Fisiologi Colon

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{\info{\author Perpus-lt5}}
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t0 \fs18\cf0\par\pard\li1133\ri0\sl-293\slmult0 \*\tx1493\fs24\cf0\f0\charscalex
100\b {A.}\b0 \tab \fs24\cf0\f0\charscalex100\b {Hemoroid}\b0 \par\pard\li1493\r
i0\sl-413\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {1.}\tab \fs24\cf0\f0\char
scalex100 {Definisi}\par\column\pard\li1000\ri0\sl-213\slmult0 \fs18\cf0\par\par
f0\par\pard\li1000\ri0\sl-453\slmult0 \fs28\cf0\f0\charscalex100\b {BAB II}\b0 \
par\pard\li0\ri0\sl-480\slmult0 \fs28\cf0\f0\charscalex100\b {TINJAUAN PUSTAKA}\
b0 \par\pard\sect\sectd\sbknone\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {Hemoroid berasal dari kata haima ya}\fs24\cf0\f0\charscalex100 {ng be
rarti darah dan rheo yang berarti}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\
f0\charscalex100 {mengalir, sehingga pengertian hemoroid }\fs22\cf0\f0\charscale
x100 {secara harfiah adalah darah yang}\par\pard\li1853\ri0\sl-413\slmult0 \fs22
\cf0\f0\charscalex100 {mengalir. Namun secara klinis diartikan sebagai pelebaran
vasa/vena didalam}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex10
0 {pleksus hemoroidalis yang tidak merupa}\fs22\cf0\f0\charscalex100 {kan keadaa
n patologik. tetapi akan}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charsc
alex100 {menjadi patologik apabila tidak menda}\fs22\cf0\f0\charscalex100 {pat p
enanganan/pengobatan yang baik.}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0
\charscalex100 {Hemoroid tidak hanya sekedar pelebaran }\fs22\cf0\f0\charscalex1
00 {vasa saja, tetapi juga diikuti oleh}\par\pard\li1853\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {penambahan jaringan dise}\fs24\cf0\f0\charscalex100 {kit
ar vasa atau vena.}{\super \fs16\up4\cf0\f0\charscalex100 {2}}\par\pard\li2573\r
i0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Anatomi Rektum merupakan bagian }\
fs22\cf0\f0\charscalex100 {utama usus besar yang terakhir dan}\par\pard\li1853\r
i0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {terbentang dari kolon sigmoid samp
ai anus (muara kebagian luar tubuh) dengan}\par\pard\li1853\ri0\sl-413\slmult0 \
fs22\cf0\f0\charscalex100 {panjang sekitar 15-20 cm. Satu inci terakhir}\fs22\cf
0\f0\charscalex100 { dari rektum dinamakan kanalis analis}\par\pard\li1853\ri0\s
l-413\slmult0 \fs22\cf0\f0\charscalex100 {dan dilindungi oleh sphincterani ekste
rnus}\fs22\cf0\f0\charscalex100 { dan internus. Pada sepertiga bagian}\par\pard\
li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {atas rektum, terdapat bagi
an yang dapat }\fs22\cf0\f0\charscalex100 {cukup banyak meluas yakni ampula rect
i,}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dan bila ini
terisi maka ingin timbul pe}\fs24\cf0\f0\charscalex100 {rasaan buang air besar.
Bagian proksimal }\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{rektum mendapat suplai darah dari arte}\fs24\cf0\f0\charscalex100 {ri mesenter
ica inferior. Suplai darah}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {tambahan untuk rektum adalah melalui arteri sakralis media dan arteri
}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {hemoroidalis in
ferior dan media yang di}\fs24\cf0\f0\charscalex100 {cabangkan dari arteri iliac
a interna dan}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ao
rta abdominalis. Alir balik vena dari }\fs24\cf0\f0\charscalex100 {kolon dan rek
tum superior melalui vena}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {mesenterica superior dan in}\fs24\cf0\f0\charscalex100 {ferior dan ven
a hemoroidal}\fs24\cf0\f0\charscalex100 {is superior, yaitu bagian}\par\pard\li1
853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dari system portal yang menga
lirkan darah }\fs24\cf0\f0\charscalex100 {ke hati. Vena hemoroidalis media dan}\
par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {inferior mengalir

kan darah ke vena ili}\fs24\cf0\f0\charscalex100 {aca dan merupakan bagian dari
sirkulasi}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sistem
ik.}{\super \fs16\up4\cf0\f0\charscalex100 {2}}\par\pard\li1493\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1493\ri0\sl-280\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {2.}\tab \f
s24\cf0\f0\charscalex100 {Etiologi }\par\pard\sect\sectd\sbknone\pard\sect\sectd
\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn426
\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {Berbagai penyebab yang dipercaya }\fs24\cf0\f
0\charscalex100 {menimbulkan terjadinya hemoroid,}\par\pard\li1853\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {antara lain sebagai berikut.}{\super \fs16\up4
\cf0\f0\charscalex100 {8}}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\m
arglsxn666\margrsxn133\cols2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li1853
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-373\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\pard\li
1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {c.}\par\pard\li185
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-360\slmult0 \fs22\cf0\f0\charsc
alex100 {d.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl
r\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \f
f0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {e.}\par\column
\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {BAB dengan posisi jon
gkok yang terlalu }\fs24\cf0\f0\charscalex100 {lama. Hal ini ak}\fs24\cf0\f0\cha
rscalex100 {an meningkatkan}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {tekanan vena yang akhirnya mengakiba}\fs24\cf0\f0\charscalex100 {tkan p
elebaran vena. Sedangkan BAB}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {dengan posisi duduk yang terlalu lama mer}\fs24\cf0\f0\charscalex100 {
upakan factor resiko hernia, karena }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\
f0\charscalex100 {saat duduk pintu hernia dapat menekan.}\par\pard\li360\ri0\sl413\slmult0 \fs24\cf0\f0\charscalex100 {Obtipasi atau konstipasi kronis, kons}\
fs24\cf0\f0\charscalex100 {tipasi adalah suatu keadaan dimana}\par\pard\li0\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {seseorang mengalami kesulitan saat}\f
s24\cf0\f0\charscalex100 { Buang Air Besar (BAB) sehingga }\par\pard\li0\ri0\sl413\slmult0 \fs24\cf0\f0\charscalex100 {terkadang harus mengejan dikarenakan }\f
s24\cf0\f0\charscalex100 {feses yang mengeras, berbau lebih}\par\pard\li0\ri0\sl

