Laporan Kasus

Appendisitis Akut
C H R I S T I N E E V E LY N T
406152009
Identitas Pasien

Nama : Tn. A
Jenis Kelamin : Laki-Laki
Umur : 25 tahun
Anamnesa

KELUHAN UTAMA:
Nyeri perut kanan bawah

KELUHAN TAMBAHAN
Mual
Riwayat perjalanan penyakit

Os datang dengan keluhan nyeri perut kanan bawah sejak kemarin

malam. Nyeri timbul tiba-tiba dan terasa hebat. Nyeri dirasakan terus
menerus saat bergerak maupun beristirahat. Sebelumnya, 2 hari SMRS, os
mengeluh nyeri di ulu hati yang menjalar ke daerah pusat. Keluhan nyeri
perut disertai oleh keluhan tambahan lain seperti Mual (+), muntah (-),
demam (-). BAB & BAK dalam batas normal.
Riwayat Penyakit Dahulu :-

Riwayat Penyakit Dalam Keluarga :-

Riwayat Pemakaian Obat-obatan :-

Pemeriksaan Fisik
Keadaan Umum : Tampak sakit sedang
Kesadaran : Compos Mentis
Tekanan Darah : 110/70 mmHg
Nadi : 72x/menit
RR : 22x/menit
Suhu : 37,3 C
Status Lokalis:
a/r Abdomen:
Inspeksi : datar
Auskultasi : BU (+) Normal
Palpasi : NT (+) di titik McBurney, Rovsing sign (+),
Blumberg sign (+), Psoas sign (+), Defence Muscular (-)
Perkusi : Timpani

RECTAL TOUCHE:
Sphincter kuat
Mukosa licin
Ampula tidak kolaps
Tidak teraba adanya massa
Nyeri pada jam 9-11
RESUME
Seorang laki-laki berusia 27 tahun, datang dengan keluhan nyeri di ulu hati
yang menjalar ke perut kanan bawah sejak 3 hari SMRS. Mual (+).

Dari pemeriksaan fisik didapat NT (+) di titik McBurney, Rovsing sign (+),
Blumberg sign (+), Psoas sign (+).
Diagnosa Banding
Appendicitis Akut
Gastroenteritis
Urolitiasis
 PEMERIKSAAN PENUNJANG

USG Abdomen

Urinalisa
DIAGNOSA KERJA
Apendicitis acute
PENATALAKSANAAN
Appendektomi
 PROGNOSA

Ad vitam : Bonam

Ad fungsionam : Bonam

Ad sanationam : Bonam
PEMBAHASAN
ACUTE APPENDICITIS
Appendix

Immunologic organ secretes IgA

Length <1 cm to >30 cm

usually 6 to 9 cm
Location of the Tip of the Appendix

retrocecal
pelvic
subcecal
preileal
right pericolic
Incidence

Most frequently seen in patients in their 2nd 3rd decades of life 8.6% for
males and 6.7%
for females.
Etiology
Obstruction of the lumen
-Fecaliths
-Lymphoid hyperplasia

Less common etiology

Hypertrophy of lymphoid tissue
Tumors
Vegetables and fruit seeds
Intestinal parasites
PATOGENESIS

Obstruksi lumen (fekalit, tumor, dll)

Mukus yg diproduksi akan mengalami bendungan

Peningkatan tekanan intra lumen/ dinding apendiks

Aliran darah berkurang

Edema dan ulserasi mukosa Apendisitis akut fokal

Terputusnya aliran darah Nyeri epigastrium

 Obstruksi vena, edema bertambah dan bakteri menembus dinding

Peradangan peritoneum Apendisitis supuratif

Aliran arteri terganggu
Nyeri di daerah
kanan bawah
Infark dinding apendiks

Gangren

Dinding apendiks rapuh
Infiltrat Perforasi

Infiltrat apendikularis Apendisitis perforasi
 Sequence of events

Occlusion of the lumen

Closed Loop Obstruction
Distension
Vascular Congestion
Serosal inflammation
Gangrene
Perforation
Pathology Sequence of events

