AKUT

ABDOMEN
S e t i a w a n Suseno, dr.
Sp.B
Introduction Akut abdomen adalah keadaan yang
memerlukan keputusan segera (FD
Moore, 1977)

1 H a r u s k a h m e n j a l a n i ope r a si ?

B i l a ha rus , k a p a n s e b a i k n y a
2 diop e ra s i?
Definisi
Gawat abdomen (Buku Ajar Ilmu Bedah, 1977)
"Keadaan klinik akibat kegawatan di rongga perut yang biasanya timbul
mendadak dengan nyeri sebagai keluhan utama"

Nyeri abdomen akut: karena keluhan utama

nyeri akut (Nyhus, Vitello, Condon 1995)
 Trik dan tips

Clinical pattern: Therapy options:

• 1. Abdominal pain with • 1. Surgery now
shock • 2. Surgery tommorow
• 2. Generalized peritonitis morning
• 3. Localized peritonitis • 3. Conservative
• 4. Bowel obstruction • 4. Discharge home
• 5. Medical illness

Schein's Common Sense Emergency Abdominal Surgery 2nd Edition

ANATOMI
ABDOMEN
Anterior 9 regio
• Epigastrium
•Hipokondrium dexrra et sinistra
•Umbilical
•Lumbar dextra et sinistra
•Hipogastrium/suprapubc
• Inguinal dextra et sinistra

Pembagian lain: 4 regio

• Kuadran kiri/kanan atas

• Kuadran kiri/kanan bawah
 BATAS
ABDOMEN
Anterior
•Area hexagonal

Superior
•Costal margin dan processus xiphoideus

Lateral
•Midaxillary line

Inferior
•Symphysis pubis, pubic tubercle, inguinal
ligament,anterior superior iliac spine, dan iliac
crest
DINDING ABDOMEN
Otot Dinding
Abdomen
Vaskularisasi
 Mengapa Akut Abdomen menjadi
hal yang luar biasa?

Keluhan utama MENGURANGI

Pasien datang dengan nyeri muncul mendadak Penyebab utama Diagnosis dan MORBIDITAS
abdomen akut: dan baru terjadi belum diketahui tatalaksana segera DAN
(kegawatan) MORTALITAS
Nyeri visceral
• Nyeri Iskemik,
• Nyeri kolik

Nyeri somatik

Nyeri bias (refered pain)

Nyeri abdomen
Saraf Reseptor Spesifikasi Lokasi Rangsangan
Nyeri

Visceral S. Otonom Peritoneum Sukar Sukar Tarikan,

Visceral dijelaskan ditunjuk regangan,
kontraksi
berlebih

Somatis S.Tepi Peritoneum Jelas, Tajam Dapat Rabaan,

Parietalis dan menusuk Ditunjuk tekanan
Referred Pain
Location
 ONS ET
NYERI

Nyeri Nyeri
PAIN PATHOLOGY

Inflamasi Obstruksi Gangguan Masalah Gangguan

peritonium lumen vaskular dan dinding metabolic
general syaraf abdomen
• Medical Illness
Obstruksi usus 》 gangguan keseimbangan cairan 1

Perfo rasi u su s 》 p erit o n it is 2

In feksi 》 sep sis 》 syo k sep sis 3

Perd arah an 》 syo k h ip o vo lem ik 4

Isk em i 》 p erfo rasi 》 5

p erit o n it is
 Severe
unrelenting pain
Stomach tender
to touch
When you should
go to the ER with
Pain extend to
back
Companied by
Fever
abdominal pain??

Bloody urine or
stool
 Introduksi
Anamnesis Keluhan
Pertanyaan terarah dan spesifik

Keluhan utama R i w a y a t p e ny a ki t
“ The Sacred s e ka ra n g

Seven and Pe r ja la na n p e n y a k i t Riwayat kehamilan

Onset, Lokasi dll
Fundamental
dan menstruasi

Four ” Riwayat penyakit

terdahulu
Riwayat operasi
 Principle of History-taking
• Identify the reason for consultation
• Identify the duration and evolution of the
problem
• Recognise the most likely organ or system
affected
• Recall the relevant leading questions
• Select the most likely pathology from a list of
differential diagnoses
Bailey & love, short practice of surgery,26th ed, 2012
 Classic Presentations of Abdominal
Pathology
Obstructive and
Closed-loop obstruction with
inflammatory pathology must
tenderness in the right iliac Caecal cancer classically
be excludedin patients with
fossa is indicative of imminent presents with anaemia
abdominal pain and altered
caecal rupture
bowel habit

Check carefully for small

Patients who have had
incarcerated hernias,
previous abdominal surgery
particularly femoral, in obese
may have adhesions
patients

Bailey & love, short practice of surgery,26th ed, 2012

 Selalu berkorelasi dengan
Anamnesis!

