Appendicitis Akut Laporan Kasus Internsip

LAPORAN KASUS

APPENDICITIS AKUT

Disusun oleh : dr. DESLIA CHAERANI Pembimbing : dr. ebi!ns"!h K!r#!din!#! R!$him% S&.'

Pend!m&ing : dr. Norm!s!ri dr. El(i Agus#in!

PRO)RA* DOKTER INTERNSIP INDONESIA RSUD Dr. KANU+OSO D+ATI,I'O,O 'ALIKPAPAN KALI*ANTAN KALI*ANTAN TI*UR -/0

1

Trusted by over 1 million members

Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.



























DATAR ISI Halaman Judul.................. Judu l......................................... .............................................. ...................................................... ............................... ... 1 Daftar Isi.............................................. Isi..................................................................... ............................................................. ...................................... 2 BAB I PENDAHULUAN............................ PENDAHULUAN................................................... .............................................. ...............................3 ........3 BAB II TINJAUAN PUSTAKA...... PUSTAKA............................. .............................................. ...........................................4 ....................4 BAB III LAP!AN KASUS......................................... KASUS........................................................................... .................................. .24 BAB I" PE#BAHASAN KASUS.................................................................. KASUS.................................................................. .33 BAB " KESI#PULAN............................... KESI#PULAN...................................................... ........................................3$ .................3$ Daftar Pusta%a.......................... Pusta%a................................................. .............................................. ...................................3& ............3&

'A' I















PENDAHULUAN A''(ndi%s dis()ut *u+a um)ai ,a,in+. Istila- usus )untu an+ di%(nal di masara%at masara%at a/am adala- %uran+ %uran+ t('at %ar(na usus )untu an+ an+ s()(narna adalaadalas(%um. s(%um. r+an r+an an+ an+ tida% tida% di%(ta-u di%(ta-uii fun+sin fun+sinaa ini s(rin+ s(rin+ m(nim) m(nim)ul%a ul%an n masalamasala%(s(-atan. P(radan+an a%ut a''(ndi%s m(m(rlu%an tinda%an )(da- s(+(ra untu% m(n+-indari %0m'li%asi an+ umumna )(r)a-aa. A''(ndi,itis m(ru'a%an '(radan+an dari a''(ndi%s (rmif0rmis an+ l()idi%(nal d(n+an s()utan inf(%si usus )untu dan ini m(ru'a%an '(na%it an+ s(rin+ di*um'ai. #(s%i'un s()a+ian )(sar 'asi(n d(n+an a''(ndi,itis a%ut da'at d(n+an muda- didia+n0sis t(ta'i tanda dan +(*alana ,u%u' )(rariasi s(-in++a dia+n0sis s(,ara %linis da'at m(n*adi sulit dit(+a%%an untu% itu d0%t(r -arus m(m' m(m'un una aii

'(n+ '(n+(t (taa-ua uan n

an+ an+ )ai% )ai% untu untu% %

m(n+ m(n+(n (nal al a''(n a''(ndi di,i ,iti tis. s. Pada Pada

a''(ndi,itis tida% mun+%in da'at dit(mu%an satu +(*ala %linis an+ tida% da'at dit(n dit(ntu tu%an %an 0l(0l(- satu satu t(s t(s %-usus %-usus untu% untu% m(ndi m(ndia+n a+n0sa 0sana na s(,ar s(,araa t('at t('at.. Pada Pada )()(ra'a %asus a''(ndi,itis da'at s(m)u- tan'a '(n+0)atan ta'i )ana% *u+a an+ m(m(rlu%an la'ar0t0mi. A''(ndi,itis a%ut da'at m(n()a)%an %(matian %ar(na '(rit0nitis dan s0%. A''(nd A''(ndi, i,it itis is m(ru'a m(ru'a%an %an '(n( '(n()a )a) ) t(rs( t(rs(rin rin+ + dari dari n(ri n(ri a)d0m a)d0m(n (n an+ an+ 'r0+r(sif dan m(n(ta' 'ada s(mua +0l0n+an umur %(+a+alan m(n(+a%%an dia+n0sa dan %(t(rlam)atan '(natala%sanaanna a%an m(n()a)%an '(nin+%atan m0r)iditas dan m0rtalitas. Pada masara%at masara%at d(n+an d(n+an %()iasaa %()iasaan n di(t tin++i tin++i s(rat s(rat a''(ndi,it a''(ndi,itis is *aran+ *aran+ t(r*adi t(r*adi di%ar(n di%ar(na%an a%an s(rat s(rat a%an m(nurun m(nurun%an %an is%0si is%0sitas tas f(s(s f(s(s m(m'(rs m(m'(rsin+% in+%at at /a%t /a%tu u tran transi sitt f(s( f(s(ss dan dan m(n+ m(n+-a -am m)at )at '(m) '(m)(n (ntu tu%a %an n f(%a f(%ali lit. t. (%a (%ali litt da'a da'att m(n()a) m(n()a)%an %an 0)stru%s 0)stru%sii 'ada lum(n lum(n a''(ndi%s a''(ndi%s.. K(*adia K(*adian n a''(ndi, a''(ndi,iti itiss da'at da'at )(r%uran+ %ar(na %()iasaan di(t tin++i s(rat dan %()iasaan m(n++una%an t0il(t *0n+%0% )ila di)andin+%an di)an din+%an d(n+an t0il(t t0i l(t dudu%.1

