direktorikuliah-ileusparalitik_0

7/31/2019 DirektoriKuliah-IleusParalitik_0

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ILEUS PARALITIK

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2/19

ILEUS?

Suatu keadaan terjadinya intestinal statis ataudisfungsi yang disertai pelebaran lumen dan

penebalan dinding. Berdasarkan etiologinya, ileus dapat dibedakan atas

dua golongan:

Obstruksi mekanis

Intra luminar obstruction, misalnya tumor intra luminar,intususepsi

Ekstrinsik obstruction, misalnya adhesi, inflamasi, tumorekstrinsik.

Obstruksi adinamik (ileus paralitik)


3/19

ILEUS PARALITIK?

Suatu keadaan akut abdomen* berupa kembungkarena usus tidak berkontraksi akibat adanya

gangguan motilitas

* Akut abdomen proses intraabdomen yang

menyebabkan severe pain yang memerlukanperawatan di RS dan sebelumnya belummendapat terapi/diperiksa dan mungkinmemerlukan intervensi bedah


4/19

ETIOLOGI ILEUS PARALITIK

Peritonitis

Ileus pasca bedah

Setelah trauma abdomen

Gangguan elektrolit

Metastase peritoneal yang difus Obat-obatan ( obat spasmolitik )


5/19

PATOFISIOLOGI

Pembedahan abdominal

ileus fisiologis hilang

dalam 2-3 hari

Bila ileus menetap dalamwaktu lebih dari 3 hari

setelah pembedahan

ileus paralitik

Post operasi

aktivasi refleks inhibisi dari arkus

spinal

hipomotilitas traktus gastrointestinal

otot dinding usus terganggu

gagal untuk mengalirkan isi usus

akumulasi gas dan cairan dalam usus


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MANIFESTASI KLINIS

Nyeri abdomen (sedang, difus)

Mual, muntah

Konstipasi absolut

Distensi abdomen

Pergerakan usus minimal, flatulence


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PERBANDINGAN KLINIS

Macam ileus Nyeri Usus Distensi Muntah

borborigmi

Bising usus Ketegangan

abdomen

Obstruksi

simple tinggi

++

(kolik)

+ +++ Meningkat -

Obstruksi

simple

rendah

+++

(Kolik)

+++ +

Lambat,

fekal

Meningkat -

Obstruksi

strangulasi

++++

(terus-menerus,

terlokalisir)

++ +++ Tak tentu

biasanyameningkat

+

Paralitik + ++++ + Menurun -

Oklusivaskuler +++++ +++ +++ Menurun +


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GAMBARAN RADIOLOGIS

Terdapat distensi baik pada usus halus maupun usus

besar, termasuk lambung dan rektosigmoid

Air-fluid level pada usus halus dan usus besar munculhanya jika ileus bertahan sampai 5-7 hari.

Seluruh rongga usus terisi udara

Preperitoneal fat menjadi tipis atau kadang

menghilang

Membentuk gambaran herring bone (duri ikan) atau

bag of popcorn


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CRITERIA OBSTRUKTIF PARALITIK

GAS DISTRIBUTIONMore air proximal to the

obstruction than distal to it.

No preferential collection

of air.

BOWEL DILATATIONDilatation proximal to the siteof obstruction.

Generalized dilatation of allbowel.

AIR-FLUID LEVELMany dilated air-fluid levels. Fewer air-fluid level that

are not dilated.

ARRANGEMENT OF

BOWEL LOOPS

step ladder appearance ormore orderly arrangement

(resembles a bag of

sausages).

Herring bone or resemblesa bag of popcorn (less

orderly arrangement).

PREPERITONEAL FAT

(+) (-)


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Jika:

- terdapat dilatasi lokal (mis. Usus halus saja)

- terdapat pada suatu bagian usus tempat distensi berakhir (mis. Pertengahan

kolon transversum)

- rektum kosong tidak terisi gas

curiga obstruksi mekanis

Jika: seluruh bagian usus dan gaster dilatasicuriga ileus paralitik


13/19

(1) ILEUS PARALITIK (7 DAY OLD FEMALE)


14/19

(1) INTERPRETASI

Gas Distribution: There are pockets of gas scattered inseveral areas of the abdomen. There is gas in the smallbowel, colon, and rectum.

Bowel Dilatation: There is mild dilation of the bowel,mostly in the colon. The dilated segment of bowel in theleft upper quadrant shows relatively smooth bowelwalls. However, most of the bowel does not show this.In other words, the haustra and plicae of most of the

bowel are well preserved. Air-Fluid Levels: None.

Arrangement of Loops: The loops are not arranged in anorderly pattern.


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(2) ILEUS PARALITIK (1 MONTH OLD FEMALE)


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(2) INTERPRETASI

Gas Distribution: There is a lot of gas in the smalland large bowel distributed throughout theabdomen.

Bowel Dilatation: The degree of bowel dilationhere is proportional throughout. In other words,the large bowel is slightly dilated, as is the smallbowel.

Air-Fluid Levels: None.

Arrangement of Loops: Disorderly arrangement ofdilated bowel. This resembles a bag of popcornrather than a bag of sausages.


17/19

(3) ILEUS PARALITIK (3 DAY OLD FEMALE)


18/19

(3) INTERPRETASI

Gas Distribution: Generalized presence of gasthroughout all quadrants.

Bowel Dilatation: The degree of bowel dilatation isproportional. The right lower quadrant maydemonstrate some smooth bowel walls, but this isprobably just the descending colon. Some of thehaustra in these segments are still preserved. Forthe remainder of the bowel, the haustra and plicae

are well preserved. Air-Fluid Levels: None.

Arrangement of Loops: Disorderly arrangementresembling a bag of popcorn.


19/19

SUMBER

Livingstone AS, Sasa JL. Ileus and obstruction in Haubrich WS, Schaffner F (eds);

Bockus Gastroenterology 5th ed. Philadelphia, WB Saunders Co., 1995

Sileu W. Acute intestinal obstruction. In : Isselbacher KJ, Braunwald E, Wilson JD,

Martin JB, Fauci AS, Kasper DL (eds). Harrisons Principles of Internal Medicine

13th ed : New York, Mc Graw-Hill, 1994

Schuffer WD, Sinanan MN. Intestinal obstruction and pseudoobstruction in :Sleissenger MH, Fordtran JS (eds). Gastrointestinal Disease; Pathophysiology/

Diagnosis / Management 5th ed. Philadelphia, WB Saunders Co, 1993

Livingstone EH, Passoro EP. Postoperative ileus. Dig. Dis. Sci. 1990; 35 : 121-32

Saudgren JE, Mc Phee MS, Greenberger NJ. Narcotic bowel syndrome treated with

clonidin. Resolution of abdominal pain and pseudoobstruction. Ann InternMed 1990; 101 : 331-4.

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