-413\slmult0 \fs24\cf0\f0\charscalex100 {busuk dan berwarna lebih gelap dari bia
s}\fs24\cf0\f0\charscalex100 {anya dan frekwensi BAB lebih dari}\par\pard\li0\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {3 hari sekali. Pada obstipasi atau
kons}\fs24\cf0\f0\charscalex100 {tipasi kronis diperlukan waktu mengejan}\par\p
ard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {yang lama. Hal ini mengak
ibatkan perega}\fs24\cf0\f0\charscalex100 {ngan muskulus sphi}\fs24\cf0\f0\chars
calex100 {ncter ani terjadi}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {berulang kali, dan semakin lama penderita mengejan maka akan membuat}\p
ar\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {peregangannya bertamb
ah buruk. Pigot }\fs24\cf0\f0\charscalex100 {et al. mengatakan bahwa konstipasi
}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kronis berhubungan
dengan kejadian hemoroid (p< 0,0001 dengan nilai OR}\par\pard\li0\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {3,93; CI 3,09-5,00).}\fs16\cf0\f0\charscalex10
0 {8.11}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Riwayat k
eluarga adalah ada tida}\fs24\cf0\f0\charscalex100 {knya anggota keluar}\fs24\c
f0\f0\charscalex100 {ga yang mempunyai}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {penyakit hemoroid atau yang menderita}\fs24\cf0\f0\charscale
x100 { hemoroid. Pigot et al. menyatakan}\par\pard\li0\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {bahwa seseorang yang memiliki riwayat keluarga pernah mend
erita hemoroid }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {mem
iliki resiko 5,17 kali menderita Hemoroid (OR 5,17;CI 4,05-6,61;}\par\pard\li0\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {p<0,0001).}{\super \fs16\up4\cf0\f
0\charscalex100 {8}}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {Kehamilan dapat menimbulkan statis vena didaerah pelvis, meskipun}\par\pard\l
i0\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {etiologinya belum diketahui se
cara past}\fs24\cf0\f0\charscalex100 {i. Kebanyakan pasien tidak timbul }\par\pa
rd\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {gejala-gejala hemoroid sep
erti sebelumnya setelah melahirkan. Adapula yang}\par\pard\li0\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {beranggapan bahwa hemoroid pada wanita}\fs24\cf0\f
0\charscalex100 { hamil disebabkan karena adanya}\par\pard\li0\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {perubahan-perubahan hormonal selama kehamilan berl
angsung. Pada wanita}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{hamil terjadi dilatasi vena ekstremita}\fs24\cf0\f0\charscalex100 {s dan anus
oleh karena ada sekresi}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {hormon relaksin. Pigot et al. }\fs24\cf0\f0\charscalex100 {mengatakan bahwa
ada hubungan yang}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
signifikan antara kehamilan }\fs24\cf0\f0\charscalex100 {dengan kejadian hemoroi
d.}{\super \fs16\up4\cf0\f0\charscalex100 {8}}\par\pard\li360\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {Obesitas atau timbunan lemak diperut. Pigot et al.
Mengatakan bahwa }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {s
eseorang yang memiliki BMI>30 ma}\fs24\cf0\f0\charscalex100 {ka memiliki resiko
1,09 kali terkena}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn6
66\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margr
sxn133\margtsxn666\margbsxn426\cols2\colno1\colw2213\colsr-0\colno2\colw9226\par
-400\slmult0 \fs24\cf0\f0\charscalex100 {f.}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-373\slmult0 \fs24\cf0\f0\charscalex100 {g.}\par\pard\li1853\ri
0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {h.}\par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
fs18\cf0\par\pard\li1853\ri0\sl-360\slmult0 \fs24\cf0\f0\charscalex100 {i.}\par\
\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-373\slmult0 \fs24\cf0\f0\charsc
alex100 {j.}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {hemoroid walaupun hubungannya tid
ak signifikan (p<0,716).}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charsca
lex100 {Tekanan darah (Aliran balik venosa), se}\fs24\cf0\f0\charscalex100 {pert
i pada hiperten}\fs24\cf0\f0\charscalex100 {si portal akibat}\par\pard\li0\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {sirosis hepatis. Terdapat anastomosis
an}\fs24\cf0\f0\charscalex100 {tara vena hemoroidalis superior,media}\par\pard\l
i0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dan inferior, sehingga peningk
atan tekana}\fs24\cf0\f0\charscalex100 {n portal dapat mengakibatkan aliran}\par
\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {balik ke vena-vena ini
dan mengakibatkan hemoroid.}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {Diet rendah serat sehing}\fs24\cf0\f0\charscalex100 {ga menimbulkan o
bstipasi.}\par\pard\li360\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Faktor
umur. Pada umur tua terjad}\fs22\cf0\f0\charscalex100 {i degenerasi dari jaringa
n-jaringan}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tubuh, o
tot sfingter juga me}\fs24\cf0\f0\charscalex100 {njadi tipis dan atonis. Ka}\fs2
4\cf0\f0\charscalex100 {rena sfingternya lemah,}\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {maka bisa timbul prolaps. Pigot }\fs24\cf0\f0\chars
calex100 {et al. Mengatakan ada hubungan yang}\par\pard\li0\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {signifikan antara umur < 50 th dengan kejadian hemoro
id dan memiliki resiko }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {1,95 kali terkena hemoroid.}{\super \fs16\up4\cf0\f0\charscalex100 {8}}\par
\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Faktor pekerjaan. Ora
ng yang haru}\fs24\cf0\f0\charscalex100 {s berdiri,duduk lama, atau harus }\par\
pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menggangkat barang berat
mempunyai pr}\fs24\cf0\f0\charscalex100 {edisposisi untuk terkena hemoroid.}\pa
r\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Menurut penelitian pek
erjaan yang ak}\fs24\cf0\f0\charscalex100 {tif memiliki resiko 1,43 kali terkena
}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {hemoroid walaupun
hubungannya tidak cukup signifikan (p<0,1).}{\super \fs16\up4\cf0\f0\charscalex1
00 {8}}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Olah raga
berat adalah olahraga }\fs24\cf0\f0\charscalex100 {yang mengandalkan kekuatan fi
sik. Yang}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {termasuk
olahraga berat antara lain}\fs24\cf0\f0\charscalex100 { mengangkat beban berat/a
ngkat besi,}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bersepe
da, berkuda, latihan pernapas}\fs24\cf0\f0\charscalex100 {an, memanah, dan beren
ang. Seseorang}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {deng
an kegiatan berolahraga yang te}\fs24\cf0\f0\charscalex100 {rlalu berat seperti
mengangkat beban}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {be
rat/angkat besi, bersepeda, berkuda, latihan pernapasan lebih dari 3 kali}\par\p
ard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {seminggu dengan waktu leb
ih dari 30 menit akan menyebabkan peregangan}\par\pard\li0\ri0\sl-413\slmult0 \f
s24\cf0\f0\charscalex100 {m. sphincter ani terjadi berulang kali, }\fs24\cf0\f0\
charscalex100 {dan semakin lama penderita mengejan}\par\pard\li0\ri0\sl-426\slmu
lt0 \fs24\cf0\f0\charscalex100 {maka akan membuat peregangannya}\fs24\cf0\f0\cha
rscalex100 { bertambah buruk. }\fs24\cf0\f0\charscalex100 {Pigot et al,}\par\par
d\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {mengatakan bahwa seseorang
yang suka}\fs24\cf0\f0\charscalex100 { berolahraga berat dapat beresiko}\par\par
d\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {terkena hemoroid sebanyak 2
,79 kali (OR 2,79 CI 1,60-4,87; p <0,01).}{\super \fs16\up4\cf0\f0\charscalex100
{8.9}}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn
133\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1493\ri0\sl-400\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100
{3.}\tab \fs24\cf0\f0\charscalex100 {Klasifikasi}\par\pard\li1853\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {Secara garis besar hemoroid bisa dibedakan men
jadi 2 macam, yaitu:}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\margls
xn666\margrsxn133\cols2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li1853\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl400\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\column\pard\li360\ri0\sl-413\slm
ult0 \fs24\cf0\f0\charscalex100 {Hemoroid eksterna, dimana terjadi }\fs24\cf0\f0
\charscalex100 {varises pada pleksus hemorodialis}\par\pard\li0\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {inferior, dibawah linea dentate,dan tertutup oleh
kulit.}\par\pard\li360\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Hemoroid
interna, dimana terjadi varises pada pleksus hemoroidalis}\par\pard\sect\sectd\s
bknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage\p
gwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn426\pard\li22
13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-413\slmult0 \fs
24\cf0\f0\charscalex100 {superior, diatas linea dentat}\fs24\cf0\f0\charscalex10
0 {e, dan tertutup oleh mukosa.}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0
\charscalex100 {Namun, bisa jadi kedua macam hemoro}\fs24\cf0\f0\charscalex100 {
id tersebut dapat terjadi secara}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f
0\charscalex100 {bersamaan.}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f0\cha
rscalex100 {Hemoroid eksterna diklasifikasikan }\fs22\cf0\f0\charscalex100 {seba
gai akut dan kronik. Bentuk akut}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\f
0\charscalex100 {berupa pembengkakan bulat kebiruan pada}\fs22\cf0\f0\charscalex
100 { tepi anus dan sebenarnya merupakan}\par\pard\li1853\ri0\sl-413\slmult0 \fs
22\cf0\f0\charscalex100 {hematoma. Walaupun disebut hemoroid tr}\fs22\cf0\f0\cha
rscalex100 {ombosis eksterna akut, bentuk ini}\par\pard\li1853\ri0\sl-413\slmult
0 \fs22\cf0\f0\charscalex100 {sangat nyeri dan gatal karena ujung \uc1\u8211Xuju
ng sy}\fs22\cf0\f0\charscalex100 {araf pada kulit merupakan reseptor}\par\pard\l
i1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {nyeri. Hemoroid eksterna kr
onik atau skinta}\fs22\cf0\f0\charscalex100 {g berupa satu atau lebih lipatan ku
lit}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {anus yang te
rdiri dari jaringan dan sedikit pembuluh darah. }\par\pard\li2573\ri0\sl-413\sl
mult0 \fs24\cf0\f0\charscalex100 {Sedangkan hemoroid interna dibagi menjadi 4 de
rajat, yaitu:}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\li1853\ri0\sl
-413\slmult0 \*\tx2213\fs24\cf0\f0\charscalex100 {a.}\tab \fs24\cf0\f0\charscale
x100 {Derajat I}\par\pard\li2213\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {
Terjadi varises / pelebaran vena tetapi}\fs22\cf0\f0\charscalex100 { belum ada b
enjolan / prolaps saat}\par\pard\li2213\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {defekasi, walaupun defekasi dengan sekua}\fs22\cf0\f0\charscalex100 {t te
naga. Derajat }\fs22\cf0\f0\charscalex100 {I dapat diketahui}\par\pard\li2213\ri
0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {melalui adanya perdarahan melalui s
igmiodoskopi.}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2213\fs24\cf0\f0\charscal
ex100 {b.}\tab \fs24\cf0\f0\charscalex100 {Derajat II}\par\pard\li2213\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {Adanya perdarahan dan prolaps jaringa}\fs2
4\cf0\f0\charscalex100 {n diluar anus saat mengejan selama }\par\pard\li2213\ri0
\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {defekasi berlangsung, tapi prolaps }
\fs24\cf0\f0\charscalex100 {ini dapat kembali secara spontan.}\par\pard\li1853\r
i0\sl-413\slmult0 \*\tx2213\fs24\cf0\f0\charscalex100 {c.}\tab \fs24\cf0\f0\char
scalex100 {Derajat III}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscal
ex100 {Sama dengan derajat II, hanya saja }\fs24\cf0\f0\charscalex100 {prolapsus
tidak dapat kembali secara}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {spontan dan harus dido}\fs24\cf0\f0\charscalex100 {rong (reposisi ma
nual).}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-400\slmult0 \*\tx2213\fs24\cf
0\f0\charscalex100 {d.}\tab \fs24\cf0\f0\charscalex100 {Derajat IV}\par\pard\li2
213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Prolapsus tidak dapat direduk
si / inkars}\fs24\cf0\f0\charscalex100 {erasi. Benjolan }\fs24\cf0\f0\charscalex
100 {/ prolapsus dapat}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscal
ex100 {terjepit diluar, dapat mengalami iritas}\fs24\cf0\f0\charscalex100 {i, in
flamasi, oedema, dan ulserasi,}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {sehingga saat hal ini terjad}\fs24\cf0\f0\charscalex100 {i baru t
imbul rasa sakit.}\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\

ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-400\slmult0 \*\tx1853\fs24\c
f0\f0\charscalex100 {4.}\tab \fs24\cf0\f0\charscalex100 { Patofisiologi }\par\p
ard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Hemoroid adalah bagian
normal dari }\fs24\cf0\f0\charscalex100 {anorektal manusia dan berasal dari}\pa
r\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bantalan jaringan i
kat sube}\fs24\cf0\f0\charscalex100 {pitelial di dalam kanalis an}\fs24\cf0\f0\c
harscalex100 {alis. Sejak berada didalam }\par\pard\li1853\ri0\sl-413\slmult0 \f
s24\cf0\f0\charscalex100 {kandungan, bantalan tersebut me}\fs24\cf0\f0\charscale
x100 {ngelilingi mengelilingi dan mendukung}\par\pard\sect\sectd\sbkpage\pgwsxn1
2240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn453\pard\li1853\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {anastomosis distal antara a. rectalis s}\fs24\cf0\f0\charscal
ex100 {uperior dengan v. rectalis superior, media,}\par\pard\li1853\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {dan inferior. Bantalan ters}\fs24\cf0\f0\char
scalex100 {ebut sebagian besar disus}\fs24\cf0\f0\charscalex100 {un oleh lapisan
otot halus }\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sub
epitelial. Jaringan hemoroid normal}\fs24\cf0\f0\charscalex100 { menimbulkan tek
anan didalam anus}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{sebesar 15-20 % dari keseluruhan tekanan }\fs24\cf0\f0\charscalex100 {anus pad
a saat istirahat (tidak ada}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2946\*\tx39
86\*\tx4600\*\tx6080\*\tx7266\*\tx8320\*\tx9306\fs24\cf0\f0\charscalex100 {aktiv
itas}\tab \fs24\cf0\f0\charscalex100 {apapun)}\tab \fs24\cf0\f0\charscalex100 {d
an}\tab \fs24\cf0\f0\charscalex100 {memberikan}\tab \fs24\cf0\f0\charscalex100 {
in}\fs24\cf0\f0\charscalex100 {formasi}\tab \fs24\cf0\f0\charscalex100 {sensoris
}\tab \fs24\cf0\f0\charscalex100 {penting}\tab \fs24\cf0\f0\charscalex100 {yang}
\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {memungkinkan anu
s untuk dapat memberikan }\fs24\cf0\f0\charscalex100 {presepsi berbeda antara za
t padat,}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {cair, d
an gas.}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\li2573\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {Pada umumnya, setiap orang memiliki 3 bantala
n jaringan ikat subepitelial}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\ch
arscalex100 {pada anus. Bantalan \uc1\u8211X bantalan ters}\fs24\cf0\f0\charscal
ex100 {ebut merupakan posisi-posisi dimana}\par\pard\li1853\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {hemoroid bias terjadi. Ada 3 posisi utama, yaitu: jam
3 (lateral kiri), jam 7}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {(posterior kanan), dan jam 11 (anterior ka}\fs24\cf0\f0\charscalex100 {
nan). Sebenarnya hemoroid dapat juga}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {menunjuk pada posisi lain, atau bahkan }\fs24\cf0\f0\charsc
alex100 {dapat sirkuler, namun hal ini jarang}\par\pard\li1853\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {terjadi. Mengenai jam tersebut, pemberia}\fs24\cf0
\f0\charscalex100 {n angka angka berdasarkan kesepakatan:}\par\pard\li1853\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {angka 6 (jam 6) menunjukan arah poste}
\fs24\cf0\f0\charscalex100 {rior / belakang, angka 12 (jam 12) }\par\pard\li1853
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menunjukan arah anterior / depan
, angka 3 }\fs24\cf0\f0\charscalex100 {(jam 3) menunjukan arah kiri, angka 9}\pa
r\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {(jam 9) menunjukan
arah kanan. Dengan pedom}\fs24\cf0\f0\charscalex100 {an tersebut kita bisa tentu
kan arah}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {jam lai
nnya. Secara umum gejala hemoroid timbul ketika hemoroid tersebut}\par\pard\li18
53\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menjadi besar, inflamasi, trom
bosis, at}\fs24\cf0\f0\charscalex100 {au bahkan prolaps. Adanya pembengkakan}\pa
r\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {abnormal pada banta
lan anus menyeba}\fs24\cf0\f0\charscalex100 {bkan dilatasi dan pembengkakan plek
sus}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {arterivenous
. Hal ini mengakibatkan pere}\fs24\cf0\f0\charscalex100 {gangan otot suspensoriu
m dan terjadi}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pr
olaps jaringan rectum melalui kanali}\fs24\cf0\f0\charscalex100 {s analis. Mukos
a anus yang berwarna}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {merah terang karena kaya akan oksigen yang terkandung di dalam anastomosis}
\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {arterivenous.}{\
super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\li1493\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-266\s
lmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {5.}\tab \fs24\cf0\f0\charscalex100 {
Manifestasi klinis}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {Keadaan klinis yang menjadi tanda da}\fs24\cf0\f0\charscalex100 {n gejala hem
oroid adalah sebagai }\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscale
x100 {berikut:}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\
margrsxn133\cols2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li1853\ri0\sl-413
\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\column\pard\li1266\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {Perdarahan}\par\pard\li720\ri0\sl-413\slmult0 \fs
24\cf0\f0\charscalex100 {Perdarahan bisa terjadi pada }\fs24\cf0\f0\charscalex1
00 {grade 1-4, perdarahan merupakan}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f
0\charscalex100 {penentu utama kecurigaan adanya hemoro}\fs24\cf0\f0\charscalex1
00 {id pada grade I. Perdarahan pada }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {hemoroid berhubungan dengan proses mengejan. Ini menjadi pemb
eda dengan}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\marg
rsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\
margtsxn666\margbsxn413\cols2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li185
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\
\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\c
harscalex100 {b.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\r
t0 \fs24\cf0\f0\charscalex100 {c.}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {perdarahan y
ang diakibatkan oleh hal la}\fs24\cf0\f0\charscalex100 {in, misalnya tumor. Pada
hemoroid,}\par\pard\li0\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {darah ke
luar saat pasien mengejan dan be}\fs22\cf0\f0\charscalex100 {rhenti bila pasien
berhenti mengejan,}\par\pard\li0\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {
sedangkan perdarahan karena sebab lain}\fs22\cf0\f0\charscalex100 { tidak mengik
uti pola ini. Darah yang}\par\pard\li0\ri0\sl-413\slmult0 \fs22\cf0\f0\charscale
x100 {keluar adalah darah sega}\fs22\cf0\f0\charscalex100 {r yang tidak bercampu
r dengan feses (hematoshezia).}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {Perdarahan kadang menetes tapi dapa}\fs24\cf0\f0\charscalex100 {t ju
ga mengalir deras. Sebab utama }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\ch
arscalex100 {perdarahan adalah trauma feses yang ke}\fs24\cf0\f0\charscalex100 {
ras. Perdarahan yang berulang- ulang}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\
f0\charscalex100 {dapat menimbulkan anemia.}{\super \fs16\up4\cf0\f0\charscalex1
00 {4}}\par\pard\li1266\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Nyeri}\pa
r\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Nyeri hebat hanya te
rjadi pada hemo}\fs24\cf0\f0\charscalex100 {roid eksterna dengan trombosis }\par
\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {nyeri tidak berhubungan
dengan }\fs24\cf0\f0\charscalex100 {hemoroid interna, tetapi bila pada hemoroid
}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {interna terjadi ny
eri, ini merupakan tanda adanya radang.}{\super \fs16\up4\cf0\f0\charscalex100 {
12}}\par\pard\li1266\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Benjolan / p
rolaps}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Benjolan/p
rolap terjadi pada grade }\fs24\cf0\f0\charscalex100 {2-4. Benjolan akan nampak
tapi}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bila diraba ak

