karakteristik penderita apendisitis akut di rsud …
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K A R A K T E R I S T I K PENDERITA APENDISITIS AKUT DI RSUD PALEMBANG BARI PERIODE
1 JANUARI 2011-31 DESEMBER 2014
SKRIPSI S e b a g a i s a l a h s a t u s y a r a t m e m p e r o l e h g e l a r
S a r j a n a K e d o k t e r a n ( S . K e d )
O l e h : R I Z K Y ZURIATI NIM: 70 2012 053
FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH PALEMBANG
2016
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H A L A M A N P E N G E S A H A N
K A R A K T E R I S T I K P E N D E R I T A A P E N D I S I T I S A K U T D I R S U D P A L E M B A N G B A R I P E R I O D E 1 J A N U A R I 2011-
31 D E S E M B E R 2014
D i p e r s i a p k a n d a n D i s u s u n O l e h R I Z K Y Z U R I A T I N I M : 70 2012 053
S e b a g a i S a l a h S a t u S y a r a t M e m p e r o l e h G e l a r S a r j a n a K e d o k t e r a n ( S . K e d )
P a d a t a n g g a l : 3 F e b r u a r i 2 0 1 6
Menyetujui
dr. H. M. All Muchtan M. Sc Pembimbing Pertama
dr. Supriyatiningsih Reiieki Pembimbing Kedua
kteran
dr. H. M. AH Muchtan M. Sc NBM/NIDN.060347091062484/0020084707
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P E R N Y A T A A N
D e n g a n i n i S a y a m e n e r a n g k a n b a h w a :
!. K a r y a T u l i s S a y a , s k r i p s i i n i a d a l a h a s l i d a n b e l u m p e m a h d i a j u k a n u n t u k
m e n d a p a t k a n g e l a r a k a d e m i k , b a i k d t U n i v e r s i t a s M u h a m m a d i y a h P a k r m b a n g ,
m a u p u n P e r g u r u a n T i n g g i l a i n n y a .
2 . K a r y a T u l i s i n i m u m i g a g a s a n , r u m u s a n , d a n p e n e l i t i a n S a y a s e n d i r i , t a n p a
b a n t u a n p i h a k l a i n , k c c u a l i a r a h a n T i m P e m b i m b i n g .
3 . D a l a m K a r y a T u l i s i n i t i d a k t e r d a p a t k a r ^ ' a a t a u p c n d a p a t y a n g t e l a t ^ d i t u l i s
a t a u d i p u b l i k a s i k a n o r a n g l a i n , k e c u a l i s e c a r a t e r t u l i s d e n g a n d i c a r t t u m k a n
s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n
d i c a n t u m k a n d a l a m d a l t a r p u s t a k a .
4 . P e m y a t a a n i n i S a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d t a n h a r i
t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i , m a k a S a y a
b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a s e s u a i d e n g a n n o r m a
y a n g b e r i a k u d i P e r g u r u a n T i n g g i i n i .
P a l e m b a n g , 3 F e b m a r i 2 0 1 6
Y a n g m e m b u a t p e m y a t a a n r r E R A l
, 1»S0D6ADF8965272^4
€ 0 0 0 «̂pRIBURUPIAH
R i z k y Z u r i a t i N I M . 7 0 2 0 1 2 0 5 3
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MDTTD DAN PERSEMBAHAN
Barangsiapa yang menghendaki kehldigjan dunia maka wajib ba^nya memiliki dmu. dan barangsiapa yang menghendaki kehidupan aihirat. maka wajib baginya memitiki ifmu. dan barangsiapa menghendaki
keduasgm maka baginya memiliki dmu (mumwdzi)
Kupersembahbn skr ips i Ini kepada; Rabbi dan Panutanku
Allah SWT dan Nabi Muhammad SAW
Kedua orangtuaku yang sangat kucintai Ayahanda Zulk i rna in .S .Pd M.SI te r imakas ih atas kasih sayang. motivasi . semangat. nasihat dan ide
yang selalu ayah berikan. / A i i n d a b Nayati KutaAar. ^Pd tGhmaias ib selahi menjadi ibu yang terbaiiL dangan dua tu/us
ikhlasmu bisa mengantar b n anakmu sampai b tahap in i . Ayahanda dan ibundalah lah semangat hidupku untuk menggapai segalanya. Terimakasih a t a s segala
ha) yang selalu ayahanda dan ihunda berikan. You ' re My Tveryth'ing
Yang tersayang kakakku Suci Ismlat i , S.Pd. bang igeng dan keponabnku r a f i f t e r i m a b s i h atas doa dan dukungan yang kakak berikan. t e t ^ l a h menjadi b k a k yang terbaik.
sabar dan selalu ada untuk adik-adikmu Yang selalu kubanggabn abangku Rizky Pra tama ter imakasih doa yang abang berikan. Tetaplah
semangat untuk menggapai kesuksesen
Untuk dusen pembimbing dan pengujl terbaik dr. All Muchtar .M.Sc. dr. Supnyatinmgsth, dr. Yesi As t r i . M.Kes dan dr. Azml Rosya Furayoga, Sp.B Ter ima kasih untuk bimbingan dan m a s u b n yang dokter berikan dalam proses penyusunan skr ips i in i .
Untuk sahabat-sahabatku yang jauh dtsana Mutia, mayumi. t ia ra , rini dsn st tah. Semangat untuk kalian. Semoga ki ta bisa t e rns jadi sahabat y s .
Untuk sahabat-sahabat yang luar biasa Mi t ra . eka. a r t i . risb kak sheny dan nadya. Tetaplah semangat menggapai segalanya.
Semoga jalan kite dipermudahkaa semangatil!
