Kapita Selekta (Dr. Wilmar. Yl, Spb.kbd)
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Transcript of Kapita Selekta (Dr. Wilmar. Yl, Spb.kbd)
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KAPITA SELEKTA BEDAH KAPITA SELEKTA BEDAH DIGESTIFDIGESTIF
KOLONEL (PURN) DR.WILMAR KOLONEL (PURN) DR.WILMAR Y.L. , Sp.B.KBDY.L. , Sp.B.KBD
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BEDAH DIGESTIFBEDAH DIGESTIFPERMASALAHAN
1. PENEGAKAN DIAGNOSA2. EVALUASI KEADAAN PENDERITA3. RENCANA PENANGGULANGAN
S: SUBJECTIVEO: OBJECTIVEA: ASSESSMENTP: PLANNING
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Abdomen akutAbdomen akutNon traumatikNon traumatikMendadak (tiba-tiba)Mendadak (tiba-tiba)Gejala utama di abdomenGejala utama di abdomenTindakan bedah segeraTindakan bedah segera
PERADANGAN (bakteri,kimia) PENYUMBATAN (volv, hern, adhe) NEOPLASMA / TUMOR (Ca, polip, KET) KELAINAN VASKULER (emboli,perforasi) KELAINAN KONGENITAL (invaginasi)
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ABDOMEN AKUT
sering
KELAINAN
T.G.I : App, OUH, OUB, HS, PUP, PU, DM, GA, Aden Mes.PANKREAS : Pankreatitis akutT. URINARI : Kolik Renal,ureteral, PNA, Sistitis akutHATI : Hepatitis akut, Abses hati LIMPA : Ruptur spontan limpa, Infark limpaT.BILIARI : Kolesistitis akut, Kolangitis akut, Kolik bilierGINEKOLOGI : KET, Tumor ov terpl, Ruptur kista ovarVASKULAR : Rupt aneurisma aorta, Trombosis mesentPERITONEAL : Abses intra abdomen, Peritonitis pr, TBCRETROPERITONEAL : Perdarahan retroperitoneal
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ABDOMEN AKUTABDOMEN AKUT
S : SUBJECTIVES : SUBJECTIVE
NYERI PERUTNYERI PERUTlokasi, jenis, progesivitas,lokasi, jenis, progesivitas,
karakterkarakter MUNTAH, DIARE, KONSTIPASI, MUNTAH, DIARE, KONSTIPASI,
DEMAMDEMAM RIWAYAT PENYAKIT KELUARGA, RIWAYAT PENYAKIT KELUARGA, MENSTRUASI, PEMAKAIAN OBATMENSTRUASI, PEMAKAIAN OBAT
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O : OBJECTIVE O : OBJECTIVE (1)(1)
ABDOMEN ABDOMEN INSPEKSI INSPEKSI DISTENSIDISTENSI
BEKAS OPERASIBEKAS OPERASI DARM STEIFUNGDARM STEIFUNG
AUSKULTASI AUSKULTASI BISING USUS↓ Pert diffBISING USUS↓ Pert diff BISING USUS ↑ DGNBISING USUS ↑ DGN KOLIK, METALIC KOLIK, METALIC
SOUND SOUND Obst Usus Obst Usus
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O : OBJECTIVE O : OBJECTIVE (2)(2)
PERKUSI PERKUSI PEKAK HATI (-) PEKAK HATI (-) SHIFTING DULLNESSSHIFTING DULLNESS NYERI KETOK, LEPASNYERI KETOK, LEPAS
PALPASI PALPASI NYERI BERBATAS TEGAS App,Koles Ak,Salp Ak,Div NYERI BERBATAS TEGAS App,Koles Ak,Salp Ak,Div NYERI DIFFUS TANPA TEKAN GE,Infl Us tanpa NYERI DIFFUS TANPA TEKAN GE,Infl Us tanpa
PertPert MURPHY SIGN : Kolisistitis akutMURPHY SIGN : Kolisistitis akut ILIOPSOAS SIGN : Abses perinefrik, Perforasi ILIOPSOAS SIGN : Abses perinefrik, Perforasi
coloncolon OBTURATOR SIGNOBTURATOR SIGN
NYERI SUDUT KOSTOVERTEBRALIS NYERI SUDUT KOSTOVERTEBRALIS Pyelonephritis akutPyelonephritis akut
NYERI KETOK DI BAWAH IGA NYERI KETOK DI BAWAH IGA Inflamasi diafragma, hepar, limpaInflamasi diafragma, hepar, limpa
RT RT
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PEMERIKSAAN PENUNJANGPEMERIKSAAN PENUNJANG
DARAH, URINE, FECESDARAH, URINE, FECES
FOTO POLOS DADA, ABDOMEN 3 FOTO POLOS DADA, ABDOMEN 3 POSISIPOSISI
ANGIOGRAFIANGIOGRAFI
USGUSG
