perdarahan sal cerna bawah

7/25/2019 perdarahan sal cerna bawah

1/25

DAFTAR ISI

BAB I PENDAHULUAN .........................................................................................1

BAB II TINJAUAN PUSTAKA ...............................................................................2

2.1 DEFINISI.............................................................................................................2

2.2 EPIDEMIOLOGI.................................................................................................2

2.3 ANATOMI...........................................................................................................4

2.4 KLASIFIKASI.....................................................................................................6

2.5 ETIOLOGI...........................................................................................................7

2.6 PATOFISIOLOGI.................................................................................................8

2.7 CEDERA ORGAN ABDOMEN..........................................................................9

2.8 GEJALA DAN TANDA KLINIK.........................................................................12

2.9 DIAGNOSIS........................................................................................................13

2.1 PENATALAKSANAAN....................................................................................17

2.11 KOMPLIKASI...................................................................................................19

2.12 PROGNOSIS.....................................................................................................2

DAFTAR PUSTAKA.................................................................................................22


2/25

BAB I

PENDAHULUAN

I!"#$%! &'()*( (+$,*%! *%!#!-(& $('# &(/)! % &(/)!. M,'&(0#&("

+#("(!( 0%+#/ !--# ($( &'()*( &)*)0 (+$,*%! $('# ($( &'()*( &%*+)".

(0())! &%/!# $#(-!," +(') ")$(/ +(!( $#((# *#"(0!( Computed

Tomografi !(*)! &'()*( &)*)0 (+$,*%! *("#/ *%')((! &(!&(!-(! +(-# (/0#

0#!#.D#(-!,"( $#!# $#%'0)(! )!&) %!-%0,0((! "%('( ,*(0. E(0)("# ((0

"(!-(& +%'*(!((& &%&(# &%'($(!- )) ")0#& ('%!( ($(!( %(" (!- $(

%0(" ($( ('%( 0(#! (!- &%'(#&.

D# E',( "%+(-#(! +%"(' &'()*( (+$,*%! $#"%+(+(! ,0%/ &'()*( &)*)0

&%')&(*( ('%!( %%0(((! 0(0) 0#!&(" &%'(&)/ %%'("(! %%'("(! &%'/($(

$#'# "%!$#'#. L)( &%*+)" 0)( &%*+( (0#!- "%'#!- &%'($# $# A*%'#( S%'#(&

"%$(!-(! 0)( &)") 0%+#/ )*)* &%'($# $# F#!0(!$#( $(! A'#( S%0(&(!.

P("#%! *)!-#! )-( *%*#0## &'()*( ,'-(! (+$,*%! $(0(* +(/(! #(

0)( (* (&() 0)( &%*+( *(") $# 0)(' $(%'(/ %')& $%(! "%%' $#)!--)!- #!--(!- (!&(& %'#!%)* (/( (&(" $($( +((/ (&() "%&%0(/ 0%!-(!.

P%!(&(0("(!((! &'()*( (+$,*%! "(*(# "%('(!- *("#/ *%')((!

+(/(! $#")"# $(0(* I0*) B%$(/ $('# !$((! (!- ,!"%'( "(*(# !$((!

(!- '($#(0. A/#':(/#' #!# &%'$((& %%!$%')!-(! )!&) 0%+#/ "%0% $(0(*

*%0()(! !$((! 0((',&,*# ($( &'()*( (+$,*%!.

K%*((! ($( &'()*( (+$,*%! $( /(!( $#&%!&)(! ,0%/ +%'(&!(

&'()*( (&() ($(!( &'()*( %!%'&( &%&(# )-( ,0%/ %&%'0(*+(&(! $(0(*

*%!%-((! $#(-!,"#". K%*((! +#("(!( $#"%+(+(! ,0%/ %'$('(/(! (&()

%'($(!-(! $(0(* ',!--( %'#&,!%)*. A!-( %*((! #!# $((& $#&)')!(!

*%0(0)# )(( %!%-(/(! &'()*( $(! %!(!--)0(!-(! ,*(0 (!- $#+%'#(!

"%$#!# *)!-#! ($( ,'+(!!(.


3/25

BAB II

TINJAUAN PUSTAKA

1 DEFINISI

T'()*( *%')((! %%'("(! #"# (!- *%!-(#+(&(! %$%'(. T'()*(

(+$,*%! ($(0(/ &'()*( (!- *%!%+(+(! &%'($#!( %')"((! ($( ,'-(!

(+$,*%! (!- $((& *%!%+(+(! %')+(/(! #"#,0,-# "%/#!--( &%'($# -(!--)(!

*%&(+,0#"*% %0(#!(! #**)!,0,-# $(! -(!--)(! ((0 +%'+(-(# ,'-(!

2 EPIDEMIOLOGIP($( &(/)! 199 "%#&(' 5 )&( ,'(!- *%!#!--(0 $# "%0)')/ $)!#( ('%!(

%$%'( ;&'()*(3 $('# "%0)')/ &'()*(

&%'"%+)&.

D('# "%0)')/ (")" &'()*( (+$,*%! $# RSCM &'()*( &%*+)" (#+(& 0)(

&)") *%!%*( &%*(& &%'(&(" ;65=< $##) ,0%/ &'()*( &)*)0. L%+#/ $('#

5= &'()*( &)*)0 $#"%+(+(! ,0%/ %%0(((! 0(0) 0#!&(" +#("(!( $#"%'&(#

$%!-(! &'()*( ($( +(-#(! &)+)/ 0(#!!(. D# !%-('(:!%-('( (!- *%!-/(')"(!

%!--)!((! "(+) %!-(*(! ($( %!$('((! $#%!(0 &'()*( &)*)0 (!-

$#"%+(+(! ,0%/ "(+) %!-(*(! #!# (!- $#"%+)& seat-belt syndrome. T'()*(


4/25

&)*)0 &%')&(*( &%'($# $# $(%'(/ %$%"((! "%*%!&('( &'()*( &%*+)" 0%+#/ "%'#!-

&%'($# $# $(%'(/ %',&((!.