'A' II















TIN+AUAN PUSTAKA

APPENDICITIS AKUT -./ ANATO*I -%1 A''(ndi%s m(ru'a%an suatu 0r+an limf0id s('(rti t0nsil payer t0nsil payer patch m(m)(ntu% m(m)(ntu% 'r0du% immun0+l0)ulin immun0+l0)ulin )(r)(ntu% )(r)(ntu% ta)un+ 'an*an+na %ira%ira 15 ,m 6%isar 6%isaran an 31$ 31$ ,m7 ,m7 d(n+a d(n+an n diam( diam(t(r t(r 5$1 5$1 ,m dan )(r'a )(r'an+% n+%al al di ,a(,um. Lum(nna s(m'it di )a+ian 'r0%simal dan m(l()ar di )a+ian distal. A''(ndi%s t(rl(ta% di %uadran %anan )a/a- a)d0m(n t('atna di il(0,a(,um dan m(ru'a%an '(rt(muan %(ti+a ta(nia ,0li 6ta(nia li)(ra ta(nia ,0li,a dan ta(nia 0m(ntum7. Dari t0'0+rafi anat0mi l(ta% 'an+%al a''(ndi%s )(rada 'ada titi% #,Burn( #,Burn(  aitu titi% 'ada +aris + aris antara anta ra um)ili,us dan SIAS %anan an+ )(r*ara% 183 dari SIAS %anan. A''(ndi9 (rmif0rmis disan++a 0l(- m(s0a'(ndi%s 6m(s(nt(ri0lum7 an+ )(r+a)un+ d(n+an m(s(nt(rium usus -alus 'ada da(ra- il(um t(rminal(. #(s(nt(r #(s(nt(ri0l i0lum um )(risi )(risi a.a'(nd a.a'(ndi%ul i%ularis aris 6,a)an+ 6,a)an+ a.il(0, a.il(0,0li, 0li,a7. a7. rifi,i rifi,iumn umnaa t(rl(ta% 2$ ,m dari %atu' il(0,(,al. #(s0a'(ndi%na m(ru'a%an *arin+an l(ma% an+ m(m'unai '(m)ulu- a''(ndi,(al dan t(r%adan+ *u+a m(mili%i limf0n0di %(,il. Stru%tu Stru%turr a''(ndi% a''(ndi%ss miri' miri' d(n+an d(n+an usus m(m'unai m(m'unai 4 la'isan la'isan aitu mu%0sa mu%0sa su)mu%0s su)mu%0sa a mus%ular mus%ularis is (%st(rna (%st(rna8'r0 8'r0'ria 'ria 60t0t 60t0t l0n+itu l0n+itudina dinall dan sir%ul sir%ul(r7 (r7 dan s(r0sa s(r0sa.. A''(ndi ''(ndi%s %s mun+% mun+%in in tida% tida% t(rli t(rli-at -at %ar(na %ar(na adana adana m(m)ran Ja,%s0n an+ m(ru'a%an la'isan '(rit0n(um an+ m(n()ar dari )a+ian lat(ral a)d0m(n %( il(um t(rminal m(nutu' ,a(,um dan a''(ndi%s. La'isan La'isan su)mu%0s su)mu%0saa t(rdiri t(rdiri dari *arin+an *arin+an i%at %(nd0r dan *arin+an *arin+an (lasti% (lasti% m(m)(ntu% *arin+an saraf '(m)ulu- dara- dan lm'-(. Antara mu%0sa dan su)mu%0sa t(rda'at lympho nodes. nodes . #u%0sa t(rdiri dari satu la'is ,0llumnar ('it-(lium dan t(rdiri dari %ant0n+ an+ dis()ut crypta lieberkuhn. lieberkuhn. Dindin+ dalam sama dan )(r-u)un+an d(n+an ,a(,um 6inner 6inner circular layer 7. 7. Dindin+ luar 6outer 6outer longitudinal muscle7 muscle 7 dila'isi 0l(- '(rt(muan %(ti+a ta(nia ,0lli















'(+an+an untu% m(n,ari m(n ,ari a''(ndi%s. A''(ndi% A''(ndi%ss '(rtama '(rtama %ali tam'a% tam'a%

saat '(r%(m) '(r%(m)an+a an+an n (m)ri0l0+ (m)ri0l0+ii

min++u %(: aitu )a+ian u*un+ dari 'r0tu)(rans ,a(,um. Pada saat ant(natal dan '0stn '0stnat atal al '(rtu '(rtum) m)u-a u-an n dari dari ,a(,um ,a(,um an+ an+ )(rl( )(rl()i)i- a%an a%an m(n*a m(n*adi di a''(ndi%s an+ a%an )(r'inda- dari m(dial m(nu*u %atu' il(0s(%al. Pada )ai a''(ndi%s )(r)(ntu% %(ru,ut  l()ar 'ada 'an+%alna dan m(n(m'it %( ara- u*un+na. K(adaan ini mun+%in m(n*adi s()a) r(nda-na insid(n a''(ndi,itis 'ada usia itu. Pada &$; %asus a''(ndi%s t(rl(ta% intra'(rit0n(al. K(dudu%an itu m(mun+%in%an a''(ndi%s )(r+(ra% dan ruan+ +(ra%na )(r+antun+ 'ada 'an*an+ m(s0a''(ndi%s '(n++antun+na. '(n++antun+n a. Pada %asus s(l()i-na a''(ndi%s t(rl( rl(ta%

r(tr (tr0'(r '(rit0n it0n((al

aitu aitu

di

)(la (la%an+

,a(,um (,um

di

)(l )(la%an %an+

%0l0nas(nd(ns atau di t('i lat(ral %0l0n as(nd(ns. <(*ala %linis a''(ndi,itis dit(ntu%an 0l(- l(ta% a''(ndi%s.

J(nis*(nis P0sisi A''(ndi%s = 4 1. Pr0m0nt Pr0m0nt0ri 0ri% % 2. 3. 4. $. &.

