1. slide appendisitis perforasi nikki

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    CASE PRESENTATIONKEGAWATDARURATAN PADA APPENDISITIS PE

    Nikkita

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    CASE REPORT 

    Identitas

     Nama : Tn. AJenis Kelamin : L

    Usia : 28 tahun

    Agama : Islam

    Status Marital : Belum menikah

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    Anamnesa (15 April 2015 paa p!"!l 1#$15%

    Kel!&an !'ama Nyeri perut seluruh area

    Os a'an) ian'ar "el!ar)a en)an "el!&an nyeri perut sSMRS$ N+eri irasa"an di seluruh area perut$ N+eri tehebat ketika bergerak $

    A,aln+a n+eri 'erasa i perut bagian kanan bawah- m!nan 'erasa 'er!smener!s se*a" 2 hari SMRS$ N+eri irasairemasremas an ditusuk-tusuk $

    Kel!&an n+eri iser'ai en)an mual an nafsu makan ber

    men+an)"al aan+a "el!&an m!n'a&- lemas- emam- a'a!p!n Tia" aa )an))!an ee"asi an 'ia" aa )an))!an /er"em

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    Masuk Rumah Sakit-15 April 201n+eri 'e

    rasa i per!' "anan/a,a& an 'erasa 'er!s

    mener!s se*a" 2 &ari SRS$Diremasremas 3 i'!s!"

    '!s!" an men+e/ar "esel!r!& aera& per!'

    N+eri i sel!r!& area perse*a" 1 &ari SRS

    4er)era" → tambah arah4A4 (4!an) Air 4esar% /4AK (4!an) Air Ke.il% /

    !al (% m!n'a& (%Nas! ma"an /er"!ran)

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    Ri,a+a' Pen+a"i' Da&!

    Pasien men+a'a"an "erap meran+eri !l! &a'i +an) ian))ap se/a)ai sa"i' maa)$ Pasien men+serin) men)"6ns!msi 6/a' maa

    ,ar!n)$ Kel!&an /er"!ran) smen)"6ns!msi 6/a' 'erse/!'$

    • 7T- D- Aler)i isan)"al

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    PEERIKSAAN FISIK

    Keaaan !m!m 'ampa" sa"i' sean)• Kesaaran K6mp6smen'is- GCS 15

    •  Tana'ana 8i'al

     Te"anan Dara& (TD% 1209:0 mm7)

    Nai (N% #: ;9meni'

    S!&! (S% C

    Respira'6r+ Ra'e (RR% 1: ;9meni'

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    • Kepala n6rm6.ep&al

    a'a "6n*!n)'i?a 'ia" anemi"- s"lera 'ia" i

     Telin)a se"re' (%

    7i!n) se"re' (%

    !l!' m!"6sa /asa& an lia& 'ia" "6'6r

    • @e&er pem/esaran KG4 (%

    •  T&6ra; sime'ris – an'!n) 4!n+i an'!n) I B II re)!ler-)all6p (%-m!rm

     – Par!par! ?esi.!ler 9- r6n.&i 9- ,&eein) 9

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    A/6men (S'a'!s @6"alis%

    Inspe"si a'ar• Per"!si 'impani

    • A!s"!l'asi 4isin) Us!s (%

    • Palpasi N+eri 'e"an (% i sel!r!& re)i6 a/6men- eans m!s"!lar (% isel!r!&

    • Ps6as si)n (%

    • O/'!ra'6r si)n (%

    • R6?sin) si)n (%

    • 4l!m/er) si)n (%

    • D!np&+ si)n (%

    PUNGGUNG "e'6" C8A 9

    EKSTREITAS a.ral &an)a'- CRT 2 e'i"- eema (%- sian6sis (%

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    DIAGNOSIS KERA

    @a"ila"i 2: '&-en)an AcuteAbdmen e!c! Susp "eritnitisSusp Appendisitis "erfrasi

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     [email protected]• P!asa pre 6perasi

