PENGKAJIAN UMUM PADA

SISTEM DIGESTIV (PENCERNAAN )

Diisusun oleh
Ns. Tuti Sulastri. S.Kep.M.Kep
A. ANATOMI & FISIOLOGIS SISTEM PENCERNAAN
1. KELENJAR SALIVA
PRODUKSI :
 ISTIRAHAT : s/d 0.3 ml/mnt
 TERSTIMULASI : 1.7- 2.1 ml/mnt
 TOTAL /HARI (24jam) : 500 – 1000 ml .

SALIVA DIMULUT BERSIFAT

HYPOTONIK DAN MENGANDUNG 99 % AIR.
2. KOMPOSISI SALIVA
 K. PAROTIS (asinus cerosa) ; saliva mengandung
protein , kaya elektrolit, enzim amilase agak
encer.
 K. SUBLINGUAL (asinus musinosa), saliva
mukus kental, antibodi dan antigen, protein dan
kabohidrat.
 K. SUBMANDIBULA (campuran cerosa dan
musinosa), elektrolit, enzim dan sel ekskresi
mukus.
 K. SALIVA MINOR sebagian besar asinus
musinosa.
 PROSES MAKANAN DI GI
FASE SEFALIK
MULUT
(Dimastikasi yg dicampur dgn sekresi saliva)
Mekanik
FASE VOLUNTER
FASE TDK VOLUNTER (RESPON REFLEK)
DISYARAFI N. IX & X
SFINGTER ESOFAGUS ATAS

Esofagus

Peristaltis
Sfigter esofagus bawah

Didorong 25 cm ke lambung (5”)

 FASE LAMBUNG
Fase lambung 3 jam
Protein dipecah
Polipeptida oleh enzim pepsin (pepsinogen) oleh cheif
mukosa lambung

Kimus (kental sprt lumpur)

Sfingter pilorus

duodenum
 Kimus msh bersifat asam
Dinetralkan oleh HCO3 (bicarbonat)----- sekresi
dr sel pankreas, empedu dr hati
Proses kimiawi oleh enzim2 hati dan usus.

1.5 l kimus memasuki usus besar melalui sfigter

ileocaecal (haustral shuttling)

Diabsorbsi sampai 150 gram feces 100 air dan

50 solid (20 jam) bila sudah penuh
Reflek defekasi
B. Pengkajian Lanjut Sistem Pencernaan
PRINSIP PENGKAJIAN
• Head to toe
• Menggunakan semua Indera
• Subyektif – Obyektif
• Memahami Anatomi, fisiologi, Pathofisiologi
sistem
 Digestive Problems
• Peptic Ulcer
• Gatric/ Colon Cancer
• Bowel obstruction
• Inflamatory bowel disease
• Appendicitis
• Cirrhosis Hepatis
• etc
• Right Hypochondriac
• Right lobe of liver
• Gallbladder
• Portion of duodenum
• Hepatic flexure of colon
• Portion of right kidney
• Suprarenal Gland
• Right Lumbar
• Ascending colong
• Lower half of right kidney
• Portion of duodenum and jejunum
• Right Inguinal
• Cecum
• Appendic
• Lower end of ileum
• Right ureter
• Right spermatic cord
• Right ovary
• Epigatric
• Pyloric end of stomach
• Duodenum
• Pancreas
• Portion of liver
• Umbilical
• Omentum
• Mensentery
• Lower part of duodenum
• Jejunum and ileum
• Hypogastric (Pubic)
• Ileum
• Bladder
• Uterus (in pregnancy)
• Left Hypochondriac
• Stomach
• Spleen
• Tail of pancreas
• Splenic flexure of colon
• Upper pole of left kidney
• Suprarenal gland
• Left Lumbar
• Descending colon
• Lower half of left kidney
• Portion of jejunum and ileum
• Left Inguinal
• Sigmoid colon
• Left ureter
• Left spermatic cord
• Left ovary
• Stand at the end of the bed

• STOP
• Look for a few seconds
• Show you are looking around the bed
• Oxygen
• Catheters generaly
• Drains cathetik
• Fluids joundic Dressings pallor
• Position joundic
• Comfortable? Brusing
Inferior venacaval obstruction Superior v.c obstruction
Perbedaan acites

Markedly enlarged gall bladder

(labeled "GB
Umbilical Hernia
• Palpasi ringansemua kwadran,tidak lebih dari 1 cm, HYD :
abdomen terasa lembut dng konsistensi lunak

• Palpasi sedang side hand, terutama u/ mengkaji liver dan lien

• Palpasi dalam back and forth, bisa teraba rectus abdominis

muscles, aorta dan colon, massa

Bimanual technique
 • ABDOMEN
• PALPATE ORGANS
Liver
RUQ
Define upper and lower borders by percussion
Surface texture?
Spleen
LUQ ?ask patient to roll towards you
Percuss ?extent & surface texture
Kidneys
Ballot
R side then L side
?CAPD ?Dialysis ?Transplant
Aortic Aneurysm
?expansile pulsation ?size ?examine fem/pop pulses
 PALPASI HEPAR
• Letakkan ta.kiri dibawah tulang iga no.11 atau
12, tekan ke atas agar liver mengarah ke
dinding abdomen
• Ta.kanan sejajar dengan SIAS,pararel dengan
margin tulang iga,lalu tekan menuju hati, in
and up, sementara anjurkan klien anda u/
deep breathing dan mengembung –
kempiskan perut
 Palpasi gallbladder
Tenderness  cholecystitis, enlargement  duct obstruction
Palpasi spleen
Yakinkan bahwa anda mempalpasi tepat dibawah costal margin ( perhatikan gambar di bawah ini )
 ABDOMEN
MASSA
• Size
• Site
• Shape
• Surface ?Fixed
• Edge
• Consistency
• Percussion note
• Bruit/bowel sounds
 PERKUSI
• Tujuan :
ukuran dan densitas organ abdomen
mendeteksi cairan,
udara, massa

Normal : tympani
Massa, cairan  pekak
 UNTUK MEMERIKSA ACITES
• Shifting Dullness
Percuss centrally then to each flank
Locate point of change on R side
Ask patient to roll towards you
Wait….
Percuss again ?area of dullness moved
• Fluid Thrill

?use patients hand in midline

Flick one side and feel the other side
 TEST APENDIX
The obturator sign. Pain on passive internal
rotation of the flexed thigh. Examiner moves
lower leg laterally while applying resistance to
the lateral side of the knee (asterisk) resulting
in internal rotation of the femur
Anatomic basis for the obturator sign:
inflamed appendix in the pelvis is in
contact with the obturator internus
muscle, which is stretched by this
maneuver