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KEDARURATAN BEDAH ANAK

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  • KEDARURATAN

    BEDAH ANAK

  • ----- Meeting Notes (11/19/15 10:38) -----

    kemungkinan organ di thorax gabung menjadi satu.

    gastroschisis,

    *

  • KEDARURATAN PADA NEONATUS :

    Kelainan Saluran Pernafasan kongenital

    1. Obstruksi jalan nafas

    2. Displacement Lung volume

    3. Pulmonal parenchymal insufficiency

    B. Kelainan Pencernaan kongenital

    1. Obstruksi usus

    2. Malrotasi

    3. Perforrasi usus

    C. Defect dinding abdomen

    1. Omphalocele pecah

    2. Gastroschisis

    ----- Meeting Notes (11/19/15 10:38) -----

    penting!!!!

    *

  • Kelainan Saluran Pernafasan Kongenital

    Jenis Kelainan :

    1. Saluran pernafasan bagian atas :

    - Mikrognatia: Pierre Robin Syndrome

    - Makroglosia

    - Choanal Atresia

    - Laryngeal/Tracheal stenosis

    - Tumor larynx dan leher

    ----- Meeting Notes (11/19/15 10:38) -----

    mikrognatia : pierre robin syndrome

    penting

    *

  • 2. Kelainan Intratoraks :

    - Atelektasis pulmonum

    - Pnemotoraks

    - Pnemomediastinum

    - Kiste dan tumor paru-paru

    - Congenital lobar emphysema

    - Hernia diaphragmatika

    - Eventerasi diaphragma

    - Atresia esophagus dengan fistule trachea

    - Trecheo dan bronchomalacia

  • This drawing on the x-ray depicts the material in the chest, including stomach, large and small intestine, and the spleen. Note how little space remains for the heart and lungs.An NG tube is very helpful in these babies to decrease stomach and bowel distention.

    ----- Meeting Notes (11/19/15 10:38) -----

    hernia diafragmatika

    *

  • Operative photograph showing

    that upon opening the chest,

    a very large right upper lobe

    was encountered and was

    allowed to herniate out

    through the incision, thus

    ----- Meeting Notes (11/19/15 10:38) -----

    kista

    *

  • B. TANDA DAN GEJALA :

    1. Resletlessnes

    2. Tachypnea

    3. Retaction

    4. Cyanosis

    ----- Meeting Notes (11/19/15 10:38) -----

    keluhan sering ditemukan : sesak

    seletlessns : butuh oto pernapasan

    *

  • C. DIAGNOSIS ;

    1. Anamnesis :

    a. Riwayat kehamilan:

    - ibu hamil dengan hidramnion

    - pre eklampsia, eklampsia

    - selama hamil ibu pernah sakit

    - riwayat trauma

    - paritas kehamilan

    - penggunaan obat-obatan, alkohol, merokok

  • b. Riwayat kelahiran :

    - kesulitan melahirkan

    - bayi lahir melalui sectio cesaria

    - trauma melahirkan

    - penyukit pada saat melahirkan

    c. Gejala dan tanda awal :

    - tangis bayi saat lahir, sianosis, sesak nafas,

    - apnea, nilai APGAR yang rendah dll

    ----- Meeting Notes (11/19/15 10:38) -----

    SC sbenernya bahaya sering emboli

    *

  • 2. Pemeriksaan fisik :

    - Inspeksi torak: simetris, asimetris dll

    - Gerakan pernafasan: simetris

    - Retraksi dinding toraks

    - Perkusi dinding toraks

    - Auskultasi : ada kelainan suara nafas dll

  • ----- Meeting Notes (11/19/15 10:38) -----

    microcephali

    syndroma down

    *

  • D. PENUNJANG DIAGNOSIS :

    1. Pemeriksaan radiologis :

    a. Foto polos toraks

    b. Foto kontras saluran nafas

    2. Pemeriksaan Laboratorium :

    a. Laboratorium rutin : DL

    b. Laboratorium khusus : AGD

  • ATRESIA ESOPHAGUS

    (panah merah)

  • Atresia esophagus: NGT dalam segmen proksimal esophagus

  • Atresia Esophagus : aspirasi pnemonia

    ----- Meeting Notes (11/19/15 10:38) -----

    pneumonia : perselubungan

    *

  • Foto polos Toraks: Hernia Difragmatika kiri

  • AP chest films from the

    day of admission

    demonstrate hyperinflation

    of the right upper lobe.

