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Bedah Digestive (Abdomen Akut)

Feb 22, 2018

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  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    BEDAH DIGESTIV

    KEPANITERAAN KLINIK STASE ILMU BEDAH

    RUMAH SAKIT ISLAM PONDOK KOPI

    FAKULTAS KEDOKTERAN

    UNIVERSITAS MUHAMMADIYAH JAKARTA

    2015

    FITRI LARASATI (2010730136)

    DR.H.SALEH SETIAAN! SP.B

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    Abdomen Akut

    Kondisi dimana gejala utamanya nyeri d

    terjadi seara tiba!tiba dan

    penanggulangannya biasanya ti

    pembeda"an diperlukan#

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    $%E&I 'E&(T

    K"#$%&' &' *"'+',+# -&/ &/"'&-+*"' &$4 /&% '"/ "$4. R&"$4 -&&4 -/"&&' +#"% "#&/'&'-/ &-+*"' &4&$ -/ #$& &-+*"'

    +&'+&' -/ +'& 4+&.

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    Diagnosis Banding

    KolesistitisAkut,'ankreatitisAkut

    'er)orasiTukak'eptik,HepatitisAkut

    Kongesti)HepatomegaliAkut,Abses"ati,'neumoniadenganreaksi

    pleura,'ielone)ritisAkut,

    Angina'ektoris

    &uptur limpa, 'er)o'ankreatitis akutaorta pea", 'er)

    'neumonia dengan pielone)ritis a

    Apendisitis, adneksitis,endometriosis, KET, Kista

    oarium terpuntir, 'untiranapendises, epiploiae, "ernia

    inkarserata, diertikulitis, ileitisregional, per)orasi aeum,abses psoas, batu ureter,

    adenitis mesenterik

    s,adneksitis,KET,

    riumterpuntir,

    serata,per)orasi

    oid,absespsoas,

    uureter#

    .bstruksi usus,apendisitis, pankreatitisakut, oklusi pemb#dara"

    mesenterial, "erniastrangulasi, ruptur

    aneurisma aorta,diertikulitis

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    T",&-/ &"'& &-&'& &'&'&'

    "/4+'"$* &' *"#/$4/ +'&"/4+'"$*

    D/"&& +#"% $$'&' && +4+' L+&/ '"/ $#/4 $'4$ -/&*&& P&/"' /&&'& ""& &4/ 4&'

    *"'"&&' "4&*&%'& &&

    N"/V/"

    T",&-/ &"'& &'&'&' "/4+'"&/"4"

    D/"&& +#"% $$'&' && 4"/$$'&' && $&4.

    R&& '"/ ""4/ -/4$$4$$8-/ D&&4 -/4$',$&' "9&& 4"&4 +#"

    N"/S+*&4/

    /enis $yeri 'erut

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    0okalisasi $yeri

    Asal .rgan

    F+"$4

    M/-$4 H/'-$4 R"4+"/4+'" P"#:/

    .rgan

    E+&$! #&*$'!-$+-"'$*! $&'

    &*"-$ J",$'$* K+#+' -/4 ;/',! $"4" A-'"&

    0ok

    E/&

    P"/$* I'&$* P/'& P/'&

    ViseralN"/ &' 4/*$# /&&'& "$&/ -"'&' #"4& +&'+'& "$4 -&' & +&' "9&& "*/+#+/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    0okalisasi $yeri

    L+&/ O&'

    A-+*"' K&'&' A4&

    E/&4/$*

    A-+*"' K// A4&A-+*"' K&'&' B&

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    N"/ S+*&4/= &'&'&' "/4+'"$*"#&'$' terus!menerus.

    N"/ V/"= '"/ kolik &/&4 &:/"

    S/&4 R&& N"/

    N"/ "9&& "4&%& "4&*&%-/"&&' +#"% +" /'>&*&/! +#"/4/4/ &$4 &4&$ &'"&4/4/ &$4.