Untuk teman- teman seperjuangan bimbingan skripsi V i n a Eva. Qodri dan teman- teman angkdtau 2012
Untuk teman-teman b s a n griya nanda te rkhusus Y u k M l f t a d a n U c i
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UNIVERSITAS MUHAMMADIYAH P A L E M B A N G F A K U L T A S K E D O K T E R A N
S K R I P S I , J A N U A R I 2 0 1 6 R I Z K Y Z U R I A T I
Karakleririsfik Pendcrifa Apendisitis Akut di RSUD Palembang Bari Periode 1 Januri 2011-31 Desember 2014
xi+ 56 Hajaman+ 8 Tabel + 5 Gambar + 7 Lampiran
A B S T R A K
A p e n d i s i t i s m e r u p a k a n m a s a l a h k e g a w a t d a r u r a t a n b e d a h y a n g u m u m d i d a p a t k a n d i m a s y a r a k a t d a n d a p a t m e n i m b u l k a n k o m p l i k a s i y a n g m e m b a h a y a k a n a p a b i l a t i d a k s e g e r a d i t a t a i a k s a n a . P e n e l i t i a n i n i b e r t u j u a n u n t u k m e n g e t a h u i k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t d i R S U D P a l e m b a n g B a r i P e r i o d e I J a n u a r i 2 0 I I - 3 1 D e s e m b e r 2 0 1 4 . J e n i s p e n e l i t i a n i n i a d a l a h p e n e l i t i a n d e s k r i p t i f r e t r t j s p e k t i f . P e n e l i t i a n i n i d i l a k u k a n d i B a g i a n R e k a m M e d i k R S U D P a l e m b a n g B a r i . P e n g a m b i l a n d a t a d i l a k u k a n s e c a r a . v a m p / / W g d e n g a n j u m l a h s a m p c l s e b e s a r 4 8 p e n d e r i t a a p e n d i s i t i s a k u t . D a t a d i a m b i l d a r i R c k a m M c d i k R S U D P a l e m b a n g B a r i d a n d i a n a l i s a s e c a r a k o m p u t e r i s a s i . H a s i l P e n e l i t i a n m e n u i n j u k k a n k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n u s i a b a n y a k t e r j a d i p a d a u s i a 2 0 - 3 0 l a h u n d a n u s i a > 3 0 t a h u n y a i t u 1 8 o r a n g ( 3 7 . 5 % ) . B e r d a s a r k a n j e n i s k e l a m i n b a n y a k t e r j a d i p a d a j e n i s k e l a m i n p e r e m p u a n y a i t u 2 5 o r a n g ( 5 2 . 1 % ) . H a s i l s k o r a l v a r a d o t e r b a n y a k p a d a h a s i l s k o r 7 - 1 0 ( a p e n d i s i t i s a k u t ) y a i t u 4 1 o r a n g ( 8 5 . 4 % ) . P e n a t a l a k s a n a a n a p e n d i s i t i s a k u t b a n y a k d i l a k u k a n d e n g a n t i n d a k a n a p e n d e k t o m i t e r b u k a ( 1 0 0 % ) . D e n g a n d e m i k i a n , p e r l u d s b e r i k a n i n f o r m a s i k e p a d a m a s y a r a k a t m e n g e n a i a p e n d i s i t i s a k u t s e r t a e d u k a s i m e n g e n a i p o l a m a k a n y a n g b a i k s e h i n g g a m e n g u r a n g i k e j a d i a n a p e n d i s i t i s a k u t d a n a p a b i l a d i a g n o s a a p e n d i s i t i s a k u t s u d a h d i t e g a k k a n , p e n a t a l a k s a n a a n a p e n d e k t o m i h a r u s s c g a r a d i l a k s a n a k a n .
Referensi: 39(2002-2015) Kata KuDci: apendisitis akut, skor alvarado., apendektomi.
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U N I V E R S I T Y O F MUHAMMADIYAH P A L E M B A N G F A C U L T Y O F M E D I C I N E
STUDENT PAPER, JANUARY 2016 R I Z K Y Z U R I A T I
Characteristics of Patients with Acute Appendicitis at Palembang Bari Hospital in Period January V\ 2011 - December 3 l"\ 2014
xi + 56 Pages + 8 Tables + 5 Images + 7 Attachments
A B S T R A C T
Appendicitis is a common surgery emergency problem which is found in society and can lead to dangerous complications if not promptly administered. This research aims to determine the characteristics of patients with acute appendicitis at the Palembang Bari hospital in Period January /", 2011 - Decemfier 31'^, 2014. This type of research is a retrospective descriptive research. This research was conducted at the Medical Records Section in Palembang Bari Hospital. Data was taken by total sampling with a total sample of 48 patients with acute appendicitis. Data were taken from Medical Records Section in Palembang Bari Hospital and analyzed by computerized. The results showed the characteristics of patients with acute appendicitis which based on age occurred at 20-30 years of age, and age> 30 years is 18 people (37.5%). Based on gender, the occurring of this disease in female is 25 people (52.1%). Results of alvarado highest scores on the .score 7-10 (acute appendicitis) is 41 people (85.4%). Many Adminis tered of acute appendicitis are with the open appendectomy (100%). Therefore, it is necessary to give information to the public about acute appendicitis and also education about good diet, there by reducing the incidence of acute app<;ndicitis and when the diagnosis of acute appendicitis has been established, treatment should be immediately implemented by using appendectomy.
Reference: 39 (2002-2015) Keywords: acute appendicitis, alvarado score, appendectomy.
