HIRSCHPRUNG

DISEASE
DEFINISI

Tidak adanya sel-sel ganglion parasimpatis dari

plexus meissner dan plexus auerbach pada usus
bagian distal.
INSIDENSI
1:5000 Kelahiran hidup Pria > Wanita—> 4:1

80% Kasus melibatkan rektum dan 10% Kasus melibatkan colon

sigmoid proksimal
 ETIOLOGI
Tidak adanya sel-sel ganglion parasimpatis dari
plexus meissner dan plexus auerbach pada usus
bagian distal.
GAMBARAN KLINIS

NEONATUS ANAK
■ Mekonium > 24 Jam ■ Konstipasi kronis
■ Muntah Hijau ■ Gizi Buruk

■ Distensi Abdomen ■ Perut Buncit

■ Terlihat gerak peristaltik usus
pada dinding abdomen
DIAGNOSIS
ANAMNESIS
1 Konstipasi, Distensi abdomen, Ggn. Pasase
usus, poor feeding, Vomiting, Riw. Keluarga

PEMERIKSAAN FISIS
2 Colok dubur, Perut kembung

PEMERIKSAAN PENUNJANG
3 Barium enema, anorektal manometry, biopsi
rektal
TATALAKSANA
DIET BEDAH SEMENTARA
Resusitasi cairan dan Kolostomi
nutrisi parenteral

01 02 03 04

FARMAKOLOGI BEDAH DEFINITIF

Antibiotik oral dan Swenson, Duhamel, Soave,
intravena Rehbein
 PROGNOSIS
Setelah operasi, pasien dengan hirscprung disease
biasanya berhasil baik, walaupun terkadang ada
gangguan BAB sehingga konstipasi adalah gejala
tersering pada pasien pasca operasi
KOMPLIKASI

KOMPLIKASI
■ Enterokolitis post operatif
■ Konstipasi
■ Striktur anastomosis
INVAGINASI
DEFINISI

Keadaan dimana suatu segmen proximal usus

masuk ke dalam lumen usus yang lebih distal,
yang menyebabkan penyumbatan lumen usus
sebagian/seluruhnya..
EPIDEMIOLOGI
6-18 bulan; 4 bulan-2 tahun dan Laki-laki > Perempuan
puncak di usia 9 bulan

Ileocoloic >>
 ETIOLOGI
● Penyebab belum diketahui
● Faktor pencetus:
Diverticulum meckeli, polip usus,
duplikasi usus, limfoma.
DIAGNOSIS
GEJALA FOTO POLOS ABDOMEN
■ Nyeri perut kolik ■ Dilatasi loop-loop usus tanpa
■ iritabilitas
adanya udara di kolon

■ Muntah
■ Currant jelly stool
USG
■ Tanda obstruksi usus
■ Target sign & Doughut sign
■ Pseudokidney appearance
TANDA
■ Color doppler: penurunan aliran
■ Massa berbentuk sosis (60%) di darah pd daerah iskemik
RUQ atau epigastrium
 GAMBARAN KLINIS
● Serangan: bayi angkat kedua kaki seperti melindungi
perut
● Interval: bayi tertidur, tampak kelelahan

PEMERIKSAAN FISIS (TRIAS)

● Nyeri kolik
● Teraba Massa Tumor
● Defekasi mengandung lendir dan darah
 TATALAKSANA AWAL TATALAKSANA
1. Tangani dehidrasi: pasang IV-> Muntah ■ Hidrostatik: saline, NaCl,
terus menerus karna obstruksi Cairan aqua, barium enema
2. pasang NGT: dekompresi -> terjadi
■ pneumostatik
distensi abdomen
3. pasang kateter: dekompresi ■ pembedahan
4. antibiotik spektrum luas: kalau demam
APPENDISITIS
AKUT
DEFINISI
peradangan yang terjadi pada Appendix
vermicularis, dan merupakan penyebab
abdomen akut yang paling sering pada
anak-anak maupun dewasa
EPIDEMIOLOGI

Paling sering 10-19 tahun

Laki-laki: 8,6%-12%
Perempuan: 6,7%-23%
DIAGNOSIS
ANAMNESIS
■ Onset tiba”
■ Nyeri 2 titik: epigastrium —> RLQ (setelah 24 jam)
■ anoreksia, mual, muntah
■ riw. gangguan cerna: diare, sembelit
■ demam
DIAGNOSIS
PEMERIKSAAN FISIS
■ Demam, takikardi
■ nyeri tekan: titik mc burney-> sensitif untuk appendiks di anteperitoneal
■ suruh batuk: dunphy sign (anak)-> nyeri meningkat dengan batuk
■ titik lain: Rovsing sign, psoas sign, obturator sign. (tapi kalau mcburney sudah
positif, tidak usah titik lain)