an menghilang. Hal ini di}\fs24\cf0\f0\charscalex100 {karenakan pada saat peraba
an, jari}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {akan menek
an vasa sehingga darah dalam vasa akan mengalir. Akibatnya,}\par\pard\li0\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {benjolan menjadi kempis. Benjolan hanya
}\fs24\cf0\f0\charscalex100 { akan teraba apabila telah terjadi}\par\pard\li0\ri
0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {trombus. Disini, benjolan teraba ke
ras.}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\sect\sectd\sbknone\pgw
sxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1493\ri0\sl-213\slmult0 \fs1
\sl-426\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {6.}\tab \fs24\cf0\f0\charsc
alex100 {Diagnosis}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {Sebelum diagnosa di buat terlebih dahulu kita melakukan anamnesis.}\par\pard\
li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Anamnesis yang baik akan m
enghasilkan diagnosa yang tepat. Anamnesis harus}\par\pard\li1853\ri0\sl-413\slm
ult0 \fs22\cf0\f0\charscalex100 {dikaitkan dengan faktor obstipasi, de}\fs22\cf0
\f0\charscalex100 {fekasi yang keras, yang membutuhkan}\par\pard\li1853\ri0\sl-4
13\slmult0 \fs22\cf0\f0\charscalex100 {tekanan intra abdominal yang tinggi (m}\f
s22\cf0\f0\charscalex100 {engejan), pasien sering jongkok berjam-}\par\pard\li18
53\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {jam di toilet, dan dapat diser
tai rasa }\fs22\cf0\f0\charscalex100 {nyeri bila terjadi pe}\fs22\cf0\f0\charsca
lex100 {radangan. Pemeriksaan}\par\pard\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\c
harscalex100 {umum lainnya tidak boleh diabaikan kare}\fs22\cf0\f0\charscalex100
{na keadaan ini dapat disebabkan oleh}\par\pard\li1853\ri0\sl-413\slmult0 \fs22
\cf0\f0\charscalex100 {penyakit lain seperti sindrom hipertensi}\fs22\cf0\f0\cha
rscalex100 { portal. Diagnosis hemoroid ditegakkan}\par\pard\li1853\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {dari pemeriksaan-pemeriksaan sebagai berikut:
}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\cols2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li1853\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {a.}\par\column\pard\li360\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {Inspeksi}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {Hemoroid eksterna mudah terlihat, terutama bila sudah menjadi}\par\p
ard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {thrombus. Hemoroid intern
a yang menjad}\fs24\cf0\f0\charscalex100 {i prolaps dapat terlihat dengan cara}\
par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard
\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\
margbsxn386\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menyuruh pasien mengejan. Prolaps
dapat }\fs24\cf0\f0\charscalex100 {terlihat sebagai benjolan yang}\par\pard\li22
13\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tertutup mukosa.}{\super \fs16
\up4\cf0\f0\charscalex100 {2}}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\c
harscalex100 {b. Rectal Toucher (RT)}\par\pard\li2933\ri0\sl-413\slmult0 \fs22\
cf0\f0\charscalex100 {Hemoroid interna stadium awal bias}\fs22\cf0\f0\charscalex
100 {anya tidak teraba dan tidak nyeri,}\par\pard\li2213\ri0\sl-413\slmult0 \fs2
2\cf0\f0\charscalex100 {hemoroid ini dapat teraba bila sudah ada thrombus atau f
ibrosis. Apabila}\par\pard\li2213\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100
{hemoroid sering prolaps, selaput lendir }\fs22\cf0\f0\charscalex100 {akan meneb
al. Trombosis dan fibrosis}\par\pard\li2213\ri0\sl-413\slmult0 \fs22\cf0\f0\char
scalex100 {pada perabaan terasa padat dengan da}\fs22\cf0\f0\charscalex100 {sar
yang lebar. Rectal toucher (RT)}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0
\charscalex100 {diperlukan untuk menyingkirkan kem}\fs24\cf0\f0\charscalex100 {u
ngkinan adanya karsinoma recti.}{\super \fs16\up4\cf0\f0\charscalex100 {2}}\par\
pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {c. Anaskopi}\par\par
d\li2933\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Pemeriksaan diperlukan u
ntuk melihat}\fs22\cf0\f0\charscalex100 { hemoroid interna yang belum}\par\pard\
li2213\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {prolaps. Anaskopi dimasuka
n untuk mengamati keempat kuadran dan akan}\par\pard\li2213\ri0\sl-413\slmult0 \
fs22\cf0\f0\charscalex100 {terlihat sebagai struktur vaskuler }\fs22\cf0\f0\char
scalex100 {yang menonjol kedalam lumen. Apabila}\par\pard\li2213\ri0\sl-413\slmu

lt0 \fs22\cf0\f0\charscalex100 {penderita diminta mengejan sedikit }\fs22\cf0\f
0\charscalex100 {maka ukuran hemoroid akan membesar}\par\pard\li2213\ri0\sl-413\
slmult0 \fs22\cf0\f0\charscalex100 {dan penonjolan atau prolaps akan }\fs22\cf0\
f0\charscalex100 {lebih nyata. Banyaknya benjolan,}\par\pard\li2213\ri0\sl-413\s
lmult0 \fs22\cf0\f0\charscalex100 {derajatnya, letak, besarnya, dan keadaan }\fs
22\cf0\f0\charscalex100 {lain seperti polip, fissure ani, dan}\par\pard\li2213\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tumor ganas harus diperhatikan.}{\
super \fs16\up4\cf0\f0\charscalex100 {2}}\par\pard\li1493\ri0\sl-413\slmult0 \*\
tx1853\fs24\cf0\f0\charscalex100 {7.}\tab \fs24\cf0\f0\charscalex100 {Diagnosis
Banding}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Diagnosi
s Banding dari hemorr}\fs24\cf0\f0\charscalex100 {hoid adalah sebagai berikut:}\
par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols
2\colno1\colw2213\colsr-0\colno2\colw9226\pard\li1853\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0
\ri0\sl-373\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\column\pard\li360\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {Perdarahan}\par\pard\li720\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {Antara lain karsinoma kolon-rekt}\fs24\cf0\f0
\charscalex100 {al, penyakit divertikel seperti}\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {diverkulitas, colitis ulserosa, dan polip. Bila dic
urigai adanya penyakit-}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {penyakit tersebut maka di}\fs24\cf0\f0\charscalex100 {perlukan pemeriksaan
sigmoidoskopi atau kolon in}\par\pard\li0\ri0\sl-426\slmult0 \fs24\cf0\f0\charsc
alex100 {loop.}{\super \fs16\up4\cf0\f0\charscalex100 {5}}\par\pard\li1080\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {Benjolan}\par\pard\li720\ri0\sl-413\sl
mult0 \fs22\cf0\f0\charscalex100 {Antara lain karsinoma anorektal atau}\fs22\cf0
\f0\charscalex100 { prolaps recti / procidentia. Pada}\par\pard\li0\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {procidentia, seluruh dinding akan prol}\fs24\
cf0\f0\charscalex100 {aps, sedangkan pada hemoroid hanya}\par\pard\li0\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {mukosa saja yang prolaps.}{\super \fs16\up
4\cf0\f0\charscalex100 {5}}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\
marglsxn666\margrsxn133\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493
ard\li1493\ri0\sl-346\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {8.}\tab \fs24
\cf0\f0\charscalex100 {Komplikasi }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {Perdarahan akut pada umumnya ja}\fs24\cf0\f0\charscalex100 {
rang, hanya terjadi apabila yang pecah}\par\pard\li1853\ri0\sl-413\slmult0 \fs22
\cf0\f0\charscalex100 {adalah pembuluh darah besar. Hemoroid dapat membentuk pin
tasan portal}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\ma
rgrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\margtsxn666\margbsxn426\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sistemik pada hipert
ensi portal dan apabila hemoroid semacam ini mengalami }\par\pard\li1853\ri0\sl413\slmult0 \fs24\cf0\f0\charscalex100 {perdarahan maka darah dapat sangat banya
k. Perdarahan akut semacam ini dapat}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {menyebabkan syok hipovolemik. Sedangkan }\fs24\cf0\f0\chars
calex100 {perdarahan kronis menyebabkan}\par\pard\li1853\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {terjadinya anemia, karena jumlah }\fs24\cf0\f0\charscale
x100 {eritrosit yang diproduksi tidak bisa}\par\pard\li1853\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {mengimbangi jumlah yang keluar. Seri}\fs24\cf0\f0\cha
rscalex100 {ng pasien datang dengan Hb 3-4. pada}\par\pard\li1853\ri0\sl-413\slm
ult0 \fs24\cf0\f0\charscalex100 {pasien ini penanganannya }\fs24\cf0\f0\charscal
ex100 {tidak langsung operasi teta}\fs24\cf0\f0\charscalex100 {pi ditunggu sampa
i Hb}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pasien menj
adi 10. prolaps hemoroid inte}\fs24\cf0\f0\charscalex100 {rna dapat menjadi irep
onibel, terjadi}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {

inkarserasi ( prolaps & terjep}\fs24\cf0\f0\charscalex100 {it diluar ) kemudian
diikuti infeksi sampai terjadi}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {sepsis. Sebelum terjadi iskemik dapat }\fs24\cf0\f0\charscalex100
{terjadi gangren dulu dengan bau yang}\par\pard\li1853\ri0\sl-413\slmult0 \fs24
\cf0\f0\charscalex100 {menyengat.}{\super \fs16\up4\cf0\f0\charscalex100 {8}}\pa
s18\cf0\par\pard\li1493\ri0\sl-400\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {
9.}\tab \fs24\cf0\f0\charscalex100 {Terapi}\par\pard\sect\sectd\sbknone\pgwsxn12
240\pghsxn15840\marglsxn666\margrsxn133\cols2\colno1\colw2213\colsr-0\colno2\col
w9226\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\column\
pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Terapi konservatif}\pa
r\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\charscalex100 {1)}\tab \fs24\
cf0\f0\charscalex100 {Pengelolaan dan modifikasi diet}\par\pard\li360\ri0\sl-413
\slmult0 \fs24\cf0\f0\charscalex100 {Diet berserat, buah-buahan dan sayura}\fs24
\cf0\f0\charscalex100 {n, dan intake air ditingkatkan. Diet}\par\pard\li360\ri0\
sl-413\slmult0 \fs22\cf0\f0\charscalex100 {serat yang dimaksud adalah diet de}\f
s22\cf0\f0\charscalex100 {ngan kandungan selulosa yang tinggi.}\par\pard\li360\r
i0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Selulosa tidak mampu dicerna oleh
t}\fs22\cf0\f0\charscalex100 {ubuh tetapi selulosa bersifat menyerap}\par\pard\l
i360\ri0\sl-413\slmult0 \*\tx893\*\tx2013\*\tx2773\*\tx3813\*\tx4693\*\tx6800\fs
22\cf0\f0\charscalex100 {air}\tab \fs22\cf0\f0\charscalex100 {sehingga}\tab \fs2
2\cf0\f0\charscalex100 {feses}\tab \fs22\cf0\f0\charscalex100 {menjadi}\tab \fs2
2\cf0\f0\charscalex100 {l}\fs22\cf0\f0\charscalex100 {unak.}\tab \fs22\cf0\f0\ch
arscalex100 {Makanan-makanan}\tab \fs22\cf0\f0\charscalex100 {tersebut}\par\pard
\li360\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {menyebabkan gumpalan isi u
sus menjadi besar namun lunak sehingga}\par\pard\li360\ri0\sl-413\slmult0 \fs22\
cf0\f0\charscalex100 {mempermudah defekasi dan mengurangi keharusan mengejan sec
ara}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {berlebihan.}{
\super \fs16\up4\cf0\f0\charscalex100 {10}}\par\pard\li0\ri0\sl-413\slmult0 \*\t
x360\fs24\cf0\f0\charscalex100 {2)}\tab \fs24\cf0\f0\charscalex100 {Medikamentos
a}\par\pard\li360\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Terapi medikame
ntosa ditujukan bagi pasien dengan hemoroid derajat}\par\pard\li360\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {awal. Obat-obatan yang sering digunakan adala
h:}{\super \fs16\up4\cf0\f0\charscalex100 {9}}\par\pard\li360\ri0\sl-413\slmult0
\*\tx720\fs22\cf0\f0\charscalex100 {a)}\tab \fs22\cf0\f0\charscalex100 {Stool S
oftener, untuk mencegah}\fs22\cf0\f0\charscalex100 { konstipasi sehingga mengura
ngi}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kebiasaan men
gejan, misalnya Docusate Sodium.}\par\pard\li360\ri0\sl-413\slmult0 \*\tx720\fs2
2\cf0\f0\charscalex100 {b)}\tab \fs22\cf0\f0\charscalex100 {Anestetik topikal, u
ntuk mengurangi }\fs22\cf0\f0\charscalex100 {rasa nyeri, misalnya Liidocaine}\pa
r\pard\li720\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {ointmenti 5% (Lidode
rm, Dermaflex). Yang penting untuk}\par\pard\li720\ri0\sl-413\slmult0 \fs22\cf0\
f0\charscalex100 {diperhatikan adalah pe}\fs22\cf0\f0\charscalex100 {nggunaan ob
at-obatan t}\fs22\cf0\f0\charscalex100 {opikal per rectal dapat}\par\pard\li720
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menimbulkan efek samping sistema
tik.}\par\pard\li360\ri0\sl-413\slmult0 \*\tx720\fs22\cf0\f0\charscalex100 {c)}\
tab \fs22\cf0\f0\charscalex100 {Mild astringent, untuk mengurangi rasa gatal pad
a daerah perianal}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn6
66\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margr
sxn133\margtsxn666\margbsxn426\cols2\colno1\colw2213\colsr-0\colno2\colw9226\par

slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\column\pard\li720\ri0\sl-213\slmult0
\slmult0 \fs18\cf0\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{yang timbul akibat iritasi karena kelembaban yang terus-menerus dan}\par\pard\l
i720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {rangsangan usus, misalnya Ha
mamelis water (Witch Hazel)}\par\pard\li360\ri0\sl-413\slmult0 \*\tx720\fs22\cf0
\f0\charscalex100 {d)}\tab \fs22\cf0\f0\charscalex100 {Analgesik, untuk mengatas
i rasa}\fs22\cf0\f0\charscalex100 { nyeri, misalnya Acetaminophen}\par\pard\li72
0\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {(Tylenol, Aspirin Free Anacin d
an Fe}\fs22\cf0\f0\charscalex100 {verall) yang merupakan obat anti}\par\pard\li7
20\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {nyeri pilihan bagi pasien yang
memiliki hiperensitifitas terhadap }\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {aspirin atau NSAID, atau pasien }\fs24\cf0\f0\charscalex100
{dengan penyakit saluran pencernaan}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0
\f0\charscalex100 {bagian atas atau pasien yang se}\fs24\cf0\f0\charscalex100 {d
ang mengkonsumsi antikoagulan oral.}\par\pard\li360\ri0\sl-413\slmult0 \*\tx720\
fs24\cf0\f0\charscalex100 {e)}\tab \fs24\cf0\f0\charscalex100 {Laxantina ringan
atau berak darah (hematoscezia). Obat supositorial }\par\pard\li720\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {anti hemoroid masih diragukan khasiatnya kare
na hasil yang mampu}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {dicapai hanya sedikit. Obat terbaru }\fs24\cf0\f0\charscalex100 {di pasaran a
dalah }\fs24\cf0\f0\charscalex100 {Ardium. Obat ini}\par\pard\li720\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {mampu mengecilkan hemoroid sete}\fs24\cf0\f0\
charscalex100 {lah dikonsumsi beberapa bulan.}\par\pard\li720\ri0\sl-413\slmult0
\fs24\cf0\f0\charscalex100 {Namun bila konsumsi berhenti maka hemoroid tersebut
akan kambuh}\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {lagi
.}\par\pard\li2160\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Terapi Tindaka
n Non Operatif Elektif}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\cha
rscalex100 {1)}\tab \fs24\cf0\f0\charscalex100 {Skleroterapi }\par\pard\li1080\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Vasa darah yang mengalami varises
disuntik Phenol 5 % dalam}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {minyak nabati sehingga terjadi nekrosis lalu fibrosis. Akibatnya, vasa}
\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {darah yang mengge
lembung akan berkontraksi / mengecil. Untuk itu}\par\pard\li360\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {injeksi dilakukan ke dalam submukosa }\fs24\cf0\f
0\charscalex100 {pada jaringan ikat longgar di atas}\par\pard\li360\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {hemoroid interna agar terjadi infl}\fs24\cf0\
f0\charscalex100 {amasi dan berakhir dengan fibrosis.}\par\pard\li360\ri0\sl-413
\slmult0 \fs24\cf0\f0\charscalex100 {Untuk menghindari nyeri yang hebat, s}\fs24
\cf0\f0\charscalex100 {untikan harus di atas mucocutaneus }\par\pard\li360\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {juction (1-2 ml bahan diinjeksikan}\fs
24\cf0\f0\charscalex100 { kekuadran simptomatik dengan alat}\par\pard\li360\ri0\
sl-426\slmult0 \fs24\cf0\f0\charscalex100 {hemoroid panjang dengan bantuan anosk
opi). Komplikasi : infeksi,}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {prostitis akut dan reaksi }\fs24\cf0\f0\charscalex100 {hipersensitifi
tas terhadap}\fs24\cf0\f0\charscalex100 { bahan yang disuntikan.}\par\pard\li360
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Skleroterapi dan diet serat meru
paka}\fs24\cf0\f0\charscalex100 {n terapi baik untuk derajat 1 dan 4.}{\super \f
s16\up4\cf0\f0\charscalex100 {4}}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\
cf0\f0\charscalex100 {2)}\tab \fs24\cf0\f0\charscalex100 {Ligasi dengan cincin k
a}\fs24\cf0\f0\charscalex100 {ret (Rubber band Ligation)}\par\pard\li1080\ri0\sl
-413\slmult0 \fs24\cf0\f0\charscalex100 {Teknik ini diperkenalkan oleh }\fs24\cf
0\f0\charscalex100 {Baron pada tahun 1963 dan biasa}\par\pard\li360\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {dilakukan untuk hemoroid yang besar atau yang