= u*un+ u*un+ a''(ndi% a''(ndi%ss m(nun*u m(nun*u% % %( ara- 'r0m0nt0 'r0m0nt0rium rium sa,ri. !(tr0, !(tr0,0li, 0li, = a''(ndi% a''(ndi%ss )(rada )(rada di )(la%an+ )(la%an+ %0l0n %0l0n as,(nd(n as,(nd(n dan )iasana r(tr0'(rit0n(al. r(tr0'(ri t0n(al. Ant(,a( Ant(,a(,al ,al = a''(ndi% a''(ndi%ss )(rada )(rada di d('an d('an ,a(,um. ,a(,um. Para,a Para,a(,al (,al = a''(ndi% a''(ndi%ss t(rl(ta t(rl(ta% % -0ri>0nt -0ri>0ntal al di )(la%an )(la%an+ + ,a(,um. ,a(,um. P(li, P(li, D(s,(n D(s,(nd(n d(n = a''(ndi%s a''(ndi%s m(n++a m(n++antun ntun+ + %( ara- '(lis '(lis min0r. min0r. !(tr0,a(,al !(tr0,a(,al = intra'(rit0nal intra'(rit0nal atau r(tr0'(rit0n(al? r(tr0'(rit0n(al? a''(ndi%s )(r'utar %( atas %( )(la%an+ ,a(,um.

P(rsarafan 'arasim'atis )(rasal dari ,a)an+ n.a+us an+ m(n+i%uti a.m(s(nt(ri%a su'(ri0r dan a.a''(ndi%ularis s(dan+%an '(rsarafan sim'atis )(rasal dari n.t0ra%alis @. l(- %ar(na itu n(ri is,(ral 'ada a''(ndi,itis )(rmula di s(%itar um)ili%us. P(ndara-an a''(ndi%s )(rasal dari a. a''( a''(nd ndi% i%ul ular aris is an+ an+ m(ru m(ru'a 'a%a %an n art( art(ri ri tan' tan'aa %0la %0lat( t(ra ral. l. Ji%a Ji%a art( art(ri ri ini ini t(rsu t(rsum) m)at at misaln misalnaa %ar(n %ar(naa tr0m) tr0m)0si 0siss m(n+alami +an+r(n.2

'ada 'ada inf(% inf(%si si a''(ndi% a''(ndi%ss a%an a%an

















s('(rti usus )(sar.
Hist0l0+is = 4   

Tuni% ni%a #u% #u%0s 0saa Tuni%a ni%a Su)m Su)mu% u%0s 0saa Tuni%a Tuni%a #us%ular #us%ularis is

= m(m m(miili%i %ri %ri'tus t(ta (ta'i tida% da% m(m m(miili%i il illus. = )an )an a% f0li f0li%( %(ll l lm'-0 m'-0id id.. = stratum stratum ,ir,ula ,ir,ular( r( s()(las()(la- dalam dalam dan stratum stratum l0n+itudinal( 6+a)un+an ti+a ta(nia ,0li7 s()(laluar.



Tuni%a S(r0sa

= )ila l(ta%na intra'(rit0n(al asalna dari '(rit0n(um is,(ral(.















%ar(na *umla- *arin+an limf( disini %(,il s(%ali *i%a di)andin+%an d(n+an *umla-na di saluran ,(rna dan di s(luru- tu)u-. tu) u-. Jarin+an Jarin+an lm'-0id lm'-0id '(rtama '(rtama %ali mun,ul 'ada a''(ndi% a''(ndi%ss s(%itar s(%itar 2 min++u s(t(la- la-ir. Jumla-na m(nin+%at s(lama 'u)(rtas dan m(n(ta' saat d(/asa dan %(mudian )(r%uran+ )(r%uran+ m(n+i%uti umur. S(t(laS(t(la- usia &5 ta-un tida% tida% ada *arin+an *arin+an lm'-0id lm'-0id la+i di a''(ndi% a''(ndi%ss dan t(r*adi t(r*adi '(n+-an, '(n+-an,uran uran lum(n a''(ndi%s %0m'lit.

-.1 DEINISI

-

A''(ndi, A''(ndi,iti itiss m(ru'a% m(ru'a%an an '(radan+ '(radan+an an 'ada a''(ndi9 a''(ndi9 (rmif0r (rmif0rmis mis.. P(rad P(radan+ an+an an a%ut a%ut a''(nd a''(ndi%s i%s m(m( m(m(rl rlu%a u%an n tinda tinda%an %an )(da)(da- s(+(r s(+(raa untu% untu% m(n,(+a- %0m'li%asi an+ umumna )(r)a-aa.

-.2 ETIOLO)I )stru%s )stru%sii lum(n lum(n m(ru'a% m(ru'a%an an '(n()a) '(n()a) utama utama a''(ndi, a''(ndi,iti itis. s. (%alit (%alit m(ru'a%an '(n()a) t(rs(rin+ dari 0)stru%si a''(ndi%s. P(n()a) lainna adala- -i'(rtr0fi *arin+an limf0id sisa )arium dari '(m(ri%saan !0(nt+(n di(t r(nda- s(rat dan ,a,in+ usus t(rmasu% as,aris. Trauma tum'ul atau trauma %ar(na colonoscopy da'at colonoscopy da'at m(n,(tus%an inflamasi 'ada a''(ndi%s. r(%u(nsi 0)stru%si m(nin+%at d(n+an m(m)(ratna 'r0s(s inflamasi. (%al (%alit it dit(m dit(mu%a u%an n 'ada 'ada 45; dari dari %asus %asus a''(n a''(ndi, di,it itis is a%ut a%ut s(%it s(%itar ar &$; m(ru'a%a m(ru'a%an n a''(ndi a''(ndi,iti ,itiss +an+r(n +an+r(n0us 0us tan'a tan'a ru'tur ru'tur dan s(%itar s(%itar 5; %asus %asus a''(ndi,itis +an+r(n0us d(n+an ru'tur.















