RISIKO APENDISITIS PADA ORANG DEWASA DENGAN

DUGAAN APENDISITIS

TUBAGUS NUNU NAHNUDIN

19360277

PEMBIMBING :

dr. MUHARAM
PENGANTAR
Apendisitis akut adalah keadaan darurat bedah umum yang paling
umum di seluruh dunia 1, tetapi diagnosisnya tetap menantang, terutama
pada wanita muda yang memiliki rentang diagnosis banding yang lebih luas
daripada pria. Perhatian utama adalah pengobatan berlebihan, dalam
bentuk apendektomi normal (pengangkatan apendiks normal secara
histologis), yang mungkin terkait dengan peningkatan komplikasi pasca
operasi, durasi rawat inap dan biaya perawatan kesehatan dibandingkan
dengan laparoskopi diagnostik saja. Ada sedikit kesepakatan tentang jalur
diagnostik yang optimal untuk pasien dengan fosa iliaka kanan akut (RIF)
sakit di Inggris. Secara tradisional, kekhawatiran atas paparan radiasi yang
terkait dengan CT telah membatasi penggunaan rutinnya 6. Meskipun
protokol dosis rendah modern telah mengurangi paparan radiasi sambil
mempertahankan kinerja diagnostik 7,8, Tingkat CT lebih rendah di Inggris
daripada di banyak negara berpenghasilan tinggi lainnya, dan ini terkait
dengan tingkat normal apendektomi (NAR) yang lebih tinggi
 METODE
Pencarian sistematis diselesaikan untuk mengidentifikasi semua model
prediksi risiko apendisitis yang ada. Model divalidasi menggunakan data Inggris
dari studi kohort prospektif internasional yang menangkap pasien berturut-turut
berusia 16-45 tahun yang datang ke rumah sakit dengan RIF akut pada Maret
hingga Juni 2017. Hasil utamanya adalah spesifisitas model terbaik yang dapat
dicapai (proporsi pasien yang tidak menderita apendisitis diklasifikasikan dengan
benar sebagai risiko rendah) sambil mempertahankan tingkat kegagalan di bawah
5 persen (proporsi pasien yang diidentifikasi sebagai risiko rendah yang benar-
benar menderita apendisitis)
menjalani eksisi apendiks dengan pemeriksaan histologis pasca operasi yang
mengkonfirmasi apendisitis akut. Pasien yang menjalani hemikolektomi kanan untuk dugaan
DIAGNOSIS APENDISITIS
apendisitis akut dikumpulkan dengan mereka yang menjalani apendektomi. Berdasarkan
laporan histopatologi asli, pasien diklasifikasikan memiliki apendisitis sederhana atau
kompleks (gangren, perforasi). NAR dihitung sebagai pasien dengan histologi apendiks
normal sebagai proporsi dari semua pasien yang menjalani operasi apendektomi. Pasien
dengan patologi apendiks selain apendisitis (seperti tumor apendiks) dimasukkan dalam
penyebut tetapi bukan pembilangnya.
Variabel tingkat pasien yang dikumpulkan termasuk usia, jenis kelamin, gejala klinis dan
temuan pemeriksaan, urinalisis dan hasil tes darah. Data dikumpulkan pada penggunaan
ultrasound, CT atau MRI, dan apakah tes ini positif untuk apendisitis (diagnosis apendisitis
dalam laporan radiologi formal). Jika pasien menjalani operasi, prosedur, temuan operasi dan
hasil histopatologi dicatat. Pasien dipantau selama masuk awal, selama setiap masuk rumah
sakit berikutnya dalam 30 hari setelah presentasi awal, dan kemudian pada 30 hari setelah
presentasi awal menggunakan kombinasi catatan rumah sakit elektronik dan kertas.
 HASIL
Beberapa 5.345 pasien di 154 rumah sakit Inggris diidentifikasi,
dimana dua pertiganya (3613 dari 5345, 67 ⋅ 6 persen) adalah perempuan.
Wanita dua kali lebih mungkin menjalani operasi dengan pengangkatan
usus buntu yang secara histologis normal (272 dari 964, 28 ⋅ 2 persen)
dibandingkan pria (120 dari 993, 12 ⋅ 1 persen) (risiko relatif 2 ⋅ 33, 95
persen ci 1 ⋅ 92 hingga 2 ⋅ 84; P < 0 ⋅ 001). Dari 15 model prediksi risiko
yang divalidasi, Skor Apendisitis Dewasa berkinerja terbaik (skor batas 8
atau kurang, spesifisitas 63 ⋅ 1 persen, tingkat kegagalan 3 ⋅ 7 persen).
Skor Respons Peradangan Apendisitis berkinerja terbaik untuk pria (skor
batas 2 atau kurang, spesifisitas 24 ⋅ 7 persen, tingkat kegagalan 2 ⋅ 4
persen)
TELAAH KRITIS

A. Analisis
1. Problem
Our Services

Your Text Here

You can simply impress your audience and add a unique zing and
appeal to your Presentations.

