AKUT ABDOMEN

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 DEFINISI

AKUT ABDOMEN / GAWAT ABDOMEN :

Nyeri abdomen yang terjadi tiba-tiba dan
berlangsung kurang dari 24 jam.
Memerlukan penanganan segera yang sering
berupa tindak bedah.

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 Jenis Nyeri
Nyeri Visceral:
• Saat terjadi rangsangan pada organ misalnya akibat
peradangan
• Peritoneum visceral dipersarafi sistem saraf otonom
• Pasien tidak dapat menunjuk lokasi nyeri
• Lokasi nyeri bergantung pada persarafan embrional
• Contoh: Apendisitis akut,

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 Foregut : gaster, duodenum, sistem hepatobilier dan pankreas
nyeri dulu hati
Midgut : usus halus sampai pertengahan kolon transversum
nyeri umbilial
Hindgut : petengahan kolon transversm sampai kolon sigmoid
nyeri perut bawah

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 Nyeri Somatik:
• Rangsangan pada saraf tepi
• Peregangan atau luka pada peritoneum parietale
• Pasien dapat menunjuk lokasi nyeri dengan tepat
• Gesekan visceral rangsangan peritoneum parietale
= referred pain
• Bergerak, bernapas, bersin, batuk meningkatkan
nyeri

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 Sifat Nyeri

• Nyeri alih
• Nyeri proyeksi
• Hiperestesi
• Nyeri kontiyu
• Nyeri kolik : diselingi saat tidak sakit

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 ETIOLOGI
1. Infeksi – radang
Appendisitis akut, perforasi apendiks, perforasi tukak
lambung, perforasi usus tifus, pankreatitis akut,
kolesistitis akut, adneksitis akut.

2. Ileus obstruktif
Hernia inkaserata, volvulus usus

3. Iskemia
Hernia strangulata, volvulus, kelainan atau
penyumbatan vaskular

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 4. Perdarahan
Kehamilan ektopik, aneurisma yang pecah

5. Cedera
Perforasi organ berongga, perdarahan limpa
atau hati

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https://doc-04-3s-docs.googleusercontent.com/docs/securesc/83ekhso9irbbea1cboh6vl55o19g…nce=7011jdhqn4o8i&user=12226118541360420945&hash=k5tu4qvvv372f3ca7bnmr76iqs7570g9 22/07/19 13.04
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 PEMERIKSAAN
Anamnesis
• Rasa sakit :
• Lokasi
• Tetap / berpindah
• Reffered pain
• Memperberat : batuk, bernapas, dll
• Memperingan : bergerak (nyeri kolik), diam
(peritonitis)

• Mual, muntah :

• BAB: Konstipasi?

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 PEMERIKSAAN FISIK

• Keadaan Umum : Baik / Sedang / Buruk

• Kesadaran :
• Compos Mentis
• Somnolen → kesadaran ↓
• Sopor → bereaksi thd rangsangan yg kuat
• Koma

• Tanda-tanda Vital: Nadi meningkat

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 • Inspeksi :
• Dinding perut : Datar, buncit
• Bekas operasi
• “Darmkontur” → “Darmsteifung”
• Tumor ? Caput Medusae ?

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 Auskultasi :
Bising usus :
Meningkat (Illeus obstruktif)
Hiperperistaltik
Metalic sound
Melemah → hilang (Illeus paralitik)
Bising pembuluh darah (Bruit)

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 • Perkusi :
• Pekak (dull) → pekak hati, buli-buli penuh
• Gendang (tympani) → meteorismus
• Disertai nyeri → peritonitis
• Batas Paru-Hepar Hilang( tanda Perforasi)
• (normal: ketuk grs mid clav ,IC V-VI = sonor --- pekak

• Palpasi :
• Hepar, lien, ginjal → bimanual
• Tumor → besar, letak, konsistensi, mobilitas
• Défense Musculaire

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 Rectal Touchér
• Lithotomy
• Miring ke kiri (Sims position)
• Knee Chest Position

Nyeri di arah jam

Ampula rekti kolaps : Illeus paralitik

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 PEMERIKSAAN PENUNJANG

1. Laboratorium :
• Minimal darah : Hb, Ht, Leukosit, thrombosit,
glukosa, ureum
Urine
• Lain – lain : Lipase, amilase
Na, K
Bilirubin, alkali fosfatase
Analisa gas darah
• Untuk OP : Waktu pembekuan & perdarahan
Golongan darah bila perlu transfusi

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 2. Radiologi :
• Toraks : “Free Air” subdiaphragma (peritonitis)
• BNO : “Air Fluid Level” (peritonitis)
• POSISI :
• TEGAK
• LEFT LATERAL DECUBITUS (LLD)

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 3. USG :
• Cairan bebas intraabdominal
• Cholelithiasis, cholecystitis, pancreatitis
• Urolithiasis
• Appendicitis
• Invaginasi, Ileus
• Aneurysma aorta

4. Endoskopi

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 5. Laparoskopi
6. Peritoneal lavage:
Hanya pada akut abdomen

7. C.T. Scan
8. M.R.I : Magnetic Resonance Imaging

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 Tindakan Pada Akut Abdomen
1. Puasa Total
2. Infus Rehidrasi
3. NGT → untuk dekompresi
4. DC→ Menilai balanced cairan
5.Obat-obatan: antibiotik, antipiretik.
jangan berikan analgesik.
6. Operatif

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 • 1. Perforasi Peritonitis
• Nyeri mendadak, hebat, menetap
• Tegang → difus → diffence muscular
• Mual muntah
• Syok

• 2. Obstruksi usus
• Nyeri hebat
• Muntah
• Konstipasi
• Tidak ada flatus
• Distensi abdomen
• Bising usus ↑ (stad. Lanjut → hilang / paralitik)
• Mungkin pernah mengalami operasi abdomen

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