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K A T A P E N G A N T A R
P u j i s y u k u r p e n e l i t i p a n j a t k a n k e p a d a A l l a h S W T a t a s s e g a l a r a h m a t d a n k a r u n i a - N y a s e h i n g g a p e n e l i t i d a p a t m e n y e l e s a i k a n p e n e l i t i a n i n i y a n g b e r j u d u l " K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t d i R S U D P a l e m b a n g B a r i P e r i o d e I J a n u a r i 2 0 1 1 - 3 1 D e s e m b e r 2 0 1 4 " s e b a g a i s a l a h s a t u s y a r a t u n t u k m e r r t r p e r o l e h g e l a r S a r j a n a K e d o k t c r a n ( S . K e d ) . S h a l a w a t b e r i r i n g s a l a m s e l a l u t e r c u r a h k e p a d a j u n j u n g a n k i t a , n a b i b e s a r M u h a m m a d S A W b e s e r t a p a r a k e l u a r g a , s a h a b a t , d a n p e n g i k u t - p e n g i k u t n y a s a m p a i a k h i r z a m a n .
P e n e l i t i m e n y a d a r i b a h w a p e n e l i t i a n i n i j a u h d a r i s e m p u m a . O l c h k a r e n a i t u , p e n e l i t i m e n g h a r a p k a n k r i l i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n g u n a p c r b a i k a n d i m a s a m e n d a t a n g .
D a l a m h a l p e n y e l e s a i a n p e n e l i t i a n i n i , p e n u l t s b a n y a k m e n d a p a t b a n t u a n , b i m b i n g a n d a n s a r a n . P a d a k e s e m p a t a n i n i , p e n u l i s i n g i n m e n y a m p a i k a n r a s a h o r m a l d a n t e r i m a k a s i h k e p a d a :
1 . A l l a h S W T , y a n g t e l a h m e m b e r ! k e h i d u p a n d e n g a n s e j u k n y a k e i m i u i a n . 2 . K e d u a o r a n g t u a y a n g s e l a l u m e m b e r i d u k u n g a n m a t e r i l m a u p u n s p i r i t u a l . 3 . D e k a n d a n s t a f f F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h
P a l e m b a n g . 4 . d r . A l i M u c h t a r , M . S c s c l a k u p e m b i m b i n g I . 5 . d r . S u p r i y a t i n i n g s i h R e j e k i d a n d r . Y e s i A s t r i , M . K e s s e l a k u p e m b i m b i n g
I I . 6 . d r . A z m i R o s y a F o r a y o g a , S p . B s e l a k u p e n g u j i . 7 . S e i u r u h p i h a k d i r e k s i , d i k l a t , r e k a m m e d i k d a n s t a f R S U D P a l e m b a n g B a r i
S e m o g a A l l a h S W T m e m b e r i k a n b a l a s a n p a h a l a a t a s s e g a l a a m a l y a n g d i b e r i k a n k e p a d a s e m u a o r a n g y a n g t e l a h m e n d u k u n g p e n e l i t i d a n s e m o g a l a p o r a n i n i b e r m a n f a a t b a g i k i t a d a n p c r k e m b a n g a n i l m u p e n g e t a h u a n k e d o k t e r a n . S e m o g a k i t a s e l a l u d a l a m l i n d u n g a n A l l a h S W T . A m i n .
P a l e m b a n g , 3 F e b r u a r i 2 0 1 6
R i z k y Z u r i a t i
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D A F T A R I S I
HALAMAN J U D U L HALAMAN PENGESAHAN i HALAMAN PERNYATAAN " M O T T O DAN PERSEMBAHAN i" A B S T R A K i v A B S T R A C T v K A T A PENGANTAR v i D A F T A R ISI v i i DAFTAR T A B E L i x DAFTAR GAMBAR x D A F T A R LAMPIRAN xi BAB I PENDAHULUAN
1 , 1 . L a t a r B e i a k a n g 1 1.2 R u m u s a n M a s a l a h 3 1.3 T u j u a n P e n e l i t i a n 3 1.4 M a n f a a l P e n e l i t i a n 3 1.5 K e a s l i a n P e n e l i t i a n 4
BAB I I TINJAUAN PUSTAKA 2 . 1 L a n d a s a n T e o r i 8
2 . 1 . 1 A n a t o m i d a n F i s i o l o g i A p e n d i k s 8 2 . 1 . 2 E p i d e m i o l o g i H 2 . 1 . 3 E t i o l o g i d a n F a k t o r R i s i k o 11 2 . 1 . 4 P a t o g e n e s i s 12 2 . 1 . 5 M a n i f e s t a s i K l i n i s 1 4 2 . 1 . 6 D i a g n o s i s 1 6 2 . 1 . 7 S k o r A l v a r a d o 2 0 2 . 1 . 8 P e m e r i k s a a n H i s t o p a t o l o g i 2 1 2 . 1 . 1 0 T a t a l a k s a n a 2 2 2 . 1 . 1 1 D i a g n o s i s b a n d i n g 2 3 2 . 1 . 1 2 K o m p l i k a s i 2 4 2 . 1 . 1 3 P r o g n o s i s 2 4
2 . 2 K e r a n g k a T e o r i 2 5
B A B H I M E T O D E P E N E L I T I A N 3 . 1 J e n i s P e n e l i t i a n 2 6 3 . 2 W a k t u d a n t e m p a t p e n e l i t i a n 2 6 3 . 3 P o p u l a s i d a n S a m p e i 2 6
3 . 3 . 1 P o p u l a s i 2 6 3 . 3 . 2 S a m p e i d a n B e s a r S a m p e i 2 6 3 . 3 . 3 K r i t e r i a i n k l u s i d a n E k s k l u s i 2 6
3 . 4 V a r i a b e l P e n e l i t i a n 2 7 3 . 5 D e f i n i s i O p e r a s i o n a i 2 7
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3 . 6 C a r a p e n g i i m p u l a n d a t a 2 8 3 . 7 M c l o d c T c k n i s A n a l i s i s D a t a 2 8