3 ANATOMI

1 Anatomi Luar

( A+$,*%! $%(!

A+$,*%! $%(! *%')((! +#$(!- (!- $#+(&("# $# +(-#(! '(!#(0 ,0%/

-('#" intermammaria ()$(0 ,0%/ %$)( ligamentum inguinale$(!simfisis pubis

"%'&( $# 0(&%'(0 ,0%/ %$)( 0#!%( (?#00('#" (!&%'#,'

+ P#!--(!-

M%')((! $(%'(/ (!- +%'($( $# (!&('( lineaaxillaris anterior $(! linea

axillaris posterior, $('# "%0( #-( % @I "(*(# crista iliaca. D# 0,("# #!# ($(

$#!$#!- ,&,& (!- &%+(0 +%'0(#!(! $%!-(! $#!$#!- ,&,& (!- #" $# +(-#(! $%(!

*%!($# %0#!$)!- &%')&(*( &%'/($( 0)( &)").

P)!--)!-

D(%'(/ #!# +%'($( $# ,"&%'#,' $('# 0#!%( axillaris posterior, $('# ))!-

()$(0 "()0( "(*(# crista iliaca. O&,&:,&,& )!--)!- $(! ,&,& ('("#!(0

*%!($# %0#!$)!- &%'/($( &'()*( &((*.

2 Anatomi daam

( R,!--(peritoneum

Peritoneum *%')((! *%*+'(! "%',"( #" (!- *%0(#"# $#!$#!-

cavitas abdominis $(! cavitas pelvis "%'&( *%0#) #"%'( abdomen $(!pelvis.

Peritoneum parietale *%0(#"# $#!$#!- cavitas abdominis $(! cavitas pelvis,

"%$(!-(!peritoneum visceral*%0#) ,'-(!:,'-(!. R,!--( ,&%!"#(0 $# (!&('(

peritoneum parietalis $(! visceralis $#"%+)& cavitas peritonealis.


5/25

+ R,!--(pelvis

M%')((! ')(!-(! (!- &%'0%&( $#(!&('( aperture pelvis superior $(!

aperture pelvis inferior. B#("(!( cavitas pelvis $#+(-# ,0%/ $#('(-*( pelvis

(!- &%'0%&( $# (&(" $(! %'#!%)* $#+((/!(. R,!--( #!# &%')&(*( +%'#"# ,'-(!

urogenitalia.

c R,!g-( retroperitoneum

R,!--( ,&%!"#(0 (!- +%'($( $# +%0((!- $#!$#!- %'#&,!%)* (!-

*%0(#"# (+$,*%!. C%$%'( ($( ,'-(! dalam retroperitoneum ")0#& $#%!(0#

('%!( $(%'(/ #!# ()/ $('# (!-()(! %*%'#"((! #"# $(! +#("(!( %$%'(

((0!( $( ((! *%!#*+)0(! -%(0(peritonitis. R,!--( #!# &%'*(") $(0(*

+(-#(! (!- $#%'#"( "(*%0!( ($( diagnostic peritoneal lavage;DPL


6/25

S)*+%'.##%$#(.,*

! KLASIFIKASI

T'()*( ($( (+$,*%! $#"%+(+(! ,0%/ $)( *%(!#"*% (!- *%')"(

(#&) ;1< &'()*( &)*)0 *%')((! &'()*( (+$,*%! &(!( %!%&'("# % $(0(*

',!--( %#&,!#)*. L)( &)*)0 ($( (+$,*%! +#"( $#"%+(+(! ,0%/ (&)/

%%'("(! #"# (&() ))0(! %"%0(((! %!$('((! +%'*,&,' %$%'( (#+(&

+%',0(/ '(-( +%!&)'(! 0%$((! $%"%0%'("# ,*'%"# (&() "(+) %!-(*(!. L%+#/

$('# 5= $#"%+(+(! ,0%/ %%0(((! 0(0) 0#!&(". ;2< T'()*( &%*+)" *%')((!

&'()*( (+$,*%! $%!-(! %!%&'("# % $(0(* ',!--( peritoneum. L)( &%*+)"

($( abdomen$#"%+(+(! ,0%/ &)")(! +%!$( &((* (&() 0)( &%*+(.

B%'$("('(! ,'-(! (!- &%'%!( &'()*( (+$,*%! $((& $#+(-# *%!($#

$)( ;1< T'()*( ($( ,'-(! ($(& "%%' /%(' 0#*( ;0#%!< $%!-(! -%(0( )&(*(

%'$('(/(!. ;2< T'()*( ($( ,'-(! ($(& +%',!--( "%%' )")" "(0)'(! %*%$)

$%!-(! -%(0( )&(*( ($(0(/ %'#&,!#".

T'()*( &)*)0 ($(!- $( *%*+%'#(! %0(#!(! (!- %0(" ($(

%'*)((! &)+)/ &%&(# $((& *%!-(#+(&(! ,!&)"#, (&() 0("%'("# ('#!-(! (&()

,'-(! $#+((/!(. T'()*( &)*)0 $((& +%')( +%!$( &)*)0 %'0(*+(&(!

;$%"%0%'("#


7/25

*%!#*+)0(! %$%'( ($( ,'-(! +%',!--( +%')( %','("# $(! ,'-(! ($(&

+%')( 0("%'("#.

T'()*( &%*+)" $#+(-# *%!($# 0)( &)") $(! 0)( &%*+(. T'()*(

&%*+)" (#+(& %0)') $#+%$((! (!&('( %!#" %%(&(! '%!$(/ (low-velocity

$%!-(! %%(&(! !-- (!ig!-velocity. T'()*( &%*+)" (#+(& %0)') $%!-(!

%%(&(! !--# *%!#*+)0(! %')"((! (!- 0%+#/ +%"('. H(*#' "%0(0) 0)(

&%*+)" (#+(& %0)') *%!-(#+(&(! %')"((! ($( ,'-(!:,'-(! $(0(*

(+$,*%!. B(/(! 0)( %0)') (!- &(!-%!"#(0 &(!( *%*(")# ',!--( (+$,*%!