mengalami prolaps.}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {Tonjolan ditarik dan pangkalnya (m}\fs24\cf0\f0\charscalex100 {ukosa pleksus
hemoroidalis) diikat}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {denga cincin karet. Akibatnya timbul}\fs24\cf0\f0\charscalex100 { iskemik ya
ng menjadi nekrosis dan}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscal
ex100 {akhirnya terlepas. Pada bekasnya akan}\fs24\cf0\f0\charscalex100 { mengal
ami fibrosis dalam beberapa}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840
\marglsxn666\margrsxn133\margtsxn666\margbsxn426\pard\li2573\ri0\sl-213\slmult0
3\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {hari. Pada satu kali terapi hanya d}\fs24\cf0\f0\charscalex100 {iikat satu ko
mpleks hemoroid sedangkan}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\chars
calex100 {ligasi selanjutnya dilakukan dalam }\fs24\cf0\f0\charscalex100 {jangka
waktu dua sampai empat }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {minggu. Komplikasi yang mungkin tim}\fs24\cf0\f0\charscalex100 {bul ada
lah nyeri yang hebat}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex
100 {terutama pada ligasi mucocutaneus j}\fs24\cf0\f0\charscalex100 {unction yan
g kaya reseptor sensorik}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {dan terjadi perdarahan saat polip lepa}\fs24\cf0\f0\charscalex100 {s at
au nekrosis (7 sampai 10 hari)}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\
charscalex100 {setelah ligasi.}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\p
ard\li2213\ri0\sl-413\slmult0 \*\tx2573\fs24\cf0\f0\charscalex100 {3)}\tab \fs24
\cf0\f0\charscalex100 {Bedah Beku (Cryosurgery)}\par\pard\li3293\ri0\sl-413\slmu
lt0 \fs24\cf0\f0\charscalex100 {Tonjolan hemoroid dibekukan dengan CO2 atu NO2 s
ehingga}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {terjadi
nekrosis dan akhirnya fibrosis. Terapi ini jarang dipakai karena }\par\pard\li25
73\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {mukosa yang akan dibekukan (di
buat ne}\fs24\cf0\f0\charscalex100 {krosis) sukar untuk ditentukan}\par\pard\li2
573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {luasnya. Cara ini cocok }\fs2
4\cf0\f0\charscalex100 {untuk terapi paliatif }\fs24\cf0\f0\charscalex100 {pada
karsinoma recti}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {
inoperabel.}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\li2213\ri0\sl-4
13\slmult0 \*\tx2573\fs24\cf0\f0\charscalex100 {4)}\tab \fs24\cf0\f0\charscalex1
00 {IRC (Infra Red Cauter)}\par\pard\li3293\ri0\sl-413\slmult0 \fs24\cf0\f0\char
scalex100 {Tonjolan hemoroid dicauter / }\fs24\cf0\f0\charscalex100 {dilelehkan
dengan infra merah.}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {Sehingga terjadilah nekros}\fs24\cf0\f0\charscalex100 {is dan akhirnya fibro
sis}\fs24\cf0\f0\charscalex100 {. Terapi ini diulang tiap}\par\pard\li2573\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {seminggu sekali.}{\super \fs16\up4\cf0
\f0\charscalex100 {4}}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2213\fs24\cf0\f0\
charscalex100 {c.}\tab \fs24\cf0\f0\charscalex100 {Terapi Operatif}\par\pard\sec
t\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols2\colno1\col
w2573\colsr-0\colno2\colw8866\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {1)}\par\column\pard\li1266\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {Hemoroidektomi }\par\pard\li720\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{Banyak pasien yang sebenarnya }\fs24\cf0\f0\charscalex100 {belum memerlukan op
erasi minta}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {untuk d
ilakukan hemoroidektomi. Biasanya jika ingin masuk militer, }\par\pard\li0\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {pasien meminta dokter unt}\fs24\cf0\f0
\charscalex100 {uk menjalankan operasi ini. Indikasi operasi}\par\pard\li0\ri0\s
l-413\slmult0 \fs24\cf0\f0\charscalex100 {untuk hemoroid adalah sebagai berikut:
}{\super \fs16\up4\cf0\f0\charscalex100 {4}}\par\pard\li0\ri0\sl-426\slmult0 \*\
tx360\fs24\cf0\f0\charscalex100 {a)}\tab \fs24\cf0\f0\charscalex100 {Gejala kron
ik derajat 3 atau 4.}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\chars
calex100 {b)}\tab \fs24\cf0\f0\charscalex100 {Perdarahan kronik yang tidak berh}
\fs24\cf0\f0\charscalex100 {asil dengan terapi sederhana.}\par\pard\li0\ri0\sl-4
13\slmult0 \*\tx360\fs24\cf0\f0\charscalex100 {c)}\tab \fs24\cf0\f0\charscalex10
0 {Hemoroid derajat 4 dengan nyeri }\fs24\cf0\f0\charscalex100 {akut dan trombos
is serta gangren.}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {P
rinsip hemoroidektomi :}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\ch

arscalex100 {a)}\tab \fs24\cf0\f0\charscalex100 {Eksisi hanya pada jaringan}\fs2
4\cf0\f0\charscalex100 { yang benar-benar berlebih.}\par\pard\li0\ri0\sl-413\slm
ult0 \*\tx360\fs24\cf0\f0\charscalex100 {b)}\tab \fs24\cf0\f0\charscalex100 {Eks
isi sehemat mungkin dilakuka}\fs24\cf0\f0\charscalex100 {n sehingga anoedema dan
kulit}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {normal tid
ak terganggu Spinchter ani.}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charsc
alex100 {Ada beberapa macam metode yang digunakan adalah :}{\super \fs16\up4\cf0
\f0\charscalex100 {2}}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\char
scalex100 {a)}\tab \fs24\cf0\f0\charscalex100 {Metode Langenbeck}\par\pard\sect\
sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\sect\sectd\sb
kpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn426\co
ls2\colno1\colw2573\colsr-0\colno2\colw8866\pard\li2213\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
ard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18
par\pard\li2213\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2)}\par\column\pa
rd\li1080\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1080\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1080\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1080\ri0\sl-413\slmu
lt0 \fs24\cf0\f0\charscalex100 {Untuk tonjolan yang soliter (hanya satu). Carany
a dengan}\par\pard\li360\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {menjepit
radiair hemoroid internus}\fs22\cf0\f0\charscalex100 {, mengadakan jahitan jelu
jur di}\par\pard\li360\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {bawah klem
dengan catgut chromic No. 2/0 dan melakukan eksisi}\par\pard\li360\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {Diatas klem. Sesudah itu klem dilepas dan jah
itan di bawah klem }\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {diikat diikuti kontinuitas mukosa.}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\
fs24\cf0\f0\charscalex100 {b)}\tab \fs24\cf0\f0\charscalex100 {Metode Miligan Mo
rgan}\par\pard\li1080\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Untuk tonjo
lan pada tiga tempat}\fs24\cf0\f0\charscalex100 { utama (jam 3, 7, 11). Caranya}
\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dengan mengangkat
vena yang vari}\fs24\cf0\f0\charscalex100 {ses kemudian dijahit walaupun}\par\p
ard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sebenarnya metode milig

an morgan originalnya tanpa jahitan. Sesuai}\par\pard\li360\ri0\sl-413\slmult0 \
fs24\cf0\f0\charscalex100 {prosedur aslinya, benjolan hemo}\fs24\cf0\f0\charscal
ex100 {roid dijepit kemudian dilakukan}\par\pard\li360\ri0\sl-413\slmult0 \fs24\
cf0\f0\charscalex100 {diseksi. Pedikel vaskuler diligasi}\fs24\cf0\f0\charscalex
100 { dan luka dibiarkan terbuka agar}\par\pard\li360\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {terjadi granulasi. Metode ini sa}\fs24\cf0\f0\charscalex100
{ngat sering digunakan di Inggris.}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs
24\cf0\f0\charscalex100 {c)}\tab \fs24\cf0\f0\charscalex100 {Metode Whitehead}\p
ar\pard\li1080\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Untuk hermoroid si
rkuler / berat. Caranya dengan melakukan}\par\pard\li360\ri0\sl-413\slmult0 \fs2
4\cf0\f0\charscalex100 {incisi secara sirkular, mengupas }\fs24\cf0\f0\charscale
x100 {seluruh v. hemoriodalis dengan }\par\pard\li360\ri0\sl-413\slmult0 \fs24\c
f0\f0\charscalex100 {membebaskan mukosa dari submukos}\fs24\cf0\f0\charscalex100
{a, bagian yang prolaps dipotong,}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\
f0\charscalex100 {kemudian dijahit kembali. Ini me}\fs24\cf0\f0\charscalex100 {r
upakan operasi hemoroid yang}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {radikal.}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\chars
calex100 {d)}\tab \fs24\cf0\f0\charscalex100 {Metode Ferguson}\par\pard\li1080\r
i0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Yaitu benjolan hemoroid ditampakka
n melalui anoskopi}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex10
0 {kemudian dilakukan eksisi dan ligasi pada posisi anatomic hemoroid}\par\pard\
li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tersebut. Metode ini diguna
kan di Amerika Serikat }\par\pard\li1080\ri0\sl-426\slmult0 \fs24\cf0\f0\charsc
alex100 {Metode hemoroidektomi yang sering dilakukan adalah metode}\par\pard\li3
60\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {langenbeck karena mudah untuk}
\fs24\cf0\f0\charscalex100 { dilakukan dan tidak mengandung}\par\pard\li360\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {resiko pembentukan jaringan parut sir
kuler yang dapat menimbulkan}\par\pard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {stenosis.}\par\pard\li1266\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
266\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1266\ri0\sl-400\slmult0 \*\tx4306\fs
22\cf0\f0\charscalex100 {Stapled Hermorrhoid Surgery}\tab \fs22\cf0\f0\charscale
x100\i {(Procedure for prolapse and }\i0 \par\pard\li0\ri0\sl-413\slmult0 \fs24
\cf0\f0\charscalex100\i {hemorrhoids/ PPH)}\i0 \par\pard\li720\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {Prosedur penanganan hemoroid in}\fs24\cf0\f0\chars
calex100 {i terhitung baru karena baru}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf
0\f0\charscalex100 {dikembangkan sekitar tahun 1990-a}\fs24\cf0\f0\charscalex100
{n. Prinsip dari PPH adalah}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn1584
0\marglsxn666\margrsxn133\margtsxn666\margbsxn453\pard\li2573\ri0\sl-213\slmult0
13\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex1
00 {mempertahankan fungsi jaringan hemoro}\fs24\cf0\f0\charscalex100 {id serta m
engembalikan jaringan}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f0\charscale
x100 {ke posisi semula. Jaringan hemoroid }\fs22\cf0\f0\charscalex100 {ini seben
arnya masih diperlukan}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f0\charscal
ex100 {sebagai bantalan saat BAB sehingga ti}\fs22\cf0\f0\charscalex100 {dak per
lu dibuang semua. Prosedur}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f0\char
scalex100 {tidak bisa diterapi secara konserva}\fs22\cf0\f0\charscalex100 {tif m
aupun terapi non}\fs22\cf0\f0\charscalex100 { operatif. Mula-}\par\pard\li2573\r
i0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {mula jaringan hemoroid yang prolap
s }\fs22\cf0\f0\charscalex100 {didorong ke atas dengan alat yang}\par\pard\li257
3\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {dinamakan dilator lalu}\fs22\cf
0\f0\charscalex100 { dijahitkan ke tuni}\fs22\cf0\f0\charscalex100 {ka mukosa di
nding anus.}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {Kemu
dian dengan menggunakan alat ya}\fs22\cf0\f0\charscalex100 {ng disebut circ}\fs2
2\cf0\f0\charscalex100 {ular stapler.}\par\pard\li2573\ri0\sl-413\slmult0 \fs22\
cf0\f0\charscalex100 {Dengan memutar sekrup yang terdapat }\fs22\cf0\f0\charscal
ex100 {pada ujung alat, maka alat akan}\par\pard\li2573\ri0\sl-413\slmult0 \fs24
\cf0\f0\charscalex100 {memotong jaringan yang berlebih }\fs24\cf0\f0\charscalex1
00 {secara otomatis. Dengan terpotongnya }\par\pard\li2573\ri0\sl-413\slmult0 \f
s24\cf0\f0\charscalex100 {jaringan tersebut maka suplay darah }\fs24\cf0\f0\char

