AKUT ABDOMEN

AKUT ABDOMEN

NON TRAUMATIK
AKUT PER AKUT
NYERI ABDOMEN

KEADAAN UMUM 6 JAM SURGERY

DO IT RIGHT FROM THE START

Mardi Rahayu - Ukrida 2

 PENYEBAB AKUT ABDOMEN
GARIS BESAR

1. NON SURGICAL (TERMASUK KELAINAN

DILUAR ABDOMEN)
2. PERITONITIS LOKAL / GENERAL
3. OBSTRUKSI GASTRO INTESTINAL
4. PERDARAHAN INTRA / RETROPERITONEAL
5. ISKEMIA / INFARK
6. UROLOGIS - GINEKOLOGIS

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

USIA TUA
KANKER
VASKULAR
SEBAB-SEBAB MEDIK
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 WORLD ORGANIZATION OF
GASTROENTEROLOGY RESEARCH COMMITTEE
ON ACUTE ABDOMINAL PAIN (1979)
N %
NON SPECIFIC ABDOMINAL PAIN 2623 43.0
ACUTE APPENDICITIS 1476 24.2
ACUTE CHOLECYSTITIS 541 8.9
SMALL BOWEL OBSTRUCTION 292 4.0
RENAL COLIC 209 3.4
PERFORATED PEPTIC ULCER 172 2.8
ACUTE PANCREATITIS 138 2.3
ACUTE DIVERTICULAR DISEASE 128 2.1
ALL OTHER CASES 568 9.8
(GYNAEC + CA COLON)

TOTAL 6097
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 NYERI ABDOMEN

SARAF RESEPTOR SPESIFIKASI LOKASI RANGSANGA

NYERI N
VISCERAL S.OTONO PERITONEUM TAK JELAS (SUKAR SUKAR KEJANG TARIK
M VISCERALIS DIJELASKAN) DISTENSI

SOMATIK S. PERITONEUM JELAS JELAS SENTUH

SENTRAL PARIETALIS TAJAM (MENUNJUK) TEKANAN
MENUSUK PANAS
RADANG

REVERSED PAIN
NYERI YANG DIALIRKAN KARENA KONFERGENSI SARAF PADA
TRAKTUS SPINOTALAMIK (EMBRIOLOGIS)

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FORE GUT

MID GUT

HIND GUT

Mardi Rahayu - Ukrida 9

 CAUSES OF
HEMOPERITONEUM
GASTROINTESTINA
L TRAUMATIC LACERATION OF LIVER, SPLEEN,
PANCREAS, MESENTERY, BOWEL
GYNECOLOGIC
RUPTURED ECTOPIC
PREGNANCY RUPTURED
RUPTURED UTERUS
GRAAFIAN FOLLICLE
VASCULAR
RUPTURED ANEURYSM : AORTOILIAC, HEPATIC,
RENAL, AND SPLENIC ARTERY

UROLOGIC
RUPTURED BLADDER

HEMATOLOGIC
RUPTURED SPLEEN
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CT SCAN OF ACUTE PANCREATITIS
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Z. COPE :

MANY EXAMINATION OF THE ABDOMEN ARE

IMPERFECT BECAUSE THE PRACTITIONER
DOES NOT ACT UPON THE IMPORTANT
PRINCIPLE OF APPLYING HIS KNOWLEDGE
OF ANATOMY

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 NYERI KLINIS

KOLIK : RENAL
BILIER
INTESTINAL

RADANG : SEPTIK
KIMIAWI

ISKEMIA

Mardi Rahayu - Ukrida 18

 PROGRES PENYAKIT

PROSES > GEJALA

WAKTU : MIGRATORY PAIN (apendisitis)
EMOSI OBJEKTIF > SUBJEKTIF
OBAT KOSTIKOSTEROID STEROID
ANALGETIKA SPASMOLITIK

DIAGNOSA BELUM PASTI JANGAN ANALGETIKA

Mardi Rahayu - Ukrida 19

 WANITA 24 TAHUN IBU 2 ANAK KECIL
NYERI ABDOMEN 24 JAM
MULAI PUSAT SAMPAI ILIAKA KANAN
TEGANG RLQ + REBOUND PHEN
LEKO 17.000
OPERASI ?

WANITA 18 TAHUN PELAJAR SMU

DIBAWA KE RS DENGAN DUGAAN APENDISITIS AKUT
KELUHAN NYERI PERUT KANAN BAWAH
DEFANS MUSKULER REBOUND PHEN LEKO 7.600
APENDEKTOMI ?

Mardi Rahayu - Ukrida 20

GEJALA KLINIS (PENUNJANG)

MUNTAH

NYERI MUNTAH : APENDISITIS

MUNTAH NYERI : GASTRO ENTERITIS
IKTERUS - HEPATOBILIER
HEMATURIA UROLOGI
OBSTIPASI G I
HAID

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DIAGNOSA
DIAGNOSE MUST BE ESTABLISHED IN THE
EARLIEST POSSIBLE STAGE

KLINIS
SOAP

LABORATORIUM - STANDAR
Hb LEKOSIT, HCT,TROMBOSIT FAAL
HEMOSTASIS

BIOKIMIA DARAH (INDIKASI)

AMYLASE
GLUKOSA
KREATININ
FAAL HEPAR
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URINE
LENGKAP

RADIOLOGI
ABDOMEN POLOS BERBARING
ABDOMEN POLOS TEGAK/DEKUBITUS
DIAFRAGMA
THORAX

ULTRASONOGRAFI

ELEKTRO KARDIOGRAFI

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WAKTU OPTIMAL PEMBEDAHAN

1. TEKANAN VENA SENTRAL STABIL 80

120 mm H2O
2. MINIMAL CAIRAN DEFISIT SUDAH
DIGANTI KOREKSI ELEKTROLIT
ABNORMAL
3. URINE 30 50 ml/JAM
4. HCT 36%
5. NASOGASTRIC TUBE
6. OBAT-OBAT
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