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# MODUL 8 LBM 3 Kelompok 19 BERAK LENDIR BERDARAH

STEP 1 1. berak le !"r ber!ara# \$ berak %a & !"'er(a" le !"r !a !ara# ). m* (a# \$ +ara 'al*ra pe +er aa ba&"a a(a' * (*k me &el*arka "'" %a kare a !"!alam *'*' (er,a!" "r"(a'" re&a &a a(a* ra &'a &a berleb"#a . 3. kemb* & \$ '*a(* kea!aa !"ma a per*( (era'a pe *# -. !"are \$ .rek/e '" berak meleb"#" ormal !a ber'".a( +a"r STEP ) 3. me &apa (er,a!" berak le !"r ber!ara# -. e("olo&" berak le !"r ber!ara# 0. me &apa ba%" m* (a# ,"ka !"ber" maka a a(a* m" *ma 1. me &apa ba%" kemb* & 2. me &apa 3ol*me *r" e berk*ra & 8. me &apa ba%" meme&a & per*( 'aa( me a &"' 9. me &apa a.'* maka me *r* 14. DD 11. !"a& o'"' 1). pe a(alak'a aa STEP 3 1. me &apa (er,a!" berak le !"r ber!ara# '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a al"ra kele ,ar l"m.e (er&a &&* pe &el*ara le !"r berleb"#a 5pe %ebab le !"r6 '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a pemb*l*# !ara# bal"k !ara# ma'*k ke*'*' 5pe %ebab berak ber!ara#6 ). e("olo&" berak le !"r ber!ara# '*mba(a \$ 3ol3*l*'7 " 3a&" a'" " .ek'" 3. me &apa (er,a!" '*mba(a '*mba(a \$ 3ol3*l*'7 " 3a&" a'" 3ol3*l*' \$ (er,a!" p* ("ra *'*' !"'ebabka kare a 8888.. " 3a&" a'" \$ ma'*k %a *'*' ke*'*' !"'ebabka 888888. -. me &apa ba%" m* (a# !a kemb* & ,"ka !"ber" maka a a(a* m" *ma '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a a"k (er,a!" m* (a#

0. me &apa 3ol*me *r" e berk*ra & +a"ra (er(amp* & !"*'*' pe %erapa +a"ra !alam pemb*l*# !ara# berk*ra & +a"ra %a & ma'*k ke &" ,al me *r* 3ol*me *r" e berk*ra & 1. me &apa ba%" meme&a & per*( 'aa( me a &"' kare a a!a %a '*mba(a !a &erak par"'(al("k pa!a *'*' 'e#" &&a me %ebabka %er"7 'e 'a'" %er" !"(a &kap ole# er3*' 3a&*' 2. me &apa a.'* maka me *r* '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a pe *# ("!ak ma* maka 8. DD Ile*' 9 ak*( ab!ome Ma+am:ma+am %a\$ Ile*' o meka "k 9 "le*' paral"("k \$ kea!aa !"ma a *'*' &a&al a(a* ("!ak mamp* melak*ka ko (rak'" per"'(al("+ * (*k me %al*rka "'" %a Ile*' meka "k \$ .a'e per(ama per"'(al("k !" ra &a'a & +epa( " (erm"((e 5ber#e (":ber&erak:ber#e ("6 ber#e (" kol"("' *l'era(". !%'e (r" 9. !"a& o'"' 14. pe a(alak'a aa

ANAMNESIS

## D"a& o'"' ba !" &

Pemer"k'aa Pe * ,a &

;ak(or pe +e(*'

Pa(o&e e'"'

E("olo&"

Pa(o."'"olo&"

## !"a& o'"' Kompl"ka'" Terap"

STEP 0 1. me &apa (er,a!" berak le !"r ber!ara# '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a al"ra kele ,ar l"m.e (er&a &&* pe &el*ara le !"r berleb"#a 5pe %ebab le !"r6 '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a pemb*l*# !ara# bal"k !ara# ma'*k ke*'*' 5pe %ebab berak ber!ara#6 ). e("olo&" berak le !"r ber!ara# '*mba(a \$ 3ol3*l*'7 " 3a&" a'" " .ek'" 3. me &apa (er,a!" '*mba(a '*mba(a \$ 3ol3*l*'7 " 3a&" a'" 3ol3*l*' \$ (er,a!" p* ("ra *'*' !"'ebabka kare a 8888.. " 3a&" a'" \$ ma'*k %a *'*' ke*'*' !"'ebabka 888888. -. me &apa ba%" m* (a# !a kemb* & ,"ka !"ber" maka a a(a* m" *ma '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a a"k (er,a!" m* (a# 0. me &apa 3ol*me *r" e berk*ra & +a"ra (er(amp* & !"*'*' pe %erapa +a"ra !alam pemb*l*# !ara# berk*ra & +a"ra %a & ma'*k ke &" ,al me *r* 3ol*me *r" e berk*ra & 1. me &apa ba%" meme&a & per*( 'aa( me a &"' kare a a!a %a '*mba(a !a &erak par"'(al("k pa!a *'*' 'e#" &&a me %ebabka %er"7 'e 'a'" %er" !"(a &kap ole# er3*' 3a&*' 2. me &apa a.'* maka me *r* '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a pe *# ("!ak ma* maka 8. DD Ile*' 9 ak*( ab!ome Ma+am:ma+am %a\$ Ile*' o meka "k 9 "le*' paral"("k \$ kea!aa !"ma a *'*' &a&al a(a* ("!ak mamp* melak*ka ko (rak'" per"'(al("+ * (*k me %al*rka "'" %a Ile*' meka "k \$ .a'e per(ama per"'(al("k !" ra &a'a & +epa( " (erm"((e 5ber#e (":ber&erak:ber#e ("6 ber#e (" kol"("' *l'era(". !%'e (r" 9. !"a& o'"' 14. pe a(alak'a aa