$((& *%!#*+)0(! %')"((! ,'-(!:,'-(! $(0(* (+$,*%! (#+(& %% 0%$((!.

" ETIOLOGI

B%'$("('(! %!%+(+!( &'()*( &)*)0 $#+(-# *%!($(# -( (#&)

+%!&)'(! ('%!( +%!$( &)*)0 %$%'( ,*'%"# $(! %$%'( %'0(*+(&(!

;$%"%0%'("#


8/25

%')"((! (!- +%'(' &%'/($( "&')&)' #!&'((+$,*%! (!- %!!- $#$((&(!

($( 0%+#/ $('# 9= (")".

# PATOFISIOLOGI

P($( &'()*( &)*)0 (+$,*%! %$%'( ($( "&')&)' $(0(* ',!--( (+$,*%!

$((& $#0("##("#(! *%!($# $)( *%(!#"*% %$%'( (#&) %)(&(! ,*'%"#

$(! %)(&(! %'0(*+(&(! ;$%"%0%'("#


9/25

7 $EDE%A O%GAN ABDOMEN

( D#('(-*(

R,+%(! $#('(-*( $((& &%'($# ($( +(-#(! *(!()! $('# % $)(

$#('(-*( (!- (0#!- %!!- *%!-%!(# %$%'( ($(0(/ $#('(-*( #'#. C%$%'(

+#("(!( 5 1 * (!(!-!( $%!-(! 0,("# $# ,"&%', 0(&%'(0 $('# $#('(-*(

#'#. P($( %*%'#"((! ,&, &/,'( ((0 ((! &%'0#/(& $#('(-*( (!- 0(+#/ !--#

(&())! (+)' +#("(!( +%')( /%*(&/,'(" (&())! ($(!( +((!-(! )$('(

(!- *%*+)(& (+)'!( -(*+('(! $#('(-*( (&())! &%'0#/(& NGT (!-

&%'("(!- $(0(* -("&%' &%'0#/(& $# &/,'(. P($( "%+(-#(! %#0 ,&, &/,'( $(*%*%'0#/(&(! ($(!( %0(#!(!.

+ O'-(! +%',!--(

1 L(*+)!- $(! )")" /(0)"

T'()*( &)*)0 $(! %!%&'("# % $(0(* 0(*+)!- %)!)* $(! #0%)*

'%0( *)$(/ $#,'%"# ($( %"0,'("# +%$(/. T'()*( %!%&'("# *%*%'0)(!

$%+'#$%*%! 0)( $(! %!)&)(! "%$%'/(!(. K($(!-:($(!- "%)*0(/ 0)( ((!

$#&%*)(! $(0(* )")" /(0)" $# (&(" "%-*%! (!- '%0( %!$% "%/#!--(

*%'%"%"# "%-*%! (!- &%'0#+(& $(! *%0()(! (!("&,*,"#" '#*%' *%')((!

!$((! (!- &%(&. F(&,' (!- $#(!--( *%!%&)"(! /(0 &%'"%+)& ($(0(/

%!#!-(&(! *%!$($( &%(!(! #!&'(0)*#!( 0,(0 ,*'%"# )")" /(0)" ($(

,0)*!( %'&%+'(0#" "%'&( $%"%0%'("# ($( (&() $%(& #"("#. P%!--)!((!

"(+) %!-(*(! *%!-(#+(&(! ()0"# 0(*+)!- $(! )")" /(0)".

2 K,0,! $(! '%&)*

T'()*( ,0,! $(! '%&)* &%'"%'#!- *%!-#) &'()*( %!%&'("# (#&("

(+$,*#!(0#". B(!( ,!&',%'"# "%/)+)!-(! $%!-(! &%'(# %$%'( ,0,!.

P%!(&(0("(!((! *%*%'0)(! +(!( %!#0(#(! 0#!# $(! &%')&(*( $#&%!&)(!,0%/ $%'((& %$%'( ($(!( %$%'( %!%'&( (!- *%!-(!(* !(( $(!

,!&(*#!("# %"%" "%'&( (&) (!- &%'0%(&(! (!&('( &'()*( $(! %'+(#(!

+%$(/. P('( (/0# %'(( &%'(# ,!"%'( 0%+#/ &%(& %)(0# %$%'( ,0,! '#!-(!

$(! ,!&(*#!("# %"%" "%$##&.

O'-(! ($(&

1 H(

K('%!( ))'(! $(! 0%&(!( /( *%')((! ,'-(! (!- (0#!- "%'#!-

&%'%!( %')"((! (!- $#(#+(&(! ,0%/ 0)( &%*+)" $(! "%'#!- (0# %')"((!


10/25

$#"%+(+(! ,0%/ &'()*( &)*)0. H(0 )&(*( (!- $#0()(! ((+#0( &%'($#

%'0)((! $# /( (#&) *%!-,!&',0 %'$('(/(! $(! *%!$'(#!("% (#'(! %*%$).

T'()*( /%(' $%!-(! /%*,$#!(*# "&(+#0 $(! $( ($( &(!$( %'$('(/(! "%'&(

$%(!" *)")0(' $#0()(! %'((&(! !,! ,%'( $%!-(! ,+"%'("# %&(& "%0(*(

*#!#*(0 3 ? 24 (*. H(')" $#0()(! %*%'#"((! CT "(! "%'#(0 USG *())!

H+ "%'#(0. I!$#("# ,%'( %$%'( /%(' (#&) &'()*( /%(' $%!-(! "/,

%'#&,!#" /%*(&,*( (!- *%0)(" %!(!-(!(! ,!"%'( -(-(0 $(! $%!-(!

%$%'( 0(#! #!&'( (+$,*#!(0.

2 L#*(

M%')((! ,'-(! (!- (0#!- "%'#!- &%'%!( %')"((! (!- $#(#+(&(!,0%/ &'()*( &)*)0. S%'#!- &%'($# /%*,'(-# (&() %'$('(/(! *("# (!- +%'("(0

$('# 0#*( (!- ')&)' "%/#!--( "%*)( )(( $#0()(! )!&) *%*%'+(##

%')"((! $# 0#*(.