    O'"4 -&'I'4"'/4& N"/

    N"/ "$4 &' -/"4&/ *$'4&% &'*"'"$ "#$ -///&' "*$'

    &$4! &'"&4/4/ &$4 8 $*&4&'&/&' &4&.M$'4&%

    U*$! +// &/"'! R/

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    U*$ = "#&/'&' $&' "*"-$ ,&&304%'! /':&/'&/ #"/% "/' &-&&/'+*& +#+' -&' "4$* $/& 0604

    P+// &/"' = P&'"&4/4/ &$4 "

    ""#&% // -' >"/ &-& 4$#&' -&' #$4$4. A-+*"' &$4 -"'&' //4&/ &/"' &&' #"/% '&*&' -&* +// &"'& "'&& *"',&-/ #"/% *$-&%.

    R/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'emeriksaan Abdomen

    I'"/ P&/ P"$/A$

    J&/'&' &$4 "&+"&/("*$'/'&'&-&'& &-%"/).P"$4 *"*$'9/4;&*&&'$$8"&&' $$.

    N"/ 4"&'D"&' *$$#& (/'>&*&/"/4+'"$* &/"4")4&'-& -&/ Murphy("&-&'&' &'-$'"*"-$)'"/ 4"&' /'4"+4 &'&'

    &4& (&" %&4/)

    '"/ "4+ (//4&/"/4+'"$*)P"& %"& -&'%/4/' -$##'"(4"-&&4 $-&&"& &4&$ 9&/&'"&)

    //' $$*"'%/#&' ("/4+'/4/ $B//' $$ metalic soun+4$/)B//' $$ &*& "/

    +#"% &//

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    M"*"-&&' &'4&& +4$/ (+#&) -"'&' &// $$(&*$#& *"#"&)P"*"/&&'

    R"4

    H8H4 ("-&&%&'8-"%/-&/) P"*. R&-/+#+/ +4+ &-+*"' 3 US; ("#&/'&' H&4/! $&' "*

    -&' &'"&)

    P"*"/&&'P"'$',&'

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    12 0angka" $yeri 'erut Kanan Atas

    1

    O4&!".'&&&'!&.-/+:&$#".)

    2

    '-/'(A'&*'"/!PF!PP)

    3

    '"*"-&%&'&4&$4/-&

    &&.+4+*/-"'&'&&4&'*"-/&'&4&

    5

    /O".&/

    6

    &'"*"-&%&'

    7

    "-&%

    *&"*"-&%&'

    C

    9&"-&%

    10

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    K.0ESISTISIS AK(T

    R&-&' &'-$' "*"-$ C5 -/"&$*&4&' -$4$ /4/$ 4"$4&*& +#"*"-$.

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    Kolesistitis Akut

    Subjekti)

    N"/ "$4 &$4 -/&."$4 &'&' &4&(+#/ &4&$ 4"$*"'"$)

    N"/ *"'"& "$'$' -&' "

    &$#& M$! *$'4&% -"*&*

    .bjekti)

    S"/' &-&

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'enatalaksanaan O":&/ "#&*& 2 G 2 ,&

    4&'-& "/4+'/4/'&. B/#& *"*&/ -/"'9&'

    +#"/4"4+*/ (12 "*$-/&')

    N+'+"&4/

    S"#&*& +":&/ /#& 4"-&&4 E*"*& &'-$' "*"-$ P"/4+'/4/ *"#$&8$*$* T/-& &-& "&/&' "4"#&%

    2G2,&*! -/#&$&' 4/'-&&'+#"/4"4+*/ ""&.

    O"&4/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'A$K&EATITIS AK(T

    S$*&4&' &-& $&' &'"&*"'"&&' "4&:&&/ -&/ ",&/'&' &"'/* &'"&.

    R">$ "*"-$ " -$4$ &'"&

    "'"& &'"&4/4/ &$4 %"*+&/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'ankreatitis Akut

    A#+%+#B&4$ "*"-$

    T&$*&

    T$& "4/

    V/$

    O&4//4&' /'&4&

    "/&

    %/""*/

    /-/+&4/

    ETI.0.GI

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'ankreatitis AkutSubjekti)

    N"/ "$4 *"'"*$ "

    &&% "#&&' (4"$*"'$$)

    N"/ "$4 "$&' &-&+// "&/' *//'

    M$! *$'4&% R/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    Tindakan segera yang "adilakukan

    P$&&

    D"+*"/ #&*$'