STEP 1 Bela,ar ma !"r" STEP 2 1. me &apa (er,a!" berak le !"r ber!ara# '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a al"ra kele ,ar l"m.e (er&a &&* pe &el*ara le !"r berleb"#a 5pe %ebab le !"r6 '*mba(a !"*'*' (er,a!" pe eka a !a pe " &ka(a (eka a pemb*l*# !ara# bal"k !ara# ma'*k ke*'*' 5pe %ebab berak ber!ara#6 5'*mber \$ ;"'"olo&" Ke!ok(era . <*%(o a ! Hall6 ). e("olo&" berak le !"r ber!ara# '*mba(a \$ 3ol3*l*'7 " 3a&" a'" " .ek'" 5'*mber \$ ;"'"olo&" Ke!ok(era . <*%(o a ! Hall6 3. me &apa (er,a!" '*mba(a '*mba(a \$ 3ol3*l*'7 " 3a&" a'" 3ol3*l*' \$ (er,a!" p* ("ra *'*' !"'ebabka kare a 8888.. " 3a&" a'" \$ ma'*k %a *'*' ke*'*' !"'ebabka 888888. '*mba(a \$ 3ol3*l*'7 " 3a&" a'" 3ol3*l*' \$ (er,a!" p* ("ra *'*' !"'ebabka kare a 3ol3*l*' !apa( !"'ebabka ole# me'e (er"*m 'e(empa( %a & (erlal* pa ,a &7 %a & mer*paka '*a(* kela" a +o &e "(al (er*(ama pa!a *'*' #al*' 5S*mber\$Pa(olo&" A a(om"k7UI7 #al )416

53ol3*l*' ///.'*r&"+al:(*(or.or&.*k'%'(emab!ome 3ol3*l*'.#(m : 1-k.#(m6 3ol3*l*' \$ (er,a!" p* ("ra *'*' kare a !"la(a'" kolo ///.+"&p.or&9" !e> " 3a&" a'" \$ ma'*k %a *'*' ke*'*' !"'ebabka " (*''ep'" mer*paka " 3a&" a'"7 'ala# 'a(* ba&"a *'*' ke!alam ba&"a ber"k*( %a !a mer*paka pe %ebab ob'(r*k'" %a & #amper e>+l*'"3e !"(em*ka pa!a ba%" !a bal"(a." (*'e'ep'" 'er" & (er,a!" pa!a "le*m (erm" al %a & ma'*k 'ek*m7 pe %ebab ob'(r*k'" " " b"'a !"kare aka kela" a +o &e "(al 5PATO;ISISOLO<I7S%l3"a7 #al -436 " 3a&" a'" \$ ma'*k %a *'*' ke*'*' !"'ebabka

p!a ba%" !a a ak !"'ebabka kare a #%per(rop#"e! pe%er?' pa(+#e' ak"ba( " .ek'" 3"r*'7 per*ba#a +*a+a7 !a pola maka 7 !ll pa!a !e/a'a a ak be'ar !"'ebabka kare a a!a %a kela" a pa(#olo&"' 5!"3er("kel me+kel7 pol"p7 (*mor6 m*# #*'a" 7 .ar"! *r ma (*7 l"ma be!a# ;K UNHASS Sebab-sebab penyumbatan usus dapat dibagi menjadi: Ob'(r*k'" meka "k a. S(r"k(*r +o &e "(al !a !"!apa( b. A(re'"a +. A *' "mpor.ora(a !. S*mba(a ba(* empe!*7 .e'e' %a & be'ar a(a* be !a a'" & e. Perleka(a 5a!#e'"6 @ Adhesi Intra Abdomen. a. Ko &e "(al \$ kare a per(*mb*#a ab ormal !ar" ro &&a per"(o e*m5p"(a 3"(ello" (e'(" al6 b. D"!apa( : I .lama'" \$ ape !"'"("'7 kole'"'("("("' ak*(7 !"3er("k*l"("' ak*(7 ra!a & !aera# pel3"'7 !a pe &&* aa ala( ko (ra'ep'" !alam *(er*' 'ebel*m %a : Pa'+a opera'" \$ ("mb*l 'e(ela# (er,a!" +e!era pa!a perm*kaa ,ar" &a 7 'eba&a" ak"ba( " '"'"7 ka*(er"'a'"7 ,a#"(a 7 a(a* meka "'me (ra*ma la" %a Patogenesis Adhesi ke("ka per"(o e*m me &alam" (ra*ma7 per!ara#a 7 !a kebo+ora pro(e" pla'ma7 !ar" perm*kaa %a & r*'ak membe (*k !epo'"( ."br" !alam ro &&a ab!ome . ;"br" " " ber.* &'" * (*k me &embal"ka ,ar" &a %a & r*'ak !a '".a( %a le &ke(7 'e#" &&a ek'*!a( ."br" !apa( meleka( ke '(r*k(*r ab!ome !" 'ek"(ar %a. Selama beberapa #ar" 'e(ela# +e!era7 perleka(a " " re3er'"bel7 !a ek'*!a( " " aka me &alam" !e&ra!a'" 'e+ara e A"ma("k ole# .ak(or ."br" ol"("k %a & !"lepa'ka 'e+ara lokal. Dalam /ak(* 0 #ar"7 ,ar" &a ."br" " " !"" 3a'" ole# ."brobla' %a & berprol".era'"7 %a & aka me &&a ("ka ."br" !e &a kompo e ma(r"k' ek'(ra'el*lar 5a (ara la" kola&e 6. Se(ela# per"'("/a " " (er,a!"7 a!#e'" me ,a!" "re3er'"bel. =a!"7 %a & me e (*ka (erbe (*k a(a* ("!ak %a a!#e'" (er&a (* & pa!a ke'e"mba &a a (ara pro'e' !epo'"'" ."br" !e &a !e&ra!a'" %a 'elama beberapa #ar" pa'+a opera'". Pencegahan : Pemaka"a a ("koa&*la \$ 'o!"*m '"(ra(7 #epar" 7 !"k*marol7 !e>(ra 7 apro(" " . :Me &#"la &ka ek'*!a( ."br" !ar" ro &&a per"(o e*m

