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APPENDISITIS AKUT

Pembimbing:
dr. Ari Jaka, SpB

KEPANITERAAN ILMU KESEHATAN BEDAH

RUMAH SAKIT UMUM DAERAH RAA SOEWONDO PATI
FAKULTAS KEDOKTERAN UNIVERSITAS TARUMANAGARA
JAKARTA
IDENTITAS PASIEN
Nama Lasiyanto
Tanggal lahir 12 -04 - 1965
Umur 52 thn 9 bulan
Jenis kelamin Laki - laki
Status kawin
Agama islam
Pendidikan -
Alamat sumbermulyo 5/2
Penjamin Bpjs pbi
ANAMNESIS
 KELUHAN UTAMA : Nyeri perut kanan bawah
 RPS : Pasien datang dari igd dengan keluhan nyeri perut kanan bawah sejak 1 minggu lalu,
nyeri dirasakan seperti tertusuk-tusuk, nyeri tidak menjalar, hilang timbul biasanya nyeri
dirasakan berjam2. Pasien juga mengeluh sesak saat bernafas disertai batuk sejak 1 mggu lalu,
sesak hilang timbul apabila sedang batuk, batuk berdahak warna putih bening. Pasien tidak
ada keluhan mual, muntah, pusing dan demam, namun minggu lalu pasien pernah mengalami
demam. Bab dan bak dbn
 RPD : pasien tidak pernah mengalami keluhan serupa, tidak pernah ada riw operasi, Pasien
punya riwayat asma dari kecil, tidak ada DM dan HT
 RPK : tidak ada keluhan serupa
STATUS GENERALIS
 Keadaan umum : Tampak sakit sedang, lemah,
terpasang DC
 Kesadaran : Compos mentis
 Tanda vital
 Tekanan darah : 120/70 mmHg
 Nadi : 102 x/menit, reguler, isi cukup
 Respirasi : 18x/menit
 Suhu : 36.70C
PEMERIKSAAN FISIK
 Kepala : Normocephale
 Mata : CA (-/-), SI (-/-), pupil isokor, refleks pupil +/+
 Hidung : Bentuk normal, discharge (-/-), deviasi sept (+)
 Telinga : Bentuk normal, otorea (-/-)
 Leher : Pembesaran KGB (-), JVP tidak meningkat
 Thorax :

 Cor: Inspeksi : Ictus cordis tidak tampak

Palpasi : Ictus cordis teraba di ICS 5 linea midklavikula
sinistra

Perkusi : Redup, batas jantung normal

Auskultasi : Bunyi jantung I & II normal, reguler,
cepat, Murmur (-), gallop (-)
  Pulmo : Inspeksi : Simetris kiri-kanan
Palpasi : Stem fremitus sama kuat, krepitasi (-)
Perkusi : Sonor di seluruh lapang paru
Auskultasi : SDV (+/+), rhonki (-/-), wheezing (+/+)
 Abdomen: Inspeksi : Datar (+), distensi (-)
Auskultasi : Bising usus (+) normal
Perkusi : Timpani (+)
Palpasi : Supel, nyeri tekan regio kanan bawah (+), teraba
massa di regio kanan bawah 5x4x3cm, Blumberg sign (+),
rovsing sign (+), psoas sign (+), obturator sign (+)
RT : Tonus spinter ani baik, Sulcus medianus teraba, Ampula tidak prolaps,
Mukosa licin, Lobus lateralis licin, benjolan -, NT + lobus lateralis kanan jam 10
dan 11, Pada handscoon darah-, fesses+
PEMERIKSAAN PENUNJANG
Parameter Nilai Unit Nilai normal
Hematologi Analyzer
Jumlah leukosit 17,4 ↑ 103/uL 3,8 – 10,6
Jumlah eritrosit 5,68 106g/dL 4,7 - 6,1
Haemoglobin 16,1 g/.dl 13,2 – 17,3
Haematokrit 45,1 % 40 -52
MCV 79,4 ↓ fL 80 - 100
MCH 28,3 pg 26 - 34
MCHC 35,7 % 32 - 36
Jumlah Trombosit 314 10 3/ul 150 - 400
RDW-SD 39,7 fL 35 – 47
RDW-CV 13,8 % 11,5 – 14,5
MPV *0000 fL 6.8 – 10.0
P-LCR *0000 % 6,8 – 10,0
PDW *0000 fL 9,0 – 13,0
 Parameter Nilai Unit Nilai normal
Hitung Jenis
Netrofil 79,20 ↑ % 50.0 – 70.0
Limfosit 10,60 ↓ % 25.0 – 40.0
Monosit 9,70 ↑ % 2.0 – 8.0
Eosinofil 0,30 ↓ % 2–4
Basofil 0.20 % 0–1

