5. Kolik Ureter
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Transcript of 5. Kolik Ureter
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Disusun Oleh :Dr.Andry Irawan
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Definisi :Kolik adalah rasa sakit hebat yang hilang timbul akibat hiperperistaltik dan spasme otot polos organ berongga yang berbentuk tabung
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Nyeri Kolik: Sangat sering terjadi Kesakitan hebat ke dokter Bisa sebagai tanda awal dari problem
serius
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DD : * Kolik ginjal / ureter * Kolik biliaris * Kolik usus
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1. Faktor Intrinsika. Intraluminal berupa :
- deposit kristal intra tubuler (obat-obatan, asam jengkol) batu
- bekuan darah karena trauma ginjal, jaringan nekrose (papila, kista atau tumor ginjal)
b. Intramural berupa : - fungsional: disfungsi ureteropelvik, vesico-
uretero junction. - Autonom : tumor, granuloma, infeksi.
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2. Faktor Ekstrinsika. Berasal dari organ reproduksi
- carcinoma cervik, kehamilan extrauteri, myoma, prolap uteri, endometriosis, infeksi, kista ovarii, abses
- prostat hipertrofi, carcinoma prostate
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b. Berasal dari Vaskular - aneurisma aorta / arteri iliaca - arteri aberan pada ureteropelvik
c. Berasal dari gastrointestinal - pembesaran kelenjar limfe - fibrosis oleh karena obat (beta bloker) - tumor, hematom.
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SIFAT SAKIT :1. Hilang timbul2. Rasa seperti ditusuk-tusuk3. Berkeringat dingin4. Lemas, shock, kolaps
OBSTRUKSI TOTAL : Sakit tidak hebat
OBSTRUKSI PARTIAL : Sakit hebat
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PENJALARAN RASA SAKIT (Colic Ureter)
* Benda asing (batu) di proksimal : Kostovetebra – pinggan g– epigastrium Sepanjang ureter Melalui syaraf genito cruralis : rasa sakit sampai
di testis / ovarium, uretra. Vesicosensory reflex melalui n. ilio inguinalis
hiper estesi di paha bagian medial atas Melalui ganglion coeliacus ke T 10 – L 1 ke
medulla oblongata nausea, vomitus, diare, mules, nyeri epigastrium
Interspinal over flow penjalaran renorenal sakit di ginjal – kontra lateral.
Penjalaran ke dada, bahu, lutut
DD/Gastrtitis
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* Benda asing (batu) di 1/3 tengah: Rasa sakit di Mc. Burney (DD / Appendicitis). Seperti diverticulitis / penyakit-penyakit kolon
ascendens, descendens dan sigmoid. Sakit disudut kostovertebra.
* Benda asing (batu) di 1/3 distal: Rasa sakit di : - Inguinal
- Supra pubic Gejala-gejala sistitis Sakit di skrotum Sakit di sudut kostovertebra
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Tujuan :1. Mengilangkan rasa sakit2. Menghilangkan spasme otot polos
Terapi : Analgetika yang kuat Kalau perlu morfin dan petidin Dibei obat-obat spasmolitika NSAID
Bahaya Morfin : AdiksiBahaya Petidin / Spasmolitika : Ileus paralitikus
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A. Batu UreterDiagnosa : - FPA / UIV
- USGPengobatan : Operatif / konservatif
Indikasi Operasi : 1. O > 5 mm2. Kolik terus3. Gross hematuria4. Infeksi5. Hidro ureteronefrosis6. Tidak bergerak
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Letak batu biasanya pada penyempitan Fisiologis :1. Pelvi Ureteric junction2. Menyilang vasa iliaka3. Uretero vesical junction
B. Bekuan DarahAkibat perdarahan masif di ginjal.
Kausa : 1. Kongenital, misalnya ginjal polikistik.2. Trauma3. Radang (banal / TBC)4. Tumor (wilms, Grawitz, Adeno Ca)5. Ada batu ginjal6. Lain-lain : sindroma nefrotik, gloamerulo nefritis,
hemangioma, keracunan obat, makanan, dll.
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C. Benda asing lain :1. Misalnya pecahan tumor – ginjal /
pelvis renis protokol seperti pada bekuan darah.
2. Benda asing lain : Ureter kateter, dll
Penyebab lain : ditangani sesuai penyebab
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Pemeriksaan :1. Laboratorium Asam urat2. Urinalisa rutin eritrosituria (+)3. USG4. FPA / UIV5. Lain-lain : -- Sitologi
Sistoskopi RPG CT Scan MRI
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TERIMA KASIH`