scalex100 {ke jaringan tersebut akan terhenti}\par\pard\li2573\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {sehingga jaringan hemoroid akan mengempis dengan s
endirinya.}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Kerja
sama jaringan dan m. sphincte}\fs24\cf0\f0\charscalex100 {r ani untuk melebar da
n mengerut}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menja
min control keluarnya caira}\fs24\cf0\f0\charscalex100 {n dan kotoran dari dubur
. Keuntungan}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pen
anganan dengan PPH antara lain}\fs24\cf0\f0\charscalex100 { nyeri minimal karena
tindakan}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dilaku
kan di luar bagian sensitive, }\fs24\cf0\f0\charscalex100 {tindakan berlangsung
}\fs24\cf0\f0\charscalex100 {cepat sekitar 20-}\par\pard\li2573\ri0\sl-413\slmul
t0 \fs24\cf0\f0\charscalex100 {45 menit, dan pasien pulih lebih cepat}\fs24\cf0\
f0\charscalex100 { sehingga rawat inap di rumah sakit}\par\pard\li2573\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {lebih singkat. Penyulit pada PPH dan }\fs2
4\cf0\f0\charscalex100 {operasi konvensional lainnya tidak}\par\pard\li2573\ri0\
sl-413\slmult0 \fs24\cf0\f0\charscalex100 {jauh berbeda. Tetapi ada kemungkinan
}\fs24\cf0\f0\charscalex100 {terjadi perdarahan, trombosis, serta}\par\pard\li25
73\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {penyempitan kanalis analis. Ji
ka terlal}\fs24\cf0\f0\charscalex100 {u banyak jaringan otot yang ikut}\par\pard
\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {terbuang akan mengakibatk
an kerusakan dinding rectum jika m. sphincter}\par\pard\li2573\ri0\sl-413\slmult
0 \fs24\cf0\f0\charscalex100 {ani internus tertarik dapat menyebabkan disfungsi
baik dalam jangka}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100
{waktu pendek maupun jangka panjang. }\fs24\cf0\f0\charscalex100 {PPH bisa saja
gagal pada }\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {hem
oroid yang terlalu besar kerena sulit untuk memperoleh jalan masuk}\par\pard\li2
573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {ke kanalis analis dan kalaupu
n bisa}\fs24\cf0\f0\charscalex100 {, jaringan mungkin terlalu tebal untuk}\par\p
ard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {masuk ke dalam stapler
.}{\super \fs16\up4\cf0\f0\charscalex100 {2}}\par\pard\li1493\ri0\sl-213\slmult0
66\slmult0 \fs24\cf0\f0\charscalex100 {10.}{ }\fs24\cf0\f0\charscalex100 {Progno
sis }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Dengan ter
api yang sesuai, pasien yang simptomatik akan menjadi}\par\pard\li1853\ri0\sl-41
3\slmult0 \fs24\cf0\f0\charscalex100 {asimptomatik. Dengan melakukan terapi oper
atif dengan hemoroidektomi }\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\cha
rscalex100 {hasilnya sangat baik, namun bisa muncul kembali (rekuren) dengan ang
ka }\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {kejadian rek
uren sekitar 2-5%. Terapi non}\fs24\cf0\f0\charscalex100 { operatif seperti liga
si cincin karet}\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666
\margrsxn133\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
s18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {(rubber b
and ligation) menimbulkan keja}\fs24\cf0\f0\charscalex100 {dian rekuren sek}\fs2
4\cf0\f0\charscalex100 {itar 30-50% antara}\par\pard\li1853\ri0\sl-413\slmult0 \
fs22\cf0\f0\charscalex100 {kurun waktu 5-10 tahun kedepan. Akan teta}\fs22\cf0\f
0\charscalex100 {pi, hemoroid rekuren ini biasanya}\par\pard\li1853\ri0\sl-413\s
lmult0 \fs22\cf0\f0\charscalex100 {dapat ditangani dengan terapi non operatif}\f
s22\cf0\f0\charscalex100 {. Hingga saat ini belum ada penelitian}\par\pard\li185
3\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {yang menunjukkan keberhasilan t
erapi }\fs22\cf0\f0\charscalex100 {dengan PPH. Setelah sembuh, penderita}\par\pa
rd\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {tidak boleh sering meng
ejan dan dianju}\fs22\cf0\f0\charscalex100 {rkan makan makanan yang berserat}\pa
r\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {tinggi.}{\super \fs
16\up4\cf0\f0\charscalex100 {11}}\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\p
fs24\cf0\f0\charscalex100 {11.}{ }\fs24\cf0\f0\charscalex100 {Pencegahan }\par\p
ard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Dari seluruh tindakan
pengobatan pe}\fs22\cf0\f0\charscalex100 {nyakit hemoroid pencegahan non}\par\pa
rd\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {operatif, medikamentosa

sampai opera}\fs22\cf0\f0\charscalex100 {tif maka yang paling terbaik adalah}\p
ar\pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {tindakan pencegaha
n. Cara terbaik }\fs22\cf0\f0\charscalex100 {untuk mencegah hemoroid yang dapat}
\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {dilakukan yaitu:
}\fs24\cf0\f0\charscalex100 {\uc1\u61447X}{\super \fs16\up4\cf0\f0\charscalex100
{12}}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2213\fs24\cf0\f0\charscalex100 {a
.}\tab \fs24\cf0\f0\charscalex100 {BAB usahakan teratur sehari sekali}\par\pard\
li1853\ri0\sl-426\slmult0 \*\tx2213\fs22\cf0\f0\charscalex100 {b.}\tab \fs22\cf0
\f0\charscalex100 {Usahakan tinja / kotoran tidak keras }\fs22\cf0\f0\charscalex
100 {sehingga pada saat BAB tidak perlu}\par\pard\li2213\ri0\sl-426\slmult0 \fs2
4\cf0\f0\charscalex100 {mengejan.}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2213\
fs24\cf0\f0\charscalex100 {c.}\tab \fs24\cf0\f0\charscalex100 {Jangan terlalu la
ma jongkok di kloset.}\par\pard\li1853\ri0\sl-426\slmult0 \*\tx2213\fs24\cf0\f0\
charscalex100 {d.}\tab \fs24\cf0\f0\charscalex100 {Banyak minum minimal 1,5 \uc1
\u8211X 2 }\fs24\cf0\f0\charscalex100 {liter air putih / sehari}\par\pard\li1853
\ri0\sl-426\slmult0 \*\tx2213\fs22\cf0\f0\charscalex100 {e.}\tab \fs22\cf0\f0\ch
arscalex100 {Hindari makanan yang dapat menyebabka}\fs22\cf0\f0\charscalex100 {n
iritasi lokal ( makanan pedas,}\par\pard\li2213\ri0\sl-413\slmult0 \fs22\cf0\f0
\charscalex100 {alkohol ) atau merangsang pencernaan }\fs22\cf0\f0\charscalex100
{( kopi, teh ).Berdasarkan penelitian}\par\pard\li2213\ri0\sl-426\slmult0 \fs24
\cf0\f0\charscalex100 {mengkonsumsi makanan pedas memiliki resiko terkena hemoro
id sebanyak }\par\pard\li2213\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {4,9
5 kali (OR 4,95;CI 2,65-9,25), sedangkan orang yang mengkonsumsi }\par\pard\li22
13\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {alkohol memiliki resiko 1,99 k
ali menderita hemoroid(OR 1,99;CI 1,21-3,27).}\par\pard\li2213\ri0\sl-293\slmult
0 \fs16\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-333\slmult0 \*\tx2213\fs24\cf0\f0\charscalex100 {f.}\tab \f
s24\cf0\f0\charscalex100 {Makanan yang seimbang , kaya serat, }\fs24\cf0\f0\char
scalex100 {sayur dan buah- bua}\fs24\cf0\f0\charscalex100 {han sehingga dapat}\p
ar\pard\li2213\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {menghindari konsti
pasi / sembelit kronis.}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx2213\fs24\cf0\f
0\charscalex100 {g.}\tab \fs24\cf0\f0\charscalex100 {Hindari stress, karena berd
asarkan penelitian seseorang yang stress memiliki}\par\pard\li2213\ri0\sl-426\sl
mult0 \fs24\cf0\f0\charscalex100 {resiko 0,49 kali terkena hemoroid }\fs24\cf0\f
0\charscalex100 {walaupun resikonya kecil tetapi}\par\pard\li2213\ri0\sl-413\slm
ult0 \fs24\cf0\f0\charscalex100 {hubungannya cukup signifikan (p<0,0001).}\fs16
\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-480\slmult0 \*\tx2213\fs24\cf0\
f0\charscalex100 {h.}\tab \fs24\cf0\f0\charscalex100 {Olah raga yang teratur sep
erti sena}\fs24\cf0\f0\charscalex100 {m, berjalan, bere}\fs24\cf0\f0\charscalex1
00 {nang, dan menungging}\par\pard\li2213\ri0\sl-426\slmult0 \fs24\cf0\f0\charsc
alex100 {pada saat menjelang tidur.}\par\pard\li1853\ri0\sl-413\slmult0 \*\tx221
3\fs24\cf0\f0\charscalex100 {i.}\tab \fs24\cf0\f0\charscalex100 {Hindari mengang
kat beban / barang ya}\fs24\cf0\f0\charscalex100 {ng berat. Berdas}\fs24\cf0\f0\
charscalex100 {arkan penelitian}\par\pard\sect\sectd\sbkpage
{\shp{\*\shpinst\shpleft2160\shptop3720\shpright3800\shpbottom4080\shpfhdr0\shpw
r3\shpwrk0\shpfblwtxt1\shplid2028\shpz1\shpbxpage\shpbypage
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7;32768}}
7;32768}}