Me &&* aka a&e ."br" ol"("k %a & me &*ra &" ma''a ."br" e+ara ("!ak la &'* & !e &a mera &'a & ak("3"(a' plasminogen activator.)3 Beberapa +o (o# a&e ."br" ol"("k " " a!ala# ."br" ol"'" 7 '(rep(ok" a'e7 *rok" a'e7 #%al*ro "!a'e7 k"mo(r"p'" 7 (r"p'" 7 pep'" 7 !a plasminogen activator.1-7)3 Plasminogen activator a!ala# pro(ea'e 'er" %a & me &ko 3er'" pla'm" o&e me ,a!" pla'm" . Pla'm" " " aka me %ebabka !e&ra!a'" ."br" . : Me +e&a# prol".era'" ."brobla' pe &&* aa a&e a (":" .lama'" 'eper("7 NSAID7 a ("#"'(am" 7 pro&e'(ero 7 Ca blocker7 !a kolk"'" . Meka "'me ker,a 'e+ara *m*m !e &a +ara me &*ra &" permeab"l"(a' 3a'k*lar7 me +e&a# pembe (*ka !a pelepa'a #"'(am" 7 !a 9a(a* me '(ab"lka l"'o'om. NSAID " " ,*&a beker,a !e &a me " &ka(ka .* &'" makro.a& !alam .* &'" %a 'eba&a" .a&o'"( !ebr"' ,ar" &a a(a* ."br" 7 !" 'amp" & mempe &ar*#" pe &*ra &a 'ekre'" " #"b"(or pla'm" o&e 'e#" &&a me " &ka(ka pro!*k'" pla'm" . A ("#"'(am" 'eper(" prome(aA" e7 me +e&a# re'po ' " .lama'"7 me '(ab"lka membra l"'o'om7 !a me +e&a# prol".era'" ."brobla'(. E.ek !ar" pro&e'(ero %a"(* e.ek a ("" .lama'"7 me +e&a# m"&ra'" le*ko'"(7 !a me &*ra &" permeab"l"(a' 3a'k*lar. Calcium channel blocker me +e&a# pelepa'a me!"a(or " .lama'" 3a'oak(". 'eper(" #"'(am" !a pro'(a&la !" E 'er(a ;. Kolk"'" me &#amba( 'ekre'" #"'(am" 7 ak("3"(a' m"(o("k7 !a kola&e '" (e'"'. : Pem"'a#a meka "k @ Lar*(a makromolek*l !a bar"er meka "k. Meka "'me ker,a +a"ra kr"'(alo"!7 !" 'amp" & ber'".a( 'eba&a" pem"'a# 'e+ara meka "' ,*&a me !"l*'" ."br" !a ek'*!a( ."br" %a & !"lepa'ka perm*kaa per"(o e*m %a & me &alam" (ra*ma. Sa%a & %a7 +a"ra kr"'(alo"! !"ab'orb'" +epa( 5044 ml !alam 1- ,am6 'e#" &&a e.ek pem"'a#a meka "' %a +epa( #"la & 'ebel*m pro'e' !epo'"'" !a pembe (*ka a!#e'" 'ele'a" @ A'am #%al*ro a( 5HA6 beker,a !e &a melap"'" lap"'a 'ero'a7 !a 'ampa" !era,a( (er(e (* me +e&a# pe &er" &a 'ero'a. HA " " !"komb" a'"ka !e &a Phosphate Buffered Saline 5PBS6 !alam +a"ra makromolek*l * (*k me +e&a# a!#e'"7 +o (o# %a Sepra+oa(B 5<e A%me7 Cambr"!&e7 Ma''.7 USA6. PBS !"ber"ka " (raopera(". 'ebel*m !"'ek'" * (*k mel" !* &" perm*kaa per"(o e*m !ar" +e!era opera'" %a & (ak la &'* &. Ca"ra " " +*k*p e.ek(". !alam me +e&a# a!#e'" pa'+a opera'". @ Karbok'"me("l'el*lo'a beker,a !e &a melap"'" perm*kaa per"(o e*m %a & (erb*ka !a mem* &k" ka pro'e' pe %emb*#a per"(o e*m %a & (erl*ka 'e+ara " !epe !e : Ma "p*la'" ,ar" &a !e &a 'ar* & (a &a be!a# %a & m" "mal !a !"'ek'" %a & leb"# ak*ra( ,*&a berpera !alam me &*ra &" pro'e' a!#e'". Pe &&* aa CO) pa!a p e*moper"(o e*m ,*&a me eka re'po ' me(abol"k 'el per"(o e*m Mengurangi terbentuknya Adhesi:

1. Hemo'(a'"' %a & +erma(\$ #emo'(a'"' %a & ("!ak mema!a" aka me &ak"ba(ka !epo'"'" ."br" !a me " &ka(ka pembe (*ka a!#e'" ). =a&a 3a'k*lar"'a'"\$ memba(a'" "'kem"a aka me !*k* & pro'e' ."br" ol"'"' 3. =a&a kelembaba ,ar" &a \$ "r"&a'" %a & 'er" & !a pe &&* aa ka''a ba'a# me +e&a# pe &er" &a ,ar" &a . A!a %a keker" &a aka me %ebabka kem* &k" a m*!a# %a (er,a!" (ra*ma per"(o e*m. R" &er Lak(a( a(a* +a"ra "r"&a'" la" %a ,*&a !apa( me &*ra &" '"'a (alk*m a(a* bek*a !ara#7 %a & !apa( mer*paka pem"+* ba&" reak'" be !a a'" &7 " .lama'" !a ak#"r %a pembe (*ka a!#e'" -. H" !ar" pe &&* aa ka''a ker" &. Pe &&* aa ka''a ker" & 'eba"k %a !"#" !ar" kare a mereka !apa( mer*'ak perm*kaa per"(o e*m !a me %ebabka (er(" &&al %a be !a a'" & 0. Mem" "malka ma "p*la'" ,ar"&a \$ ma "p*la'" ,ar" &a me " &ka(ka kem* &k" a ker*'aka 3a'k*lar a(a* ,ar" &a . B"la !"perl*ka ma "p*la'" per"(o e*m7 &* aka " '(r*me a(ra*ma("k a(a* ,ar". Sela" "(*7 pemo(o &a !a ka*(er"'a'" !"*'a#aka 'em" "mal m* &k" * (*k me &*ra &" (ra*ma 'er(a memper(a#a ka 3a'k*lar"'a'" 1. <* aka ,a#"(a %a & #al*' !a o reak(".. U (*k me &#" !ar" reak'" be !a a'" &7 &* aka be a & !e &a *k*ra %a & #al*' !a (erb*a( !ar" ba#a '" (e("' 2. H" !ar" pe &&* aa &ra.( !ar" per"(o e*m. Graft !ar" per"(o e*m me %ebabka (ra*ma ba&" per"(o e*m !a me &*ra &" 3a'k*lar"'a'" 8. H" !ar" ,a#"(a per"(o e*m %a & ke(a(. =a#"(a %a & ke(a( aka me %ebabka e.ek "'kem"a pa!a per"(o e*m7 ba#ka beberapa a#l" be!a# ("!ak melak*ka pe ,a#"(a per"(o e*m 'aa( me *(*p l*ka opera'". 9. Mem" "malka pe &&* aa be !a a'" &. Be !a a'" & !apa( me %ebabka ker*'aka perm*kaa per"(o e*m7 me "mb*lka " .lama'"7 !a ak#"r %a pembe (*ka a!#e'". 14. H" !ar" "le*' paral"("k berlar*( pa'+a be!a#. U'a#aka per"'(al("k *'*' +epa( kembal"7 kare a !e &a ber&erak %a *'*' melal*" pro'e' per"'(al("k !a ak("3"a' ."br" ol"'"'7 a!#e'" %a & (emporer aka 'e&era me &alam" l"'"' kare a ko (ak a (ara perm*kaa 'ero'a ("!ak (erlal* lama 11. Me +e&a# ("mb*l %a " .ek'". A!a %a pro'e' " .ek'" %a & berla ,*( pa!a per"(o e*m aka (er*' mera &'a & pro'e' " .lama'" !a '" (e'"' kola&e 7 'er(a ak("3"(a' ."br" ol"'"' aka !"#amba(7 'e#" &&a (er,a!" a!#e'" %a & perma e 1). =a &a (" &&alka ,ar" &a ekro("k. =ar" &a ekro("k aka mera &'a & pro'e' m"&ra'" 'el:'el e*(ro."l !a pelepa'a me!"a(or la" %a. Pa!a ak#"r %a7 pro'e' " .lama'" aka berla ,*( !a ak("3"(a' ."br" ol"'"' !"#amba(. Pemeriksaan penunjang Laparaskopi USG Dapa( me &"!e ("."ka'" !a member"ka &ambara !aera# a!#e'" " (raab!ome . <eraka per&e'era ormal !apa( (er,a!" 'e+ara 'po (a