3 . 7 . 1 D a t a P r i m e r 2 8 3 . 7 . 1 D a t a S e k u n d e r 2 8 3 . 7 . 1 C a r a P e n g o l a h a n d a n A n a l i s i s D a t a 2 9
3 . 8 A l u r P e n e l i t i a n 3 0
BAB IV HASIL DAN PEMBAHASAN 4 . 1 H a s i l 3 1 4 . 2 P e m b a h a s a n 3 5
BAB V K E S I M P U L A N DAN SARAN 5 . 1 K e s i m p u l a n 4 0 5 . 2 S a r a n 4 0
DAFTAR PUSTAKA 4 1 LAMPIRAN 4 5 B I O D A T A R I N G K A S
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D A F T A R T A B E L
T a b e l H a l a m a n
1.1 K e a s l i a n P e n e l i t i a n 4
2 . 1 S i s t e m S k o r i n g A l v a r a d o 2 0
3 . 1 D e f i n i s i O p e r a s i o n a i 2 7
4 . 1 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t B e r d a s a r k a n U s i a . . . 3 1
4 . 2 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t B e r d a s a r k a n J e n i s
K e l a m i n - 3 2
4 . 3 D i s t r i b u s i F r e k u e n s i S k o r A l v a r a d o 3 3
4 . 4 H a s i l S k o r A l v a r a d o 3 4
4 . 5 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t B e r d a s a r k a n J e n i s
T a t a l a k s a n a 3 5
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D A F T A R G A M B A R
G a m b a r H a i a m a n
2 . 1 A n a t o m i A p e n d i k s V e r m i f o r m i s n o r m a l 8
2 . 2 P r o y e k s i d a n V a r i a n P o s i s i A p e n d i k s V e r m i f o r m i s 9
2 . 3 A p e n d i k s y a n g M e n g a l a m i P c r a d a n g a n 14
2 . 5 K e r a n g k a T e o r i 2 5
3 , 1 A i u r P e n e l i t i a n 3 0
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D A F T A R L A M P I R A N
L a m p i r a n H a l a m a n
1 . D a t a R e k a m M e d i k P a s i e n A p e n d i s i t i s A k u t 4 5
2 . P e n g o l a h a n D a t a d e n g a n S P S S 4 8
3 . K a r t u B i m b i n g a n 5 1
4 . S u r a t t z i n P e g g a m b i l a n D a t a A w a l 5 2
5 . S u r a t T e l a h s e l c s a i P e n g a m b i l a n D a t a A w a l 5 3
6 . S u r a t I z i n P e n e l i t i a n 5 4
7 . S u r a t T e l a h s e l e s a i P e n e l i t i a n 5 5
x i
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BAB I
P E N D A H U L U A N
1.1. Latar Belakang
A p e n d i k s a d a l a h o r g a n b e r b e n t u k t a b u n g y a n g b e r p a n g k a l d i s e k u m ,
m e m i l i k i l u m e n y a n g s e m p i l d i b a g i a n p r o k s i m a l d a n m e l e b a r d i b a g i a n d i s t a l
( S j a m s u h i d a j a t , 2 0 1 0 ) . A p a b i l a t e r j a d i p r o s e s p e r a d a n g a n y a n g t i m b u l s e c a r a
m e n d a d a k p a d a d a e r a h a p e n d i k s m a k a d i s e b u t d e n g a n a p e n d i s i t i s a k u t
( P e n n e n k e s , 2 0 1 4 ) . A p e n d i s i t i s a k u t m e r u p a k a n m a s a l a h k c g a w a t d a r u r a t a n
a b d o m i n a l y a n g p a l i n g u m u m t e r j a d i ( H u m e s , 2 0 0 6 ) . D i t a n d a i d e n g a n a d a n y a
p e r a s a a n t i d a k n y a m a n p a d a d a e r a h p e r i u m b i l i k u s , d i i k u t i d e n g a n a n o r e k s i a , m u a l
d a n m u n t a h y a n g d i s e r t a i d e n g a n n y e r i t e k a n k u a d r a n k a n a n b a w a h j u g a r a s a
p e g a l d a l a m a t a u n y e r i p a d a k u a d r a n k a n a n b a w a h ( R o b b i n s , 2 0 0 7 ) . P c n y a k i t i n i
t e r j a d i k a r e n a p r o s e s o b s t r u k s i d i l u m e n a p e n d i k s . p e n y e b a b y a n g t e r s e r i n g a d a l a h
a k i b a t h i p c r p l a s i a j a r i n g a n l i m f o i d , f e k a l i t , t u m o r d a n c a c i n g a s k a r i s
( S j a m s u h i d a j a t , 2 0 1 0 ) .
B i l a a p e n d i s i t i s a k u t t i d a k s e g e r a d i t a t a i a k s a n a m a k a a k a n m e n i m b u l k a n
k o m p l i k a s i y a n g m e m b a h a y a k a n y a i t u p e r f o r a s i a p e n d i k s y a n g d a p a t b e r k e m b a n g
m e n j a d i p e r i t o n i t i s a t a u a b s e s ( P a p a n d r i a d k k , 2 0 1 3 ) . B e r d a s a r k a n p e n e l i t i a n
P a p a n d r i a p a d a t a h u n 2 0 1 3 s e b a n y a k 6 8 3 . 5 9 0 p a s i c n y a n g m e n d e r i t a a p e n d i s i t i s ,
3 0 , 3 % m e n g a l a m i p e r f o r a s i . T i n d a k a n p e n a t a l a k s a n a a n y a n g p a l i n g t e p a t p a d a
k a s u s a p e n d i s i t i s a d a l a h a p e n d e k t o m i . S e k i t a r 3 0 . 0 0 0 o r a n g m e n j a l a n i
a p e n d e k t o m i s e t i a p t a h u n d i A m e r i k a S c r i k a t ( R , D a v i d , 2 0 1 5 ) .