    T"&/ 9&/&' $'4$ "&/&' /

    P"*"/&' &'4/+#/'"/ $#& &

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'E&3.&ASI T(KAK 'E'TIK

    P"+&/ 4$& "4/ 4"$4&*&-$+"-"'$* *"$&&' "'"& '"/ "$4 %"&4 4/&4/& &-&-"'&' /

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'er)orasi Tukak 'eptik

    Subjekti)

    P&/"' -"'&'/

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    Tindakan

    P"*&&'&' P/& #&*$' $'4$ -"-&' "'/&&' 9&/&' #&*$'

    R"$/4&/ 9&/&'

    A'"4/& $'4$ *"'$&'/ '

    *"*"&// /&' / :"'& -&' &$.

    P"*"-&%&' -/#&$&'

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    Trauma 'erut

    L$& &-& // +'& "$4 -&-"'&' &4&$ 4&'& 4"*$&''& -/'

    B"-&&&' "'"&'&! 4&$*& &4& 2 &/&' "&! &/4$=

    T&$*& "$4 -"'&' "'"4&/ " -&"/4+'"$* (4&$*& 4"*$)

    T&$*& "$4 4&'& "'"4&/ "/4+'"$* (4&$*& 4$*$#)

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    A'&*'"/ P"*"/&&' F// P"*"' P"'

    Diagnosis

    A&% 4$$&' S"',&4& && &'

    -/&&/ B&&/*&'&

    4",&-/'&"9"#&&&'

    B"'4$&' &'%"&4 &-& "$4

    J",& &-& -/'-/' "$4P&-& #$& 4"*&84$$ -"'&' // "$4

    &' "#$& ;",& &-& 4&$*& 4$*$# "$4 &/&4

    "%/#&'&' -&&%! *"*&8 "$&&'&-& +&'8 //4&/ 9&/&' $$

    R//-/4 &/&4 %"*&4+*& &-& -/'-/'"$4.

    H"*&4*"'$

    ,/& &100 $9&/&'

    (4&$ P&& L&:

    Akibat Trauma Ter"adap .rgan

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    L$& T$$ =

    P"-&&%&'

    I/4&/ "/4+'"$*

    (+&' "+'&)

    L$& T"*& =

    K"$&&' O&' &'-/#$/ "#$$

    T&$*

    K"$&&'4","/-/&'4&

    -"'&' 4$

    Akibat Trauma Ter"adap .rgandalam 'erut

    ' l k

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    'enatalaksanaan S+ ("-&&%&') ;&'$&' ,&' '&& P"*&&'&' /& #&*$'

    P"*&&'&' &4"4"

    T&$*& P"$4

    L&&+4+*/ -/#&$&' =T&'-&4&'-& &'&' "/4+'"! +

    $$ 4& 4"-"'&! -&&% -&* #&*$#/! "4$*! &-& $-&& "& /'4&"

    L$& T$$

    D/&',$&' L&&+4+*/L$& T"*&

    L&&+4+*/T&$*& T$*$#

  • 7/24/2019 Bedah Digestive (Abdomen Akut)

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    GA$GG(A$ 'ASASE (S(S

    S"/' -/"$4 ,$& /#"$! -&&4 -/"&'$&' "/4/ $$ &/&4 "*&+&4&' &4&$ "#&/'&' /4"*/ ""4/ -"'&' $"*/& "%/'& 4",&-/ &/

    P"'"& #&/' /&% &-&'& $*&4&

    #$*"' $$ &/&4 "#"&4&' &4&$ *A&' 4",&-/ "'/'&4&' "/4/ $$&%& $'4$ *"'&4&/ %&*&4&'.

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    Gangguan 'asase (sus

    Subjekti)

    P"$4 "*$' M$'4&% T/-& /& >&4$ T/-& /& BAB R/

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    Tindakan

    P"*&&'&' I'$ $'4$ "%/-+"/ "#"4+#/4

    K&4"4" $/'

    P"*&&'&' /& #&*$'*"'$&'/ 4"&'&' I'4& &-+**"'"&' -/&&*&! "%/'& *"'&&&'

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    Tinjauan 'ustaka

    TE&I*A KASIH