Murdani PPT ABD PAIN LIA
Murdani PPT ABD PAIN LIA
Mayer A, Gupta A, Wall Wong Yu Heng.Clinical Perspective on Abdominal Pain: Wall And Melzacks Textbook of Pain.Sixth Edition.
New York: Saunders 2013:734-57
DEFINISI
Suatu sensasi yang tidak
menyenangkan pada abdomen
WHO unpleasant sensory or
emotional experience associated with
actual or potential tissue damage, or
described in terms of such damage.
Greenberger NJ. Chronic and Recurrent Abdominal Pain. 2012: Available from :
http://www.merckmanuals.com/professional/gastrointestinal_disorders/symptoms_of_gi_disorders/chronic_and_recurrent
_abdominal_pain.html
EPIDEMIOLOGI
Mencapai 5-10 % (UGD)
1,5 % (rawat jalan)
dapat terjadi pada semua umur dan hampir 50% pasien
dewasa pernah mengalami
Perhatian khusus usia tua (di atas 65 tahun),
pasien-pasien immunokompromise dan wanita pada
usia reproduksi
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
Abdullah M.Firmansyah A.M.Diagnostic Approach and Management of Acute Abdominal Pain: Acta Medica Indonesiana- The
Indonesian Journal Of Internal Medicine.2012. Di unduh dari www.indoactamedika.com pada tanggal 17 Februari 2014.
ANATOMI DAN PATOSIOLOGI
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014
:223-31
1.Nyeri viseral
2.Nyeri somatik
3.Referred pain
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
REFERRED PAIN
KLASIFIKASI
Nyeri akut Nyeri kronik
Onset cepat Berlangsung > 3 bulan
Mendadak dan dalam Terus menerus atau
hitungan (menit jam) hilang timbul
Dapat terjadi dengan
intensitas yang berat
Sperber AD, Drossman DA. Functional Abdominal Pain Syndrome:constant Or Frequently Recurring
Abdominal Pain. Am J Gastroenterol (2010);105.P.770774.
Etiologi
Abdominal Akut
Penyebab Nyeri Abdomen Akut
Kolik Renal
Abdullah M. Nyeri Perut. In : Setyohadi B, Arsana PM, Suryanto A, Soeroto AY, Abdullah M. EIMED PAPDI Kegawatdaruratan Penyak it
Dalam. Edisi Ke-2. Jakarta: Internapublishing 2012: 447-54
ETIOLOGI
ABDOMINAL KRONIK
DIAGNOSIS LOKASI DURASI FAKTOR2 YANG TANDA DAN LABORATO- FAKTOR2 EKSTA ABDOMEN,
/SUMBER MEPERBERAT RIUM YANG MENDUKUNG PSIKOSOSIAL KO-MORBID, ATAU
ATAU DIAGNOSIS LAINNYA
MERINGANKAN
Inflamasi
Refluks Esofagitis erosive Epigastrium atau Berat : Persisten Diperberat dengsn Acid brash Drug riwayat: Tidak ada Extra-esogafus: asthma,
retrosternal, Diffus Ringan : remit posisi NSAID, alendronate, CCB, laringitis, sore throat,
terlentang,makana - and -blockers, recurrent bronchitis atau
anticholinergics, tricyclics pneumonia, batuk kronik,
dental erosions, sinusitis
Co-morbid or other:
scleroderma, diabetes
mellitus, ZollingerEllison
syndrome, obesitas,
pregnancy
Functional dyspepsia Kuadran kanan atas, Remits atau relaps Dipicu oleh makanan, Muntah, bloating, normal Hb Anxietas, depresi, early Extra-abdominal: backache,
epigastrium, or kuadran stress and WCC life stress headache
kiri atas; diffus or local Komorbid: irritable bowel
(tergantung subtipe) syndrome (IBS)
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
DIAGNOSIS
P3 : Positional, palliating, and provoking
factors
Q : Quality
R3 : Region, radiation, referral
S : Severity
T3 : Temporal factors
Macaluso CR, McNamara RM. Evaluation and Management of Acute Abdominal Pain in the Emergency
Department. International Journal of General Medicine (2012);5.p.789-797.
ANAMNESIS
Lokasi nyeri
Intensitas
Durasi dan Progresivitas Nyeri
Faktor pencetus dan pereda
Gejala Tambahan
Anoreksia
Gejala usus lainnya
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
Macaluso CR, McNamara RM. Evaluation and Management of Acute Abdominal Pain in the Emergency Department. International Journa l of
General Medicine (2012);5.p.789-797
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
PEMERIKSAAN FISIK
Pemeriksaan Abdomen
Pemeriksaan peritonitis
Pemeriksaan Panggul
Pemeriksaan Rektum
Abdullah M. Nyeri Perut. In : Setyohadi B, Arsana PM, Suryanto A, Soeroto AY, Abdullah M. EIMED PAPDI
Kegawatdaruratan Penyakit Dalam. Edisi ke-2. Jakarta: InternaPublishing 2012: 447-54
Macaluso CR, Mcnamara RM. Evaluation And Management Of Acute Abdominal Pain In The Emergency
Department. International Journal Of General Medicine (2012);5.P.789 -797
PEMERIKSAAN
PENUNJANG DIAGNOSTIK
Laboratorium
Radiologi
Ultrasonografi (USG)
Endoskopi
CT scan
Angiografi
1. Abdullah M. Nyeri Perut. In : Setyohadi B, Arsana PM, Suryanto A, Soeroto AY, Abdullah M. EIMED PAPDI Kegawatdaruratan
Penyakit Dalam. Edisi ke-2. Jakarta: InternaPublishing 2012: 447-54
2. Macaluso CR, McNamara RM. Evaluation and Management of Acute Abdominal Pain in the Emergency
Department. International Journal of General Medicine (2012);5.p.789 -797.