ak"ba( &eraka per apa'a a(a* !"" !*k'" !e &a palpa'" ab!ome . <eraka visceral slide %a & (erba(a' mer*paka " !"ka'" %a & k*a( a!a %a a!#e'" " (raab!ome
Bagian Bedah Fakultas Kedokteran Universitas Indonesia, Jakarta Bedah dan Perawatannya. E.Oswari. FK UI.

.. Her "a : : : : : enis hernia menurut tempatnya \$ #er "a " &*" al"' \$ #er "a !& "'" per*( %& (ampak p! !aera# 'ela pa#a 5re&"o " &*" al"'6 #er "a .emoral"' \$ #er "a "'" per*( %& (ampak !" !aera# .o'a .emoral"' #er "a *mb"l"kal"' \$ #er "a "'" per*( %& (ampak !aera# p*'ar #er "a !"a&#.ra&ma("+a \$ #er "a "'" per*( %& ma'*k melal*" l*ba & !"a&#.ra&ma("+a ke ro &&a !a!a #er "a *+le*' p*lpo'*' 5HNP6 \$ #er "a %& (er,a!" p! '*m:'*m (*la & belaka &7 (er,a!" kare a *+le*' p*lpo'*' %& bera!a !"a (ara ) (*la & belaka & me o ,ol kel*ar 7 be ,ola " " !apa( me eka '*m'*m (*la & belaka & a(a* 'ara. %a7 b"a'a %a #er "a (er,a!" p! (*la & p* &&* & ak"ba( pe !er"(a mera'a 'ak"( p! ke:) (* &ka" ba/a# !a b"la leb"# #eba( !apa( me %ebabka kel*mp*#a ke:) kak" enis menurut dapat tidaknya masuk kemba!i : #er "a re3er'"ble #er "a "rre3er'"ble 5" +ar+era(a6 enis menurut dapat tidaknya ter!ihat dr !uar : #er "a " (er a \$ #er "a (er,a!" !" !alam ro &&a ba!a 7 e> \$ #er "a !"a&#.ra&ma("+a #er "a ek'(er a \$ %& me o ,ol kel*ar 'e#" &&a (ampak !r l*ar enis menurut isi : #er "a a!"po'a \$ %& "'" %a (er!"r" !r ,ar" &a lemak #er "a l"((re \$ #er "a " ka'era(a a(a* '(ra &*la(a %& 'eba&"a !" !" & *'*' %a (er,ep"( !alam +" +" #er "a 'l"!" & #er "a \$ "'" #er "a m,!" 'eba&"a !r !" !" & ka (o & #er "a "tio!ogi : 'eba&"a !" !" & ro &&a lema# %& !"'ebabka +a+a( ba/aa a(a* kea!aa %& !"!apa( 'e'*!a# la#"r Geja!a : (ampak be ,ola !"l"pa(a pa#a b"la "'" %a (er,ep"( aka me "mb*lka pera'aa 'ak"(!" empa( "(* !"'er(a" pera'aa m*al b"la (er,a!" #er "a " &*" al"' '(ra &*la(a pera'aa 'ak"( aka ber(amba# #eba( 'er(a k*l"( !"a(a' %a me ,a!" mera# !a pa a' #er "a .emoral"' ke+"l m* &k" ber"'" !" !" & ka !* & ke +" &7 'e#" &&a me "mb*lka &e,ala 'ak"( ke +" & 5!"'*r"a6 !"'er(a" #ema(*r"a 5ke +" & !ara#6 !" 'amp" & be ,ola !" ba/a# 'ela pa#a #er "a !"a&#.ra&ma("ka me "mb*lka pera'aa 'ak"( !" !aera# per*( !"'er(a" 'e'ak a.a' b"la pa'"e me &e,a 9 ba(*k mk be ,ola #er "a aka ber(amba& be'ar

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Penata!aksanaan : opra'" me *(*p #er "a %a #er "o&ra." \$ !" !" & per*( %& lema# !"po(o & !a !",a#"( #er "ora." \$ 'el*r*# ka (o & #er "a !"po(o & m"'al p! #er "a " ka'era(a %& (ela# me ,a!" &a &&re #er "opla'("k \$ !" !" & %& lema# "(* !"(empel" !& .a'"a7 m"'al !"amb"l .a'"a o(o( pa (a(