P%!(&(0("(!((! %$%'( 0#*( $((& $#0()(! $%!-(! &%'(# ,%'( $(!

!,! ,%'(. J#( &%'(# ,%'( /(')" $##0#/ "0%!,'(# $((& $#0()(! $%!-(!

*%*+%'#(! (&:(& /%*,"&( &,#(0 $#(/#& (&() "0%!,&,*# ('"#(0 %$%'(

$%!-(! (")0('#"("#. K,!&'(#!$#("# !$((! %!%0(*(&(! 0#*( ($(0(/ ,!$#"#

("#%! (!- $( "&(+#0 ()0"# 0#*( (&() '(-*%!&("# (!- 0)(" $(! %$%'(

%*+)0)/ $('(/ /#0)" (!- 0)(" "%'&( %-(-(0(! *%!((# /%*,"&("#".

3 P(!'%("

U*)*!( %$%'( (!'%(" &%'($# ($( ))0(! 0(!-")!- $# $(%'(/

%#-("&'#)* $%!-(! ,0)*!( %'&%+'(0#" "%+(-(# (0(". P%!#!-(&(! ($(' (*#0("%

(!- ,!"&(! /(')" $#)'#-(# ($(!( %$%'( (!'%(". P($( 8 (* %'&(*( ("(

&'()*( %*%'#"((! CT $%!-(! double contras+#"( "(( +%0)* *%*%'0#/(&(!

%$%'( (!'%(". P%*%'#"((! /(')" $#)0(!- #( $#)'#-(# ($(!( %$%'( ($(

,'-(! &%'"%+)&. J#( CT "(! *%'(-)(! *(( $#(!)'(! )!&) $#0()(!

%*+%$(/(! %"0,'("#.

4 T'(&)" )'#!('#)"

( G#!(0

D%0((! )0)/ "(*(# $%0((! )0)/ 0#*( %'"%! &'()*( -#!(0 $#"%+(+(!

,0%/ &'()*( &)*)0 (!- "%('( 0(!-")!- *%!-%!(# (+$,*%! #!--(!- $(!

)!--)!-. T'()*( &%'"%+)& $#"%+(+(! ('%!( %%0(((! 0(0) 0#!&(" %'%0(/#(!

(&)/ $(! ,0(/'(-( ,!&(. T(+'((! %!$('((! ($( %%(&(! !--# +#"(

*%!%+(+(! &'()*( %*+)0)/ $('(/ )&(*( ('%!( $%"%0%'("# %(&. L)( ('%!(


11/25

"%!(&( (# $(! #"() *%')((! 0)( &%*+)" &%'+(!( (!- *%!-%!(# -#!(0

"%/#!--( #( &%'$((& 0)( ($( #!--(!- /(')" $###'(! &'()*( -#!(0. P($(

0)( &%*+)" -#!(0 8= +%'/)+)!-(! $%!-(! &'()*( #"%'( (+$,*%!.

G#!(0 (!- &%'0%&( ($( ',!--( '%&',%'#&,!%)* +(-#(! (&(" /(!(

&%'#"("# ,0%/ %$#%0 %*+)0)/ $('(/ "%'&( )'%&%' "%*%!&('( *(""( -#!(0

*%0((!- +%+(" $(0(* +(!&(0(! 0%*( (!- +%'($( $(0(* ("#( -%',&(. K('%!(

#"("# (!- "%$##& -#!(0 *)$(/ *%!-(0(*# $#"0,("# ,0%/ ("%0%'("# *())!

$%"%0%'("# *%!$($( (!- +#"( *%!%+(+(! &'()*( "%%' ()0"# ,00%!-

""&%* (&() ",+%(! ($( #!*( ('&%'# '%!(0#" "%/#!--( &%'($# ,0)"# ('"#0(

*(),)! ,*0#& %*+)0)/ $('(/.@%!( '%!(0#" #'# &%'0%&( %!&'(0 (,'&( "%/#!--( 0)( %!%&'("# $# $(%'(/ #!#

+#"( *%!%+(+(! &'()*( ($( % $)( "&')&)'. @%!( '%!(0#" (!- +%'$%(&(!

$%!-(! (!'%(" $(! ,0% (&(" -#!(0 #'# "%'&( $),$%!)* $%!-(! &%# *%$#(0

-#!(0 (!(! +#"( *%!%+(+(! &'()*( ,*+#!"(# (#&) &'()*( (!'%("

$),$%!)* $(! -#!(0. A!(&,*# -#!(0 (!- *%!-(0(*# %0(#!(! "%%'

/#$',!%',"#" (&() &)*,' *(0#-!( 0%+#/ *)$(/ *%!-(0(*# ')&)' ('%!( ($(!(

&'()*( -#!(0.

+ U'%&%' %"#( )'#!('#( $(! )'%&/'(

T'()*( &)*)0 )'%&%' ('(!- &%'($# $(! +#("(!( *+)0 (#+(& !$((!

0((',&,*#. R)&)' #!&'(%'#&,!#)* $('# (!$)!- %*#/ +#("(!( *+)0 (#+(&

'(&)' %0# (&() %( ))0(! 0(!-")!- ($( %')& +(-#(! +((/. G%(0( (!-

*+)0 +%')( '(!-"(!-(! %'#&,!%)*. P%*%'#"((! $%!-(! CT "(! $((&

*%!$%&%"# (#'(! #!&'(%'#&,!%)*. C%$%'( &%'"%+)& )-( $((& $#,!#'*("#

$%!-(! %*%'#"((! retrograde(&() CT "&,-'(/.

C%$%'( )'%&/'( (!&%'#,' 0%+#/( ('(!- &%'($# !(*)! +#("(!( *+)0 (#+(&

straddle in"ury (!- *%!%+(+(! *+)0!( /%*(&,* $# $(%'(/ %!#" $(!