  • E. SIKAP DAN TINDAKAN :

    1. Resusitasi jalan nafas dan pernafasan

    2. Resusitasi jantung

    3. Resusitasi cairan

    4. Persiapan rujukan

    5. Persiapan tindakan pembedahan

  • A clinical photograph shows the hyperexpanded right chest.

  • Presently, children are not rushed to the operating room. As pulmonary hypertension is the major concern, and operative intervention can trigger this, aggressive attempts are made to stabilize the child for 5 to 7 days prior to operative correction. Interventions such as high-frequency ventilation and nitric oxide therapy are used.

    If the child cannot be stabilized, she can be placed on an ECMO(extra corporeal membrane oxygenation) circuit essentially an artificial lung for up to three weeks while the lung matures. In this case, the child stabilized on high-frequency ventilationand nitric oxide and was operated on six days after birth. Pre-operative positioning is shown here.

  • KELAINAN SALURAN PENCERNAAN KONGENITAL

    I. Obstruksi saluran pencernaan

    II. Malrotasi saluran pencernaan

    III. Perforasi saluran pencernaan

  • Skema saluran pencernaan

  • Obstruksi saluran pencernaan :

    A. Jenis kelainan :

    1. Atresia esophagus

    2. Pilorostenosis

    3. Atresia duodenum

    4. Atresia jejunum

    5. Atresia ileum

    6. Mekonium ileus

    7. Mekonium plug syndrome

    8. Penyakit Hirsachsprungs

    9. Anorectal malformation

    10. Atresia kolon

  • This drawing on the x-ray depicts the material in the chest, including stomach, large and small intestine, and the spleen. Note how little space remains for the heart and lungs.An NG tube is very helpful in these babies to decrease stomach and bowel distention.

  • Operative photograph shows the massive fluid filled stomach (on the left) and duodenal bulb (on the right) which was found to contain over 400 cc of fluid.

    ----- Meeting Notes (11/19/15 10:38) -----

    distensi, lambung membesar, duodenum juga membesar.

    kemu

    *

  • Operative photograph

    showing dilation of

    the proximal jejunum

    with a blind end.

    Operative Finding :

    ----- Meeting Notes (11/19/15 10:38) -----

    apple pie

    *

  • ----- Meeting Notes (11/19/15 10:38) -----

    flat bottom : handle bucket.

    keluar mekonium +

    *

  • ----- Meeting Notes (11/19/15 10:38) -----

    letak rendah.

    kalau berkedut ada otot nya hanya dierobek

    *

  • B. Gejala Utama :

    1. Muntah muntah

    2. Hipersalivasi

    3. Distensi abdomen

    4. Retensi mekonium

    5. Gangguan defekasi

    ----- Meeting Notes (11/19/15 10:38) -----

    muntah kehijauan.

    *

  • C. Penunjang Diagnosis :

    1. Pemeriksaan radiologis :

    a. Foto polos abdomen

    b. Foto kontras saluran cerna

    2. Pemeriksaan laboratorium :

    a. Pemeriksaan lab. rutin : Dl,UL

    b. Pemeriksaan Lab. Khusus

  • ATRESIA ESOPHAGUS

    (panah merah)

  • Atresia esophagus: NGT dalam segmen proksimal esophagus

  • Atresia Esophagus : aspirasi pnemonia

  • Obstruksi usus ok P.Hirschsprungs dilatasi usus halus dan kolon tanpa udara dalam rektum

    ----- Meeting Notes (11/19/15 10:38) -----

    mega kolon : hisrprung

    yang idlatasi proximal

    *

  • Obstruksi usus ok Intussusepsi

    ----- Meeting Notes (11/19/15 10:38) -----

    masuknya segmen proximal ke distal

    *

  • Obstruksi usus halus

  • Barium enema mekonium ileus, terlihat mikrokolon

    ----- Meeting Notes (11/19/15 10:38) -----

    mkeonium, hirsprung

    *

  • ----- Meeting Notes (11/19/15 10:38) -----

    coil string : pake barium

    *

  • ----- Meeting Notes (11/19/15 10:38) -----

    sa

    *

  • D. Sikap dan Tindakan :

    1. Bayi dipuasakan

    2. Pasang pipa nasogastrik

    3. Pasang infus sesuai kebutuhan

    4. Berikan antibiotika sesuai indikasi

    5. Letakkan bayi dalam penghangat

    6. Siapkan bayi untuk dilakukan pembedahan

    7. Segera rujuk bayi ke RS yang mampu menangani kasusnya

  • II. MALROTASI SALURAN PENCERNAAN :

