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ADENOCARCINOADENOCARCINO

MAMA

COLORECTALCOLORECTAL

oleholeh

Dr. H. Rivai Ismail, SpBDr. H. Rivai Ismail, SpB

7/21/2019 adenocarsinoma colorecatal

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SigmoidSigmoid

RectumRectum

CaecumCaecum

TransversumTransversum

DesendenDesenden

AscendenAscenden

Lokasi

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EtiologiEtiologi risk aktor risk aktor 

Diet tinggi lemak rendah seratDiet tinggi lemak rendah serat

Ri!a"at keluargaRi!a"at keluarga  #$% &#$% & Aktivitas isik "g kurangAktivitas isik "g kurang

'(esitas'(esitas

Inlamasi (o!el diseaseInlamasi (o!el disease

  $ )lserative colitis$ )lserative colitis

  $ Crohn,s disease$ Crohn,s disease

*enetik*enetik

$ +amilier pol"ps colon$ +amilier pol"ps colon

  $ Adenoma pol"p$ Adenoma pol"p

)retro sigmoidostom")retro sigmoidostom"

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atologiatologi

-akroskopik -akroskopik

- +ungaing+ungaing

- )lserative)lserative

-ikroskopik -ikroskopik

- AdenocarsinomaAdenocarsinoma- -ucoid carsinoma-ucoid carsinoma

- Signet ring carsinomaSignet ring carsinoma

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Tanda dan ge/alaTanda dan ge/ala

 0eluhan chronik 123$45670eluhan chronik 123$4567

Acute on chronik 18$3867Acute on chronik 18$3867

Acute perorasiAcute perorasi

Chronik Chronik Bleeding occultBleeding occult

  -aroon-aroon

  gelapgelap  HitamHitam

  merah terangmerah terang

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eru(ahan pola BABeru(ahan pola BAB

DiareDiare

0onstipasi0onstipasi

9"eri o(struksi partial9"eri o(struksi partial

Bentuk eses kecil, pipih:pitaBentuk eses kecil, pipih:pita

0olon kanan mucus0olon kanan mucus

Rectum tenesmusRectum tenesmus

 

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0eluhan lain0eluhan lain

 BB ;BB ;

9asu makan (erkurang9asu makan (erkurangDemamDemam

-assa-assa

'(struksi akut'(struksi akut ileusileuserorasi 1 tu caecumerorasi 1 tu caecum

+istula (uli$(uli+istula (uli$(uli

  )terus)terus

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Diagnose

 Klinis

Radiologis endoscopi

Laboratorium

Rectal toucher rectum

patologis

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RADIOLOGI

Foto polos abdomen

Barium enema (double kontras

!t scanning"RI

#$G rektum (%R#$%

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&ndoscopi

$igmoidoscop'

!olonoscop'

Biopsi Labor

 Darah rutin

Faal hepar FOB% kolon kanan

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atologi ) diagnose pasti

"etastase ) langsung  Inplantasi

  *ematogen +,porta-hati

  Limogen +ircho. node

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$tadium berdasarkan duke

Dukes ADukes A Terbatas Di mukosaTerbatas Di mukosa

Dukes BDukes B Menembus MuskularisMenembus Muskularis

mukosamukosa

Dukes CDukes C

  C 1C 1

  C 2C 2

Meta KGBMeta KGB

KGB dkt tKGB dkt tuummoor Pr r Pr imer imer 

KGB JauhKGB Jauh

Dukes DDukes D Metastase JauhMetastase Jauh

Hepar,Hepar, paru, paru, in!alin!al

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terapi

Obstruksi ) colostomi

#ntuk colon kiri

Kolon kanan

 reseksi anastomose/on obstruksi

Reseksi 0 anastomose

Rektum ) anterior reseksi

  Lo. anterior reseksi

  "iles,,,,,,,,,,,,,,

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ad1u+ant

Kemoterapi ) 2F# 0 Leuco+erin

Radiasi

!olostom'

%emporer 

ermanenLoop colostomi

Double barrel colostomi