/ NO
SIMPLE OR STRANGULATION
HIGH OR LOW OBSTRUCTION
PARTIAL OR TOTAL
MECHANIC OR FUNCTIONAL
SYSTEMIC COMPLICATION
LOCAL COMPLICATION

HIGH GIT OBSTRUCTION

GASTRIC OUTLET OBSTRUCTION

- HPS ( HYPERTROPHIC PYLORIC STENOSIS )

- ANTHRAL WEB
- PYLORIC MUCOSA PROLAPS
DUODENAL OBSTRUCTION
- ATRESIA/STENOSIS DUODENUM
- PANCREAS ANNULARE
- LADD`S MEMBRANE

MECHANICAL LOWER GIT

OBSTRUCTION

MECONIUM ILEUS
MECONIUM PLUG SYNDROME
NEONATAL SMALL LEFT COLON SYN DROME
MALROTATION WITH VOLVULUS
INCARCERATED HERNIA
JEJUNOILEAL ATRESIA
COLONIC ATRESIA
INTESTINAL DUPLICATION
INTUSSUSCEPTION
NEC

FUNCTIONAL LOWER GIT

OBSTRUCTION
SEPSIS
INTRACRANIAL HEMORRHAGE
HYPOTHYROIDISM
MATERNAL DRUG INGESTION OR

ADDICTION
HYPERMAGNESEMIA
HYPOKALEMIA

THIRDS SPACE SYNDROME

APA PERBEDAAN DAN PERSAMAAN

KASUS GASTRO ENTERITIS DAN ILEUS

PROBLEM ILEUS

PROGNOSIS
ILEUS LETAK TINGGI
ILEUS LETAK RENDAH

GIT HAEMORHAGE
UPPER : MELENA
LOWER : HEMATOCHEZIA

RECTAL BLEEDING
LIGAMENTUM TREITZ LIMITED

TERAPI NUTRISI PARENTERAL

EBB PHASE : CAIRAN RESUSITASI RL/ ASERING
FLOW PHASE : CAIRAN NUTRISI
KH : D5, D10
PROTEIN : ASAM AMINO 2,5%, 5%,10%
LEMAK
: LIPID 20%
ELEKTROLIT: KAEN I B, 3A, 3B
MINERAL

PROGRAM CAIRAN :
( 6 JAM )
1.JUMLAH CAIRAN
2.JENIS CAIRAN
3.CARA PEMBERIAN
4.MONITORING

Jumlah cairan :
1. Defisit cairan / dehidrasi
a. Dehidrasi Ringan : 5% ( 50ml/kgbb x TBW )
b . Dehidrasi Sedang : 10% (100ml/kgbb x TBW )
c. Dehidrasi Berat : 15% (150ml/kbbb x TBW )
* Tonisitas darah:Hipotonis,isotonis,hipertonis
2. Maintenance
Neonatus: 24 jam post operatif dikurangi 30%
3. Perkiraan cairan hilang dalam 24 jam
( on going loss )
2&3 modification to Fluid intake ( see table )

TOTAL BODY WATER ( ASHCRAFT )

UMUR
Gestasional 12 minggu
12 minggu 32 minggu
Aterm
3-5 hari
Neonatus
80
Children
75
Young Man
Young Woman
Over 60 years man
Over 60 years women

%
94
80
78
-3 5
75 65 60
50
50
45

MAINTENANCE ( ASHCRAFT )
* Daily Fluid Requirements
Weight

Volume

Premature (< 2kg )

Neonatus & infant (2-10 kg )
Infant & children (10-20kg )
Children ( > 20 kg )

150 ml / kg
100ml/kg for first 10kg
1000ml+50ml/kg over 10 kg
1500ml+20ml/kg over 20 kg

Increase
Full activity + oral feeds
Fever
Room temperature > 31 C
Hyperventilation
Neonate - preterm (1-1.5 kg )
- radiant heater
- photo terapy
Burn
- first day
- Subsequently

X 1.5
+ 12 % per C
+ 30 % per C
X 1.2
X 1.2
X 1.5
X 1.5
+ 4% per 1%
area burn
+ 2% per 1%
area burn

KOMPOSISI LARUTAN KA EN DAN ASERING

KOMPOSISI ELEKTROLIT ( mEq/L )
NAMA PRODUK OSMOLARITAS Na+

Cl-

K+

Ca++ Asetate Lactate- Glukosa Kalori KEMASAN

mOsm/L

Kcal/L

KaeN 1 B

282

38.5

38.5

KaeN 3 A

290

60

50

10

KaeN 3 B

290

50

50

KaeN MG3

695

50

50

Asering

273.4

130

108.7

37.5

150

500

20

27

108

500

20

20

27

108

500

20

20

100

400

500

2.7

28

500/1000
500

Distribution Comparative :
Kompartemen

Umur
Neonatus Children

CES

Plasma : 1

Adult

Intersisil : 3
CIS

1
Transeluler : 1 % - 3 % BB

ADH : antidiuretic hormone

IPPH : intermittent positive pressure ventilation

INSENSIBLE WATER LOSS

Umur Neonatus
Udara bebas tanpa kelembaban
Humidified isolette
Pemanasan

/kgbb/hr
28 cc
14 cc
40 - 45 cc

Umr
Bayi
Anak
Remaja

/kgbb/hr
50-60 cc
40 cc
30 cc

KASUS :
PASIEN BAYI USIA 40 HARI(BB 4KG)

DENGAN ILEUS DISERTAI DEHIDRASI

BERAT DAN FEBRIS SUHU 400C,
ASIDOSIS METABOLIK DAN ANEMIA.
HASIL LAB.HB 8G%, ALBUMIN 2 G/DL, K+
2 MEQ/L, NA+ 160 MEQ/L, TROMBOSIT
50000 MM2/DL.
TERANGKAN PENATALAKSANAAN
LENGKAP ?