    Gambaran umum :

    1. Diagnosis sulit ditegakkan

    2. Gejala awal tampak sebagai tanda obstruksi

    3. Setiap obstruksi usus setinggi duodenum dapat dicurigai sebagai adanya malrotasi usus

    4. Obstruksi usus tinggi tinggi parsial selalu disebabkan oleh malrotasi

    5. Malrotasi berbahaya dan menjadi emergensi jika mengalami volvulus

  • Skema malrotasi usus

  • Skema saluran pencernaan

  • Malrotasi

  • Volvulus

  • Volvulus usus

  • Volvulus

  • B. PENUNJANG DIAGNOSIS :

    Radiologi :

    a. Foto polos abdomen :

    hilangnya gambaran udara dalam duodenum

    b. Foto dengan kontras enema barium :

    terlihat gambaran posisi sekum di daerah plexura hepatis

  • C. SIKAP DAN TINDAKAN :

    1. Bayi dipuasakan dan dipasang infus

    2. Pasang pipa nasogastrik

    3. Berikan antibiotika sesuai indikasi

    4. Persiapkan bayi untuk tindakan pembedahan

    5. Segera rujuk bayi ke RS. yang mampu melakukan tindakan pembedahan

  • Close-up operative photograph shows the entire midgut being twisted around a single narrow mesentery.

  • Operative photograph shows the midgut to be dusky but not necrotic.

    Operative Finding :

  • Operative photograph

    showing the midgut to

    be dusky in color.

  • III. PERFORASI SALURAN CERNA :

    Gejala :

    1. Distensi abdomen yang terjadi dengan cepat dan tiba-tiba

    2. Bayi terlihat mengalami gangguan pernafasan

    3. Liver dullnes hilang pada pemeriksaan abdomen

    4. Pada perkusi abdomen tympani

    5. Dengan pemeriksaan foto polos abdomen terlihat gambaran udara bebas dalam rongga peritoneum

  • B. Penyebab perforasi saluran cerna :

    1. Obstruksi saluran cerna

    2. Necrotizing enterocolitis (NEC)

    3. Perforasi gaster spontaneus kongenital

    4. Kelainan saluran nafas bagian atas kongenital

    C. Sikap dan tindakan :

    1. Resusitasi pernafasan dan cairan

    2. Pasang pipa nasogastrik

    3. Berikan antibiotik sesuai indikasi

    4. Funktie steril rongga peritoneum untuk dekompresi

    5. Segera rujuk bayi ke RS. yang mampu untuk pembedahan

    ----- Meeting Notes (11/19/15 10:38) -----

    karena perforasi ada nyeri abdmen

    hati hati NEC

    *

  • Necrotizing enterocolitis (NEC)

  • NEC

    Perforasi

  • Operative photograph shows the bowel to be white and necrotic throughout its entire length from the duodenum to the colon

  • Meconium ileus is most often seen in the first few days of life in neonates with cystic fibrosis, but can rarely occur in infants with a normal pancreas. In cystic fibrosis, the abnormal pancreatic secretions lead to inspissated meconium that produces intestinal obstruction. The dilated coils of ileum are opened here to reveal the inspissated green meconium (which may also be tarry or gritty), while the unopened colon at the upper left and the appendix at the lower left beyond the ileocecal valve are not dilated, and little or no meconium is passed per rectum.

  • Meconium peritonitis shown here as a greenish exudate overlying the serosal surfaces of the peritoneal cavity can complicate meconium ileus in utero, particularly in fetuses with cystic fibrosis. The bowel ruptures and leaks meconium, which produces a chemical peritonitis. Calcifications in the spilled meconium may be seen radiographically. Another complication of meconium ileus is volvulus.

