Oleh
dr. Rahmi Faridah Azzahro
RSUD Waled Kabupaten Cirebon
Identitas
Nama :Tn. T
Umur : 58 tahun
Jenis Kelamin : Laki-laki
Alamat : Karangwareng
Pekerjaan : Wiraswasta
Agama : Islam
Status Perkawinan : Menikah
Tanggal Pemeriksaan : 11 September 2017
No. RM : 840360
Anamnesis
Keluhan Utama: Benjolan yang keluar dari anus
- Riwayat Alergi :
- Diabetes Melitus:
disangkal Tidak diketahui
- Riwayat Sembelit : (+) - Hipertensi: Tidak
diketahui
- Alergi: Tidak diketahui
Pemeriksaan Fisik
Status Lokalis
Kesadaran : Composmentis
Keadaan umum : Tampak sakit sedang
Tanda-tanda vital: Tekanan darah : 130/80
mmHg
Nadi : 84x/menit
Respirasi : 22x/menit
Suhu : 37.0C
Lanjutan..
Status Generalis:
Abdomen :
c. Perkusi : Timpani
Diagnosis banding:
Karsinoma kolorektum
Divertikel kolon
Polip rekti
Penatalaksanaan Awal
Cefuroxime 750 mg/ 8 hr
Ketorolac 30 mg/ 8 hr
Rencana Hemoroidektomi
Follow up pasien
12/9/2017
O:
Suhu : 36,5C -Td: 110/70 mmHg
Nadi : 70x/mnt - KU : Baik, CM
RR : 16x/mnt
Kepala : CA -/-, SI-/-,
Thorax : Simetris, Retraksi (-) Ketinggalan gerak (-) Sonor +/+ Vesikuler +/+,
S1/S2 reguler, Bising (-)
Abd : Supel, BU (+) Normal, Timpani (+)
Eks : akral hangat, edema ekstremitas superior-/-, Inferior -/-
Status lokalis: tampak luka pos op terpasang tampon kasa, darah + 30 cc
A : post hemorroidektomi
O:
Suhu : 36,5C -Td: 110/70 mmHg
Nadi : 70x/mnt - KU : Baik, CM
RR : 16x/mnt
Kepala : CA -/-, SI-/-,
Thorax : Simetris, Retraksi (-) Ketinggalan gerak (-) Sonor +/+ Vesikuler +/+, S1/S2
reguler, Bising (-)
Abd : Supel, BU (+) Normal, Timpani (+)
Eks : akral hangat, edema ekstremitas superior-/-, Inferior -/-
Status lokalis: tampak luka pos op, darah-, nanah -
A : post hemorroidektomi
Cefadroxil 2x500mg
Prognosis
Quo Ad Vitam: Bonam
Quo Ad Functionam: Bonam
Quo Ad Sanationam: Dubia ad bonam
TINJAUAN
PUSTAKA
Hemorrhoids
18
Classification
Grade I: May bulge into the lumen but do not
extend below the dentate line.
Grade II: Prolapse out of the anal canal with
defecation or with straining but reduce
spontaneously.
Grade III: Prolapse out of the anal canal with
defecation or straining, and require the patient
to reduce them into their normal position.
Grade IV: Irreducible and may strangulate.
19
Bleeding
Painless bleeding usually associated with a bowel movement.
Bright red blood coats the stool at the end of defecation.
Blood may drip into the toilet or stain toilet paper.
Chronic blood losses from hemorrhages can be substantial
enough to induce iron deficiency anemia.
Bleeding should be investigated:
Flexible sigmoidoscopy or anoscopy in low-risk younger
patients
Colonoscopy
20
Pruritus
Irritation or itching of perianal skin
Some patients also complain of mild incontinence or
wetness.
21
Pain
Thrombosis, which can occur in both internal and
external hemorrhoids. Thrombosis of external
hemorrhoids may be associated with excruciating pain.
22
Therapy:
American Society of Colon and Rectal
Surgeons (ASCRS) Guidelines
Conservative (not generally effective in Grades III, IV)
Fiber
Meta-analysis of seven controlled trials found a significant
and consistent benefit from fiber supplementation in
improving bleeding (RR 0.50, 95% CI 0.28-0.68)
Also potentially useful:
Sitz baths
help to relieve irritation and pruritus. In warm water two to
three times per day.
Topicals
Steroids
24
Therapy
Surgery
For refractory to above
Thrombosed external
Complications following a standard closed hemorrhoidectomy
include urinary retention, urinary tract infection, fecal impaction,
delayed hemorrhage, and pain
25
Therapy
In patients with thrombosed external hemorrhoids
Either observation or excision. Excision within 48 to 72 hours of
the onset of symptoms will result in the most rapid relief of
symptoms.
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THANK YOU