PEMERIKSAAN LAB
■ Darah lengkap
■ urinalisis
■ Parameter koagulasi
■ Tes kehamilan)
DIAGNOSIS
SKOR
1. ALVARADO: jika USG tidak bisa

1. LABEDA
DIAGNOSIS
RADIOLOGI
■ USG -> hanya deteksi cairan
■ CT scan
■ MRI
TATALAKSANA

■ Non operatif
■ Bakteriologi
■ Operatif
- open surgery
- laparoskopi
- bedah transluminal orificium alami
 TRAUMA
MAKSILOFASIA
L
DEFINISI
Suatu ruda paksa yang mengenai tulang wajah dan
jaringan sekitarnya sehingga menyebabkan hilangnya
kontinuitas jaringan dan atau tulang wajah.
 KLASIFIKASI
MAKSILOFASIAL
TRAUMA JARINGAN LUNAK

Klasifikasi berdasarkan jenis dan penyebab luka:

● Ekskoriasi (Vulnus excoriatum)
● Luka sayat (vulnus scissum)
● Luka robek (Vulnus laceratum)
● Luka tusuk (vulnus punctum)
● Luka bakar (combustio)
● luka tembak (Vulnus sclopetorum)
TRAUMA JARINGAN KERAS

Lower Face/Mandibula: paling sering pria

OTOT MASTIKASI
1. M. temporalis: elevasi dan retraksi
2. M. masseter: elevasi dan protraksi
3. M. medial pterygoid: elevasi, retraksi dan
excursion
4. M. lateral pterygoid: depresi dan protrusi
5. M. digastricus: depresi
LOKASI FRAKTUR MANDIBULA

Anterior Body Midbody Posterior Body

Cenderung tidak stabil Bagian yang stabil dari Tidak stabil karena dekat
karena canine dan corpus mandibula angulus
premolar root
KLASIFIKASI FRAKTUR
1. Simple fracture
2. Comminuted fracture
3. Segmental fracture
4. Bone defect fracture
5. Edentulous mandible
DIAGNOSIS
ANAMNESIS
Riwayat dan mekanisme trauma
■ Nyeri
■ edema
■ deformitas mandibula
■ Perdarahan maloklusi
■ trismus
■ unstable mandibula
■ luka terbuka
DIAGNOSIS
PEMERIKSAAN FISIS
1. Palpasi bimanual: menggerakan dengan 1 tangan ke atas dan 1 ke bawah
2. Nyeri tekan preaurikular: Fraktur kondilus

PEMERIKSAAN PENUNJANG
Radiologi:
■ Foto panoramic/OPG: tidak bisa dilakukan jika pasien tidak sadar
■ Skull X-ray
■ CT Scan bone window + 3D reconstruction
 TATALAKSANA
1. Observasi
- indikasi observasi: non displaced, non mobile, gigi geligi stabil--> pasien tidak boleh
mengunyah dan menjaga kebersihan gigi
1. Reduksi tertutup
- Indikasi: non displaced, memungkinkan untuk pasien dewasa—>pasang wire atau arch
bar, 6 minggu
1. Reduksi terbuka
- Indikasi: Displaced fracture, non compliance patient (sprt anak”, sulit diatur), simple
fraktur, comminuted fraktur—> gigi harus oklusi (gigi molar 1 atas dan bawah sejajar),
baru bisa pasang plat
Setelah operasi:
- diet cair, tidak boleh mengunyah sampai 6-8 minggu
- jaga oral hygiene
- Fisioterapi: latihan buka tutup mulut
TRAUMA JARINGAN KERAS

Midface/sepertiga tengah wajah

MIDFACE FRACTURE
Le fort fracture: bilateral maxillar fracture

LeFort 1 LeFort 2 LeFort 3

Fraktur horizontal, garis Fraktur piramidalis. Dari Fraktur di sutura

fraktur mendatar di pterigoid- rima orbita Frontonasal dan
pterigoid inferior, nasal dan sisi zygomaticum
sebelahnya
MIDFACE FRACTURE
Zygomaticomaxillary Fractur