%'#!%)*. P("#%! $%!-(! %$%'( &%'"%+)& +#"(!( *%-(0(*# %')"((! +%'(& ($(

",!-#,")" )'%&/'(. E"0,'("# +%$(/ $#!# $#!$#("#(! $%!-(! *,+#0#"("# )'%&/'(

$(! %"#"# "%-*%! %$'( $%!-(! '%(!("&,*,"#".

$ O'-(! '%',$)"#

C%$%'( #!&'((+$,*#!(0 (!- *%!-%!(# ,'-(! ('(!- &%'($# ($( ("#%!

(!- $( /(*#0 $(! +#("(!( $#&%*)(! %( $#0()(! 0((',&,*# (#+(& (!-

0(#!.

% P%*+)0)/ $('(/ (+$,*%!


12/25

C%$%'( ($( %*+)0)/ $('(/ +%"(' (+$,*%! +#("(!( *%!%+(+(!

#!"&(+#0#"("# /%*,$#!(*# $(! $#&%*)(! ($( "((& 0((',&,*#. P($( +%+%'((

(")" %'$('(/(! $((& +%'/%! "%!$#'#. P($( %*%'#"((! CT "(! *)!-#!

$#&%*)(! ($(!( "%)$,(!%)'#"*(. J#( (!%)'#"*( &%'($# ($( %*+)0)/ $('(/

+%"(' *(( *%')((! #!$#("# %'+(#(! %*+)0)/ $('(/ (!- ')"( $%!-(!

('( 0((',&,*#. P($( +%+%'(( (")" %'$('(/(! $((& +%'%! "%!$#'#. P($(

%*%'#"((! CT "(! *)!-#! $#&%*)(! ($(!( "%)$,(!%)'#"*(. J#(

(!%)'#"*( &%'($# ($( %*+)0)/ $('(/ +%"(' *(( *%')((! #!$#("# %'+(#(!

%*+)0)/ $('(/ (!- ')"( $%!-(! ('( 0((',&,*# $(! *%!%-(/ %'$('(/(!

(!- &%'($#

& GEJALA DAN TANDA KLINIK

G%(0( ((0 $('# %$%'( (+$,*%! *%0#) *)(0 *)!&(/ $(! $%*(*.

D('(/ $(0(* )'#!% )-( "%+(-(# &(!$( (!- 0(#!!(. C%$%'( ($( (+$,*%! +#"(

$#$((&(! !%'# (+$,*%! $#"&%!"# (&() () ($( (0("# $(! ")('( )")" +#"(

*%!)')! (&() $( ($(. P%'0#!$)!-(! (+$,*%! (#&) $%!-(! %!%-(!-(! $('#

$#!$#!- %')& )!&) *%!(-( ,'-(!:,'-(! (!- *%!-(0(*# #!0(*("# $# $(0(*

(+$,*%!. P!%)*,%'#&,!%)* *%')((! )$('( (&() -(" $# $(0(* ',!--(

(+$,*%! +#"( *%!($# ")(&) #!$#("# ($(!( ')&)' $('# ,'-(! +%',!--(. P($(

0)( &%*+)" +#"( $#$((&(! ($(!( %#"%'("# ;%0)('!( ,'-(!:,'-(! $(0(*

(+$,*%! $('# &%*(& 0)( &%'"%+)&


13/25

T'()*( &%*+)" $((& *%!-(#+(&(! %'#&,!#" "(*(# $%!-(! "%"#" +#0(

*%!-%!(# ,'-(! (!- +%',!--( #!&'(%'#&,!%(0. R(!-"(!-(! %'#&,!%(0 (!-

*+)0 "%")(# $%!-(! #"# $('# ,'-(! (!- +%',!--( &%'"%+)& *)0(# $('# -("&%' (!-

+%'"#(& #*#( "(*(# $%!-(! ,0,! (!- +%'#"# %"%". R(!-"(!-(! #*#( ,!"%&!(

(0#!- %(& $(! %"%" (0#!- 0(*+(&. B#0( %','("# &%'($# $# +(-#(! (&("

*#"(0!( $# $(%'(/ 0(*+)!- *(( ((! &%'($# %'(!-"(!-(! "%-%'( "%")$(/

&'()*( $(! ((! &%'($# -%(0( %'#&,!#" /%+(& "%$(!-(! +#0( +(-#(! +((/

"%%' ,0,! *)0(:*)0( $( &%'$((& -%(0( ('%!( *#',,'-(!#"*%

*%*+)&)/(! (&) )!&) +%'%*+(!-+#( +(') "%&%0(/ 24 (* *+)0 -%(0(

()& (+$,*%! ('%!( %'(!-"(!-(! %'#&,!%)*.

' DIAGNOSIS

a Anamn()i)

D((&(! %&%'(!-(! *%!-%!(# %'0)((!!( +#0( *)!-#! $('#

%!$%'#&(!( "%!$#'# ,'(!- "%#&(' ,'+(! %*+(( (*+)0(!" ,0#"# (&() "("#:

"("# 0(#!!( "%"%-%'( *)!-#! +%'"(*((! $%!-(! )"(/( '%")"#&("#.


14/25

* P(m(ri+)aan Fi)i+

U!&) %*%'#"((! #"# 0()(! #!"%"# ()")0&("# %')"# $(! +(')

(0("#. U!&) #!"%"# 0#/(& *)0(# $('# %($((! )*)* 0#%! %"'%"# ((/

&(!$( $%/#$'("# %'$('(/(! $(! &(!$(:&(!$( ",. P($( &'()*( (+$,*%!

+#("(!( $#&%*)(! ,!&)"#, (+'("#, 0(%'("# $(! %/#*,"#". E/#*,"#"

*%')((! #!$#("# ($(!( %'$('(/(! $# #!&'((+$,*%!. T%'$((& E/#*,"#" ($(

$(%'(/ )*+#0#(0 +#("( #&( "%+)& Cullen#s $ign "%$(!-(! %/#*,"#" (!-

$#&%*)(! ($( "(0(/ "(&) (!--)0 $#"%+)& "%+(-(# Turner#s $ign. T%'($(!-

$#&%*)(! ($(!( %#"%'("# (#&) *%!,!,0!( ,'-(! (+$,*%! %0)(' "%%'

)")" ,0,! (!- &%'($# ($( &'()*( &%*+)" (&() &((*.