CT SCANCT SCAN
ENDOSKOPIENDOSKOPI
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A : ASSESSMENTA : ASSESSMENT
PERADANGAN PENYUMBATANPERDARAHANPERFORASI
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P : PLANNINGP : PLANNINGPENANGGULANGAN PENANGGULANGAN DARURAT DARURAT
DEFENITIFDEFENITIF
PENANGGULANGAN DARURAT PUSKESMAS – UGD RS PUASA NGT IVFD RL / NACL 0,9% FOLEY CATHETER ANTIBIOTIKA
PENANGGULANGAN DEFINITIF OPERATIF PENYEBAB
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KOLESISTITIS AKUTKOLESISTITIS AKUT
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APPENDICITIS APPENDICITIS (1)(1)
APPENDICITIS APPENDICITIS ABDOMEN AKUTABDOMEN AKUT
SERINGSERING
♂ ♂ > ♀> ♀
10 – 30 TAHUN10 – 30 TAHUN
PATOFISIOLOGI PATOFISIOLOGI
APPENDICITIS PENYUMBATAN LUMEN
-FOLIKEL LIMFOID - BIJI-BIJI-FEKALIT - STRIKTUR FIBROSIS -BENDA ASING - NEOPLASMA
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APPENDICITIS APPENDICITIS (2)(2)
MUKUS >>
TEK. INTRA LUMEN ↑↑
ALIRAN LIMFE ↓↓
- EDEMA- DIAPEDESIS BAKTERI- ULSERASI MUKOSA
APPENDICITIS ACUT
NYERI EPIGASTRIUM
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APPENDICITIS APPENDICITIS (3)(3)
- OBSTRUKSI VENA- EDEMA >>- BAKTERI DDG- RADANG PERITONEUM
- ALIRAN ARTERI ↓↓- GANGREN
APPENDICITIS SUPURATIF AKUT
NYERI P. KA BAWAH
APPENDICITIS GANGRENOSA
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APPENDICITIS APPENDICITIS (4)(4)
- DINDING RAPUH- DINDING PECAH
- PROSES LAMBAT- OMENTUM &USUS BERGERAK KE APPENDIX
- ABSES- SEMBUH
APPENDICITISPERFORASI
- APPENDICIAL MASS- PERIAPPENDICULAR INFILTRAT
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APPENDICITIS APPENDICITIS (5)(5)
S : SUBJECTIVES : SUBJECTIVE
SAKIT PERUT KANAN BAWAH SAKIT PERUT KANAN BAWAH
TIBA- TIBA, TERUS-TERUSANTIBA- TIBA, TERUS-TERUSAN
SEBELUMNYA SAKIT DI ULU HATISEBELUMNYA SAKIT DI ULU HATI
SEKITAR PUSAT, MENETAPSEKITAR PUSAT, MENETAP
DI PERUT KANAN BAWAHDI PERUT KANAN BAWAH
DEMAM DAN MUAL, MUNTAH DEMAM DAN MUAL, MUNTAH
DIARE DIARE
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APPENDICITIS APPENDICITIS (6)(6)
O : OBJECTIVEO : OBJECTIVE
ABDOMEN PERITONITIS DIFFUSA EC APPENDICITIS AKUT PERFORASI
INSPEKSI : - TEGANG AUSKULTASI : - PERISTALTIK LEMAH S/D (-) PERKUSI : - LIVER DUMPING (-) PALPASI : - DEFANCE MUSCULAR (+)
PEMERIKSAAN PENUNJANG - LEUKOSIT ↑- NEUTROFIL ↑- USG : DOUGHNAT (+)
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APPENDICITIS APPENDICITIS (7)(7)
A : ASSESSMENTA : ASSESSMENT
- APPENDICITIS ACUT- APPENDICITIS ACUT
- APPENDICITIS SUPURATIF ACUT- APPENDICITIS SUPURATIF ACUT
- APPENDICITIS GANGRENOSA- APPENDICITIS GANGRENOSA
- APPENDICITIS PERFORASI- APPENDICITIS PERFORASI
- APPENDICIAL MASS = - APPENDICIAL MASS =
PERIAPPENDICULAR INFILTRATPERIAPPENDICULAR INFILTRAT
- APPENDICIAL ABCESS- APPENDICIAL ABCESS
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APPENDICITIS APPENDICITIS (8)(8)
P : PLANNINGP : PLANNING
PENANGGULANGAN: - DARURATPENANGGULANGAN: - DARURAT
- DEFINITIF- DEFINITIF
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APPENDICITIS APPENDICITIS (9)(9)
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APPENDICITIS APPENDICITIS (9)(9)APPENDICITIS PERFORATA GANGRENOSAAPPENDICITIS PERFORATA GANGRENOSA
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THANK YOU THANK YOU