  • DEFEK DINDING ABDOMEN

    Jenis kelainan :

    1. Omphalocele pecah

    2. Gastroschisis

    B. Problemnya :

    1. Hipotermi

    2. Hipovolume

    3. Infeksi

    4. Gangren saluran cerna

    5. Kelainan penyerta organ lain

  • Omphalocele

  • Omphalocele

  • Omphalocele utuh (tidak pecah)

  • Gastroschisis

  • Gastroschisis

    ----- Meeting Notes (11/19/15 10:38) -----

    ter

    *

  • Gastroschisis

  • Bagian usus yang nekrosis pada gastroschisis

  • Pemasangan mesh pada gastroschisis

    ----- Meeting Notes (11/19/15 10:38) -----

    biar ga terpapar udara dan biar mask sendiri spontan

    *

  • Omphalocele dengan mesh yang telah diserap

  • Hernia ventralis abdomen pasca repair omphalocele

  • Omphalocele tidak pecah dengan granulasi dan epitelisasi

  • Extrophia vesica urinaria (Exstrophia vesicae)

  • ----- Meeting Notes (11/19/15 10:38) -----

    hermafrodit

    *

  • Extrophia Vesicae

  • Extrophia vesicae

  • C. Sikap dan tindakan :

    1. Cegah pasien mengalami hipotermi dengan menempatkan bayi pada penghangat

    2. Berikan infus sesuai kebutuhan untuk mencegah hipovolume

    3. Antibiotika intravena sesuai indikasi untuk mencegah infeksi

    4. Organ abdomen yang diluar rongga dibungkus dengan baham steril

    5. Segera rujuk pasien ke RS

  • Kontra insisi pada kulit dinding abdomen untuk menutup defek pada gastroschisis dan omphalocele pecah

  • Pasca repair extrophia vesicae

  • KEDARURATAN PADA ANAK-ANAK :

    Usia dibawah usia 1 tahun :

    1. Hernia inguinalis strangulasi

    2. Intussusepsi ( Invaginasi)

    3. Obstruksi usus ok. Berbagai penyebab

    4. Trauma

    II. Pada anak usia 1 6 tahun :

    1. Hernia inguinalis strangulasi

    2. Apendisitis akut

    3. Obstruksi usus ok. Bolus askariasis

    4. Trauma

  • A clinical photograph demonstrates the currant jelly stools.

  • Operative photograph shows the intussusception with the dusky terminal ileum (on the patient's left) protruding into the cecum (on the patient's right). Note that the appendix is intussuscepted with the ileum.

  • Operative photograph shows dilatation of almost the entire small bowel except for the decompressed terminal ileum in the left lower corner of the photograph.

  • Operative photograph is a close-up view of the area of caliber change and reveals a Meckel diverticulum with an omphalomesenteric duct remnant. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus.

  • ----- Meeting Notes (11/19/15 10:38) -----

    kemungkinan organ di thorax gabung menjadi satu.

    gastroschisis,

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    penting!!!!

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    mikrognatia : pierre robin syndrome

    penting

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    hernia diafragmatika

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    kista

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    keluhan sering ditemukan : sesak

    seletlessns : butuh oto pernapasan

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    SC sbenernya bahaya sering emboli

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    microcephali

    syndroma down

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    pneumonia : perselubungan

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    distensi, lambung membesar, duodenum juga membesar.

    kemu

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    apple pie

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    flat bottom : handle bucket.

    keluar mekonium +

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    letak rendah.

    kalau berkedut ada otot nya hanya dierobek

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    muntah kehijauan.

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    mega kolon : hisrprung

    yang idlatasi proximal

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    masuknya segmen proximal ke distal

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    mkeonium, hirsprung

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    coil string : pake barium

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    sa

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    karena perforasi ada nyeri abdmen

    hati hati NEC

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    ter

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    biar ga terpapar udara dan biar mask sendiri spontan

    *

    ----- Meeting Notes (11/19/15 10:38) -----

    hermafrodit

    *

    This drawing on the x

    -

    ray depicts the material in the chest,

    including stomach, large and small intestine, and the spleen.

    Note how little space remains for the heart and lungs.

    An NG

    tube is very helpful in these babies to decrease stomach and

    bowel distention.

    Presently, children are not rushed to the operating room. As pul

    monary

    hypertension is the major concern, and operative intervention ca

    n trigger this,

    aggressive attempts are made to stabilize the child for 5 to 7 d

    ays

    prior to

    operative correction. Interventions such as high

    -

    frequency ventilation and

    nitric oxide therapy are used.

    If the child cannot be stabilized, she can be placed on an ECMO

    (extra

    corporeal membrane oxygenation) circuit

    essentially an artificial lung

    for

    up to three weeks while the lung matures. In this case, the chil

    d stabilized on

    high

    -

    frequency ventilation

    and nitric oxide and was operated on six days after

    birth. Pre

    -

    operative positioning is shown here.