U!&) ()")0&("# "%0(#! ")('( +#"#!- )")" (!- $#%'#"( $# %*(& )($'(!

$#*(!( ($(!( %"&'(("("# $('(/ *%!%+(+(! /#0(!-!( +)!# +#"#!- )")" )-(

%'0) $#$%!-('(! ($(!( +)!# +')#&" $('# ('&%'# '%!(0#" +)!# +')#&" ($(

)*+#0#(0 *%')((! #!$#("# ($(!( &'()*( ($( ('&%'# '%!(0#". P%')"# )!&)

*%0#/(& (((/ ($( !%'# %&,. S(0(/ "(&) %*%'#"((! %')"# ($(0(/ )# %')"#

!) $%!-(! *%0%&((! &(!-(! #'# ($( "#"# $#!$#!- &/,'(" %'&%!-(/(! (!&('(

"#!( #0#(( (!&%'#,' ")%'#,' %*)$#(! !) $%!-(! &(!-(! (!- 0(#! "%/#!--(

&%'($# -%&('(! $# $(0(* ('%!( +%!&)'(! '#!-(! +#0( ($( !%'# *%')((! &(!$(

($(!( '($(!- (&() (+"%" $# ')(!- ")+'%!# (!&('( /( $(! $#('(-/*(.

S%0(#! #&) +#"( $#&%*)(! ($(!( +)!# *(!# +#0( $#0(&("# 0(*+)!- ()&

$# )($'(! (&(" (&() +)!# '%$) +#0( ($( /%*,%'#&,!%)*. P($( (&) %')"#

+#0( $#&%*)(! +(0(!% "#-! $#*(!( +)!# '%",!(! (!- 0%+#/ %'(" ($( (!--)0

(!(! %( 0#%! +%'+('#!- % "(*#!- #'# *%')((! &(!$( ($(!( ')&)'%

0#*%. S%$(!-(! +#0( +)!# '%",!(! 0%+#/ %'(" ($( /( *%!(!$((! ($(!(

)$('( +%+(" (!- *(").

A$(!( $('(/ (&() (#'(! )")" $(0(* ',!--( %'#&,!%)* ((!

*%*+%'#(! &(!$(:&(!$( '(!-"(!-(! %'#&,!%)* +%')( !%'# &%(! !%'# %&,

!%'# 0%(" $(! %()(! ;rigidity< $#!$#!- (+$,*%!. K%()(! $#!$#!- (+$,*%!

$((& )0( $#(#+(&(! ,0%/ /%*(&,*( ($( $#!$#!- (+$,*%!. A$(!( $('(/

$(0(* ',!--( (+$,*%! $((& $#&%!&)(! $%!-(! s!ifting dullness "%$(!-(!

)$('( +%+(" $#&%!&)(! $%!-(! %( /( (!- +%'(!( (&() *%!-/#0(!-. B#"#!-

)")" +#("(!( *%0%*(/ (&() /#0(!- "(*( "%(0#. B#"#!- )")" (!- !,'*(0 +%0)*


15/25

+%'(' +(/( $( ($( ((:(( $(0(* ',!--( (+$,*%!. T'()*( (+$,*%! $#"%'&(#

'(!--"(!-(! %'#&,!%)* $((& *%*+%'#(! -%(0( +%')( !%'# ($( $(%'(/ +(/)

&%')&(*( (!- "%+%0(/ #'#. G%(0( #!# $#%!(0 "%+(-(# referred pain(!- $((&

*%*+(!&) *%!%-((! $#(-!,"#".

P%*%'#"((! 0(#! (!- %'0) $#0()(! %*%'#"((! '%&)* ($(!( $('(/

*%!)!)(! %0(#!(! ($( )")" +%"(' )0$,"%!&%"#" %*)!-#!(! ($(!( $('(/

$(0(* 0(*+)!- $(! (&%&%'#"("# ($(!( $('(/ *%!)!)(! 0%"# ($( "(0)'(!

%!#!-.

, P(m(ri+)aan La*oratorium

S%('( ')! $#%'#"( /%*,-0,+#! /%*(&,'#& /#&)!- %!#" 0%),"#& $(!

)'#!(0#"#". N#0(#:!#0(# (*#0("% )'#!% $(! "%')* $((& *%*+(!&) )!&) *%!%!&)(!

($(!( %'0)((! (!'%(" (&() %','"# )")".

1 D('(/ 0%!-(

H%*,-0,+#! $(! /%*(&,'#& !,'*(0 $#&%*)(! #( $( &%'($#

%'$('(/(!. P("#%! (!- *%!-(0(*# %'$('(/(! $((& $#0()(! &'(!")"# $%!-(!

(#'(! '#"&(0,#$. T'(!")"# &',*+,"#& $#%'0)(! #( &%'($# &',*+,"#&,%!#(

;0(&%0%' ,)!& 5.>*0< $(! %'$('(/(! (.

2 K#*#( "%')*

P%*%'#"((! #*#( "%')* %!!- $#0()(! )!&) *%!-(&(/)# ($(!(

%$("%#*+(!-(! %0%&',0#&. P%*%'#"((! -)0( $('(/ "%(&) )-( %!!-

$#-)!((! )!&) *%!-%&(/)# "&(&)" *%!&(0 ("#%!.

3 L%%' )!%,! &%"& ;LFT**3

(*0("% 0%+#/ $('# 1 )>1 *0.

10 PENATALAKSANAAN

a Trauma Tumu

T#!$((! ((0 (!- $#0()(! %'&(*( (0# ($(0(/ primary survey)!&)

*%!-#$%!#("# %'*("(0(/(! (!- *%!-(!(* $%!-(! "%-%'(. S&(+#0#"("#%)Cs


18/25

(%irway, )ret!ing, Circulation $#0()(! "%('( "#*)0&(!. P("#%! $%!-(!