Your Text Here

You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Our Team Layout

Your Picture Here Your Picture Here Your Picture Here Your Picture Here

Name Here Name Here Name Here Name Here

Programmer Programmer Programmer Programmer
You can simply im- You can simply im- You can simply im- You can simply im-
press your audience press your audience press your audience press your audience
and add a unique and add a unique and add a unique and add a unique
zing. zing. zing. zing.
Timeline Style

2016 2017 2018 2019

Your Text Here Your Text Here Your Text Here Your Text Here
You can simply You can simply You can simply You can simply
impress your au- impress your au- impress your au- impress your au-
dience and add a dience and add a dience and add a dience and add a
unique zing. unique zing. unique zing. unique zing.
Infographic Style
Your Text Here
01 You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

02 You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

03 You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

04 You can simply impress your audience and add a
unique zing and appeal to your Presentations.
 Your Picture Here

This PowerPoint Template has clean and neu-

Welcome!! tral design that can be adapted to any content

and meets various market segments.
Infographic Style

35%
Your Text Here
You can simply impress your
audience and add a unique zing
and appeal to your Presenta-
tions.
28%
Your Text Here
You can simply impress your
audience and add a unique zing
and appeal to your Presenta-
tions.

Get a modern PowerPoint Presentation that is beautifully designed. Easy to change colors,
photos and Text. You can simply impress your audience and add a unique zing and appeal to
your Presentations.
 Your Text Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations.

Your Text Here

Your Picture Here
You can simply impress

Portfolio
your audience and add a
unique zing and appeal to
your Presentations.

Presentation Your Text Here

You can simply impress

Designed your audience and add a

unique zing and appeal to
your Presentations.
Infographic Style
Modern PowerPoint
Presentation
30%
You can simply impress your
audience and add a unique
zing.
30%
You can simply impress your
audience and add a unique
zing.
Your Text
Your Text
Get a modern PowerPoint Presenta-
tion that is beautifully designed. Easy
to change colors, photos and Text.
You can simply impress your audience
and add a unique zing and appeal to
your Presentations. Get a modern
PowerPoint Presentation that is beau-
tifully designed. Easy to change col-
ors, photos and Text.
Chart Style

60% 50% 80% 40%

Your Text Here Get a modern PowerPoint Presentation that is

You can simply im-
press your audience
80% beautifully designed. Easy to change colors,
photos and Text. You can simply impress your
Text Here audience and add a unique zing and appeal to
and add a unique zing. your Presentations.
 Portfolio Designed

Your Text Here Your Text Here Your Text Here Your Text Here
You can simply impress You can simply impress You can simply impress You can simply impress
your audience and add a your audience and add a your audience and add a your audience and add a
unique zing. unique zing. unique zing. unique zing.

Your Picture Here

Worldmap Style

Your Text Here Your Text Here

Easy to change colors, Easy to change colors,
photos and Text. photos and Text.

Text Here Text Here 150,000 280,000

50% 50% 50% 50%
Text Here

Text Here Your Text Here Your Text Here

Easy to change colors, Easy to change colors,
photos and Text. photos and Text.

120,000 160,000
50% 50% 50% 50%
Chart Style

50% 20% 70% 30%

Get a modern PowerPoint Presentation that is beautifully designed. Easy to change colors, photos and
Text. You can simply impress your audience and add a unique zing and appeal to your Presentations. Get a
modern PowerPoint Presentation that is beautifully designed. Easy to change colors, photos and Text.
Portfolio Presentation

Your Picture Here Your Picture Here Your Picture Here Your Picture Here Your Picture Here
Infographic Style
You can simply impress your audience
Modern PowerPoint and add a unique zing.
Presentation

You can simply impress your

audience and add a unique
zing.
PowerPoint PowerPoint PowerPoint
Get a modern PowerPoint Presentation Presentation Presentation Presentation
that is beautifully designed. Easy to
change colors, photos and Text. You can
simply impress your audience and add a
unique zing and appeal to your Presen-
tations. Easy to change colors, photos
and Text. Get a modern PowerPoint
Presentation that is beautifully designed. PowerPoint PowerPoint PowerPoint
Easy to change colors, photos and Text. Presentation Presentation Presentation
Table Style

Your Text Here Your Text Here Your Text Here Your Text Here

$52 $52 $52 $52

Text Here Text Here Text Here Text Here

Text Here Text Here Text Here Text Here

Text Here Text Here Text Here Text Here

Text Here Text Here Text Here Text Here

Text Here Text Here Text Here Text Here

Text Here Text Here Text Here Text Here

 Your Text Here Your Text Here
You can simply impress You can simply impress
your audience and add a your audience and add a
unique zing. unique zing.