-.3 PA PATOISIOLO)I TOISIOLO)I A''(ndi,itis )iasana dis()a)%an 0l(- '(num)atan lum(n a''(ndi%s 0l(- -i'(r'lasia f0li%(l limf0id f(%alit )(nda asin+ stri%tur %ar(na fi)r0sis a%i)at '(radan+an s()(lumna atau n(0'lasma. )stru%si lum(n an+ t(rtutu' dis()a)%an 0l(- -am)atan 'ada )a+ian 'r0%simalna dan )(rlan*ut 'ada '(nin+%atan s(%r(si n0rmal dari mu%0sa a''(nd a''(ndi%s i%s an+ an+ dist( dist(nsi nsi.. )st )stru% ru%si si t(rs() t(rs()ut ut m(n m(n()a ()a)%a )%an n mu%us mu%us an+ an+ di'r0du%si mu%0sa m(n+alami )(ndun+an. #a%in lama mu%us t(rs()ut ma%in )ana% namun (lastisitas dindin+ a''(ndi% a''(ndi%ss m(m'un m(m'unai ai %(t(r)at %(t(r)atasan asan s(-in++a s(-in++a m(n()a) m(n()a)%an %an '(nin+%a '(nin+%atan tan t(%anan intralum(n. intralum(n. Ka'asitas lum(n a''(ndi%s n0rmal -ana s(%itar 51 ml. Ji%a s(%r(si s(%itar 5$ ml da'at m(nin+%at%an t(%anan intralum(n s(%itar &5 ,mH2.

#anusi nusiaa

m(ru (ru'a% 'a%an

sal sala-

satu

dari ari

s(di% di%it

an+ an+

da'at 'at

m(n+%0m'(nsasi '(nin+%atan s(%r(si an+ ,u%u' tin++i s(-in++a m(n*adi +an+r(n atau t(r*adi '(rf0rasi.2 T(%anan %anan an+ an+ m(nin m(nin+%a +%att t(rs( t(rs()ut )ut a%an a%an m(n m(n()a ()a)%a )%an n a''(n a''(ndi% di%ss m(n+alami -i'0%sia m(n+-am)at aliran limf( t(r*adi uls(rasi mu%0sa dan inasi inasi )a%t(ri )a%t(ri.. Inf(%si Inf(%si m(n()a m(n()a)%an )%an '(m)(n+ '(m)(n+%a%a %a%an n a''(ndi%s a''(ndi%s )(rtam) )(rtam)aa6(d(ma7 6(d(ma7 dan s(ma%in s(ma%in is%(mi is%(mi% % %ar(na %ar(na t(r*adi t(r*adi tr0m)0si tr0m)0siss '(m)ulu '(m)ulu- daradaraintramu intramural ral 6dindin 6dindin+ + a''(ndi% a''(ndi%s7. s7. Pada Pada saat saat inilainila- t(r*adi t(r*adi a''(ndi, a''(ndi,iti itiss a%ut f0%al an+ ditandai 0l(- n(ri ('i+astrium. ('i+astrium.














+an+r(n0sa. Bila dindin+ an+ t(la- ra'u- itu '(,a- a%an t(r*adi a''(ndi,itis '(rf0rasi. Bila s(mua 'r0s(s di atas )(r*alan lam)at 0m(ntum dan usus an+ )(rd(%atan a%an )(r+(ra% %( ara- a''(ndi%s a ''(ndi%s -in++a tim)ul suatu massa l0%al an+ dis()ut infiltrate appendicularis. appendicularis. P(radan+an a''(ndi%s t(rs()ut da'at m(n*adi a)s(s atau m(n+-ilan+. Infiltrat a''(ndi%ularis m(ru'a%an ta-a' 'at0l0+i a''(ndi,itis an+ dimulai di mu%0sa dan m(li)at%an s(luru- la'isan dindin+ a''(ndi%s dalam /a%tu 244: *am '(rtama ini m(ru'a%an usa-a '(rta-anan tu)u- d(n+an m(m)atasi m(m)atasi 'r0s(s radan+ d(n+an m(nutu' a''(ndi%s d(n+an 0m(ntum 0m(ntum usus -alus atau adn(%sa s(-in++a t(r)(ntu% massa '(ria''(ndi%ular '(ria''(ndi%ular.. Di dalamna dalamna da'at t(r*adi n(%r0sis *arin+an )(ru'a a)s(s an+ da'at m(n+alami '(rf0rasi. Ji%a Ji%a

tida tida% % t(r) t(r)(n (ntu tu% %

a)s( a)s(s s

a''( a''(nd ndi, i,it itis is

a%an a%an

s(m s(m)u)u-

dan dan

mass massaa

'(ria''(ndi%ular '(ria''(ndi%u lar a%an m(n*adi t(nan+ untu% s(lan*utna a%an m(n+urai diri s(,ara lam)at.

Dalam 'at-0+(n(sis a''(ndi,itis a%ut urutan %(*adianna adala- = $ 1. )st )stru ru%s %sii lum( lum(n n m(n m(n() ()a) a)%a %an n s(%r s(%r(s (sii mu%u mu%uss dan dan ,air ,airan an an+ an+ m(n()a)%an '(nin+%atan t(%anan intraluminal. 2. K(ti K(ti%a %a t(%an t(%anan an intra intralum lumin inal al m(nin m(nin+%a +%at t t(%an t(%anan an dalam dalam mu%0s mu%0saa (nula dan limfati% m(nin+%at aliran dara- dan limf( t(r-am)at %ar(na t(%anan m(nin+%at 'ada dindin+ a''(ndi,(al. 3. K(ti% (ti%aa t(%a t(%ana nan n %a'i %a'il( l(rr m(nin (nin+% +%at at t(r* t(r*ad adii is%( is%(m mia mu%0s u%0saa inflamasi dan uls(rasi %(mudian )a%t(ri tum)u- '(sat di dalam