%'*("(0(/(! (0(! !((" (&() (!- *%*#0## ,&%!"# *%!-(!(* $#0()(!

%*("(!-(! endotrac!eal tube. A&("# ("#%! (!- *%!-(0(*# (!%( (&()

/#,%!("# "%'&( ("#%! (!- *%!-(0(*# &(#!%( $%!-(! *%*+%'#(! ,"#-%!.

M%!)')!!( ")('( !((" *)!-#! $#&%*)(! ($( /%*,&/,'(" (&()

!%)*,&/,'(" "%/#!--( %'0) $#0()(! $%,*'%"#. I$%!#("# /#,,0%*# $(!

&(!$( "/, $(! *%!('# ")*+%' %'$('(/(!. A&("# "%-%'( $%!-(! %*+%'#(! (#'(!

#!&'(%!(. S%&%0(/ &%'&(!-(!# "%*)( 0()(! %*%'#"((! #"# 0%!-( *)0(# $('#

%(0( "(*(# % (# $%!-(! *%*,)"(! ($( $(%'(/ (!- *%!-(0(*#

&'()*(. S%&%0(/ *%0()(! primery survey $(! '%")"#&("# ((0 "%-%'( 0%!-(#

$%!-(! secondary survey )!&) *%!-#$%!#("# "%*)( ,&%!"# (!-

*%*)!-#!(! *%!#*+)0(! %$%'(. )edside ultrasonograp!y*%')((! "(0(/

"(&) ',&,,0 )!&) *%!#0(# ($(!( %'$('(/(! #!&'(%'#&,!%)*. J#( /("#0

%!#0(#(! !%-( (&() *%'(-)(! DPL +#"( $#0()(! ($( ("#%! (!-

/%*,$#!(*#!( $( "&(+#0. P("#%! (!- *%!-(0(*# #!"&(+#0#"("# /%*,$#!(*#

(&() $#&%*)(! (+!,'*(0#&(" (!- %0(" ($( %*%'#"((! #"# $(! ',"%$)'

$#(-!," *%*%'0)(! #!&%'%!"# %*+%$(/(!. P%!%*)(! (!- "%"## ($(

&(/( $#(-!," "%%' &%'+) ($(!( (#'(! +%+(" (&() %$%'( ,'-(! ($(&

($( ",!,-'(* (&() CT:"(! *%')((! #!$#("# )!&) $#0()(! #!&%'%!"#

%*+%$(/(!.

P("#%! /(')" $#*,!#&,' "%('( %&(& $# ICU +%$(/ "%&%0(/ "%0%"(#

0((',&,*#. B(!( ("#%! ((! *("#/ $##!&)+("# $(! $#+%'#(! %!("#.

P%'/((! /(')" $#&))(! ($( ")/) ("#%! %0(!('(! '%")"#&("# %*+%'#(!

(#'(! $(! $('(/ %!--(!(! %0%&',0#& $(! *%*,!#&,' %0)('(! $'(#!(-%. P($(

("#%! $%!-(! ($(!( +) %'$('(/(! (!- +%'0(!)& *)!-#! *%*)!(#

%)!&)!-(! )!&) $#0()(! %(0)("# $%!-(! (!-#,-'(# )!&) *%!-%&(/)# ($(!(

%*+,0#"("# $(! +%+%'(( ("#%! *%*%'0)(! %"0,'("# %*+(0# )!&)

*%!-,!&',0 %'$('(/(!. P("#%! (!- *%!(0(!# ',"%$)' ,!&',0 %')"((!

$%*(-%:,!&',0 ',%$)'%"< $(!>(&() (!- $#0()(! %!)&)(! (+$,*%!

"%*%!&('( /(')" $#0()(! ,%'("# %*+(0# $(0(* 24:48 (* )!&) %'+(#(!

$%#!#%


19/25

* Lu+a Tu)u+

K('%!( !--#!( '%)%!"# 0((',&,*# !%-( ($( !$((! 0((',&,*#

')! "%('(!- ,'(!- %!$%')!- )!&) 0%+#/ "%0% $(0(* *%*)&)"(! !$((!

0((',&,*# ($( 0)( &)") (+$,*%!.

T#!$((! 0((',&,*# /(!( $#0()(! +#0( ($(!( &(!$(:&(!$( '(!-"(!-(!

%'#&,!%(0 ", +#"#!- )")" &( &%'$%!-(' ',0(" #"%'( *%0(0)# 0)( &)")

$('(/ $(0(* 0(*+)!- +)0#:+)0# '%&)* )$('( +%+(" #!&'(%'#&,!%(0 $(! 0(("%

%'#&,!%(0 *%*+%'#(! /("#0 ,"#. S%0(#! $('# #&) %!$%'#&( $#,+"%'("# "%0(*(

24:48 (*.

B(-#(! I0*) B%$(/ FKUI>RSCM *%*((# ('( %!%!&)(! &%'0%+#/ $(/)0)

(((/ 0)( &)") #&) *%!%*+)" %'#&,!%)* $%!-(! ('( *%!-%"0,'("# 0)(

&)"). L)( &)") (!- *%!%*+)" %'#&,!%)* $#0(!)&(! $%!-(! !$((!

0((',&,*#.

, Lu+a T(m*a+

B%'+%$( $%!-(! 0)( &)") (+$,*%! (!- +%0)* &%!&) *%!-%!(# (0(&

$(0(* (+$,*%! 0)( &%*+( /(*#' "%0(0) *%!#*+)0(! %')"((! ($( (0(&

$(0(* %')&. D#(!)'(! ($( 0)( &%*+( %')& (-(' $#0()(! 0((',&,*#.

11 KOMPLIKASI

K,*0#("# +#"( &%'($# ($( &'()*( (!- $((& $##$%!#("# *())!

(!- $( &%'#$%!#("#. P%'$('(/(! #!&'((+$,*%! #!%"# "%"#" $(! %*((!

