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7/21/2019 Peritonitis Fix http://slidepdf.com/reader/full/peritonitis-fix 1/32 Oleh : Septiani Orthi Armelia (2011730097) Pembimbing : Dr. Gatot Sugiharto Sp! Sta"e !e#ah $S%D Se&ar'angi %*+ ,aporan a"u" Peritoniti" 1
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Peritonitis Fix

Mar 04, 2016

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Oleh :

Septiani Orthi Armelia

(2011730097)

Pembimbing : Dr. Gatot Sugiharto Sp!

Sta"e !e#ah $S%D Se&ar'angi

%*+

,aporan a"u"Peritoniti"

1

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-#entita" Pa"ienama : An. S/ +eni" &elamin : ,a&ila&i

%"ia : 12 tahun

Alamat : i"aat anggal : 17 oember 2014

2

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eluhan %tama5eri #i "eluruh bagian perut "e6a& 1 hari

S*$S

3

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$i'a5at Pen5a&it Se&arangPa"ien #atang &e rumah "a&it #engan &eluhan n5eri

#i "eluruh bagian perut "e6a& 1 hari S*$S. 5eri#ira"a&an teru" meneru" #an "ema&in "a&it 6i&abergera&. Selain itu perut tera"a &era" #an&embung. Pa"ien mual #an muntah "etiap "ele"aima&an muntah beri"i ma&anan 8 gela" auanamun muntah tera&hir ber'arna hi6au. Pa"ien 6ugamengeluh #emam #an !A! air ;10< len#ir ()#arah () #alam 12 6am tera&hir. Pa#ahal #alam =

hari tera&hir pa"ien ti#a& bi"a !A! #an &entut.Pa"ien memili&i ri'a5at 6atuh #ari pohon 1 minggu

S*$S #an bagian anu"n5a tertu"u& ranting pohon.

=

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$i'a5at Pen5a&it DahuluPa"ien belum pernah mengalami &eluhan "erupa

"ebelumn5a

$i'a5at Pen5a&it eluargaeluhan 5ang "ama #i &eluarga #i"ang&al

$i'a5at Pengobatan!elum pernah berobat "ebelumn5a

$i'a5at AlergiAlergi obat #i"ang&al

4

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Pemeri&"aan i"i&ea#aan %mum : ampa& "a&it "e#ange"a#aran : ompo"menti"

 an#a >ital :

a#i : 11? <@menitSuhu : 37.4

Pernapa"an : 2= <@menit

 e&anan #arah : 110@70 mmBg

?

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Statu" Generali"epala : normohepal*ata : &on6ungtia anemi" @

"&lera i&teri& @ pupil bulati"o&or reCe&" aha5a @

Bi#ung : "e&ret @

 elinga : normotia "e&ret ()

*ulut : hiperemi" () anemi" () &ering

,eher : ti#a& a#a pembe"aran &elen6argetah bening #an tiroi#

7

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E

 BO$AFParu-n"pe&"i : normohe"t pergera&an #a#a "imetri"Palpa"i : ti#a& a#a pergera&an #a#a 5ang

tertinggal n5eri te&an () o&al remitu" "imetri"

Per&u"i : "onor #i "eluruh lapang paruAu"&ulta"i : e"i&ular (@) ron&hi (@)'heeHing (@)

 +antung-n"pe&"i : itu" or#i" ti#a& terlihatPalpa"i : itu" or#i" teraba #i -S 4 mi#laiula

"ini"traPer&u"i : bata" 6antung relati #alam bata"normal

Au"&ulta"i : bun5i 6antung - #an -- regularmurmur () gallop ()

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Ab#omen-n"pe&"i: Di"ten"i ab#omen () #een"e mu"ular

()

Au"&ulta"i : !i"ing u"u" 2<@menit

Per&u"i : impaniPalpa"i : 5eri te&an "eluruh &ua#ran ab#omen

() ti#a& a#a pembe"aran hepar #an "pleen

I&"tremita"

Superior : A&ral #ingin $ J 2 #eti& e#ema(). Siano"i" ()e#ema ()

-nerior : A&ral #ingin $ J 2 #eti& e#ema ().Siano"i" ()e#ema ()

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10

Pemeri&"aan retal touher : onu" otot bai&

*u&o"a liin

*a""a ()

5eri ()

 er#apat ee" () #arah () len#ir ()

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Statu" ,o&ali"

11

Statu" lo&ali" et regio ab#omen-n"pe&"iDi"ten"i ab#omen () #een"e mu"ular ()

Au"&ulta"i!i"ing u"u" menurun (2<@menit)

Per&u"i impani #i "eluruh regio ab#omen

Palpa"i5eri te&an #i "eluruh ab#omen

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$e"ume

,a&ila&i 12 tahun n5eri #i "eluruh bagian perut"e6a& 1 hari S*$S. Perut tera"a &era" #an &embung.au"ea () omitu" () ebri" () #iare ().

Sebelumn5a ti#a& bi"a !A! #an Catu". *emili&iri'a5at 6atuh #ari pohon #engan bagian anu"n5atertu"u& ranting pohon.