P-l(+m P-l(+m0n 0n ialaiala- 'r0s(s 'r0s(s '(na-ana '(na-anan n dalam dalam *arin+an *arin+an i%at l0n++ar. l0n++ar. Pada ada

0ran 0ran+ +

d(/a d(/asa sa

t(r* t(r*ad adii

%ar( %ar(na na

%(t( %(t(rl rlam am)a )ata tan n

dala dalam m

m(n(+a% m(n(+a%%an %an dia+n0sa dia+n0sa s(dan+%a s(dan+%an n 'ada ana% %(,il %(,il dis()a)% dis()a)%an an a''(ndi%s %(,il dan %uran+ %0muni%atif. 2. #i%r0'( #i%r0'(rf0r rf0rasi asi massa massa 8 infil infiltrat trat(( '(ria''( '(ria''(ndi% ndi%s. s. #i%r #i%r0'( 0'(rf rf0ra 0rasi si adala adala- suatu suatu '(rada '(radan+a n+an n 0l(0l(- 0m(n 0m(ntum tum dan *arin+an s(%itarna. s (%itarna. Tu)u- m(l0%alisir '(rf0rasi 0l(- %ar(na %ar(n a daa ta-an tu)u- m(nin+%at 6d(n+an '(m)(rian anti)i0ti%7. Ji%a '(rad '(radan+a an+an n tida% tida% s(m'urna s(m'urna da'at da'at t(r*ad t(r*adii '(n()ar '(n()aran an 'us 'us dari ruan+an 0m(ntum.

Pada ana%ana% %ar(na 0m(ntum l()i- '(nd(% dan a'(ndi%s l()i 'an*an+ dindin+ a''(ndi%s l()i- ti'is. K(adaan t(rs()ut ditam)a- d(n+an daa ta-an ta-an tu)utu)u- an+ masi- %uran+ %uran+ m(mudam(muda-%an %an t(r*adi t(r*adina na '(rf0ras '(rf0rasi. i. S(dan+%an S(dan+%an 'ada 0ran+ tua '(rf0rasi muda- t(r*adi %ar(na t(la- ada +an++uan '(m)ulu- dara-. 3 K(,(' K(,('ata atan n r(nt(t r(nt(tan an '(rist '(risti/ i/aa t(rs() t(rs()ut ut t(r+ t(r+ant antun+ un+ 'ada 'ada irul irul(ns (nsii mi%r0 mi%r00r 0r+an +anism ism( ( daa daa ta-an ta-an tu)utu)u- fi)r0 fi)r0sis sis 'ada 'ada dindi dindin+ n+ a''(nd a''(ndi% i%s s 0m(ntum usus an+ lain '(rit0n(um 'ari(tal( dan *u+a 0r+an lain s('(rti (si%a (si%a urinaria urinaria ut(rus ut(rus tu)a tu)a m(n,0)a m(n,0)a m(m)ata m(m)atasi si dan m(l0%al m(l0%alisir isir 'r0s(s 'r0s(s '(radan+an ini. Bila 'r0s(s m(l0%alisir ini )(lum s(l(sai dan suda- t(r*adi '(rf0rasi ma%a a%an tim)ul '(rit0nitis. Ca Calau'un lau'un 'r0s(s m(l0%alisir sudas(l(sai t(ta'i masi- )(lum ,u%u' %uat m(na-an ta-anan atau t(+an+an dalam ,aum a)d0minalis 0l(- %ar(na itu '(nd(rita -arus )(nar)(nar istira-at.2

















!. )e4!l! Klinis A''(ndi,itis infiltrat dida-ului 0l(- %(lu-an a''(ndisitis a%ut an+ %(mudian %(mudian dis(rtai adana massa '(ria'(ndi%ular. '(ria'(ndi%ular. <(*ala a''(ndisitis a''(ndisitis a%ut umumna tim)ul %uran+ dari 3& *am dimulai d(n+an n(ri '(rut an+ dida-ului an0r(%sia. an0r(%sia. <(*ala %lasi% a''(ndi,itis a''(ndi,itis a%ut )iasana )(rmula dari n(ri n(ri di da(rada(ra- um)ili% um)ili%us us atau '(rium)i '(rium)ili%u li%us. s. N(ri N(ri m(n(ta' m(n(ta' %adan+ %adan+ dis(r dis(rtai tai %ram %ram an+ an+ -ilan+ -ilan+ti tim) m)ul. ul. Dalam Dalam 212 212 *am n(ri n(ri )(rali )(rali- %( %uadran %anan an+ a%an m(n(ta' dan di'(r)(rat )ila )(r*alan atau )atu%. Pada '(rmulaan tim)ulna '(na%it )(lum ada %(lu-an a)d0m(n an+ m(n(ta'. Namun dalam )()(ra'a *am n(ri a)d0m(n %anan )a/a- a%an s(ma%in 'r0+r(sif.2 T(rda'a (rda'att *u+a %(lu-an malais( malais( dan d(mam d(mam an+ tida% tida% t(rlalu t(rlalu tin++ tin++i. i. Su-u Su-u tu)utu)u- )iasa )iasana na nai% nai% -in++a -in++a 3:0 t(ta t(ta'i 'i 'ada 'ada %(ada %(adaan an '(rf0rasi su-u tu)u- m(nin+%at -in++a 30. Biasana *u+a t(rda'at %0nsti'asi %0nsti'asi t(ta'i %adan+%adan+ %adan+%adan+ t(r*adi diar( mual dan munta-. S()a+ian )(sar 'asi(n m(n+alami 0)sti'asi 0)sti'a si 'ada a/al n(ri '(rut dan d an )ana% 'asi(n ' asi(n an+ m(rasa n(ri )(r%uran+ s(t(la- )uan+ air )(sar. Diar( tim)ul 'ada )()(ra'a 'asi(n t(rutama t(ru tama ana%ana%.2















m(m(rlu%an 0)at '(n,a-ar. Tinda%an itu dian++a' )(r)a-aa %ar(na )isa m(m' m(m'(r (rmu muda da-

t(r* t(r*ad adin ina a

'(rf '(rf0r 0ras asi. i.