    • I8FD Rin)er @a"'a' 20 'pm ma"r6• Pemasan)an !rinar+ .a'&e'&er

    • ei"amen'6sa – Ce'ria;6ne in* 2 ; 1 )r per I8

     – Ke'6r6la. in* 2 ;

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    PEERIKSAAN PENUNA

    @a/ R!'in7/ 15$2 )r9l (n6rmal%

    @e!"6si' 12$200 )r9l (le!"6si'6

    7T 5$: (n6rmal% T&r6m/6si' 1#0$000 (n6rmal%

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    R6en')en T&6ra; AP

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    1= April 2015Dia)n6sa pre 6perasi

    Acute Abdmen e!c! Susp "eritnitis e!c! SusAppendisitis "erfrasi

     enis pem/ea&an

    #apartmi $ksplratif 

    Dia)n6sa p6s' 6perasi

    Appendisitis "erfrasi

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    %llw &p "st'p-1( April 2015

    S&)*$+,.$

    • Pasien 'ia" men)el!&"an sa"i' paa l!"p6s'6p

    • Pasien s!a& a'!s sesaa' se'ela& 6pera

    selesai$ Pasien *!)a men)"6nHrmasi 'ela• Pasien men+an)"al m!al- m!n'a& ma!p

    sesa"$ Nam!n pasien merasa emam mse/el!m pemeri"saan$

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    ')*$+,.$

    • Kesaaran 'ampa" sa"i' rin)an- .6mp6sme

    •  Tana'ana 8i'al

     Te"anan Dara& (TD% 1209:0 mm7)Nai (N% : "ali per meni'

    S!&! (S% C

    Respira'6r+ Ra'e (RR% 1: "ali per meni'

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    • Kepala n6rm6.ep&al

    • a'a "6n*!n)'i?a 'ia" anemi"- s"lera 'ii.'eri.

    •  Telin)a se"re' (%

    7i!n) se"re' (%- 'erpasan) NGT paa n6"anan +an) s!a& 'ia" /erpr6!"si

    • !l!' m!"6sa /asa& an lia& 'ia" "6'6

    • @e&er pem/esaran KG4 (%

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     T&6ra; sime'ris an'!n) 4!n+i an'!n) I an IIre)!ler-

    )all6p (%- m!rm!r (%Par!par! ?esi.!ler 9- r6n.&

    ,&eein) 9

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    A/6men s'a'!s l6"alis

    • Inspe"si

     Tampa" ?er/an men!'!p l!"a p6s'6plapar6'6m+- rem/esan (%

     Tampa" ?er/an men!'!p selan) rainase$Pr6!"si a"'i ari rainase /er!pa .airan/er,arna mera&- rem/esan (%

    • Per"!si 'impani

    • A!s"!l'asi 4isin) Us!s = "ali per meni'

    • Palpasi s!pel- N+eri Te"an (% i areal!"a p6s'6p$

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    • P!n))!n) "e'6" C8A 9

    • Geni'al 'erpasan) !rin "a'e'er en)an pr/er,arna "!nin) pe"a'

    • E"s'remi'as a.ral &an)a' an CRT 2 e

    ASS$SSM$N,

    @a"ila"i 2: '& POD I @apar6'6m+ e$. pere$. appenisi'is per6rasi

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    "#ANNN/

    • NGT i.a/!'