Occlusion of the lumen

1.Closed loop obstruction caused by
proximal obstruction
2.Distension result of continued secretion
by mucosa
nerve endings of visceral afferent nerves
are stimulated
vague, dull, diffuse pain in the
midabdomen
crampy pain
3. Vascular congestion venous
pressure is exceeded as a result of
continued distension due to mucosal
secretion and rapid multiplication of
bacteria Nausea and vomiting

4. Serosal inflammation
right lower quadrant pain
Bacteriology
Escherischia coli, Bacteroides fragilis
Antibiotics = 24 to 48 hours,
nonperforated
7 to 10 days, perforated

Shift of IV antibiotics to Oral

1.WBC is NORMAL
2.Afebrile for 24 hours
SYMPTOMS

Abdominal Pain
Appendicitis usually starts with periumbilical and diffuse
pain that eventually localizes to the right lower quadrant.

Gastrointestinal symptomps
-Nausea
-Vomiting
-Anorexia
symptomps
ANOREXIA

Abdominal Pain initially at the epigastrium then

localizes to the right lower quadrant

Vomiting
Clinical SIGNS
(anatomic position of the inflammed area and ruptured or not)

Uncomplicated Appendicitis
Vital signs are minimally changed
Lie supine with right thigh flexed
Slow movement with caution
Clinical SIGNS

Right Lower quadrant Physical Signs

diminished bowel sounds
Maximal tenderness at McBurneys Point
Direct rebound tenderness
Rovsings Sign
Cutaneous hyperesthesia (T10,T11,T12)
Muscle Guarding
resistance to palpation is dependent on
severity
McBurneys Point
Signs to elicit
1. Pointing Sign/direct tenderness
2. Rovsings Sign
3. Psoas Sign
4. Obturator Sign
 Diagnosis
Laboratory
1. CBC
Acute, Uncomplicated
10,000 to 18,000 WBC with predominance of PMNs
>18,000 WBC = Perforated Appendix?
2. Urinalysis
3. Imaging Studies
Imaging Studies

Plain Film of Abdomen rarely helpful

Barium enema
Ultrasound Graded Compression Sonography
+ noncompressible appendix 6 mm or greater in the
A-P direction
+ appendicolith
+thickened appendiceal wall with
periappendiceal fluid
CT-Scan
Differential Diagnosis

Gynecologic Disorders
Pelvic Inflammatory Disease
Ruptured Graafian Follicle
Twisted Ovarian Cyst
Ruptured Ectopic Pregnancy
Acute Gastroenteritis
Meckel's Diverticulitis
Crohn's Disease
Medical Treatment
Adequate hydration should be ensured
Electrolyte abnormalities should be corrected
Pre-existing cardiac, pulmonary, and renal conditions
should be addressed
Most surgeons routinely administer antibiotics to all
patients with suspected appendicitis.
simple acute appendicitis - antibiotic coverage within
24hrs
perforated or gangrenous appendicitis -antibiotics are
continued until the patient is afebrile and has a
normal WBC
single-agent therapy with cefoxitin or cefotetan
 Surgical Management

1. Open Appendectomy
2. Laparoscopic
Perforated Appendicitis

Must receive fluid resuscitation

IV antibiotics
Operated by open method or
laparoscopic approach
Antibiotics for 7 to 10 days or until
afebrile with normal wbc
Post-operative Complications

Infection - most common complication after surgery

2 common sites of infection
1. Subcutaneous wound
2. Abdominal cavity

- Infection rate for uncomplicated appendicitis < 1

%
- Incidence of intra abdominal abscess < 1 %
Daftar pustaka

Mike K Liang, Roland E Andersson, Bernard M, David H: The

Appendix, Schwartsz Principles of Surgery 10th Ed, page 1243-
1257.