Bila Bila

t(rd t(rda' a'at at

'(ra '(ran+ n+sa san+ n+an an

'(rit0n(um )iasana )iasan a 'asi(n m(n+(lu- sa%it '(rut '(r ut )ila )(r*alan atau )atu%. ) atu%.2 Bila Bila l(ta% l(ta% a''(nd a''(ndi%s i%s r(tr r(tr0s( 0s(%a %all di luar luar r0n++a r0n++a '(rut '(rut %ar(na %ar(na l(ta%na t(rlindun+ s(%um ma%a tanda n(ri '(rut %anan )a/a- tida% )(+itu *(las dan tida% ada ran+san+an '(rit0n(al. !asa n(ri l()i- %( ara '(rut sisi %anan atau n(ri tim)ul 'ada saat )(r*alan %ar(na %a r(na %0ntra%si %0n tra%si 0t0t 's0as ma0r an+ m(n(+an+ m(n(+an + dari d0rsal.3 A''(ndi%s an+ t(rl(ta% di r0n++a '(lis )ila m(radan+ da'at m(nim)ul%an +(*ala dan tanda ran+san+an si+m0id atau r(%tum s(-in++a '(ristalti% m(nin+%at '(n+0s0n+an r(%tum a%an m(n*adi l()i- ,('at dan )(rulan+ulan+. Ji%a a''(ndi%s tadi m(n(m'(l %( %andun+ %(mi- da'at t(r*adi '(nin+%atan fr(%u(nsi %(n,in+ %ar(na ran+san+an dindin+na.3 Pada Pada )()(r )()(ra'a a'a %(ada %(adaan an a''(n a''(ndi, di,iti itiss a+a% a+a% sulit sulit didia didia+n0 +n0si siss s(-in++a tida% ditan+ani 'ada /a%tuna dan t(r*adi %0m'li%asi. <(*ala a''(ndi,itis a%ut 'ada ana% tida% s'(sifi%. <(*ala a/alna s(rin+ -ana r(/( r(/(ll dan dan tida tida% % mau mau ma%a ma%an. n. Ana% s(rin+ s(rin+ tida% tida% )isa )isa m(lu m(lu%is %is%a %an n rasa rasa n(rina dalam )()(ra'a *am %(mudian a%an tim)ul munta-munta- dan















A''(ndi%s umumna t(rl(ta% di s(%itar #,Burn( namun '(rlu diin+at diin+at )a-/a )a-/a l(ta% l(ta% anat0mi anat0miss a''(ndi% a''(ndi%ss s()(narn s()(narna a da'at da'at 'ada s(mua titi% 3&50 m(n+(lilin+i m(n+(lilin+i 'an+%al ,a(,um. ,a(,um. A''(ndisi A''(ndisitis tis l(ta% r(tr0,a(,al r(tr0,a(,al da'at da'at di%(t di%(ta-u a-uii dari dari adan adanaa n(ri n(ri di antar antaraa ,0sta ,0sta 12 dan dan s'ina s'ina ilia ilia,a ,a '0st(ri0r su'(ri0r. A''(ndi,itis l(ta% '(lis da'at m(n()a)%an n(ri r(%tal.2 S(,ara t(0ri '(radan+an a%ut a''(ndi%s da'at di,uri+ai d(n+an adan adan a n(r n(rii 'ada 'ada '(m( '(m(ri ri%s %saa aan n r(%t r(%tum um 6recta rectall touche toucher r 7. 7 . Nam Namun '(m(ri%saan ini tida% s'(sifi% untu% a''(ndi,itis *i%a tandatanda a''(ndi,itis lain t(la- '0sitif.

S(,ara %linis di%(nal )()(ra'a manu(r dia+n0sti% = 23$ •

Ro(sing5s Sign P(n(%an P(n(%anan an 'ada a)d0m(n a)d0m(n %uadran %uadran %iri )a/a)a/a- a%an a%an m(nim)u m(nim)ul%an l%an n(ri n(ri di a)d0m(n a)d0m(n %uadran %uadran %anan %anan )a/a-. )a/a-. Hal ini dis()a)%an dis()a)%an 0l(%ar(na iritasi dari '(rit0n(um. Dis()ut *u+a n(ri t(%an %0ntralat(ral. S(rin+ '0sitif 'ada a''(ndi,itis namun tida% s'(sifi%.















•

Ob#ur!#or Test Pasi(n t(rl(ntan+ tan+an %anan '(m(ri%sa )(r'(+an+an 'ada t(la'a% %a%i %anan 'asi(n s(dan+%an tan+an %iri di s(ndi lututna. K(mudian '(m(ri%sa m(m'0sisi%an s(ndi lutut 'asi(n dalam '0sisi fl(%si dan arti,ulati0 ,09a( dalam '0sisi (nd0r0tasi %(mudian (%s0r0tasi. T(s ini '0sitif )ila 'asi(n m(rasa%an n(ri di -i'0+astrium saat (%s0r0tasi. N(ri 'ada manu(r ini m(nun*u%%an adana '(rf0rasi a'(ndi%s a)s(s a)s(s l0%al l0%al irita iritasi si m.0)t m.0)tura urat0 t0riu riuss 0l(0l(- a''(nd a''(ndi% i%ss d(n+a d(n+an n l(ta% l(ta% r(tr0,a(,al atau adana -(rnia 0)turat0ria.















