diagnostik bedah urologi
DESCRIPTION
BEDAH UROLOGITRANSCRIPT
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Dr. Juli Ismail, SpB. SpBTKVBAGIAN ILMU BEDAH
FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS/ RS Dr. M. DJAMIL PADANG
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DIAGNOSA KELAINAN – KELAINAN BEDAH UROLOGI
A. ANAMNESA OBSTRUKSI (KOLIK) INFEKSI PERUBAHAN WARNA URIN
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ANAMNESA MIKSI
• FREKWENSI• NYERI• MENGEDAN• PUAS• PANCARAN• VOLUME• WARNA
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B. PEMERIKSAAN
1. FISIK GINJAL BULI – BULI PENIS URETRA SCROTUM DAN ISINYA PROSTAT - VISERA
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CARA :
• INSPEKSI• PALPASI• PERKUSI• AUSKULTASI
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2. DENGAN ALATCATHETERISASIBUSINASICYSTOSCOPY3. LABORATORIUMURINEFAAL GINJAL4.RONTGENBNO IVP
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Urolithiasis ( Batu Saluran Kemih )
• Dikenal 4800 SM• Masalah kesehatan yang tak pernah habis• Perkembangan ilmu dan teknologi belum
berhasil menemukan faktor penyebab tunggal• Penemuan alat canggih dalam pengobatan
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LOKASI BATU SALURAN KEMIH
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Struktur Batu
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Pembentukan Batu( Calculogenesis )
A. Tahap KausalegeneseBerbagai faktor menciptakan kondisi optimal untuk dapat terbentuknya batu baik di dalam maupun diluar urine seperti derajat kejenuhan, pH urine, infeksi, obstruksi, nutrisi dll.
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B. Tahap FormalegeneseTerbentuknya batu dalam kondisi yang sudah optimal ada 3 pendapat :
• Proses presipitasi lewat jenuh (Vermeulen 1965)
• Yang penting ialah adanya matrix sebagai inti batu (Boyee 1559)
• Yang penting peranan senyawa-senyawa inhibitor & solubisator (Thomas 1968)
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KOMPOSISI BATU
• Calsium Oxalat (58 %)• Calsium Fosfat• MgNH4 Fosfat (28 %)• Urat/NH4 Urat (12%)• Cystine• Xanthine
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FAKTOR-FAKTOR PENYEBAB
1. Faktor fisis dalam urine– Supersaturasi komp. batu– Defisiensi inhibitor– pH Urine– Salting Out Effect
2. Faktor Infeksi3. Faktor Anatomi ( Obstruksi )
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ETIOLOGI – PATOGENESA3 Teori Pembentukan Batu
4. Faktor Metabolik (Diet)5. Faktor adanya Nidus6. Faktor Idiopatik
1. Supersaturasi Presipitasi2. Adanya Matrix
• Protein• Mukoprotein
3. Senyawa Inhibitor• Magnesium• Sitrat • Pirofosfat
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Faktor Penyebab
1. Faktor Kimia– Calsium Oxalat (58 %)– MgNH4 Fosfat (28 %)– Urat/NH4 Urat (12%)– Cystine & Xanthine
2. Faktor Fisis– Supersaturasi– pH– S.O.E
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3. Faktor Infeksi– Pseudomonas– Proteus– Klebsiela
4. Faktor Anatomi– Obstruksi
5. Faktor Metabolik– Hiperparatiroid– Gout– Herediter
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6. Faktor Diet/Obat– Protein– Acetazolamid (Diamox)– HCT– Vitamin C
7. Faktor Lingkungan Kerja
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FATOFISIOLOGI
Gagal Ginjal
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DIAGNOSTIKAnamnese
KeluhanKemungkinan Penyebab
PemeriksaanFisikLabor
Urine : pH, SedimenDarah : Ca, Uric Acid
Ro FotoBNOIVP
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1. Nefrolithiasis2. Ureterolithiasis3. Vesicolithiasis4. Urethrolithiasis
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TERAPITujuan :
Hilangkan BatuCegah Residif
EVALUASI PASIENEVALUASI PASIENAPAKAH ADA INDIKASI OPERASIAPAKAH ADA INDIKASI OPERASI
TENTUKAN KEMUNGKINAN FAKTOR TENTUKAN KEMUNGKINAN FAKTOR PENYEBABPENYEBAB
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PENGOBATANa. Konservatif ( 80 % )b. Operatif ( 20 % )
– Tertutup– Terbuka
• TERTUTUP :1. Teknik Sistoskopi2. Nefrotomi Perkutan3. Litotripsi Ultrasonografi Perkutan (PCL)4. ESWL
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• TERBUKA1. Pyelolithotomi Simpleks2. Pyelolithotomi Diperluas3. Pyelonefrolithotomi4. Nefrolithotomi Anatrofik5. Nefrolithotomi Radial
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PENCEGAHAN
1. Hidrasi2. Tentukan jenis batu
– Atur pH Urine– Atur Diet– Beri Obat Inhibitor
3. Koreksi Kelainan Anatomis dengan Pembedahan