Your Text Here Your Picture Here Your Text Here

You can simply impress You can simply impress
your audience and add a your audience and add a
unique zing. unique zing.

Your Text Here Your Text Here

You can simply impress You can simply impress
your audience and add a your audience and add a
unique zing. unique zing.
Infographic Style

1 2 3 4 5

Your Text Here Your Text Here Your Text Here Your Text Here Your Text Here
You can simply im- You can simply im- You can simply im- You can simply im- You can simply im-
press your audience press your audience press your audience press your audience press your audience
and add a unique zing and add a unique zing and add a unique zing and add a unique zing and add a unique zing
and appeal to your and appeal to your and appeal to your and appeal to your and appeal to your
Presentations. Presentations. Presentations. Presentations. Presentations.
Infographic Style
Your Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

You can simply impress your audience and add a
unique zing and appeal to your Presentations.

Your Text Here

You can simply impress your audience and add a
unique zing and appeal to your Presentations.
 01
Your Text Here
Your Picture Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations.
02
Your Text Here
Your Picture Here You can simply impress
your audience and add a
unique zing and appeal to
your Presentations.
03
Your Text Here
You can simply impress Your Picture Here
your audience and add a
unique zing and appeal to
your Presentations.
04
Your Text Here
Your Picture Here You can simply impress
your audience and add a
unique zing and appeal to
your Presentations.
Infographic Style

Your Text Here

Easy to change colors, photos and Text.

Your Text Here

Easy to change colors, photos and Text.
Your Picture Here
Your Text Here
Easy to change colors, photos and Text.

Your Text Here

Easy to change colors, photos and Text.

Your Text Here

Easy to change colors, photos and Text.
 70%
You can simply impress your audience
and add a unique zing.

80%
You can simply impress your audience

Chart Info- and add a unique zing.

graphic 50%
Style You can simply impress your audience
and add a unique zing.
Table Style

Your Text Here Your Text Here Your Text Here Your Text Here

$150 $100 $80 $99

You can simply You can simply You can simply You can simply
impress your impress your impress your impress your
audience and audience and audience and audience and
add a unique add a unique add a unique add a unique

Text Here Text Here Text Here Text Here

 Simple Worldmap
Your Text Here
Presentation
40% Easy to change colors,
photos and Text. Get a modern PowerPoint Presentation that is beau-
tifully designed. Easy to change colors, photos and
Text. You can simply impress your audience and add
Your Text Here a unique zing and appeal to your Presentations.
30% Easy to change colors,
photos and Text.

Your Text Here

20% Easy to change colors,
photos and Text.

Your Text Here

10% Easy to change colors,
photos and Text.
 Modern PowerPoint
Presentation
Get a modern PowerPoint Presentation that is beauti-
fully designed. Easy to change colors, photos and Text.
Your Picture Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations. Easy to
change colors, photos and Text. Get a modern Power-
Point Presentation that is beautifully designed. Easy to
change colors, photos and Text.

Simple
Get a modern PowerPoint
Portfolio Presentation that is beautifully
designed. Easy to change
Designed colors, photos and Text. You
can simply impress your audi-
Your Picture Here
ence and add a unique zing
and appeal to your Presenta-
tions. Easy to change colors,
photos and Text
Columns Style
Your Text Here
You can simply impress your audience and add a unique zing and appeal to
your Presentations. Easy to change colors, photos and Text. I hope and I
believe that this Template will your Time, Money and Reputation. You can
simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.

Easy to change colors, photos and Text. I hope and I believe that this Tem-
plate will your Time, Money and Reputation. You can simply impress your
audience and add a unique zing and appeal to your Presentations. You can
simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.

You can simply impress your audience and add a unique zing and appeal to
your Presentations. Easy to change colors, photos and Text.
Columns Style
Your Text Here
You can simply impress your audi-
ence and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
You can simply impress your audi-
ence and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text. I
hope and I believe that this Tem-
plate will your Time, Money and
Reputation. You can simply impress
your audience and add a unique
zing and appeal to your Presenta-
tions.
Your Text Here
You can simply impress your audi-
ence and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
You can simply impress your audi-
ence and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text. I
hope and I believe that this Tem-
plate will your Time, Money and
Reputation. You can simply impress
your audience and add a unique
zing and appeal to your Presenta-
tions.
 Thank you
Insert the title of your subtitle Here
Fully Editable Shapes
 Fully Editable Icon Sets : A

You can Resize without los-

ing quality

You can Change Fill Color &

Line Color

FREE
PPT TEM-
PLATES
www.allppt.com
 Fully Editable Icon Sets : B

You can Resize without los-

ing quality

You can Change Fill Color &

Line Color

FREE
PPT TEM-
PLATES
www.allppt.com
 Fully Editable Icon Sets : C

You can Resize without los-

ing quality

You can Change Fill Color &

Line Color

FREE
PPT TEM-
PLATES
www.allppt.com