s(rum mulai m(nin+%at antara &12 *am inflamasi *arin+an. K0m) K0m)in inasi asi 3 t(s t(s aitu aitu adana adana '(nin '(nin+%a +%atan tan !P !P  : m,+8m m,+8mL L -itun -itun+ + l(u%0 l(u%0sit sit  11.5 11.555 55 dan '(rs(n '(rs(nta tas( s( n(utr n(utr0fi 0fill  $; m(mi m(mili% li%ii s(nsitiitas :&; dan s'(sifitas 5.;. P(m(ri% P(m(ri%saan saan urin( urin( )(rmanfa )(rmanfaat at untu% untu% m(nin+% m(nin+%ir%a ir%an n dia+n0si dia+n0siss inf(%si dari saluran %(mi-. Calau'un da'at dit(mu%an )()(ra'a l(u%0sit atau atau (rit (ritr0 r0si sitt dari dari irit iritas asii ur(t ur(t-r -raa atau atau (si (si,a ,a urin urinar aria ia s('( s('(rt rtii an+ an+ dia%i)at dia%i)at%an %an

0l(- inflama inflamasi si a''(ndi%s. a''(ndi%s. Namun 'ada a''(ndi,it a''(ndi,itis is a%ut

dalam sam'l( urin( ,at-(t(r tida% a%an dit(mu%an )a%t(riuria.23

b. Pe Pemer meri7 i7s! s!!n !n R!di R!diol olog ogii 0t0 0t0

'0l0 '0l0ss

a)d0 a)d0m m(n

*ara *aran+ n+

m(m m(m)ant )antu u

'(n( '(n(+a +a%a %an n

dia+ dia+n0 n0si siss

a''(ndi, a''(ndi,iti itiss a%ut a%ut namun namun )(rmanfa )(rmanfaat at untu% untu% m(nin+% m(nin+%ir%a ir%an n dia+n0s dia+n0sis is )andin+. Adana fecalith *ara *aran+ n+ t(rl t(rlii-at at 'ada 'ada f0t0 f0t0 '0l0 '0l0s s ta'i ta'i )ila )ila dit(mu%an san+at m(ndu%un+ dia+n0sis. Ultra Ultras0n s0n0+r 0+rafi afi ,u%u' ,u%u' )(rm )(rmanf anfaat aat dalam dalam m(n(+ m(n(+a%% a%%an an dia+n dia+n0si 0siss a''(ndi,itis. US< dila%u%an %-ususna untu% m(li-at %(adaan %uadran %anan )a/a- atau n(ri 'ada '(lis 'ada 'asi(n ana% atau /anita. Adana Adana

















CT s$!n deng!n in8l!m!si !&endi7s% #!m&!7 8e7!li# 9#!nd! &!n!h

Dia+n0sis )(rdasar%an '(m(ri%saan )arium (n(ma t(r+antun+ 'ada '(n(muan tida% s'(sifi% a%i)at dari massa (%strinsi% 'ada ,a(,um dan a''(ndi%s an+ %0s0n+ dan di-u)un+%an d(n+an %(t('atan an+ )(r%isar antara 4:$5;.4















  15 A''(ndis A''(ndisitis itis a%ut a%ut '(rlu '(rlu 0'(ra 0'(rasi si dini. dini.

-.= DIA)NOSIS 'ANDIN)

/.

-%1%3

)!s#r !s#ro oen#e n#eri#is i#is Pada +astr0(nt(ritis mual dan munta- s(rta diar( m(nda-ului rasa sa%it. Sa%it Sa%it '(rut '(rut dirasa dirasa l()il()i- rin+an rin+an dan tida% tida% t(+as. t(+as. Hi'(r'( Hi'(r'(rist ristalti alti% % s(rin+ s(rin+ dit(mu%an. D(mam dan l(u%0sit0sis %uran+ m(n0n*0l.

-.

Di(er#i$uli#is #is #(s%i'un di(rti,ulitis )iasana t(rl(ta% di '(rut s()(la- %iri namun tida% m(nutu' %(mun+%inan untu% t(r*adi di '(rut s()(la- %anan. <(*ala %linis san+at miri' d(n+an a''(ndi,itis a%ut.















D(mam D(n+u( da'at dimulai d(n+an sa%it '(rut miri' '(rit0nitis. '(rit0nitis. Di sini dida' dida'at at%an %an -asil -asil t(s t(s '0sit '0sitif if untu% untu% Rumple Leede Leede tr0m)0sit0'(nia dan -(mat0%rit an+ m(nin+%at.

6. Kis# Kis#! ! O(!r O(!riu ium m Ter& Ter&un un#ir #ir Tim)ul n(ri m(ndada% d(n+an int(nsitas an+ tin++i dan t(ra)a massa dalam r0n++a '(lis 'ada '(m(ri%saan '(rut ,0l0% a+inal atau ,0l0% r(%t r(%tal al..

Tida% da%

t(rd t(rda' a'at at

m(n(tu%an dia+n0sis.

d(ma d(mam. m.

P(m( P(m(ri ri%s %saa aan n

ultr ultras as0n 0n0+ 0+ra rafi fi

da'a da'att















s(-in++a m(m)uat 0'(rasi )(r)a-aa ma%a -arus m(nun++u '(m)(ntu%an a)s(s an+ da'at muda- didrainas(. #assa #assa a''(ndi% a''(ndi%ss t(r*adi t(r*adi )ila )ila t(r*adi t(r*adi a''(ndi, a''(ndi,itis itis +an+r(n0 +an+r(n0sa sa atau atau mi%r0'(rf0rasi ditutu'i atau di)un+%us 0l(- 0m(ntum dan atau l(%u% usus -alus. Pada Pada massa '(ria''(ndi%ul '(ria''(ndi%ular ar an+ dindin+anna dindin+anna )(lum s(m'urna s(m'urna da'at t(r*adi '(n()aran 'us %( s(luru- r0n++a '(rit0n(um *i%a '(rf0rasi dii% dii%ut utii