Orbital fracture

Palatal fracture
DIAGNOSIS
ANAMNESIS
Riwayat dan mekanisme trauma
■ Nyeri
■ edema
■ perdarahan subkonjungtival
■ penglihatan ganda
■ gerak bola mata terbatas
■ mata tenggelam-> fraktur orbital floor
■ wajah asimetris
■ perdarahan oronasal
■ maloklusi
■ luka terbuka
DIAGNOSIS
PEMERIKSAAN FISIS
1. Palpasi-> krepitasi dan nyeri.
di Rima orbita sup dan inf., nasal,zygomaticum, le fort 1(zygoma dan apertura piriformis), le
fort 2(nasal dan rima orbita inf), le fort 3(fronto zygoma dan frontonasal

PEMERIKSAAN PENUNJANG
Radiologi:
■ Skull X-ray
■ CT Scan bone window + 3D reconstruction
 TATALAKSANA
1. Observasi
- Jarang dilakukan karena sering terjadi maloklusi dan compliance pasien buruk
1. Reduksi tertutup
- transmolar wiring
1. Reduksi terbuka

Setelah operasi:
1. diet cair, dilarang mengunyah 6-8 mgg
2. oral hygiene
3. fisioterapi: latihan buka tutup mulut
TERIMA
KASIH
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 01
ABOUT THE
DISEASE
You can enter a subtitle here if you need it
ABOUT THE DISEASE

JUPITER MARS VENUS

Jupiter is the biggest planet Mars is a very cold place. It’s Venus has a beautiful name
in the Solar System and the full of iron oxide dust, which and is the second planet from
fourth-brightest object in the gives the planet its reddish the Sun. It’s a terribly hot
night sky cast planet
AWESOME
WORDS
ABOUT THE DISEASE

ABOUT THE DISEASE

CERES PLUTO MERCURY

VENUS MARS NEPTUNE EARTH SATURN

Venus is really a Mars is a very Neptune is far Earth harbors Saturn has many
hot place cold place away from us lots of life rings
PATHOLOGY

VENUS MARS
Venus is the second planet Despite being red, Mars is a
from the Sun very cold place

SATURN JUPITER
Saturn is a gas giant and has Jupiter is the biggest planet
several rings in the Solar System
SYMPTOMS OF THE DISEASE

SYMPTOM 1
Despite being red, Mars is a
cold place. This planet is full
of iron oxide dust

SYMPTOM 2
Jupiter is a gas giant and the
biggest planet in the Solar
System
RISK FACTORS
VENUS RISK
35%
Venus is the second FACTOR 1
planet from the Sun

JUPITER
RISK
It’s the biggest planet
42%
FACTOR 2
of them all

SATURN
Follow the link in the graph to RISK
Saturn is a gas giant modify its data and then paste the 23%
FACTOR 3
and has rings new one here. Click here for info
KEY NUMBERS

50,000 5,000
Mercury is quite a small planet Venus is the second planet from the Sun

20,000 60,000
Despite being red, Mars is a cold place Jupiter is the biggest planet of them all
A PICTURE IS WORTH
A THOUSAND WORDS
923,857
People have suffered from dyslipidemia last year
A PICTURE
REINFORCES
THE CONCEPT
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DIAGNOSIS

MERCURY THE SUN VENUS

Mercury is the closest planet The Sun is the star at the Venus is the second planet
to the Sun center of the Solar System from the Sun

MARS EARTH JUPITER

Despite being red, Mars is a Earth is the third planet from Jupiter is the biggest planet
very cold place the Sun of them all
PREVENTION

HABITS DESCRIPTION M Tu W Th F Sa Su
Mercury is the closest planet
MERCURY to the Sun
X X X X

Venus is the second planet

VENUS from the Sun
X X

Earth is the third planet from

EARTH the Sun
X X

Despite being red, Mars is

MARS actually a cold place
X X X X X
TREATMENT

MERCURY THE SUN

Mercury is the closest planet 01 02 The Sun is the star at the
to the Sun center of the Solar System

MARS EARTH
Despite being red, Mars is a 04 03 Earth is the third planet from
very cold place the Sun
PREVALENCE
VENUS
Venus is the second planet
from the Sun

JUPITER
Jupiter is the biggest planet
of them all

SATURN
Follow the link in the graph to modify its data and then paste the Saturn is composed of
new one here. For more info, click here hydrogen and helium
 CONCLUSION 1 CONCLUSION 2
Mercury is the closest planet to the Sun and Earth is the third planet from the Sun and the
the smallest one in the Solar System only one that harbors life

CONCLUSION 3
Mars is a cold place. It’s full of iron oxide
dust, which gives the planet its red cast
OUR TEAM

JENNA DOE MARK ROE SONIA SMITH

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