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GAWAT ABDOMENKelompok 3
Tutor : dr. Sigit Wahyu Jatmiko Sp.B (RE)
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Differential Diagnosa
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DIAGNOSA AKUT ABDOMEN
• keadaan MENDADAK ABDOMEN
3. Gejala Penyerta
2. Penyebab:a.Gastrointestinalb.Hepar, lien, pankreas & saluran limfec.Saluran kemihd.Ginekologis
Trauma Non-Trauma
Tindakan Bedah Akut;a.Defans muskulerb.Nyeri menghebatc.Distensid.Masa lunak pd abdomen/rectum yg disertai febris
Urgent
1. Penatalaksanaan Awal
4. Pemeriksaan Fisik
5. Pemeriksaan Penunjang
Medikasi
Prinsip Penatalaksanaan ≠ Inflamasi Obtruksi Iskemi PerforasiDan HARUS TUNTAS
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Gejala Penyerta
Muntah• Prominent - Gastritis akut
- Syndr Mallory Weiss- Pankreatitis Akuta
• Empedu (-)- Stenosis Pilorik
• Empedu (+)- Obstruksi Usus
Konstipasi
- Ileus Paralitik
- Obstruksi Parsial
Obstipasi
- Ileus Obstruktif
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Melena Hematemesis
- Lesi Gastroduodenal
- Syndr Mallory Weiss
Hematochezia
- Lesi Colon, Hemorhoid
Riwayat Menstruasi
- KET, Riwayat keluarga
- Riwayat Perjalanan Jauh
Diare• Darah Positif
- Peny. Crohn- Kolitis Ulseratif- Kolitis Iskemia- Disentri amebik/basiler
• Ikterus- Penyakit Hepatobilier
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PEMERIKSAAN RADIOLOGIS
RutinPemeriksaan ronsen standar ATLS:
- foto servikal lateral - toraks AP - pelvis AP
Tambahan - foto abdomen AP - kontras
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Pemeriksaan Imaging Akut AbdomenTrauma
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Focused Abdominal Sonography for Trauma (FAST)Focused Abdominal Sonography for Trauma (FAST)• Diagnostik prosedur pilihan pada pasien tidak stabilDiagnostik prosedur pilihan pada pasien tidak stabil• Cepat, sederhana, portabelCepat, sederhana, portabel• Temuan Positif: cairan (darah) dalam rongga peritonealTemuan Positif: cairan (darah) dalam rongga peritoneal
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DPL (Diagnostic Peritoneal Lavage)• Invasif (<1% tingkat komplikasi)• Sangat tidak spesifik• Sangat sensitif peningkatan insiden non-terapi laparotomi
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Abdominal CT Scan• Very specific (95-100%)• Good sensitivity (85-99%)• Dapat mengevaluasi retroperitenium
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Pemeriksaan Imaging Akut AbdomenNon – Trauma
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APPENDISITIS
Rontgen Foto Polos
Tidak spesifik, kurang dari 5% hanya terlihat gambaran appendicolith di right lower quadrant
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USG
(Gb Atas) Transverse ultrasound image of the right lower quadrant of the abdomen (left view, noncompressed, right view, compressed) revealing a thick-walled, noncompressible tubular structure (an inflamed appendix) with a shadowing appendicolith (arrow).
(Gb Bawah) a longitudinal ultrasound image revealing the thick-walled inflamed appendix and appendicolith (arrow) and a small periappendiceal fluid collection.
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CT-Scan
Terdapat gambaran “Bull’s eye sign” dan apendiks yang berdilatasi
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Ileus Paralitik
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Ileus Obstruktif
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Perforasi
Foto Polos Abdomen
Didapatkan udara bebas di bawah difragma yg disebabkan oleh perforasi usus
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Pancreatitis
Foto Polos Abdomen
Tidak memberikan kepastian dalam mendiagnosis tetapi dapat menunjukkan calcification dari pancreas dan pseudocyst.
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CT-Scan
Pancreas yang edema, hemorrhagic, calcification
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Penatalaksanaan
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Trauma
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Algoritma Penanganan Trauma Tumpul Abdomen
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Algoritma Penanganan Trauma Tembus Abdomen
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Non Trauma
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Peritonitis 1. Pre Operasi• Resusitasi cairan• Oksigenasi• NGT, DC• Antibiotika• Pengendalian suhu tubuh
2. Durante Operasi• Kontrol sumber infeksi• Pencucian rongga
peritoneum• Debridement radikal• Irigasi kontinyu• Ettapen lavase/stage
abdominal repair
3. Pasca operasi• Balance cairan• Perhitungan nutrisi• Monitor vital Sign• Pemeriksaan laboratorium• Antibiotika
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Apendisitis•Apendektomi•Antibiotik profilaksis sebelum operasi
Pankreatitis•Hidrasi IV•Analgetik•Penyedotan dg NGT
Diverticulitis •Antibiotik (e.g. siprofloksasin 500-750 mg, 2x sehari + metronidazol 500 mh 4x sehari)
Kolesistisis•Antibiotik dan MRS bila ada demam danleukositosis yg signifikan•kolesistektomi
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Ileus paralitik
•Dekompresi•Obat simpatolitik/parasimpatomimetik
Ileus obstruktif
•Dekompresi dengan pipa lambung (NGT)•Pemasangan infus untuk koreksi keseimbangan cairan dan elektrolit. Juga keseimbangan asam-basa.•Koreksi bedah. Tindakan bedah yang dilakukan sesuai dengan kelainan patologinya.•Antibiotika profilaksis atau terapeutik tergantung proses patologi penyebabnya.
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Evaluasi Akut Abdomen
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KIE
• Setelah mengobati penyakit yang mendasari, edukasi tentang pencegahan penyakit berulang
• Hindari faktor resiko dan penyulit (infeksi sekunder, imunodefisiensi,)
• edukasi tentang kepatuhan minum obat (pastikan pasien tidak putus obat)
• Terapi suportif adekuat• Bila ada gejala akut abdomen, segera bawa ke RS
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Terima Kasih