S a l a h s a t u u p a y a u n t u k m e n g u r a n g i a n g k a k c s a k i t a n d a n a n g k a k e m a t i a n
d e n g a n c a r a m e n i n g k a t k a n k u a l i t a s d a n k u a n t i t a s p e l a y a n a n m e d i s y a i t u m e m b u a t
d i a g n o s i s y a n g t e p a t ( O m a n d k k , 2 0 1 4 ) . P e n e g a k a n d i a g n o s i s a p e n d i s i t i s a k u t
d i d a s a r k a n p a d a a n a m n e s i s d a n p e m e r i k s a a n f i s i k s e r t a p e m e r i k s a a n p e n u n j a n g .
T e r d a p a t s i s t e m p e n i l a i a n y a n g d a p a t m e m b a n t u d a l a m m e n d i a g n o s i s a p e n d i s i t i s
a k u t y a i t u s k o r A l v a r a d o . S k o r A l v a r a d o t e r d i r i d a r i 3 g e j a l a , 3 t a n d a d a n 2 h a s i l
l a b o r a t o r i u m . A p a b i l a d i d a p a t k a n n i l a i s k o r 7 - 1 0 m a k a d i d i a g n o s i s m e i n g a l a m i
1
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a p e n d i s i t i s a k u t . S d a i n i t u , p e m e r i k s a a n y a n g m e m p e r h a t i k a n p e r u b a h a n
h i s t o p a t o l o g i y a n g t e r j a d i p a d a s t r u k t u r j a r i n g a n a p e n d i k s . d a p a t m e n i n g k a t k a n
a k u r a s i d i a g n o s i s d a r i s u a t u a p e n d i s i t i s a k u t , y a n g t i d a k h a n y a b e r d a m p a k b a g i
p e n a t a l a k s a n a a n y a n g l e b i h b a i k t e t a p i j u g a b a g i k o m p l i k a s i y a n g d a p a t t e r j a d i ,
s e r t a t i n g k a t m o r b i d i t a s d a n m o r t a l i t a s n y a ( H e l l e n , 2 0 0 5 ) .
A p e n d i s i t i s d a p a t d i t e m u k a n p a d a s e m u a u m u r , h a n y a p a d a a n a k k u r a n g
d a r i s a t u t a h u n j a r a n g d i l a p o r k a n . I n s i d e n t e r t i n g g i p a d a k e l o m p o k u m u r 2 0 - 3 0
t a h u n , s e t e l a h i t u m e n u r u n . I n s i d e n s p a d a l a k i - l a k i d a n p e r e m p u a n u m u m n y a
s e b a n d i n g , k e c u a l i p a d a u m u r 2 0 - 3 0 t a h u n , k e t i k a i n s i d e n s p a d a l a k i - l a k i l e b i h
t i n g g i ( S j a m s u h i d a j a t , 2 0 1 0 ) . D i R S U P H . A d a m M a l i k s e l a m a t a h u n 2 0 0 9
t e r d a p a t s e b a n y a k 6 0 k a s u s a p e n d i s i t i s . P a l i n g b a n y a k d i l e m u k a n p e n d e r i t a
a p e n d i s i t i s p a d a u s i a 2 1 - 3 0 t a h u n s e b e s a r 3 5 % , s e d a n g k a n b e r d a s a r k a n j e n i s
k e l a m i n p a l i n g b a n y a k d i t e m u k a n p a d a p c r e m p u a n s e b e s a r 6 0 % ( C P I v a n , 2 0 1 0 ) .
R a t a - r a t a 6 - 9 % p o p u l a s i d i d u n i a m e n d e r i t a a p e n d i s i t i s d a l a m h i d u p n y a .
I n s i d e n a p e n d i s i t i s a k u t d i n e g a r a m a j u l e b i h t i n g g i d a r i p a d a n e g a r a b e r k e m b a n g .
S u r v e i m e n u n j u k k a n b a h w a s e k i t a r 1 0 % o r a n g d i A m e r i k a S c r i k a t d a n n e g a r a
B a r a t m e n d e r i t a a p e n d i s i t i s d a l a m s u a t u s a a t ( R o b b i n s , 2 0 0 7 ) . S e l a i n i t u . j u g a d i
l a p o r k a n h a s i l s u r v e i a n g k a i n s i d e n s ! a p e n d i s i t i s , d i m a n a t e r d a p a t 1 I k a s u s
a p e n d i s i t i s p a d a s e t i a p 1 0 . 0 0 0 o r a n g d i A m e r i k a ( D a h m a r d e h e i , 2 0 1 3 ) .
B e r d a s a r k a n p e n e l i t i a n B u c k i u s M T p a d a t a h u n 2 0 1 2 d i d a p a t k a n b a h w a t e r j a d i
p e n i n g k a t a n k e j a d i a n a p e n d i s i t i s a k u t d a r i 7 , 6 2 m e n j a d i 9 , 3 8 d a r i 1 0 . 0 0 0 a n t a r a
t a h u n 1 9 9 3 - 2 0 0 8 d i A m e r i k a S e r i k a t .
M e n u r u t W H O ( W o r l d H e a l t h O r g a n i z a t i o n ) , i n s i d e n s i a p e n d i s i t i s d i A s i a
p a d a t a h u n 2 0 0 4 a d a l a h 4 . 8 % p e n d u d u k d a r i t o t a l p o p u l a s i . A p e n d i s i t i s
m e r u p a k a n p e n y a k i t u r u t a n k e e m p a t t e r b a n y a k d i I n d o n e s i a p a d a t a h u n 2 0 0 6 .