APTT 29,0 detik 20,0 - 40,0

Kontrol 32,4 detik
PT 15,0 ↑ detik 10 - 14
INR 1,14 detik
 Parameter Nilai Unit Nilai normal
Hematologi Klinik
GulaDarah Sewaktu 87 mg/dl 70 - 160
SGOT 38,5 ↑ U/L < 35
SGPT /ALAT 48,2 ↑ U/L < 45
Ureum 24,6 mg/dl 10 - 50
Creatinin 0,83 mg/dl 0 ,60 – 1,20
Natrium Darah 135,4 mmol/L 135 - 155
Kalium Darah 3, 74 mmol/L 3,6 – 5,5
Chlorida Darah 99,4 mmol/L 95 - 108
Sero Imunologi
HBsAg Non Reaktif
RESUME
 Pasien datang dari igd dengan keluhan nyeri perut kanan bawah sejak 1 minggu lalu , nyeri
seperti tertusuk-tusuk, hilang timbul , disertai keluhan sesak dan batu berdahak kental warna
putih, dan mempunyai riw asma
 Pemeriksaan fisik didapatkan pada auskultasi pulmo wheezing +/+, pada palpasi abdomen
didapatkan nyeri tekan regio kanan bawah (+), teraba massa di regio kanan bawah 5x4x3cm,
Blumberg sign (+), rovsing sign (+), psoas sign (+), obturator sign (+), pada RT didapatkan
nyeri tekan pada jam 10 dan 11 pada lobus lateral kanan.
 Pemeriksaan penunjang di dapatkan leukositosis, peningkatan netrofil dan monosit, PT, SGPT,
dan SGOT dan penurunan limfosit dan eosinofil.
DIAGNOSIS KERJA
 Abdominal pain ec susp periapendicular infiltrat
PENATALAKSANAAN
 Awasi KU
 USG Abd
 Inj cefoperazon 1gr/12jam
 Ranitidine 50mg/12jam
 Pamol 50mg/8jam
PROGNOSIS
 Quo ad vitam : dubia
 Quo ad functionam : dubia
 Quo ad sanationam : dubia
 APPENDICITIS
Inflammation & obstruction of the vermiform appendix

http://www.privatehealth.co.uk/EasysiteWeb/getresource.axd?AssetID=2683&amp;type=full&amp;servicetype=inline&amp;customSizeId=0
 EPIDEMIOLOGY
 In USA > 250.000 appendectomies/year that has been done & it is the common abdominal
emergency surgery

 Predilection of age is 5-30 years old

 < 2 years old  its incidens is 70-80% for perforation & the common peritonitis because of
the delaying diagnostic
 ETIOLOGY
 Mucosal ulceration
 Fecal mass (fecalith or appendicolith)
 Vegetable matter or seeds
 Stricture (lymphoid hyperplasia, neoplasm)
 Infection (parasite)
 PATOPHYSIOLOGY
Mucus, stool (fecalith or Necrosis
I
appendicolith), lymphoid hyperplasia, f
vegetable matter or seeds, neoplasm
or parasites The blood supply to Reduced Perforation
the appendix is cut
blood flow
off
Appendicular Peritonitis
Inflammation abcsess

Obstructs the Obstruction of Pressure in

appendix mucus outflow appendix
increases

Multiplying bacteria,
Restricting blood flow inflammation and Appendix
to the organ pressure continue to contracts
increase

Severe abdominal pain

 SIGNS AND SYMPTOMS
 Aching pain that begins around your periumbilical and often shifts to your lower right
abdomen
 Pain that becomes sharper over several hours
 Tenderness that occurs when you apply pressure to your lower right abdomen
 Sharp pain in your lower right abdomen that occurs when the area is pressed on and
then the pressure is quickly released (rebound tenderness)
 Pain that worsens if you cough, walk or make other jarring movements
 Nausea
 Vomiting
 Loss of appetite
 Low-grade fever ( 37,2-37.8°C)
 Constipation
 Inability to pass gas
 Diarrhea
 Abdominal swelling
 DIAGNOSIS
 Medical history
 Physical examination
 low grade fever
 Pain at Mc Burney’s point
 Rebound tenderness
 Guarding
 Psoas sign +
 DIAGNOSIS
 Urine test to exclude a urinary tract infection
 Blood tests to identify an infectious process → leukocytosis,
neutrophilia shift to the left
 Diagnostic imaging tests, such as CT scans (X-ray tests), ultrasound
(using sound waves) and laparoscopy
APPENDICITIS: PSOAS SIGN
APPENDICITIS: PSOAS SIGN
APPENDICITIS: OBTURATOR
SIGN
Passively flex
right hip and knee
then internally
rotate the hip
ULTRASOUND EXAMINATION
CT-SCAN EXAMINATION
 APPENDICITIS DIFFERENTIAL
DIAGNOSIS Age Group Differential Diagnosis
Infants Pyloric stenosis
Pre-school aged children Intussusception, Meckel’s diverticulitis, acute
gastroenteritis
School-aged children Gastroenteritis, mesenteric lymphadenitis, IBD,
constipation, functional pain
 APPENDICITIS DIFFERENTIAL
DIAGNOSISAge Group
Adult
Women (childbearing years)
Elderly
Differential Diagnosis
Pyelonephritis, colitis, diverticulitis
Pelvic inflammatory disease (PID), tuboovarian
abscess, ruptured ovarian cyst, ovarian torsion
Diverticulitis, bowel obstruction, malignancies of the
GI tract and reproductive system, perforated ulcers,
cholecystitis
 TREATMENT
 Surgical removal (open appendectomy, laparoscopic appendectomy)
 IV fluids and antibiotics (Metronidazole, Gentacimin, Cefotetan, Cefoxitin)
APPENDECTOMY
 COMPLICATION
 Intra-abdominal abscess
 Appendicitis perforation
 Intestinal obstruction
 Incisional hernia
 Peritonitis
 Death
 PROGNOSIS
 If the appendix has not ruptured, recovery is usually quick, and children
usually leave the hospital one or two days after surgery.
 Most children can usually return to normal activities in two to three weeks. If
rupture occurs, the recovery process can be more complicated.
 PREVENTION
 Nutrition : >> fiber (green vegetables, fruits)
 Study : low fiber diet, high in sugar and meat → >> risk of appendicitis
Thankyou :)