Bedah Digestif - SKD 4A - Akut Abdomen

7/23/2019 Bedah Digestif - SKD 4A - Akut Abdomen

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Akut Abdomen...

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Akut Abdomen

• perubahan kondisi akut pada organ-organ intraabdomen

• infamasi atau ineksi

• menyebabkan rasa nyeri yang hebat dan timbul mendadak

• cepat memburuk dan mengancam

nyawa• membutuhkan penegakan diagnosis

yang cepat dan tepatTownsend et al,

2005



Etiologi Akut Abdomen

1. nfamasi

!. "ekanik

#. $eoplasma%. &askular

'. (eek )ongenital

*. +rauma



PENYEBAB AKUT ABDOMEN

SEGALA USIA ANAK-ANAK

A,E$(+ $&A$A

,E/0/A 2234A"B2$ /A(A$ A42/A$ )E"5

$6E/ AB("E$ $$ ,E0) 5E/$A

7$$ BE(A58 /A(A$ A42/A$ $A,A A+A

B+/2) 22

,A$)/EA++ A)2+ WANITA

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USIA TUA

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&A)24A/

EBAB-EBAB "E()



5istory :

• Where is your pain? Has it always been there?

• Does the pain radiate anywhere?

• How did the pain begin (sudden vs. gradualonset)? How long have you had the pain?

• What were you doing when the pain began?

• What does the pain feel like?

•

On a scale of 0!0" how severe is the pain?• Does anything #ake the pain better or worse?

• Have you had the pain before?

Chie Complaint : Abdominal ,ain



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Visceral and NOT Referred Pain

• referred to areascorresponding to theembryonic origin of theaffected structure. Foregutstructures (stomach,duodenum, liver, and pancreas) cause upperabdominal pain. Midgutstructures (small bowel, proximal colon, and

appendix) cause periumbilical pain.Hindgut structures (distalcolon and G tract) causelower abdominal pain



4ocaliing pain -- /2;

• 5epatitis

• Cholecystitis

• Cholangitis

• ,neumonia

• ubdiaphragmatic

abscess



4ocaliing pain -- 42;

• plenic inarct

• plenic abscess

• astritis3,2(



4ocaliing pain -- /4;

• Appendicitis

• nguinal hernia

•

$ephrolithiasis• B(

• alpingitis

• Ectopic pregnancy

• <arian pathology



4ocaliing pain -- 44;

• Diverticulitis

• nguinal hernia

• $ephrolithiasis

• B(

• alpingitis


• <arian pathology



4ocaliing pain -- epigastric

• ,2(

• astritis

•

,ancreatitis• E/(

• Cardiac 7"=pericarditis= etc8



4ocaliing pain --periumbilical

• ,ancreatitis

• bstruction

• Early appendicitis

• mall bowelpathology

• astroenteritis



4ocaliing pain -- pel<ic

• 2+

•

,rostatitis• Bladder outlet

obstruction

• ,(

• 2terine pathology



4ocaliing pain -- di>use

• astroenteritis

• schemia

• bstruction

• ()A

•

B



,hysical E?amination @ (irected @

• eneral appearance

• &ital igns

• Abdomen – nspection

– Auscultation

– ,ercussion – ,alpation



• ,el<ic

• enital

•

Back• /ectal

• 5ead-to-toe

,hysical E?amination @ (irected @



(i>erential (iagnosis

• Appendicitis

• Biliary colic=cholecystitis=

cholangitis• Bowel obstruction

• (i<erticulitis


•

astroenteritis• ntussuception

• "esenteric schemia

• <arian torsion

• ,ancreatitis

• ,el<ic nfammatory(isease 7,(8

• ,erorated peptic ulcer• /uptured or leaking

abdominal aorticaneurysm 7AAA8

• +esticular torsion

• 2reteral colic

• &ol<ulus



(iagnostic +esting

• 4aboratory tudies – CBC

– 2rinalysis

– ,regnancy

– Amylase34ipase

– ther

• Electrocardiogram



(iagnostic +esting - continued -

• /adiologic tudies – ,lain 0ilms

– 2ltrasound

– Computed +omography



E9A4A )4$ 7,E$2$9A$8

• "2$+A5

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"2$+A5 @ $6E/ : A+/ @ E$+E/+

• )+E/2 - 5E,A+B4E/

• 5E"A+2/A @ 2/4

• B+,A @

• 5A(



DIAGNOSA

DIAGNOSE MUST BE ESTABLISED IN TE EA!LIESTPOSSIBLE STAGE

KLINIS

SOAP

LABO!ATO!IUM - STANDA!

" # LEKOSIT$ %T$T!OMBOSIT # &AAL EMOSTASIS

BIOKIMIA DA!A 'INDIKASI(

AMYLASE

GLUKOSAK!EATININ

&AAL EPA!



U!INE

4E$)A,

!ADIOLOGI

AB("E$ ,4 BE/BA/$

AB("E$ ,4 +EA)3(E)2B+2

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ULT!ASONOG!A&I

ELEKT!O KA!DIOG!A&I



Acute abdominal pain

• urgical – Appendicitis

– Cholecystitis

–

Bowel obstruction – Acute mesenteric

ischemia

– ,eroration

– +rauma

– ,eritonitis

• $onsurgical – Cholangitis

– ,ancreatitis

– $onabdominalcauses

– Choledocholithiasis

–

(i<erticulitis – ,2(3-itis

– gastroenteritis

Bedah Digestif - SKD 4A - Akut Abdomen

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