&. Dol3*l*' #. I (*'*'ep'"o 5" 3a&" a'"6 ". Ile*' Ob'(r*k'" Da'k*lar7 (rombo'"' ar(er" me'e (er"ka S*mber \$ Be!a# !a Pera/a(a %a. O'/ar"7 E -. me &apa ba%" m* (a# !a kemb* & ,"ka !"ber" maka a a(a* m" *ma '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a a"k (er,a!" m* (a# Meka "'me m* (a# Ber a.a' !alam Na"k %a (*la & l"!a# !a lar" & * (*k memb*ka '(r" &.ero.a&*' ba&"a a(a' '*pa%a memb*ka Pe *(*pa &lo("' Pe &a &ka(a pala(*m mole * (*k me *(*p are' po'(er"or Da(a & ko (rak'" %a & k*a( keba/a# !"a.ra&ma ber'ama !& ra &'a & ko (rak'" 'em*a o(o( !" !" & ab!ome Pa!a 'aa( m* (a# ko (rak'" " (r"k'" k*a( (er,a!" pa!a !e*!e *m !a lamb* & ber'ama !& relak'a'" 'eba&"a !ar" '(r" &.er e'o.a&*' ba&"a ba/a# '#& memb*a( m* (a#a m*la" ber&erak !lm e'o.a&*' o M* (a# mrp '*a(* +ara (rak(*' !"&e'("3*' member'"#ka !"r" %a 'e !"r" !ar" "'" %a7!"'(e '" %& berleb"#a a(a* r"(a'" !e*!e *m me %ebabka ra &'a &a k*'*' * (*k m* (a# 5S*mber \$ ;"'"olo&" Ke!ok(era <*%(o !a Hall6 0. me &apa 3ol*me *r" e berk*ra & +a"ra (er(amp* & !"*'*' pe %erapa +a"ra !alam pemb*l*# !ara# berk*ra & +a"ra %a & ma'*k ke &" ,al me *r* 3ol*me *r" e berk*ra & 5S*mber \$ ;"'"olo&" Ke!ok(era <*%(o !a Hall6 1. me &apa ba%" meme&a & per*( 'aa( me a &"' kare a a!a %a '*mba(a !a &erak par"'(al("k pa!a *'*' 'e#" &&a me %ebabka %er"7 'e 'a'" %er" !"(a &kap ole# er3*' 3a&*' 5S*mber \$ ;"'"olo&" Ke!ok(era <*%(o !a Hall6 2. me &apa a.'* maka me *r* '*mba(a maka a !a m" *ma (er(amp* & !"*'*' (er,a!" pembe'ara *'*' kemb* & "'" %a pe *# ("!ak ma* maka

5S*mber \$ ;"'"olo&" Ke!ok(era <*%(o !a Hall6 8. DD Ile*' 9 ak*( ab!ome Ma+am:ma+am %a\$ Ile*' o meka "k 9 "le*' paral"("k \$ kea!aa !"ma a *'*' &a&al a(a* ("!ak mamp* melak*ka ko (rak'" per"'(al("+ * (*k me %al*rka "'" %a Ile*' meka "k \$ .a'e per(ama per"'(al("k !" ra &a'a & +epa( " (erm"((e 5ber#e (":ber&erak:ber#e ("6 ber#e (" Ile*' ob'(r*k(". \$ kare a 3ol3*l*'7 " 3a&" a'"7 a(re'"a7 ba !7 #er "a " kar'era(a7 kel" a a ba/aa 7 a!e'"7 a'kar"a'"'7 (*mor pr"mer7 TBC7 !"3er("+*l*m me+kel7 ob' maka a Ile*' per"(o "("' 5kare a " .ek'"6 <ab* &a ke!*a %a

5 S*mber \$ ;"'"olo&" Ke!ok(era . <*%(o A ! Hall6 9. D"a& o'"' ak*( ab!ome Anamnesis Pa!a '*a(* pe %ak"( be!a# !ar*ra( a am e'"' mer*paka pemer"k'aa %a & 'a &a( pa (" &. Ba#a :ba#a *(ama %a & dapat !"perole# melal*" a am e'"' %a & member"ka " .orma'" sangat ber#ar&a pa!' pro'e' pe e&aka !"a& o'"' a!ala# \$ A. Lokasi nyeri D" a(a' (ela# !"ber"ka !a.(ar kem* &k" a !"a& o'"' ba ding !ar" pe %ak"(:pe %ak"( ber!a'arka loka'" . Loka'" %er" (er'eb*( apaka# !"!aera# \$ : K/a!ra ka a a(a'7 +o (o# \$ ab'e' #epar. : K/a!ra k"r" a(a'7 +o (o# \$ " .ark m"okar! ak*(7 p e*mo "a : Para *mb"l"+al7 +o (o# \$ "le*' ob'(r*k'"7 ape !"k'7!"3er+*l"("'. : K/a!ra ka a ba/a#7 +o (o# \$ #er "a " &*" al"' " +a'era(a9 '(ra &*la(e. : K/a!ra k"r" ba/a#7 +o (o# \$ #er "a " &*" al"' " +a'era(a9 '(ra &*la(e. B. Ra!"a'" pera'aa nyeri Ka!a &:ka!a & " .orma'" me &e a" +ara pe %ebara ra'a %er" 5ra!"a'" pera'aa %er"6 !apa( member"ka pe(* ,*k me &e a" a'al:*'*l a(a* loka'" pe %ebab %er" "(*. N%er" %a & bera'al !ar" 'al*ra empe!* me ,alar ke 'amp" & 'ampa" ba&"a ba/a# '+ap*la ka a . N%er" kare a appe !"+"("' !apa( m*la" !ar" !aera# ep"&a'(r"*m * (*k ke( *!"a berp" !a# ke k/a!ra ka a ba/a#. N%er" !ar" !aera# rek(*m !apa( me e(ap !" !aera# p* &&* & ba/a#. #. \$entuk rasa nyeri

