AKUT ABDOMEN

DIVISI BEDAH DIGESTIF

BAGIAN ILMU BEDAH
FK. UNAIR SURABAYA
 AKUT ABDOMEN

NON TRAUMATIK
AKUT PER AKUT
NYERI ABDOMEN
KEADAAN UMUM 6 JAM SURGERY

DO IT RIGHT FROM THE START

 PENYEBAB AKUT ABDOMEN
GARIS BESAR

1. NON SURGICAL (TERMASUK KELAINAN

DILUAR ABDOMEN)
2. PERITONITIS LOKAL / GENERAL
3. OBSTRUKSI GASTRO INTESTINAL
4. PERDARAHAN INTRA / RETROPERITONEAL
5. ISKEMIA / INFARK
6. UROLOGIS - GINEKOLOGIS
 PENYEBAB AKUT ABDOMEN

SEGALA USIA ANAK-ANAK

APENDISITIS INVAGINASI
PERFORASI USUS/LAMBUNG RADANG SALURAN KEMIH
NYERI ABDOMEN NON SPESIFIK HERNIA
(NON BEDAH) RADANG SALURAN NAPAS ATAS
OBSTRUKSI USUS
PANKREATITIS AKUT WANITA
KOLIK GINJAL/ URETER RADANG PELVIS
DYSPEPSIA RADANG SALURAN KEMIH
HERNIA KEHAMILAN EKTOPIK
KOLESISTITIS AKUT/BILIER KISTA OVARIUM

USIA TUA
KANKER
VASKULAR
SEBAB-SEBAB MEDIK
 WORLD ORGANIZATION OF GASTROENTEROLOGY
RESEARCH COMMITTEE ON ACUTE ABDOMINAL
PAIN (1979)

N %
NON SPECIFIC ABDOMINAL PAIN 2623 43.0
ACUTE APPENDICITIS 1476 24.2
ACUTE CHOLECYSTITIS 541 8.9
SMALL BOWEL OBSTRUCTION 292 4.0
RENAL COLIC 209 3.4
PERFORATED PEPTIC ULCER 172 2.8
ACUTE PANCREATITIS 138 2.3
ACUTE DIVERTICULAR DISEASE 128 2.1
ALL OTHER CASES 568 9.8
(GYNAEC + CA COLON)

TOTAL 6097
 NYERI ABDOMEN

SARAF RESEPTOR SPESIFIKASI LOKASI RANGSANGAN

NYERI
VISCERAL S.OTONOM PERITONEUM TAK JELAS (SUKAR SUKAR KEJANG TARIK
VISCERALIS DIJELASKAN) DISTENSI

SOMATIK S. SENTRAL PERITONEUM JELAS JELAS SENTUH

PARIETALIS TAJAM (MENUNJUK) TEKANAN
MENUSUK PANAS
RADANG

REVERSED PAIN
NYERI YANG DIALIRKAN KARENA KONFERGENSI SARAF PADA
TRAKTUS SPINOTALAMIK (EMBRIOLOGIS)
Appendix
Ileum Perforation
Liver Abscess
Gaster Perforation
Others
FORE GUT

MID GUT

HIND GUT
 CAUSES OF HEMOPERITONEUM

GASTROINTESTINAL
TRAUMATIC LACERATION OF LIVER, SPLEEN, PANCREAS,
MESENTERY, BOWEL
GYNECOLOGIC
RUPTURED ECTOPIC PREGNANCY
RUPTURED GRAAFIAN FOLLICLE
RUPTURED UTERUS
VASCULAR
RUPTURED ANEURYSM : AORTOILIAC, HEPATIC, RENAL,
AND SPLENIC ARTERY

UROLOGIC
RUPTURED BLADDER

HEMATOLOGIC
RUPTURED SPLEEN
Z. COPE :

MANY EXAMINATION OF THE ABDOMEN ARE

IMPERFECT BECAUSE THE PRACTITIONER
DOES NOT ACT UPON THE IMPORTANT
PRINCIPLE OF APPLYING HIS KNOWLEDGE OF
ANATOMY
 NYERI KLINIS

KOLIK : RENAL
BILIER
INTESTINAL

RADANG : SEPTIK
KIMIAWI

ISKEMIA
 PROGRES PENYAKIT

PROSES > GEJALA

WAKTU : MIGRATORY PAIN (apendisitis)
EMOSI OBJEKTIF > SUBJEKTIF
OBAT KOSTIKOSTEROID STEROID
ANALGETIKA SPASMOLITIK

DIAGNOSA BELUM PASTI JANGAN ANALGETIKA

 WANITA 24 TAHUN IBU 2 ANAK KECIL
NYERI ABDOMEN 24 JAM
MULAI PUSAT SAMPAI ILIAKA KANAN
TEGANG RLQ + REBOUND PHEN
LEKO 17.000
OPERASI ?

WANITA 18 TAHUN PELAJAR SMU

DIBAWA KE RS DENGAN DUGAAN APENDISITIS AKUT
KELUHAN NYERI PERUT KANAN BAWAH
DEFANS MUSKULER REBOUND PHEN LEKO 7.600
APENDEKTOMI ?
GEJALA KLINIS (PENUNJANG)

MUNTAH
NYERI MUNTAH : APENDISITIS
MUNTAH NYERI : GASTRO ENTERITIS
IKTERUS - HEPATOBILIER
HEMATURIA UROLOGI
OBSTIPASI G I
HAID
DIAGNOSA
DIAGNOSE MUST BE ESTABLISHED IN THE
EARLIEST POSSIBLE STAGE

KLINIS
SOAP

LABORATORIUM - STANDAR
Hb LEKOSIT, HCT,TROMBOSIT FAAL
HEMOSTASIS

BIOKIMIA DARAH (INDIKASI)

AMYLASE
GLUKOSA
KREATININ
FAAL HEPAR
URINE
LENGKAP

RADIOLOGI
ABDOMEN POLOS BERBARING
ABDOMEN POLOS TEGAK/DEKUBITUS
DIAFRAGMA
THORAX

ULTRASONOGRAFI

ELEKTRO KARDIOGRAFI
WAKTU OPTIMAL PEMBEDAHAN

1. TEKANAN VENA SENTRAL STABIL 80 120

mm H2O
2. MINIMAL CAIRAN DEFISIT SUDAH DIGANTI
KOREKSI ELEKTROLIT ABNORMAL
3. URINE 30 50 ml/JAM
4. HCT 36%
5. NASOGASTRIC TUBE
6. OBAT-OBAT