Pa#a pemeri&"aan K"i& #i#apat&an tan#a ital : na#i

11?<@menit "uhu 37.4 Pernapa"an 2= <@menitte&anan #arah 110@70 mmBg. Pa#a pemeri&"aanab#omen #i#apat&an a#an5a #i"ten"i ab#omen#ean" mu"ular n5eri te&an #i "eluruh regio

ab#omen !% menurun.12

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DiLerential Diagno"i"Peritoniti" e.. perora"i re&tumPeritoniti" e.. t5phoi# perora"i

13

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Penatala&"anaan

1=

Pemeri&"aan laboratorium : hematologi rutinele&trolit 'i#al

oto thora< M oto polo" ab#omen 3 po"i"i

$e"u"ita"i airan  $, 20 tpmPua"a&anG #e&ompre"iD

arma&ologi$aniti#ine 2 < 0.24 mg*etroni#aHole 3 < 400 mg

-nteren"i operatie : ,aparotomi I&"plora"i

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Pemeriksaan Hasil Nilai Rujukan Satuan

HEMATOLOGI LENGKAP

Hemoglobin 1=.2 13.417.4 g@#,

Hematokrit 30.2 =242 N

Eritrosit 2.77 =.7?.1 10?@,

Leukosit 9.= =.E10.E 103@,

Trombosit 223 140=40 103@,

MC 10E.9 E09= ,

MCH 41.3 2731 pg

MCHC =7.1 3337 N

R!"#S! 1=2.E 374= ,

P!" 17.7 91= ,

MP 12.E E12 ,

14

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1?

Pemeriksaan Hasil Nilai Rujukan Satuan

!I$$ERENTIAL

L%M & 3.3 2? Q 3? N

M'! & 3.= 0 Q 11 N

NE( & 91.9 =0 Q 70 N

EOS & 1.2 1 Q 3 N

)AS & 0.2 J 1 N

A)SOL(T

L%M * 0.32 1.00 Q 1.=3 103@,

M'! * 0.33 0 Q 1.2 103@,

NE( * E.?2 1.E Q 7.? 103@,

EOS * 0.11 0.02 Q 0.40 103@,

)AS * 0.01 0.00 Q 0.10 103@,

Pemeriksaan Hasil Nilai Rujukan Satuan

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Pemeriksaan Hasil Nilai Rujukan Satuan

KIMIA KLINIK 

Glukosa !ara+ Puasa 74 70110 mgN

Natrium ,Na- 12E.9 1341=E mI@,

Kalium ,K- 2.93 3.404.30 mI@,

Cal.ium Ion 0.?1 1.141.29 mmol@,

AST ,SGOT- 20 1437 %@,

ALT ,SGPT- 1E 127E %@,

(reum 47.? 1040 mgN

Kreatinin 0.7 01.0 mgN

IM(NOSEROLOGI

HbsAg on reatie on reatie

"i/al ,Salmonella

T01+i # O-

egati egati  

"i/al ,Salmonella

T01+i # H-

egati egati  

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Pemeri&"aan $ontgen

1E

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-nterpreta"i

19

Preperitoneal at ti#a& 6ela". ontur &e#ua gin6alti#a& 6ela". P"oa" line ti#a& 6ela". i#a& tampa&&on&remen opa&. Di"tribu"i u#ara #alam u"u" halu"berlebih #engan penebalan "ebagian #in#ingn5amembentu& gambaran herring bone. Di"tribu"i u#ara

#alam &olon normal. Air Cui# leel () "tep la##erpa#a po"i"i ,,D ree air "ub#iaragma (). S&eletal5ang tere&"po"e ti#a& tampa& o"teoKt.

e"an : *en5o&ong ileu" ob"tru&ti leta& tinggipneumoperitoneum

or pulmo pleura "&eletal tampa& normale"an : *en5o&ong a#an5a pneumoperitoneum

#itan#ai ba5angan u#ara "ub#iaragma bilateral

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 in6auan Pu"ta&a

Peritoniti"

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Din#ing Ab#omen

22

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 +anuar5 E 201? %*+ $S%D -A+%$23

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Peritoneum

2=

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 +anuar5 E 201? %*+ $S%D -A+%$24

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DeKni"i Peritoniti"

2?

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la"iK&a"i Peritoniti"

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Itiologi Peritoniti"

2E

Area Sumber Penyebab

Esofagus Keganasan, trauma, iatrogenik  

Lambung Perforasi ulkus peptikum, keganasan, trauma, iatrogenik  

Duodenum Perforasi ulkus peptikum, trauma (tumpul dan

 penetrasi) iatrogenik 

Traktus bilier Kolesistitis, perforasi batu dari kandung empedu,keganasan, kista duktus koledokus, trauma, iatrogenik 

Pankreas Pankreatitis, trauma, iatrogenik  

Kolon asendens Iskemia kolon, hernia inkarserata, obstruksi loop,

 penyakit Crohn, keganasan, Diertikulum !e"kel,

trauma

Kolon desendens dan apendiks Iskemia kolon, diertikulitis, keganasan, kolitis ulseratif

dan penyakit Crohn, apendisitis, olulus kolon, trauma,

iatrogenik 

#alping uterus dan oarium  Pelvic inflammatory disease, k eganasan, trauma

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Ge6ala lini" Peritoniti"

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Pemeri&"aan Penun6angPeritoniti"Pemeri&"aan #arah : leu&o"ito"i" "hit to

the let

%rine : ureum &reatinin

Fra5 :oto thora&" PA@lateral ; u#ara beba" #i

lobu" inerior

oto polo" ab#omen ; a"ite" tan#atan#aob"tru&"i u"u" berupa airCui# leel #an&a#ang&a#ang u#ara beba"

30

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Penatala&"anaan Peritoniti"

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Datar Pu"ta&a

32

 o'"en# *. +r #&&. Sabiston textbook ofSurgery . Il"iier. %nite# State o Ameria.200E

ole et al. 1970. Cole and Zollinger textbook

of Surgery 9th edition. Appeltonentur5 orpaui et al. 200E Borri"on" Prinipal o

-nternal *e#iine >olume 1 *Gra' hill.

!runiar#i . harle" #&&. Schwartz’s

Principles of Surgery Eight Edition.Tinner *. D&&. Abdoinal !perations tenth

editions. %nite# State" o Ameria. 1997.