J u m l a h p a s i e n r a w a t i n a p k a r e n a p e n y a k i t a p e n d i k s p a d a t a h u n t e r s e b u t 2 8 . 9 4 9
p a s i e n , b c r a d a d i u r u t a n k e e m p a t s e t e l a h d i s p e p s i a , d u o d e n i t i s , d a n p e n y a k i t
s i s t e m c e m a l a i n n y a . P a d a r a w a t j a l a n , k a s u s p e n y a k i t a p e n d i k s m e n d u d u k i u r u t a n
k e i i m a ( 3 4 . 3 8 6 p a s i e n r a w a t j a l a n ) , s e t e l a h p e n y a k i t p e n c e r n a a n l a i n , d i s p e p s i a ,
g a s u i t i s d a n d u o d c n i i i s ( D e p k e s , 2 0 0 8 ) . J u m l a h k a s u s a p e n d i s i t i s d i J a w a T e n g a h
t a h u n 2 0 0 9 d i l a p o r k a n s e b a n y a k 5 . 9 8 0 d a n 1 7 7 d i a n t a r a n y a m e n y e b a b k a n
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k c m a l i a n . J u m l a h p e n d e r i t a a p e n d i s i t i s t e r t i n g g i a d a d i K o t a S e m a r a n g , y ; i k n i 9 7 0
o r a n g .
M e n g i n g a t a p e n d i s i t i s m e r u p a k a n m a s a l a h k c g a w a t d a r u r a t a n b e d a h y a n g
u m u m d i d a p a t k a n d i m a s y a r a k a t d a n d a p a t m e n i m b u l k a n k o m p l i k a s i y a n g
m e m b a h a y a k a n a p a b i l a t i d a k s e g e r a d i t a t a i a k s a n a , m a k a p e n e l i t i m e n g a n g g a p
p e r l u d i l a k u k a n p e n e l i t i a n t e n t a n g K a r a k t e r i . s t i k P e n d e r i t a A p e n d i s i t i s A k u t d i
R S U D P a l e m b a n g B a r i p e r i o d e I J a n u a r i 2 0 1 1 - 3 1 I 9 e s e m b e r 2 0 1 4 .
1.2. Rumusan Masalah
B a g a i n i a n a k a i a k l e r i s l i k p e n d e r i t a a p e n d i s i t i s a k u l d i R S U D P a l e m b a n g
B a r i p e r i o d e 1 J a n u a r i 2 0 1 1 s a m p a i d e n g a n 3 1 D e s e m b e r 2 0 1 4 ?
1.3. Tujuan Penelitian
1.3.1. Tujuan Umum
M e n g e t a h u i k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u l d i R S U D P a l e m b a n g
B a r i p e r i o d e 1 J a n u a r i 2 0 1 1 s a m p a i d e n g a n 3 1 D e s e m b e r 2 0 1 4 .
1.3.2. Tujuan Khusus
1 . M e n g e t a h u i k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n u s i a
d a n j e n i s k e l a m i n .
2 . M e n g e t a h u i k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n
p e n e g a k k a n d i a g n o s i s d e n g a n m e n g g u n a k a n s k o r A l v a r a d o .
3 . M e n g e t a h u i k a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n
p e n a t a l a k s a n a a n .
1.4. Manfaat Penelitian
1.4.1. Bagi Peneliti
D e n g a n a d a n y a p e n e l i t i a n i n i p e n e l i t i d a p a t m c n a m b a h p e n g e t a h u a n t e n t a n g
p e n y a k i t a p e n d i s i t i s a k u t s e r t a d a p a t m e n j a d i a c u a n s c b a g a i m a h a s i s w a k l i n i k
d a l a m m e l a k u k a n d i a g n o s i s d a n p e n a t a l a k s a n a a n a p e n d i s i t i s a k u l .
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1.4.2. Bagi Masyarakat
D e n g a n p e n e J i l i a n i n i m e m b e r i k a n m a n f a a t d a l a m m c n y e d i a k a n b c r b a g a i
i n f o r m a s i t e n t a n g p e n y a k i t a p e n d i s i t i s a k u t m u l a i d a r i d e f i n i s i , g e j a l a d a n t i n d a k a n I
y a n g d i l a k u k a n .
1.43. Bagi Akademik
H a s i l p e n e l i t i a n i n i d a p a t d i g u n a k a n s e b a g a i d a t a d a n b a h a n r e f e r e n s i u n l u k
p e n e l i t i a n s e l a n j u t n y a
1.5. Keaslian Penelitian
T a b e l I . I . K e a s l i a n P e n e l i t i a n
N a m a l a h u n J u d u i M e t o d e H a s i l P e n e l i t i a n
P e n e l i t i P e n e l i t i a n
I v a n C P 2 0 1 0 K a r a k t e r i s t i k R e t r o s p e k t i f D a r i h a s i l p e n e l i t i a n
r t p s i f r ! T i t i f t r t l If t#*T^ ct"! I f TV * tlM**Flt'51
i V a l a N l d 1 AllIV l i u c i i u i a p e n d i s i t i s d i a p e n d i s i t i s b e r d a s a r k a n
R S U P H - A d a m j e n i s k e l a m i n p a l i n g
M a l i k M e d a n b a n y a k d i j u m p a i p a d a
p a d a t a h u n 2 0 0 9 p c r e m p u a n y a i t u
s e b a n y a k 3 6 o r a n g
( 6 0 % ) . K a r a k t e r i s t i k
p e n d e r i t a a p e n d i s i t i s
b e r d a s a r k a n u s i a p a l i n g
b a n y a k d i l e m u k a n p a d a
k e l o m p o k u s i a 2 1 - 3 0
t a h u n y a i t u s e b a n y a k 2 1
o r a n g ( 3 5 % ) .
