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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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TATA@AKSANA• 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• EPIDEIO@OGI
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$"i(
). insissate( barium (ari emeriksaan
*ra+ sebelumn+a
,. tum"r
-. bi'i sa+uran atau buahbuahan
/. arasit intestine0 seerti %a%ing askaris
ANIFESTASI K@INIS
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ANIFESTASI K@INIS
Ge*ala
1$ 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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KOP@IKASI RUPTU
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KOP@IKASI RUPTUAPPENDIKS
• Appene"'6mi
•Ke.!ri)aan r!p'!rDemam C
W4C 1:$0009mm2
@6.alie re/6!n 'enerness paa contained rupture,allin)6J )a)al 3 peri'6ni'is )eneralisa'a
• Tana iri'asi peri'6ne!mR6?sin) si)n (n+eri i R@ saa' @@ i'e"an%
In?6l!n'ar+ )!arin) m!s.!lar resis'an.e
N+eri saa' /er*alan an /a'!"
TATA@AKSANA
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TATA@AKSANA
Se'ela& ia)n6sis apa' i'e)a"an- pasien isiap"an
6perasi$• 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
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