N%er" pa!a ak*( ab!ome !apa( berbe (*k %er" (er*' me er*' a(a* ber*pa kol"k. %. Perubahan &isio!ogi a!at pencernaan 1. Na.'* maka 7 m*al7 m* (a#De.eka'" (era(*r7 me +re(7 ob'("pa'"7 Per*( kemb* &7 'era &a kol"k ). S*!a# berapa lama 'em*a per*ba#a " " berla &'* & ". Perubahan anatomi . A!a %a be ,ola eopla'ma A!a %a l*ka ak"ba( (ra*ma A!a %a beka' opera'" apa. Pemer"k'aa ."'"k !"lak'a aka !e &a memer"k'a !*l* keadaan *m*m pe !er"(a 5'(a(*' &e eral"'6 * (*k e3al*a'" kea!aa '"'("m pema.a'a 7 '"'("m kar!"o3a'k*ler !a '"'("m 'ara. %a & mer*paka '"'("m 3"(al * (*k kela &'* &a ke#"!*pa . Pemer"k'aa kea!aa lokal 5'(a(*' lokal"' ab!ome 6 pe !er"(a !"lak'a aka 'e+ara '"'(ema("' !e &a " 'pek'"7 palpa'"7 perk*'" !a a*'k*l(a'". Ta !a:(a !a k#*'*' pala ak*( ome (er&a (* & pa!a pe %ebab %a 'eper(" (ra*ma7 pera&a 7 per.ora'" a(a* ob'(r*k'". Inspeksi Ta !a:(a !a k#*'*' pa!a (ra*ma !aera# ab!ome a!ala# \$ Pe !er"(a ke'ak"(a . Per a.a'a !a &kal kare a %er" !aera# ab!ome .Pe !er"(a p*+a(7 ker" &a( !" &" .Beka':beka' (ra*ma pa!' !" !" & ab!ome 7 memar7 l*ka7kolap' ome (*m a(a* *'*'.Ka!a &:ka!a & pa!a (ra*ma (*mp*l ab!ome '*kar !"(e (*ka (a !a:(a !a k#*'*'7 maka #ar*' !"lak*ka pemer"k'aa ber*la & ole# !ok(er %a & 'ama * (*k me !e(ek'" kem* &k" (er,a!" %a per*ba#a pa!a pemer"k'aa ."'"k.Pa!a "le*' ob'(r*k'" (erl"#a( !"'(e '" ab!ome b"la ob'(r*k'" %a re !a#7 !a b"la ora & %a k*r*' ka!a &:ka!a & (erl"#a( (al'"' *'*' (Darm-steifung). Kea!aa *(r"'" pe !er"(a Pa!pasi a6 Ak*( ab!ome member"ka ra &'a &a pa!' per"(o e*m melal*" pera!a &a a(a* "r"(a'" per"(o e*m 'e+ara lokal a(a* *m*m (er&a (* & !ar" l*a' %a !aera# %a & (erke a "r"(a'". b6Palpa'" aka me * ,*kka ) &e,ala \$ 1.Pera'aa %er" Pera'aa %er" %a & mema & '*!a# a!a (er*' me er*'aka ber(amba# pa!' /ak(* palpa'" 'e#" &&a !"ke al &e,ala %er" (eka !a %er" lepa'. Pa!a pe"(o "("' lokal aka ("mb*l ra'a %er" !" !aera# pera!a &a pa!' pe eka a !" !" & ab!ome !" !aera# la" . ).Ke,a & o(o( (defense musculaire muscular rigidit!) Ke,a & o(o( !"("mb*lka kare a ra'a %er" pa!' per"(o "("' !"..*'a %a & kare a ra &'a &a palpa'" ber(amba# 'e#" &&a 'e+ara re.lek' (er,a!" ke,a & o(o(.

Perkusi Perk*'" pa!' ak*( ab!ome !apa( me * ,*kka ) #al. 16 Pera'aa %er" ole# ke(oka pa!' ,ar". I " !"'eb*( 'eba&a" %er" ke(ok. )6B* %" ("mpa " kare a me(eor"'m*' !"'ebabka !"'(e '" *'*' %a & ber"'"ka &a' pa!' "le*' ob'(r*k'" re !a#. A*'k*l(a'" A*'k*l(a'" ("!ak member"ka &e,ala kare a pa!a ak*( ab!ome (er,a!" pera &'a &a per"(o e*m %a & 'e+ara re.lek' aka me &ak"ba(ka "le*' paral"("k. Pemer"k'aa pe * ,a & Pemeriksaan recta! toucher perabaa rek(*m !e &a ,ar" (el* ,*k ,*&a mer*paka pemer"k'aa r*(" * (*k me !e(ek'" a!a %a (ra*ma pa!' rek(*m a(a* kea!aa amp*lla re+(" apaka# ber"'" .ae+e' a(a* (eraba (*mor.Se(ela# !a(a:!a(a pemer"k'aa ."'"k (erk*mp*l !"perl*ka ,*&a pemer"k'aa (amba#a ber*pa \$ '.Pemeriksaan !aboratorium ") Pemeriksaan darah rutin Pemer"k'aa Hb !"perl*ka * (*k base-line data b"la (er,a!"per!ara#a (er*' me er*'. Dem"k"a p*la !e &a pemer"k'aa #ema(okr"(. Pemer"k'aa le*ko'"( %a & meleb"#" )4.4449mm (a pa (er!apa( %a " .ek'" me * ,*kka a!a %a per!ara#a +*k*p ba %ak (er*(ama pa!' kem* &k" a r*p(*ra l"e al"'.Ser*m am"la'e %a & me " &&" me * ,*kka kem* &k" a a!a %a (ra*ma pa krea' a(a* per.ora'" *'*' #al*'. Ke a"ka (ra 'am" a'e me * ,*kka kem* &k" a (ra*ma pa!' #epar. B) Pemeriksaan urine rutin Me * ,*kka a!a %a (ra*ma pa!' 'al*ra kem"# b"la !",*mpa" #ema(*r". Ur" e %a & ,er "# bel*m !apa( me %" &k"rka a!a %a (ra*ma pa!a 'al*ra *ro&e "(al. (. Pemeriksaan radio!ogi ") #oto thoraks Selal* #ar*' !"*'a#aka pemb*a(a .o(o (#orak' !alam po'"'" (e&ak * (*k me %" &k"rka a!a %a kela" a pa!a (#orak' a(a* (ra*ma pa!' (#orak' Ham' ,*&a !"per#a("ka a!a %a *!ara beba' !" ba/a# !"a.ra&ma a(a* a!a %a &ambara *'*' !alam ro &&a (#orak' pa!a #er "a !"a.ra&ma("ka. B) Plain abdomen foto tegak Aka memperl"#a(ka *!ara beba' !alam ro &&a per"(o e*m7 *!ara beba' re(roper"(o eal !eka( !*o!e *m7 +orp*' al"e *m7 per*ba#a &ambara *'*'. C) \$%P (\$ntravenous P!elogram) Kare a ala'a b"a%a b"a'a %a #a %a !"m" (aka b"la a!a per'a &kaa (ra*ma pa!a &" ,al. D) Pemeriksaan &ltrasonografi dan C'-scan