    • ei"amen'6sa

    Ce'ria;6ne 2 ; 1 )r I8

    Ke'6r6la. 2 ;

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    A""$NS

    "$R%'R

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    A)'M$N

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    /AA, A)'M$N

    Ga,a' a/6men mer!pa"an "linis +an) a"i/a' "e)a,a'ar6n))a per!' +an) /iasan+a menaa" en)an n+eri se

    "el!&an !'ama$ )a,a' a/memerl!"an 'ina"an se)era /iasan+a mer!pa"an 'ina" /e

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    NERI PERUT

     ENIS

    1$ N+eri ?iseral2$ N+eri parie'al

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    • N+eri ?iseral 'er*ai apa/ila 'erapa' ran)san)an paa 6r)as'r!"'!r i alam r6n))a per!'- misaln+a "arena .eera a'a

    • Ran)san)an /er!pa 'ari"an- re)an)an- a'a! "6n'ra"si +an)a"an mens'im!l!s sis'em s+ara 6'6n6m paa peri'6ne!m ?men+elim!'i 6r)an6r)an per!' se&in))a menim/!l"an n+es+ara 'erse/!' 'ia" pe"a 'er&aap ran)san)an ra/aan apem6'6n)an se&in))a sa+a'an a'a! pen*a&i'an 'ia" a"anmenim/!l"an n+eri$

    • Pasien +an) merasa"an n+eri ?iseral /iasan+a 'ia" apa' mse.ara 'epa' le'a" n+erin+a- se&in))a /iasan+a pasien mensel!r!& 'elapa" 'an)ann+a !n'!" men!n*!"an area n+eri$

    • N+eri ?iseral men!n*!"an p6la +an) "&as ses!ai en)an peem/ri6nal 6r)an +an) /ersan)"!'an$

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    • N+eri parie'alis (s6ma'is% 'er*ai "arena

    ran)san)an paa /a)ian +an) ipersaraH 6sara 'epi- misaln+a re)an)an paa peri'6neparie'alis an l!"a paa inin) a/6men$N+erin+a le/i& a"!'- 'a*am (seper'i i'!s!"

    an apa' i'en'!"an l6"asin+a "arena seras6ma'i. aJeren' lan)s!n) /eraa i sa'! sisis'em sara$ Ran)san)an apa' /er!pa ra/ran)san) "imia,i- 'e"anan- a'a! raan)$

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    NERI PERUT

    SIFAT

    1$ N+eri ali& (Referred pain%Se/a)ai .6n'6&iara)ma an area ise"i'ar /a&! ipersaraH6le& sera/!' C

    2$ N+eri pina& (Shifting

     pain%

    E'i6l6)i

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    E'i6l6)i

    E'i6l6)i

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    E'i6l6)i

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    APPENDIKS

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    APPENDISITIS AKUT• DEFINISI

    Inamasi lapisan alam appeni"s• [email protected]

    Insiensi i ne)ara ma*! le/i& /an+a" i/anin

    ne)ara /er"em/an)

    Insiensi 'er'in))i paa "el6mp6" !sia 20

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    !ti"l"gi:

    #. $e%alith &aling sering2. hiertr"$i 'aringan lim$"i(

    ). insissate( barium (ari emeriksaan

    *ra+ sebelumn+a

    ,. tum"r 

    -. bi'i sa+uran atau buahbuahan

    /. arasit intestine0 seerti %a%ing askaris

    ANIFESTASI [email protected]

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    ANIFESTASI [email protected]

    Ge*ala

    1$ N+eri /erpina&

    2$ An6re;ia (pen!r!nan nas! ma"an

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     Tana

    1$ 8i'al si)n n6rmal

    2$ P6sisi pasien 'erlen'an) en)an

    men)an)"a' pa&a an /er)era" se.araperla&an

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    Pemeri"saan @a/6ra'6ri!m

    • 7ema'6l6)i

    il le!"6si'6sis 10$0001:$0009mm2- *imen)ini"asi"an aan+a per6rasi a'a!