{\sp{\sn pVerticies}{\sv 8;16;(0,1093);(3146,40);(3160,40);(3160,53);(3160,53);(
3160,53);(13,1106);(0,1106);(0,1106);(0,1106);(0,1093);(3120,0);(3253,13);(3146,
120);(0,1093);(0,1093);}}
824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45
824;24577;32768}}
;(2960,120);(13,13);(0,13);(0,13);(0,0);(13,0);(2946,53);(3066,120);(2946,173);(
13,0);(13,0);}}
824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45
824;24577;32768}}
{\shp{\*\shpinst\shpleft3946\shptop9640\shpright7200\shpbottom10813\shpfhdr0\shp
wr3\shpwrk0\shpfblwtxt1\shplid2067\shpz48\shpbxpage\shpbypage
{\sp{\sn pVerticies}{\sv 8;16;(13,0);(3160,1120);(3160,1120);(3160,1133);(3160,1
133);(3146,1133);(0,13);(0,13);(0,0);(0,0);(13,0);(3160,1066);(3253,1160);(3120,
1173);(13,0);(13,0);}}
824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45824;1;45
824;24577;32768}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\margtsxn666\margbsxn400\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li22
\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {seseorang yang melak
ukan kegiatan fisik }\fs24\cf0\f0\charscalex100 {yang berat akan beresiko 2,79 k
ali}\par\pard\li2213\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {menderita he
moroid daripada }\fs24\cf0\f0\charscalex100 {yang tidak(OR 2,79;CI 1,60-4,87).}
\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100\b {B. Kerangka Te
ori}\b0 \par\pard\li1493\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Berdasar
uraian diatas maka dapat di}\fs24\cf0\f0\charscalex100 {tulis kerangka teori se
bagai berikut :}\par\pard\li2066\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2066\ri
0\sl-320\slmult0 \fs20\cf0\f0\charscalex100 {Umu}\fs20\cf0\f0\charscalex100 {r }
\par\pard\li7560\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Tekanan darah}\p
ar\pard\li1773\ri0\sl-306\slmult0 \fs20\cf0\f0\charscalex100 {Jenis kelamin}\par
\pard\li7720\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Konsti}\fs20\cf0\f0\
charscalex100 {p}\fs20\cf0\f0\charscalex100 {asi}\par\pard\li1906\ri0\sl-320\slm
ult0 \fs20\cf0\f0\charscalex100 {Peker}\fs20\cf0\f0\charscalex100 {j}\fs20\cf0\f
0\charscalex100 {aan}\par\pard\li4826\ri0\sl-240\slmult0 \*\tx7480\fs20\cf0\f0\c
harscalex100 {Kejadian}\tab \fs20\cf0\f0\charscalex100 {Diet rendah}{ }\fs20\cf0
\f0\charscalex100 {serat}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\ma
rglsxn666\margrsxn133\cols3\colno1\colw3706\colsr-0\colno2\colw3573\colsr-0\coln
o3\colw4160\pard\li1733\ri0\sl-360\slmult0 \fs20\cf0\f0\charscalex100 {Gemar mak
anan}\par\pard\li2160\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {pedas}\par\
8\cf0\par\pard\li1960\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Obesitas}\p
fs20\cf0\f0\charscalex100 {Olah raga berat }\par\pard\li1133\ri0\sl-213\slmult0
ard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-386\slmult0 \*\tx
1493\fs24\cf0\f0\charscalex100\b {C.}\b0 \tab \fs24\cf0\f0\charscalex100\b {Kera
ngka Konsep}\b0 \par\column\pard\li1066\ri0\sl-240\slmult0 \fs20\cf0\f0\charscal
ex100 {Hemoroid}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs20\cf0\f
0\charscalex100 {
Gambar 2.1 Kerangka Teori }\fs12\cf0\f0\charscalex100 {1
,2,3,8,10,13.14}\par\column\pard\li440\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4
40\ri0\sl-306\slmult0 \fs20\cf0\f0\charscalex100 {Kehamilan}\par\pard\li0\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs20\cf0\f0\charscalex10
0 {Gaya hidup/perilaku}\par\pard\li80\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li80
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li80\ri0\sl-293\slmult0 \fs20\cf0\f0\char
scalex100 {Riwayat keluarga }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn1584
0\marglsxn666\margrsxn133\pard\li1493\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex
100 {Berdasarkan teori dapat dirumuskan}\fs24\cf0\f0\charscalex100 { kerangka ko
nsep sebagai berikut:}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\margl
sxn666\margrsxn133\cols2\colno1\colw3986\colsr-0\colno2\colw7453\pard\li1493\ri0
\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Variabel Bebas}\par\pard\li1653\ri0\
sl-440\slmult0 \fs20\cf0\f0\charscalex100 {Riwayat keluarga}\par\pard\li1960\ri0
\par\pard\li1960\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {Konstipasi}\par\
mult0 \fs18\cf0\f0\charscalex100 {Olah raga berat }\par\pard\li1133\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-466\slmult0 \*\tx149
3\fs24\cf0\f0\charscalex100\b {D.}\b0 \tab \fs24\cf0\f0\charscalex100\b {Hipotes
is}\b0 \par\column\pard\li2906\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Va
riabel Terikat}\par\pard\li2866\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2866\ri0
\par\pard\li2866\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Kejadian hemoroi
d}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-466\slm
ult0 \fs24\cf0\f0\charscalex100 {Gambar 2.2 Kerangka Konsep}\par\pard\sect\sectd
\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1493\ri0\sl-413\
slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {1.}\tab \fs24\cf0\f0\charscalex100
{Ada hubungan antara Riwayat Keluarga dengan kejadian hemoroid.}\par\pard\li1493
\ri0\sl-413\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {2.}\tab \fs24\cf0\f0\ch
arscalex100 {Ada hubungan antara Konstipasi dengan kejadian hemoroid.}\par\pard\
sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\sect\sec
td\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn6
66\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-413
\slmult0 \*\tx1853\fs24\cf0\f0\charscalex100 {3.}\tab \fs24\cf0\f0\charscalex100
{Ada hubungan antara Olahraga berat dengan kejadian hemoroid.}\par}

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{\rtf\ansi\deff0\ansicpg1252

par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {inferior mengalir

s24\cf0\f0\charscalex100 {feses yang mengeras, berbau lebih}\par\pard\li0\ri0\sl

imbul rasa sakit.}\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\

tapi}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {bila diraba ak

scalex100 {yang menonjol kedalam lumen. Apabila}\par\pard\li2213\ri0\sl-413\slmu

onibel, terjadi}\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {

d\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c

lmult0 \fs24\cf0\f0\charscalex100 {dilakukan untuk hemoroid yang besar atau yang

rinsip hemoroidektomi :}\par\pard\li0\ri0\sl-413\slmult0 \*\tx360\fs24\cf0\f0\ch

ard\li360\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {sebenarnya metode milig

s24\cf0\f0\charscalex100 {jaringan tersebut maka suplay darah }\fs24\cf0\f0\char

rd\li1853\ri0\sl-413\slmult0 \fs22\cf0\f0\charscalex100 {operatif, medikamentosa

{\sp{\sn fLine}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}

{\sp{\sn fLine}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}

{\sp{\sn fLine}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}

{\sp{\sn pSegmentInfo}{\sv 2;34;16384;45824;1;45824;1;45824;1;45824;1;45824;1;45

{\sp{\sn fFlipH}{\sv 0}}

{\sp{\sn fillColor}{\sv 0}}

{\sp{\sn shapePath}{\sv 4}}

{\sp{\sn rotation}{\sv 0}}

{\sp{\sn shapeType}{\sv 0}}

{\sp{\sn fLayoutInCell}{\sv 1}}}}

{\sp{\sn lineType}{\sv 0}}

{\sp{\sn lineColor}{\sv 0}}

{\sp{\sn fFillOK}{\sv 1}}

{\sp{\sn shapePath}{\sv 4}}

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