Bere* a 'eba&a" pemer"k'aa (amba#a pa!a pe !er"(a %a & bel*m !"opera'" !a !"'a &'"ka a!a %a (ra*ma pa!a #epar !a re(roper"(o e*m. 3. Pemeriksaan khusus ") "bdominal paracentesis Mer*pal+a pemer"k'aa (amba#a %a & 'a &a( ber&* a * (*k me e (*ka a!a %a per!ara#a !alam ro &&a per"(o e*m. Leb"# !ar" 144.444 er"(ro'"(9mm !alam lar*(a NaCl %a & kel*ar !ar" ro &&a per"(o e*m 'e(ela# !"ma'*kka 144::)44 ml lar*(a NaCl 4.9E 'elama 0 me "(7 mer*paka " !"ka'" * (*k laparo(om". B) Pemeriksaan laparoskopi D"lak'a aka b"la a!a ak*( ab!ome * (*k me &e(a#*" la &'* & '*mber pe %ebab %a. C6 B"la !",*mpa" per!ara#a !a a *' perl* !"lak*ka rek(osigmoidoskopi. D6 Pema'a &a nasogastric tube((G') * (*k memer"k'a +a"ra %a & kel*ar !ar" lamb* & pa!' (ra*ma ab!ome . Dar" !a(a %a & !"perole# melal*" a am e'"'7 pemer"k'aa ."'"k7 pemer"k'aa (amba#a !a pemer"k'aa k#*'*' !apa( !"a!aka a al"'"' !a(a * (*k memperole# !"a& o'"' ker,a !a ma'ala#:ma'ala# 'amp" &a %a & perl* !"per#a("ka . De &a !em"k"a !apa( !"(e (*ka (*,*a pe &oba(a ba&" pe !er"(a !a la &ka#:la &ka# %a & !"perl*ka * (*k me +apa" (*,*a pe &oba(a TU=UAN PEN<OBATAN AKUT ABDOMEN Dapa( !"ba&" !*a \$ 16 Pe %elama(a ,"/a pe !er"(a )6Mem" "mal"'a'" kem* &k" a (er,a!" %a +a+a! !alam .* &'" ."'"olo&"' ala( pe +emaa pe !er"(a. B"a'a %a la &ka#:la &ka# "(* (er!"r" !ar" \$ 16T" !aka pe a &&*la &a !ar*ra( A6 Ber*pa (" !aka re'*'"(a'" * (*k memperba"k" '"'("m per a.a'a !a kar!"o3a'k*ler %a & mer*paka (" !aka pe %elama(a ,"/a pe !er"(a. B"la '"'("m 3"(al pe !er"(a '*!a# '(ab"l !"lak*ka (" !aka la ,*(a ber*pa 5B6 !a 5C6. B6 Re'(ora'" ke'e"mba &a +a"ra !a elek(rol"(. C6 Pe +e&a#a " .ek'" !e &a pember"a a ("b"o("ka. )6T" !aka pe a &&*la &a !e." "(". T*,*a pe &oba(a !" '" " a!ala# \$ 16 Pe %elama(a ,"/a pe !er"(a !e &a me &#e ("ka '*mber per!ara#a . )6 Mem" "mal"'a'" +a+a! %a & m* &k" (er,a!" !e &a +ara \$ me &#"la &ka '*mber ko (am" a'". mem" "mal"'a'" ko (am" a'" %a & (ela# (er,a!" !e &a member'"#ka ro &&a per"(o e*m

me &embal"ka ko (" *"(a'pa''a&e *'*' !a me %elama(ka 'eba %ak m* &k" *'*' %a & 'e#a( * (*k mem" "mal"'a'" +a+a! ."'"olo&"'. T" !aka * (*k me +apa" (*,*a " " ber*pa opera'" !e &a memb*ka ro &&a ab!ome %a & !" amaka laparo(om". Laparo(om" ek'plora'" !ar*ra( A6 T" !aka 'ebel*m opera'" 1.Kea!aa *m*m 'ebel*m opera'" 'e(ela# re'*'"(a'" 'e!apa( m* &k" #ar*' '(ab"l. B"la " " ("!ak m* &k" (er+apa" kare a per!ara#a %a & 'a &a( be'ar7 !"lak'a aka opera'" la &'* & * (*k me &#e ("ka '*mber per!ara#a . ).Pema'a &a N<T (nasogastric tube) 3.Pema'a &a dauer-katheter -.Pember"a a ("b"o("ka 'e+ara pare (eral pa!' pe !er"(a !e &a per'a &kaa per.ora'" *'*'7 '#o+k bera( a(a* (ra*ma m*l("pel. 0.Pema'a &a thora)-drain pa!' pe !er"(a !e &a .rak(*r "&a7 #aemo(#orak' a(a* p e*mo(#orak'. B6 I '"'" laparo(om" * (*k ek'plora'" 'eba"k %a " '"'" me!"a a(a* para me!"a pa ,a &. C6 La &ka#:la &ka# pa!a laparo(om" !ar*ra( a!ala# \$ 1.Se&era me &a!aka ek'plora'" * (*k me em*ka '*mberper!ara#a . ).U'a#a me &#e ("ka per!ara#a 'e+epa( m* &k" .B"la per!ara#a bera'al !ar" or&a pa!a( pe &#e ("a per!ara#a !"+apa" !e &a (ampo ab!ome * (*k 'eme (ara. Per!ara#a !ar" ar(er" be'ar #am' !"#e ("ka !e &a pe &&* aa klem 3a'k*ler. Per!ara#a !ar" 3e a be'ar !"#e ("ka !e &a pe eka a la &'* &. 3.Se(ela# per!ara#a ber#e (" !e &a (" !aka !ar*ra( !"ber"ka ke'empa(a pa!' a e'(e'" * (*k memperba"k" 3ol*me !ara#. -.B"la (er!apa( per.ora'" a(a* la'era'" *'*' !"a!aka pe *(*pa l*ba & per.ora'" a(a* re'ek'" *'*' !e &a a a'(omo'"'. 0.D"a!aka pember'"#a ro &&a per"(o e*m !e &a "r"&a'" lar*(a NaCl ."'"olo&"k. 1.Sebel*m ro &&a per"(o e*m !"(*(*p #ar*' !"a!aka ek'plora'" '"'(ema("' !ar" 'el*r*# or&a !alam ab!ome m*la" !ar" ka a a(a' 'ampa" k"r" ba/a# !e &a memper#a("ka !aera# re(roper"(o eal !*o!e *m !a b*r'a ome (al"'. 2.B"la '*!a# a!a ko (am" a'" ro &&a per"(o e*m !"&* aka drain !a '*bk*("' 'er(a k*("' !"b"arka (erb*ka. S. Soe)andi Bagian Bedah #akultas *edokteran &niversitas Sumatera &tara +edan Ma+am:ma+am %a\$