K a r a k t e r i s t i k p e n d e r i t a
a p e n d i s i t i s b e r d a s a r k a n
s u k u y a i t u t e r d a p a t
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E y i i n 2 0 0 9 K a r a k t e r i s t i k A n a l i s i s
p a s i e n d a n s e c a r a
d i a g n o s i s d c s k r i f t i f
h i s t o l o g i p a d a
k a s u s a p e n d i s i t i s
b e r d a s a r k a n d a t a
r e g i s t r a s i d i
D e p a r t e m e n
P a t o l o g i
A n a t o m i F K U I
R u m a h S a k i t
P u s a t N a s i o n a l
C i p t o
M a n g u n k u s u m o
p a d a t a h u n
2 0 0 3 - 2 0 0 7
p a l i n g b a n y a k d i j u m p a i
p a d a s u k u s u k u B a t a k
s e b a n y a k 2 3 o r a n g
( 3 8 , 3 % ) - K a r a k t e r i s t i k
p e n d e r i t a a p e n d i s i t i s
b e r d a s a r k a n p e k e r j a a n
a d a l a h p a l i n g b a n y a k
t e r d a p a t p a d a p e n d e r i t a
a p e n d i s i t i s y a n g b e k c r j a
s e b a g a i P N S s e b a n y a k
2 3 o r a n g ( 3 8 . 3 % )
D a r i h a s i l p e n g o l a h a n
d a t a d i d a p a t k a n b a h w a
a p e n d i s i t i s a k u t a d a l a h
a p e n d i s i t i s t e r b a n y a k ,
p e r e m p u a n l e b i h
b a n y a k d i t e m u k a n
m e n d e r i t a a p e n d i s i t i s
d a r i p a d a l a k i - l a k i i , p a d a
u s i a 2 1 - 3 0 t a h u n p a l i n g
b a n y a k d i t e m u k a n
p a s i e n a p e n d i s i t i s a k u t ,
y a i t u 2 9 . 5 % d a r i 5 8 4
p a s i e n y a n g d i d i a g n o s i s
a p e n d i s i t i s a k u t . p a d a
u m u r 1 1 - 2 0 t a h u n
a p e n d i s i t i s a k u t
p e r f o r a s i p a l i n g b a n y a k
d i t e m u k a p y a i t u
s e b a n y a k 3 2 p a s i e n
( 2 7 . 1 % ) d a r i t o t a l 1 1 8
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J a l i l e t a l 2 0 1 1 S i s t e m S k o r A n a l i l i k
A l v a r a d o p a d a
P r e d i k s i
A p e n d i s i t i s
A k u t
p a s i e n a p e n d i s i t i i s a k u t
p e r f o r a s i d a n p a d a
u m u r 3 1 - 4 0 t a h u n
a p e n d i s i t i s k r o n i s
p a l i n g b a n y a k
d i t e m u k a n y a i t u
s e b a n y a k 2 1 p a s i e n
( 2 6 . 2 % ) d a r i t o t a l 8 0
p a s i e n a p e n d i s i t i s
k r o n i s .
S e n s i t i v i t a s ,
s p e s i f i s i t a s , n i l a i
p r e d i k s i p o s i l i T d a n
n i l a i p r e d i k s i n e g a t i f
s k o r A l v a r a d o u m t u k
a p e n d i s i t i s a k u t a d a l a h
6 6 % , 8 1 % , 9 6 % , 2 9 % .
S e n s i t i v i t a s l e b i h : t i n g g i
m e s k i p u n t i d a k
s i g n i f i k a n u n t u k l a k i -
laki
d e n g a n s k o r l e b i h d a r i 7
d a r i p a d a p e r c m p u a n
d e n g a n s k o r y a n g s a m a
( 9 7 % d a n 9 2 % ) . N a m u n ,
u n t u k s k o r k u r a n g d a r i
7 , s e n s i t i v i t a s a n t a r a
l a k i - l a k i s e c a r a
s i g n i f i k a n l e b i h t i n g g i
d a r i p a d a p e r e m p u a n
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d e n g a n s k o r y a n g s a m a
( 7 9 % d a n 6 1 % ; p
< 0 , 0 5 )
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B A B I I
T I N J A U A N P U S T A K A
2.1. Landasan Teori
2 .1 .1 . Anatomi dan Fisiologi Apendiks
Apendiks vermifomiis adalah organ sempiL, berbentuk tabung yang
mempunyai otot dan mengandung jaringan limfoid. Panjang apendiks
vermiformis bervariasi dari 3-5 inci (8-13 cm). Dasamya melekat pada
pcrmukaan posteromedial caecum, sekitar 1 inci (2,5 cm) di bawah Junctura
ileocaecalis. Bagian apendiks vermiformis lainnya bebas. Apendiks
vermifcmnis diliputi seluruhnya oleh peritoneum, yang melekat pada lapisan
di bawah mcsenterium instestinum tenue melalui mesentenumnya sendiri
yang pendek,mesoapendiks. Mesoapendiks berisi arteria, vena appendicularis
dan saraf-saraf ( S n c l l , 2 0 0 6 ) .
Ciambar 2.1. Anatomi Apendiks Vermiformis Norma! Sumbcr: Sobotta. 2012
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Apendiks tcrletak di regio iliaca dextra dan pangkal diproyeksikan ke
dinding anterior abdomen pada sepertiga lateral dan dua pertiga medial garis
yang menghubungkan spina iliaca anterior aiperior dan umbilicus (titik
McBumey). Lokasi ujung apendiks lebih bervariasi dan berproyeksi ke titik
LANZ (tiansisi antara sepertiga kanan dan dua pertiga kiri pada garis yang
men^ubun^ran kedua spina iliaca anterior posterior. Varian posisi apendiks
vermiformis yaitu descendens ke dalam pelvis minor, retrosekal (posisi yang
paling sering), pre-ileal dan retro-ileal (Sobotta, 2012). Posisi anatomi
apendiks mcncntukan gejala dan Ictak dari spasme otot ketika apendiks
mengalami pcradangan (Moore, 2011).
