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MATERI BEDAHPERSIAPAN UKDI BATCH 2/2013MENUJU FKUB LULUS 100%UROLOGYMALE GENITAL DISORDERSDisordersEtiologyClinicalTorsio testisTorsio intra/ekstra vaginalNyeri berat pada testis secara tiba-tiba, bengkak pada skrotum atau inguinal, rasa tidak enak pada perut, mual muntah HidrokelAnomali kongenital, sumbatan darah di korda spermatika, inflamasi atau cederaAkumulasi cairan di sekitar testis, pembengkakan testis, transiluminasi +VarikokelInsufisiensi venaNyeri atau rasa berat pada skrotum, bengkak, gambaran seperti cacing bergerombolHernia scrotalisPatensi persisten dari prosesus vaginalisMassa di skrotum terlihat terutama ketika batuk atau menangisKriptorkismusAnomali kongenitalTestis terletak di luar kantung skrotum, teraba sebagai massa di inguinal

PHIMOSISPhimosisPreputium tidak bisa diretraksikan dari glans penisFisiologis pada neonatusKomplikasi:BalanitisPostitisBalanopostitisTx:Dexamethasone 0,1% (6 minggu) untuk retraksi spontanSirkumsisiParaphimosisJeratan akibat preputium yang teretraksi di belakang sulcus coronariusEmergency:Obstruksi vena superfisial nyeri dan edema nekrosisTx:Reposisi manualDorsal insisi

EPISPADIA vs HYPOSPADIAEpispadia: the urethra ends in an opening on the upper aspect (the dorsum) of the penisPenis typically broad, shortened upward curvature (dorsal chordee)Attached to the pelvic bones, which are widely separatedHypospadia: the urethral opening is ectopically located on the ventrum of the penis proximal to the tip of the glans penisThree anatomical characteristics: - An ectopic urethral meatus- An incomplete prepuce- Chordee ventral shortening and curvature

URETEROLITHIASISUrinary tract stone diseaseSigns:- Flank pain- Irritative voiding symptom- Nausea - Microscopic hematuriaStone:Opaque: calciumSemi opaque: MAPNon opaque: urate, cystineDiagnosis: IVP

URETHRA TRAUMAAnteriorAnatomy:Fossa navicularisPendulous urethraBulbous urethraEtiology: straddle injury, direct strikes or kicks to the perineum, penile fracturePosteriorAnatomy:Prostatic urethraMembranous urethraEtiology: massive deceleration (falls or vehicular collision), pelvic fracture

BPH vs CA PROSTATBPHPrevalensi: umum pada pria diatas usia 40 thEtiologi: peningkatan level testosteron sejalan dengan usiaPE: enlarged, boggy prostate on DRELab: peningkatan PSABagian prostat yg terkena: lebih sering sentralGejala klinis: LUTSTx: alpha adrenergic, 5 alpha reductase inhibitor, PDE 5 inhibitor, TURPCA PROSTATPrevalensi: kanker terbanyak pada priaEtiologi: pertumbuhan sel prostat yg tidak terkendali akibat gen, diet, obat2anPE: nodular (bumpy), firm, enlarged prostate on DRELab: peningkatan PSA dan ALPBagian prostat yg terkena: lebih sering lateral, dapat menjalar ke area pelvis dan tulangGejala klinis: LUTS, back pain, hematuriaTx: radical prostatectomy, radiation therapy, paliatifMari menjawab soal-soal

CARDIOTHORACIC & VASCULARCHEST TRAUMADisordersEtiologyClinicalHematothorax Lacerated blood vessel in thoraxAnxiety,tachypnea,shock,tachycardia,bloody sputum,diminished breath sounds on affected side,flat neck veins,dullness to percussionSimple pneumothoraxBlunt trauma, spontaneousOpening in lung tissue that leaks air into chest cavity, chest pain,dyspnea,tachypneadecreased breath sounds on affected side,hipersonorOpen pneumothoraxPenetrating chest woundOpening in chest cavity that allows air to enter pleural cavity, dyspnea,sudden sharp pain,subcutaneous emphysema,decreased lung sounds on affected side,sucking chest woundDisordersEtiologyClinical Tension pneumothoraxAnxiety,dyspnea,tachypnea,tachycardia,absent breath sounds on affected side, accessory muscle use, JV distention,narrowing pulse pressures,hypotension,tracheal deviation, hypersonor

Cardiac tamponadeVascular ruptureTrias Beck: JVP meningkat, hipotensi, suara jantung menjauh. Pulsus paradoxus, Kussmaul sign.Flail chestTraumaa segment of the rib cage breaks becomes detached from the rest of the chest wall, 3 ribs broken in 2 or more places (multiple segmental),painful when breathing,paradoxical breathing

Needle DecompressionOcclusive dressingVASCULAR DISORDERS

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GENERALTHE BREASTTumorOnsetFeatureCa mammae30-menopauseInvasive Ductal Carcinoma , Pagets disease (Ca In situ),Peaudorange, hard, painful, not clear border, infiltrative, discharge,retraction of the nipple,axillary massFAM 50 th, nyeri abdomen dan punggung bawah, painless jaundice, palpable gallbladder (Courvoisier sign), loss appetite and weight, urine gelap dan feses pucat, diabetes melltus, tumor marker CA 19-9Disorder Clinical FeatureAcute cholecystitisNyeri RUQ akut, menjalar ke punggung atau di ujung scapula dextra (Collins sign), demam, leukositosis, feses acholis, jaundice, nausea vomiting, palpable gallbladder, Murphy sign +, 3F (female, fat, forty)CholelitiasisNyeri abdomen episodik (saat konsumsi makanan berlemak), nyeri mereda stelah 30-90 menit, dyspepsia, Collins sign +Mari menjawab soal-soal