Ile*' o meka "k 9 "le*' paral"("k \$ kea!aa !"ma a *'*' &a&al a(a* ("!ak mamp* melak*ka ko (rak'" per"'(al("+ * (*k me %al*rka "'" %a. Per"'(al("k *'*' !"#amba( ak"ba( pe &ar*# (ok'" 9(ra*ma %a & mempe &ar*#" pe &e !al"a o(o om mo("l"(a' *'*'. "tio!ogi: : Pembe!a#a ab!ome kare a a!a %a re.lek pe &#amba(a per"'(al("k ak"ba( 3"'era ab!ome %a & (er'e (*# (a &a . Ile*' meka "k \$Ter,a!" ob'(r*k'" !alam l*me *'*'9 ob'(r*k" m*ral %a & !"'ebabka ole# (eka a ek'(r" '"k. ;a'e per(ama per"'(al("k !" ra &'a & +epa( " (erm"((e 5ber#e (":ber&erak:ber#e ("6 ber#e (". Ob'(r*k'" meka "' '"mplek5#a %a (er!apa( 1 (empa( ob'(r*k'"6 Ob'(r*k'" le &k* & (er(*(*p5'e!"k"( %a (er!apa( ) (empa( ob'(r*k'"6. T"!ak !apa( !"!ekompre'"7 'e#" &&a (eka a " (ral*me me " &ka( +epa( !a me &ak"ba(ka (er,a!" %a pe eka a pemb*l* !ara#7 "'kem"a7 " .ark. "tio!ogi: : A!#e'" kare a opera'" 'ebel*m %a : T*mor &a a' !a 3ol3*l*' : Ka ker kolo : I (*'*'ep'"\$" 3a&" a'" 'ala# 'a(* ba&"a *'*' ke !lam ba&"a ber"k*( %a "tio!ogi : 1. &a &&*a (er#a!ap per"(o "*m7 m"'al %a \$ : per"(o "("' ak"ba( +e!era 9 opra'" : per"(o "("' kare a bak(er" : per"(o "("' kare a Aa( k"m"a ). per*ba#a p! pemb*l*# !ara# : (er,a!" '(ra &*la'"7 m"'al %a \$ p! #er "a " ka'era(a : (romb*' kare a bak(er" : ob'(r*k'" %& berkepa ,a &a 3. &a &&*a !" l*ar per"(o e*m : per!ara#a : " .ek'" : +e!era p! &" ,al : +e!era p! '%ara. re(roper"(o eal Ile*' paral"("k Ter,a!" b"la (er!apa( &a &&*a pa!a per"'(al("k *'*'7 m"'al \$ p! pera!a &a per"(o e*m7 &a &&*a '%ara. o(o( *'*'7 *rem"a !a (er'*mba( %a pemb*l*# !ara# me'e (r"*m Geja!a : : m* (a# F m* (a# : per*( kemb* & : ob'("pa'" : ("!ak (era'a m*la' : ("!ak a!a b"'" & *'*'

: b"la (er,a!" per"(o "("' ("mb*l pera'aa 'ak"( p! per*( !a !" !" & per*( me e&a & : pa a' : !e %*( a!" +epa( : leko'"(o'"' Pengobatan : Pr" '"p %a me +e&a# ("mb*l %a "le*' paral"("k7 perl* !"per#a("ka G : 'ebel*m opra'" ,a &a !"ber" ka(ar("k 9 oba( *r*':*r*' : per"k'a 'em*a pa'"e %& me &el*# 'ak"( per*( 'e+ara 'ek'ama7 'e#" &&a b"la (er!apa( ape !"'"("'7 #er "a7 a(a* pe %ebab la" %& perl* 'e&era !"lak*ka opra'" !apa( !"lak'a aka '+r +epa( : 'elama opra'" *'*' ,a &a (erlal* ba %ak meme&a & *'*' apab"la ("!ak !"perl*ka 'ekal" : 'ekal" "le*' paral"("k (er,a!" 'a &a( '*l"( !"oba(" kol"("' *l'era(". D%'e (r" Disentri Basiler (Shigellosis) Infeksi akut ileum terminalis dan kolon yang disebabkan oleh bakteri genus Shigella. Patofisiologi Semua strain kuman Shigella menyebabkan disentri, yaitu suatu keadaan yang ditandai diare, dengan konsistensi tinja biasanya lunak (tidak cair) disertai eksudat inflamasi yang mengandung leukosit polimorfonuklear (PMN) dan darah. olon merupakan tempat utama yang diserang Shigella namun ileum terminalis dapat juga terserang. Pada kasus yang sangat berat dan mematikan kuman dapat ditemukan juga pada lambung serta usus halus. Setalah mele!ati lambung dan usus halus, kuman ini mengin"asi sel epitel mukosa kolon dan berkembangbiak di dalamnya. Perbatasan in"asi kuman ke sel di sekitarnya melalui mekanisme cell#to cell transfer. \$alaupun lesi a!al terjadi di lapisan epitel namun respons inflamasi lokal yang menyertai cukup berat, melibatkan leukosit PMN dan makrofag. %al tersebut menyebabkan edema, mikroabses, hilangnya sel goblet, rusaknya arsitektur jaringan dan ulserasi mukosa. &ila penyakit berlanjut, terjadi penumpukan sell inflamasi pada lamina propria, dengan abses pada kripta merupakan gambaran yang utama. S. dysentriae, S. fle'neri, dan S. sonnei menghasilkan eksotoksin antara lain Sh()*, Sh()+, toksin Shiga, yang mempunyai sifat enterotoksik, sitotoksik, dan neurotoksik.

atau manifestasi akut kolitis ulserosa idiopatik. 1alam keadaan itu biopsi harus dikerjakan dalam !aktu 0 hari dari gejala. Pada fase akut infeksi Shigella, tes serologi tidak bermanfaat. Pada disentri subakut gejala klinis serupa dengan kolitis ulserosa. 1emikian pula pemeriksaan barium enema, sigmoidoskopi dan histopatologi juga tidak dapat membedakannya. Perbedaan utama adalah kultur Shigella yang positif dan perbaikan klinis yang bermakna setelah pengobatan dengan antibiotik yang adekuat. Diagnosis Banding # Salmonellosis # Sindrom diare karena enterotoksin (. coli # olera # olitis ulserosa Komplikasi omplikasi yang terjadi dapat berupa komplikasi intestinal dan ekstraintestinal. omplikasi intestinal biasanya berupa megakolon toksik, perforasi intestinal, dehidrasi, renjatan hipo"olemik dan malnutrisi. Sedangkan komplikasi ekstratraitestinal yang telah dilaporkan cukup banyak, di antaranya adalah batuk, pilek, pneumonia, meningimus, kejang, neuropati perifer, sindrom hemolitik uremik, trombositopenia, reaksi leukemoid dan artritis (sindrom 5eiter). Penatalaksanaan *. Mengatasi gangguan keseimbangan cairan dan elektrolit +. 6ntibiotik eputusan pengguanaan antibiotik sepenuhnya berdasarkan beratnya penyakit, yaitu pasien dengan gejala disentri sedang sampai berat dan diare persisten. &eberapa jenis antibiotik yang dianjurkan7 # ampisilin 0' 822 mg9hari atau # kotrimoksa,ol +' + tablet9 hari atau # tetrasiklin 0' 822 mg9hari selama 8 hari :. Narkotik dan deri"atnya %indari obat yang dapat menghambat motilitas usus seperti narkotika dan deri"atnya, karena dapat mengurangi eliminasi bakteri dan mempro"okasi terjadinya megakolon toksik. 0. Pengobatan simtomatik

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