Kesadaran Dehidras Keadaa

Tanda Warna kulit
Pemeriksaan

keadaan i n
vital pucat/ikterus/
umum /syok umum
fisik
Pemeriksaan Fisik
Status generalis
• Keadaan umum

Tanda Vital
• Nadi, Tekanan darah, Pernafasan, Suhu

Status lokalis abdomen:

• Inspeksi, auskultasi,perkusi, palpasi, rectal toucher
Lokalis
abdomen & Rectum

INSPEKSI AUSKULTASI PERKUSI PALPASI RECTUM

Seluruh Colok
kuadran dubur
Distensi abdomen Dimulai dari area Dimulai dari area
Venektasi Ampula recti
bebas nyeri bebas nyeri, hingga
Peristaltik usus Frekuensi kolaps/tidak Teraba
lokasi nyeri
yang terlihat Nada bising masa Feces/darah
usus maksimal
Clinical features of peritonitis
Abdominal pain, worse on
movement, coughing and Pyrexia (may be absent) Raised pulse rate
deep respiration

Tenderness ±
Pain/tenderness on Absent or reduced bowel
guarding/rigidity/rebound
rectal/vaginal examination sound
of abdominal wall,

Systemic inflammatory
response syndrome
(SIRS), multiorgan
dysfunction syndrome
(MODS) in later stages
 PEMERIKSAAN PENUNJANG

LABORATORIUM X-Ray ULTRASONOGRAPI

Pemeriksaa n dasar Kontras

Selektif atas indika si N o n k o n t ra s

Foto Polos Abdomen

■ Pre-peritoneal fat
■ Garis psoas
■ Sebaran gas dirongga abdomen
■ Opaque (batu?)
H GK

GK

Garis psoas
 Step ladder appearance
Multiple air-fluid level

Pelebaran usus oleh

udara
Udara dibawah
diafragma
= pneumoperitoneum H
Left lateral decubitus =
LLD

pneumoperitoneum
 Abdomen distention and

Peritonitis Akut 1
Rigidity
Fever
Dehydration/s hock
"Board-like" abdomen pain
< Bowel sound

Risk factor:
Abdominal surgery
2 Ectopic pregnancy
Perforation

3 》
WBC
Xray
 Pe r it o ni ti s

B IO TIN B E N E F ITS | A M
C
 Derajat Iritasi Peritoneum
Oleh cairan yang berada dalam rongga peritonium
(Lowenfels, 1975)

Empedu Pus Isi usus halus Cairan lambung

Darah Urin Cairan pankreas

IRITASI RING 》》》》》》》 IRITASI BERAT

AN
Derajat Iritasi Peritoneum
Common cause acute abdomen
Appendisitis
Nausea

vom iting

fever

Abdominal pain
Obturator sign
Laboratory test
Pain with internal rotation
Mc burney Blood :
of the right hip
》 WBC
Nyeri tekan pada mc. Psoas sign Urinalysis
Burney
Pain of extention of right Pregnancy test !!

1/3 from anterior superior hip

iliac anterior- belly button
Rovsing's sign

Left lower quadrant pain 》

right lower quadrant pain
 Intestinal
Obstruction
Crampy pain
Obstipation
Distention
vomiting
Intussuception

Classic triad
• Sudden severe paroxysmal
colicky pain
• Bilious vomiting early
• Curent jelly stools (late
finding)
THERAPY

PR E S U R G E R Y SURGERY POST SURGERY

Fluids Source controls ICU
A n tim ic rob ials Drainage Internist
Support : P ed iatric ian
Ventilator , Inotropic , Nutritionist
Blood
1 hour bundle of Sepsis
Take home messages
Etiologi Abdominal Pain

Morbiditas dan mortalitas ditentukan oleh

kecepatan penanganan

Diperlukan pengetahuan tentang: anatomi,fisiologi,

pemeriksaa fisik dan pengalaman multi dispilin
Terima kasih