NEUROBASIS CRANII FRACTURE

BRAIN INJURYPrimaryIt occur at the time of original insult Direct damage done to brain parenchyma and associated with vascular injuries Brain tissue can be lacerated, punctured or bruised by broken bones or foreign bodies Damage is already doneIrreversibleDamage control (debridement)SecondaryDamage that occurs after the initial insult (ongoing injury processes)Expanding mass lesions, swelling or bleeding quickly overwhelm buffers End result is increased intracranial pressure (ICP) and/or herniationDiagnosis and treatments target minimizing the effects of these indirect insultsINTRACRANIAL HEMORRHAGESFeaturesSubarachnoidSubduralEpiduralLokasiThe inner most layer around the brain tissueBetween the dura and arachnoidThe outermost layer between the skull and duraMekanismeRuptur vaskular (berry aneurysm atau AVM)Kerusakan bridging veins. Dapat merupakan kejadian akut atau kronis.Laserasi arteri meningia media atau venaNyeriNyeri sangat berat, dirasakan di belakang kepala, sudden onsetNyeri tumpulNyeri berat, not sudden onsetKesadaranDapat menurun dengan cepatBerfluktuasi dari waktu ke waktuTerdapat periode lucid awal, diikuti dengan penurunan kesadaranGejala neurologisKaku kudukGangguan memori, epilepsi, mengantuk, pusingTerjadi setelah periode lucid, mual muntah, kejang, komaInvestigasiCT/MRI: irregular shaped bloodCT/MRI: crescent shaped, midline shiftCT/MRI: lens shaped (biconvex), bone fractureManagementSurgical clipping aneurysm, ballon therapy/stenting AVM. Give nimodipine to reduce risk of vasospasme.Burr hole or craniotomySurgery to evacuate blood and ligate bleeding vessels

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ORTHO & TRAUMATRAUMA PATIENT

HYPOVOLEMIC SHOCK

EBL = BB x % EBV x % EBLResusitasi cairan hukum 3:1 COMPARTMENT SYNDROME Compartment SizeTight dressing; Bandage/CastLocalized external pressure; lying on limbClosure of fascial defects

Compartment ContentBleeding: vascular injury, bleeding disordersCapillary Permeability: Ischemia / Trauma / Burns / Exercise / Snake Bite / Drug Injection / IVFDiagnosis:Pain out of proportionPalpably tense compartmentPain with passive stretchParesthesia/hypoesthesiaParalysisPulselessness/pallorEmergent Treatment:Remove cast or dressingPlace at level of heart (DO NOT ELEVATE to optimize perfusion)Alert OR and AnesthesiaFasciotomyFOREHAND FRACTUREJenisDeformitasTipikalCollesFraktur metafisis distal radius ekstraartikularPaling banyak pada tulang osteoporosis, akibat jatuh pada posisi tangan dorsofleksi, bentuk dinner forkSmithFraktur dislokasi radioulnar ke arah anterior (volar)Kebalikan dari Colles, akibat jatuh pada posisi tangan palmarfleksi, bentuk garden spadeMonteggiaFraktur 1/3 proksimal ulna disertai dislokasi sendi radioulnar proksimalGaleazzi Fraktur radius distal disertai dislokasi sendi radioulnar distal

COLLESSMITHMonteggia

Galeazzi

HIP DISLOCATIONAnteriorPain in the hipInability to walk or adduct the leg.The leg is externally rotated, abducted, and extended at the hipPosteriorKnee painPain in the back hipDifficulty moving the lower extremityThe leg is shortened and internally rotated with flexion and adduction at the hip

NameOriginLocationMorphologyOsteosarkoma(10 25 th)OsteogenikMetafiseSekitar lututTumor besar destruksi korteksCodman TriangleSel gns mbtk osteoidKondrosarkoma( 30 60 th)KondrogenikPelvis, femur, kostaTumor lobulated translusen bercak-2 kalsifikasiSel kartilago anaplastikEwing Sarkoma(10 15 th)Sel neural di sumsum tlgDiafise femur, tibia, humerusTdd small round cell mbtk rosette Onion skinMultiple Myeloma( 50 70 th)Sel plasmaSkull, sternum, kostae,vertebra-soliter/multiple, lesi litik, Bence Jones prot.+Tumor metastaseCa paru, Ca mamma, Ca thyroid, Ca prostatCa ren

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PAEDSGIT CONGENITAL MALFORMATION

INTUSSUCEPTIONage 6 to 12 months male gender abdominal pain vomiting lethargy/irritability blood per rectum /currant jelly stoolpalpable abdominal massPortio-like on DRE

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PLASTICBURN INJURY

Berat luka bakar:Ringan: derajat 1 luas < 15% a/ derajat II < 2%Sedang: derajat II 10-15% a/ derajat III 5-10%Berat: derajat II > 20% atau derajat III > 10% atau mengenai wajah, tangan-kaki, kelamin, persendian, pernapasan

To estimate scattered burns: patient's palm surface = 1% total body surface areaParkland formula = Baxter formulaCLEFT LIP AND PALATE

MAXILLOFACIAL TRAUMA

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Dont rationalize and stagnate yourself into a life of failure. Excuses dont fulfill dreams. Life is 10% what happen to you and 90% how you react to it.SUCCESS IS YOU!Thank you