'(ri '(rit0 t0ni niti tiss

'uru 'urul( l(nt ntaa

+(n( +(n(ra rali lisa sata ta..

l(l(-

%ar( %ar(na na

itu itu

mass massaa

'(ria''(ndi%ular an+ masi- )()as disaran%an s(+(ra di0'(rasi untu% m(n,(+a- '(nulit t(rs()ut. S(lain itu 0'(rasi l()i- muda-. Pada ana% di'(rs di'(rsia ia'%a '%an n untu% untu% 0'(ras 0'(rasii dalam dalam /a%t /a%tu u 23 23 -ari -ari sa*a. sa*a. Pasi Pasi(n (n d(/asa d(/asa d(n+an d(n+an massa massa '(ria '(ria'(n '(ndi% di%ula ularr an+ an+ t(r'a t(r'an,a n,an+ n+ d(n+a d(n+an n '(ndi '(ndindi ndin+a n+an n s(m'urna dian*ur%an untu% dira/at da-ulu dan di)(ri anti)i0ti% sam)il















ana% %(,il /anita -amildan '(nd(rita usia lan*ut *i%a s(,ara %0ns(ratif tida% tida% m(m) m(m)ai ai% % atau atau )(r%(m )(r%(m)a )an+ n+ m(n*a m(n*adi di a)s(s a)s(s dian*u dian*ur% r%an an 0'(ras 0'(rasii s(,('atna. Bila 'ada /a%tu m(m)u%a '(rut t(rda'at '(ria''(ndi%ular infiltrat ma%a lu%a 0'(rasi ditutu' la+i a''(ndi%s a''(ndi%s di)iar%an sa*a. T(ra'i T(ra'i %0ns(ratif 'ada '(ria''(ndi%ular '(ria''(ndi% ular infiltrat = 1. Total bed rest '0sisi '0sisi fa/l(r a+ar 'us t(r%um'ul di ,aum d0u+lassi. 2. Di(t Di(t luna% luna% )u)ur )u)ur sari sarin+. n+. 3. Anti) Anti)i0t i0ti%a i%a 'ar(n 'ar(nt( t(ral ral dalam dalam d0sis d0sis tin++i tin++i anti)i anti)i0ti 0ti% % %0m)in %0m)inasi asi an+ an+ a%ti a%tiff t(rt(r-ad ada' a' %uma %uman n a(r0 a(r0) ) dan dan ana( ana(r0 r0). ). Baru Baru s(t( s(t(la la%(adaan %(adaan t(nan+ t(nan+ aitu aitu s(%itar s(%itar &: min++u min++u %(mudian %(mudian dila%u%a dila%u%an n a''(nd(,t0m. a''(nd(,t0m. Kalau Kalau suda- t(r*adi a)s(s dian*ur%an dian*ur%an drainas( sa*a dan a''(nd(,t0m di%(r*a%an s(t(la- &: min++u %(mudian. Ji%a

















didiam%an s(lama 2 *am )ila 'us suda- %uran+ dari 155 ,,8-ari drain da'at di'utar dan ditari% s(di%it d(mi s(di%it s('an*an+ 1 in,i tia' -ari. Anti Anti)i0 )i0ti% ti% sist( sist(mi mi% % dilan* dilan*ut% ut%an an sam' sam'ai ai minim minimal al $ -ari -ari '0st '0st 0'(ras 0'(rasi. i. Untu% m(n+(,(% '(n+(,ilan a)s(s tia' -ari '(nd(rita di'(ri%sa ,0l0% du)ur.

P(nd(rita '(ria''(ndi%ular infiltrat di0)s(rasi s(lama & min++u t(ntan+ = 4















-.// KO*PLIKASI K0m'li% K0m'li%asi asi an+ 'alin+ 'alin+ s(rin+ s(rin+ dit(mu% dit(mu%an an adalaadala- '(rf0ras '(rf0rasi i )ai% )(ru'a '(rf0rasi )()as mau'un '(rf0rasi 'ada a''(ndi%s an+ t(lam(n+ m(n+al alam amii '(nd '(ndin indi din+ n+an an )(ru )(ru'a 'a mass massaa an+ an+ t(rd t(rdir irii atas atas %um' %um'ul ulan an a''(ndi%s s(%um dan l(%u% usus -alus.2















'A' III LAPORAN KASUS 1./ ANA*NESIS















3. 3.  sam' sam'ai ai 3:.2 3:.2 .. D(m D(mam r(da r(da saat saat 'asi 'asi(n (n m(n+% (n+%0n 0nsu sum msi Para Para,(t ,(tam am0l 0l ta)l(t ta)l(t $55m+. $55m+. N(ri N(ri '(rut '(rut masi masi- diras dirasa%a a%an n s('(rt s('(rtii -ari -ari s()(lumna. #(rasa mual tan'a munta-. Dua -ari %(mudian 6538548251&7 'u%ul 1$.55 CITA 'asi(n m(rasa%an n(ri '(rut di da(ra- ulu -ati 'usar t(rutama di '(rut %anan )a/a-. D(ma D(mam m d(n+an d(n+an

su-u su-u 3:.2 3:.2  %(mudi %(mudian an t(ra t(rasa sa mual mual dis(r dis(rta taii munta munta-















S#!#us )ener!lis Pemeri7s!!n

H!sil

Ke&!l! *!#!

'ormocephali 'ormocephali ram)ut -itam K0n*un+tia an(mis 8 r(fl(%s ,a-aa lan+sun+ 8

Teling!

r(fl(%s ,a-aa tida% lan+sun+ 8 s,l(ra i%t(ri% 8 'ormotia 'ormotia lian+ t(lin+a la'an+ 8 m(m)ran tim'ani















































































































Appendicitis Akut Laporan Kasus Internsip

Recommend Documents