    6era'e PN pre6mina'e

    Urinalisis!n'!" men)eleminasi "em!n)"inan inesal!ran "emi&

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    Keterangan:

    1#: hamir asti aen(isitis → "erasi

    38: ke%en(erungan aen(isitis

    -/: %"%"k (engan aen(isitis tai ti(ak bersi$at

    (iagn"stik → 4T s%an

    , %en(erung bukan aen(isitis tetai ti(ak menutu

    kemungkinan

    Ima)in)

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    Ima)in)

    • C&es' ;ra+ !n'!" men)eleminasi reered pain ari pr6ses pnel6/!s "anan /a,a&

    • 4ari!m enema *i"a appeni"s 'erisi 3 eliminasi appenisi'is- n

    /erla"! se/ali"n+a

    • USG

    Appeni"s n6rmal l66p /6,el +an) /!n'! an 'ia" /erperis'aari .e.!m- iame'er 5 mm

    Appenisi'is aan+a appeni.6li'&- pene/alan inin) appenaan+a periappeni.eal !i

    • CT s.an

    Appenisi's ila'asi appeni"s M 5.m an inin)n+a mene/ae.ali'&- aan+a /!"'i inamasi en)an pene/alan mes6appen

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    [email protected] RUPTU

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    [email protected] RUPTUAPPENDIKS

    • Appene"'6mi

    •Ke.!ri)aan r!p'!rDemam C

    W4C 1:$0009mm2

    @6.alie re/6!n 'enerness paa contained rupture,allin)6J )a)al 3 peri'6ni'is )eneralisa'a

    •  Tana iri'asi peri'6ne!mR6?sin) si)n (n+eri i [email protected] saa' @@ i'e"an%

    In?6l!n'ar+ )!arin) m!s.!lar resis'an.e

    N+eri saa' /er*alan an /a'!"

    [email protected]

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     [email protected]

    Se'ela& ia)n6sis apa' i'e)a"an- pasien isiap"an

    6perasi$• 7irasi +an) ae"!a'

    • "6re"si )an))!an ele"'r6li'

    • m6ni'6rin) "6nisi .aria.- p!lm6nar+- an renal

    • Pre6pera'i an'i/i6'i" !n'!" men!r!n"an "6mpli"as

    ine"si!s paa appenisi'is paa !n.6mpli.a'eappenisi'is- an'i/i6'i" i/eri"an selama 2 *am-sean)"an paa appenisi'is per6rasi- an'i/i6'i" sampai pasien ae/ril an W4C n6rmal

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    Open Appene"'6mi

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    Open Appene"'6miinsisi M%. Burne+ 5"blik6 atau 7"%k+

    a9is 5trans9erse6 a(a 7L

    &'ika (iagn"sis (iragukan0 lakukan insisi

    l";er mi(line0 lalu eksl"rasi r"ngga erit"neal

    <

    i(enti$ikasi aen(i* (engan men+usuri

    taenia %"li a(a %e%um<

    m"bilisasi aen(iks (engan

    memisahkan (ari mes"aen(i*

    <

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    <

    lakukan ligasi atau ligasi (an in9ersi aen(i%eal

    &hal ini (ilakukan 'ika aen(i%eal stum masih 9iabel (a

    ti(ak terlibat r"ses in$lamasi0 lakukan ligasi (engan n"suture

    <

    irigasi r"ngga erit"neal

    <

    tutu luka lais (emi lais

    @apar6s.6p+

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    apa 6s.6p+

    Kele/i&an

    Ine"si l!"a p6s'6p le/i& minimal• N+eri p6s'6pera'i le/i& minimal

    • Ra,a' inap le/i& sin)"a'- ,ala!p!n per/eaann+a "!ran)

    • Cepa' "em/ali "e a"'iH'as

    Persiapan• 1$ General anes'&esia

    • 2$ Pemasan)an NGT an Urinar+ .a'e'&er

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    (ilakukan (engan ) "rt=tr"%ar 

    #. umbili%us 5> # mm6

    2. suraubi% 5># atau #2 mm6

    ). LL0 eigastrium0 atau 7U 5- mm6

    <eksl"rasi untuk mengeleminasi at"l"gi lain

    <

    i(enti$ikasi aen(iks (engan men+usuri

    taenia

    <(iseksi a(a base (ari aen(iks untuk

    memisahkan base aen(iks (an mesenter+

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     TERIA KASI7