$((& &%'($#.'elayed ruptur (&() delayed !emmorage $('# ,'-(! ($(& /)")"!(

0#*( $((& *)!)0. P($( ("#%! (!- *%!(0(!# 0(('(&,*# $(! %'+(#(!,*0#("# "(*( $%!-(! ,!$#"# 0(#! (!- *%*%'0)(! !$((! ,%'("#.

C('0," et al ;25< *%!%*)(! +%+%'(( ,*0#("# ("( 0((',&,*#

($( &'()*( (+$,*%!. (!- (0#!- +(!( ($(0(/ (+"%" #!&'((+$,*#!(0 "%+(!(

;12=


20/25

K,*0#("# (!- 0%+#/ 0(*+(& 0(-# *%0#) ,+"&')"# )")" /(0)" $(! /%'!#(

#!"#"#,!(0.

12 P%OGNOSIS

P',-!,"#" ("#%! (!- *%!$%'#&( &'()*( (+$,*%! )*)*!( +(#. A!-(

%*((! ($( ("#%! (!- $#'((& $# ')*(/ "(#& "%#&(' 5:1=. S%+(-#(! +%"('

%*((! (!- $#"%+(+(! ,0%/ &'()*( (+$,*%! $((& $#%-(/. T'()*( (+$,*%!

*%')((! "(0(/ "(&) %!%+(+ &%'"%'#!- $('# %*((! (#+(& ")(&) &'()*( (!-

$((& $#%-(/.

J#( %$%'( (+$,*%! $( "%-%'( $#$#(-!,"#" ")(&) %($((! (!- 0%+#/

+)') $((& &%'($#. T%'(# (!- &%'0(*+(& ((! *%!%+(+(! *,'+#$#&(" $(!

*,'&(0#&(" (!- !--# #( &%'($# %','("# "(0)'(! -("&',#!&%"!(0.

A!-( ("#%! (!- "%0(*(& $('# &'()*( &%*+)" (+$,*%! $( *%!#!-(&

"%('( !(&( ('%!( %*((! $(0(* 24 (* %'&(*( "%+(-(# (#+(& $('# ",

%'$('(/(! #''%%'"#+0% $(! %?"(!-)!("#. L%+#/ $('# 8= %*((! &%'($# $(0(*

24 (* "((& %$(&(!-(! $# ')*(/ $(! 667= ($( "((& ,%'("# ((0 ('%!( %$%'(

%*+)0)/ $('(/ (+$,*%!. S%+(0#!( (!-( ("#%! (!- "%0(*(& $('# &'()*(

&%*+)" (+$,*%! &(!( %$%'( %*+)0)/ $('(/ *("#/ !--#.

D#"&'#+)"# )!( $('# %*((! ($( &'()*( &%*+)" (+$,*%! "(!-(&

+%'+%$( $#+(!$#!-(! ($( &'()*( &)*)0 (+$,*%!. S%+(-#(! +%"(' %*((!

('%!( &'()*( &%*+)" (+$,*%! &%'($# (!&('( 1 6 (* $('# "((& $(&(!- $# ')*(/

"(#& $##) )*0(/ (!- 0%+#/ %#0 ($( 6 24 (* "%&%0(/ %$(&(!-(!.

S%+(0#!( )*0(/ &%'!--# %*((! ('%!( &'()*( &)*)0 (+$,*%! &%'($# 72

(* "%&%0(/ %$(&(!-(! $# ')*(/ "(#& $(! )*0(/ (!- 0%+#/ %#0 $(0(* (*

%'&(*( %$(&(!-(!. K%*((! ('%!( &'()*( &%*+)" (+$,*%! 0%+#/ "%'#!-

&%'($# $# #!"&0("# -((& $(')'(& ;IGD< (&() ')(!- ,%'("# $#+(!$#!-(! $%!-(!

&'()*( &)*)0 (+$,*%! (!- &%')&(*( &%'($# $# ICU.

S%('( )*)* %*((! &%'($# $(0(* 72 (* %'&(*( ('%!( /#,%')"#

$(! "%)%0%!(. K%*((! $# ICU $)( *#!--) (&() 0%+#/ %*)$#(! +#("(!(

('%!( ,*0#("# "%"#" "#!$',* '%",! #!0(*("# "#"&%*# ;SIRS""&%*#

#!0(**(&,' '%",!"% "!$',*%


21/25

F(&,':(&,' (!- *%!#!-(&(! *,'&(0#&(" $('# &'()*( &%*+)" (+$,*%!

($(0(/ %!#" %0(*#! %'%*)(! 0(*(!( ('( (!&('( "((& %($#(! $(!

$#*)0(#!( !$((! ,%'("# ($(!( ", "((& $(&(!- % ')*(/ "(#& $(! ($(!(

%$%'( %(0(.


22/25

DAFTA% PUSTAKA

1 R. S(*")/#$((& #* $% J,!-. 24. Trauma dan )encana. B)) A('I0*) B%$(/. E$#"# I. P%!%'+#& +)) %$,&%'(! EGC. J(('&(.

2 U$%(!#. 28. %bdominal Trauma, )lunt. D%('&*%!& , E*%'-%!

M%$##!% C/('0%" D'% U!#%'"#& , M%$##!% (!$ S#%!% U!#%'"#& ,

C(0#,'!#( L,". A(#0(+0% ',*

/&&>>%*%$##!%.*%$"(%.,*>('%>43344:,%'#%. ;A%"%$ 211 7

J(!)(' >%*%$##!%.*%$"(%.,*>('%>433554:,%'#%. ;A%"%$ 211 7

J(!)('('%>82299:,%'#%. ;A%"%$ 211 7

J(!)('821995:,%'#%. ;A%"%$ 211 7J(!)('>.(".,'->&'()*(>)+0#(,!">(+$,*#!(0.$ ;A%"%$ 211 21

J(!)('>.(".,'->&'()*(>)+0#(,!">(+$,*#!(0.$
http://www.facs.org/trauma/publications/abdominal.pdfhttp://www.facs.org/trauma/publications/abdominal.pdf


25/25

2

perdarahan sal cerna bawah

Documents

Transcript of perdarahan sal cerna bawah