APENDISITIS

Stase Ilmu Bedah RSIJ Cempaka Putih

Pembimbing: dr. Winoto, Sp.B

PANJANGNYAKIRA-KIRA

ADA KESAMAAN

Anatomi

Berasal dari MID GUT Di fossa iliaka kanan titik Mc. Burney

Basis di puncak sekum pertemuan 3 taenia

Bentuk tabung, panjang 3 – 15 cm

Pangkal lumen sempit, distal lebar

Lokasi : retrosekal (65%), pelvinal, antesekal, medial, preileal,postileal, dll

Vaskularisasi A.apendikularis (end arteri)

Inervasi N.vagus dan thorakalis X

Berasal dari MID GUT Di fossa iliaka kanan titik Mc. Burney

Basis di puncak sekum pertemuan 3 taenia

Bentuk tabung, panjang 3 – 15 cm

Pangkal lumen sempit, distal lebar

Lokasi : retrosekal (65%), pelvinal, antesekal, medial, preileal,postileal, dll

Vaskularisasi A.apendikularis (end arteri)

Inervasi N.vagus dan thorakalis X

Definition

Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy.

Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy.

Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock

Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock

Etiology

Patogenesis

APENDISITIS AKUTAPENDISITIS AKUT

Symptoms :- Nyeri visera di epigastrium, sekitar umbilicus- Mungkin Kolik

Patogenesis

Patogenesis Appendisitis

APENDISITIS AKUT SUPURATIF / PURULENTAAPENDISITIS AKUT SUPURATIF / PURULENTA

Symptoms - Nyeri sentral berpindah ke perut kanan bawah- Nyeri somatik ( peritonitis lokal)- Mual dan muntah

Gejala Klinis

Pemeriksaan Fisik

McBurney’s Point

McBurney’s point (1) appears about one-third of the distance along a line starting at the right ASIS (3) and ending at the umbilicus (2).

Anatomic basis for the psoas sign: inflamed

appendix is in a retroperitoneal location

in contact with the psoas muscle, which is

stretched by this maneuver.

The psoas sign. Pain on passive extension of the

right thigh. Patient lies on left side. Examiner extends patient's right thigh while

applying counter resistance to the right hip

(asterisk).

Anatomic basis for the obturator sign: inflamed appendix in the pelvis is

in contact with the obturator internus muscle, which is stretched by this

maneuver.

The obturator sign. Pain on passive internal rotation of the flexed thigh. Examiner moves lower leg laterally while applying resistance to the lateral side of the

knee (asterisk) resulting in internal rotation of the

femur.

Pemeriksaan Fisik

Pemeriksaan Penunjang

In fewer than 5 percent of patients, an opaque

fecalith may be apparent in the right lower

quadrant. Plain abdominal films generally are not recommended unless other conditions(e.g., perforation, intestinal obstruction, ureteral

calculus) are suspected.8 Likewise, as advanced cross-sectional imaging

techniques have become available, barium enema is now used infrequently.

COMPUTED TOMOGRAPHY

Ultrasonogram showing longitudinal section (arrows) of inflamed appendix.

ULTRASONOGRAPHY

Computed tomographic scan showing enlarged and

inflamed appendix (A)

extending from the

cecum (C).

Computed tomographic scan showing

cross-section of inflamed

appendix (A) with

appendicolith (a).

COMPUTED TOMOGRAPHY

Alvarado Scale for the Diagnosis of

Appendicitis  Manifestations Value

Symptoms Migration of pain 1

  Anorexia 1

  Nausea and/or vomiting 1

Signs Right lower quadrant tenderness (Nyeri fossa iliaca kanan)

2

  Rebound (Nyeri lepas) 1

  Elevated temperature (> 37,30C ) 1

Laboratory values Leukocytosis (> 10×103/L     ) 2

  Left shift in leukocyte count (neutrofil > 75%  )

1

    Total points 10

>7 : Appendiksitis akut

• Skor 1 – 4 : dipertimbangkan appendicitis akut : Observasi

• Skor 5 – 6 : possible appendicitis tidak perlu operasi : Antibiotik

• Skor 7 – 9 : appendicitis akut perlu pembedahan : Operasi dini

Modified Alvarado score (Kalan et al) tanpa observasi of

Hematogram

DIANGNOSIS BANDING

• Gastroenteritis• Demam Dengue• Limfadenitis Mesenterika• Kelainan Ovulasi• Infeksi Panggul• Kehamilan di Luar Kandungan• Kista Ovarium Terpuntir• Endometriosis Eksterna• Urolitiasis Pielum/Ureter Kanan• Penyakit Saluran Cerna Lainnya

Appendectomy

Drainage

Conservative

Posisi duduk atau setengah duduk, bagian kepala tempat tidur lebih tinggi atau dinaikkan.

Fowler (45o-90o) dan semi fowler (15o-45o). Dilakukan untuk mempertahankan kenyamanan,

memfasilitasi fungsi pernapasan, dan pasien pasca bedah.

REFERENSI

1. De Jong, W. & Sjamsuhidajat, R.,2004. Buku Ajar Ilmu Bedah Edisi 2. EGC. Jakarta.2. Reksoprodjo,  S.,  dkk.  1995.  Kumpulan Kuliah Ilmu Bedah.  Bagian  Bedah  Staf 

Pengajar Fakultas Kedokteran Universitas Indonesia. Bina Rupa Aksara. Jakarta.3. Mansjoer,  A.,  dkk.  2000.  Kapita Selekta Kedokteran Edisi Ketiga Jilid Kedua. 

Penerbit Media Aesculapius Fakultas Kedokteran Universitas Indonesia. Jakarta.4. Bagian  Ilmu  bedah  Fakultas  Kedokteran  Universitas  Sumatra  Utara. 

http://library.usu.ac.id/ download/fk/bedah-emir%20jehan.pdf5. Mubin, Halim. Buku Panduan Praktis : Ilmu Penyakit Dalam Diagnosis dan Terapi

Edisi 2. Jakarta : Penerbit Buku Kedokteran EGC. 2007.6. Price,  Sylvia  A.  Patofisiologi  :  Konsep Klinis Proses-Proses Penyakit, Edisi 4. 

Jakarta: Penerbit Buku Kedokteran EGC. 1995.7. Schwartz, Spencer, S., Fisher, D.G., 1999. Principles of Surgery Sevent Edition. Mc-

Graw Hill a Division of The McGraw-Hill Companies. Enigma an Enigma Electronic Publication.

. . .TERIMA KASIH. . .