Macaluso CR, Mcnamara RM. Evaluation And Management Of Acute Abdominal Pain In The Emergency Department.
International Journal Of General Medicine (2012);5.P.789 -797.
Sperber ad, drossman da. functional abdominal pain syndrome:constant or frequently recurring abdominal pain. am j gastroenterol
(2010);105.p.770774.
POPULASI KHUSUS
Wanita
Usia tua
Cartwright SL, Knudson MP. Evaluation of Acute Abdominal Pain in Adults. Am Fam Physician
(2008);77(7).p.971-978
Cartwright SL, Knudson MP. Evaluation Of Acute Abdominal Pain In Adults. Am Fam Physician (2008);77(7).P.971-978.
TATA LAKSANA
ABDOMEN AKUT
Tentukan kasus bedah atau bukan
Analgetik sebagai terapi awal dapat menurunkan rasa nyeri tanpa harus mengaburkan
diagnosis.
Analgetik yang biasa diberi berupa opioid
1.Daldiyono, Syam AF. Nyeri Abdomen Akut. In: Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S. Buku Ajar Ilmu Penyakit Dalam.
Edisi ke-5, Internapublishing 2009: 474-76
2. Cartwright SL, Knudson MP. Evaluation of Acute Abdominal Pain in Adults. Am Fam Physician (2008);77(7).p.971-978 .
Pada pasien tidak stabilprinsip
resusitasi tetap dilakukan
Nyeri abdomen akut yang berat harus
ditatalaksana dengan segera
Operasi ruptur viskus, ruptur
aneurisma aorta abdominalis, infark
usus, apendisitis dan obstruksi usus
total
Spears CD, Boulanger BR, Reddy S. Abdominal Pain. In: Griffith CH, Hoellein AR, Feddock AC, Harrell HE. First Exposure Intern al
Medicine: Hospital Medicine. New York: Mcgrawhill 2007: 171-79
Obstruksi parsial diobservasi dan dapat diatasi
dengan mengistirahatkan usus dan
dekompresi
Volvulus sigmoid dapat dikurangi dengan
sigmoidoskopi
Divertikulitis berkurang dengan
mengistirahatkan usus dan pemberian
antibiotik spektrum luas
Spears CD, Boulanger BR, Reddy S. Abdominal Pain. In: Griffith CH, Hoellein AR, Feddock AC, Harrell HE. First Exposure
Internal Medicine: Hospital Medicine. New York: Mcgrawhill 2007: 171-79
Tranfusi darah
Bedside ultrasonografi dapat di
gunakan untuk mendeteksi secara
cepat pasien-pasien dengan cairan
bebas intraperitoneal, volume
cairan dan kelainan yang terjadi
pada aorta
Fauci AS, Kasper DL, Longo DL, Braunwald E, Lauser SL, Jameson JJ, Et Al. Abdominal Pain. Harrison's Principles Of Internal Medicine.
Edisi Ke18. New York: Mcgrawhill 2012: 233-39.
Nyeri abdomen kronik
Kompleks dan multidisiplin
Non- Farmakologis dan Farmokologis
Sperber AD, Drossman DA. Functional Abdominal Pain Syndrome:constant Or Frequently Recurring Abdominal Pain. Am J
Gastroenterol (2010);105.P.770774.
Chronic Abdominal Pain Algorithm. Mc Graw Hill Companies.2013
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014 :223-31
Colucciello Colucciello SA, Lukens TW, Morgan DL. Assessing Abdominal Pain In Adults: A Rational, Cost -Effective, and Evidence-
Based Strategy. International Journal of General Medicine (2012);5.p. 789 97
Colucciello Colucciello SA, Lukens TW, Morgan DL. Assessing Abdominal Pain In Adults: A Rational, Cost -Effective, and Evidence-Based Strategy.
International Journal of General Medicine (2012);5.p. 78997
Colucciello Colucciello SA, Lukens TW, Morgan DL. Assessing Abdominal Pain In Adults: A Rational, Cost -Effective, and Evidence-Based Strategy.
International Journal of General Medicine (2012);5.p. 78997
Budhramand, R.Gavin, N.Rimon, Abdominal Pain: Rosenss Emergency Medicine. Eight Edition.New York : Saunders 2014
:223-31