Gambar 2.2. Proyeksi dan Varian Posisi Apendiks Vermiformis Sumber: Sobtitta, 2012
Di dalam abdomen, dasar apendiks mudah ditemukan dengan mencari
taeniae coli caecum dan mengikutinya sampai dasar apendiks, tempat taeniae
coli bersatu membentuk tunica muscularis longitudinal yang Icn^tap
(Snell, 2006).
Pada 65% kasus, apendiks tcrletak intraperitoneal. Kcdudukan ini
mcmungkinkan apendiks bergerak, dan niang geraknya bergantung pada
panjang mcspapendiks penggantungnya. Pada kasus selebihnya, apendiks
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t e r i e t a k r e t r o p e r i t o n e a l , y a i t u d i b e l a k a n g c a e c u m , d i b e l a k a n g k o l o n a s e n d e n s ,
a t a u d i t c p i l a t e r a l k o l o n a s e n d e n s . G e j a l a k l i n i s a p e n d i s i t i s d i t c n t u k a n o l e h
I c t a k a p e n d i k s . P e r s a r a f a n p a r a s i m p a t i s b e r a s a l d a r i c a b a n g n e r v u s v a g u s
y a n g m c n g i k u t i a r t e r i m e s e n t e r i k a s u p e r i o r d a n a r t e r i a p e n d i i k u l a r i s ,
s e d a n g k a n p e r s a r a f a n s i m p a t i s b e r a s a l d a r i n e r v u s t o r a k a l i s X . O l e h k a r e n a
i t u , n y e r i v i s e r a l p a d a a p e n d i s i t i s b c r m u l a d i s e k i t a r u m b i l i k u s . P e r d a r a h a n
a p e n d i k s b e r a s a l d a r i a r t e r i a p e n d i k u l a r i s y a n g m e r u p a k a n a r t e r i t a n p a
k o l u t e r a i . J i k a a r t e r i i n i t e r s u m b a t , m i s a l n y a k a r e n a t r o m b o s i s p a d a i n f e k s i ,
a p e n d i k s a k a n m e n g a l a m i g a n g r e n .
A p e n d i k s m e n g a n d u n g j a r i n g a n l i m f o i d y a n g m e m p r o d u k s i ,
m e n y i m p a n , a t a u m e m p r o s e s l i m f o s i t . J a r i n g a n l i m f o i d b e r a d a d i t e m p a t -
t e m p a t s t r a t e g i s u n l u k m e n g h a m b a t m a s u k n y a m i k r o o r g a n i s m e s e b e l u m
m i k r o o r g a n i s m e t e r s c b u t m e m i l i k i k e s e m p a t a n u n t u k m e n y e b a r j a u h
( S h e r w o o d , 2 0 U ) .
A p e n d i k s t e r s e b u t m c n g h a s i l k a n i e n d i r 1-2 m l p e r h a r i . L e n d i r i t u
n o r m a l n y a d i c u r a h k a n k e d a l a m l u m e n d a n s e l a n j u t n y a m e n g a l i r k e s e k u m .
H a m b a t a n a l i r a n i e n d i r d i m u a r a a p e n d i k s t a m p a k n y a b c r p e r a n p a d a
p a t o g e n e . s i s a p e n d i s i t i s . I m m u n o g l o b u l i n s e k r e t o a r y a n g d i h a s i l k a n o l e h
G A L T {gut associated lymphoid tissue) y a n g t e r d a p a t d i s c p a n j a n g s a l u r a n
c e m a t e r m a s u k a p e n d i k s , i a i a h I g A . I m u n o g l o b u l i n i t u s a n g a t e f e k t i f s e b a g a i
p e l i n d u n g t e r h a d a p i n f e k s i . N a m u n d e m i k i a n , p e n g a n g k a l a n a p e n d i k s t i d a k
m e m p e n g a n i h i s i s t e m i m u n t u b u h k a r e n a j u m l a h j a r i n g a n l i m f c d i s i n i k e c i l
s e k a l i j i k a d i b a n d i n g k a n d e n g a n j u m l a h n y a d i s a l u r a n c e m a d a n d i s e l u m h
t u b u h ( S j a m s u h i d a j a t , 2 0 1 0 ) .
A p a b i l a t e r j a d i p r o s e s p c r a d a n g a n y a n g t i m b u l s e c a r a m e n d a d a k p a d a
d a e r a h a p e n d i k s m a k a d i s e b u t d e n g a n a p e n d i s i t i s a k u t ( P e n m c n k e s , 2 0 l 4 ) .
A p e n d i s i t i s a k u t m e r u p a k a n m a s a l a h k c g a w a t d a r u r a t a n a b d o m i n o l y a n g
p a l i n g u m u m t e r j a d i ( H u m e s , 2 0 0 6 ) .
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2.1.2. Epidemiologi
I n s i d e n a p e n d i s i t i s a k u t d i n e g a r a m a j u I c b i h t i n g g i d a r i p a d a n e g a r a
b e r k e m b a n g . R a t a - r a t a 6 - 9 % p o p u l a s i d i d u n i a m e n d e r i t a a p e n d i s i t i s d a l a m
h i d u p n y a . S u r v e i m e n u n j u k k a n b a h w a s e k i t a r 1 0 % o r a n g d t A m e r i k a S e r i k a t
d a n n e g a r a B a r a t m e n d e r i t a a p e n d i s i t i s d a l a m s u a t u s a a t ( R o b b i n s , 2 0 0 7 ) .
M e n u r u t W H O ( W o r l d H e a l t h O r g a n i z a t i o n ) , i n s i d e n s i a p e n d i s i t i s d i
A s i a p a d a t a h u n 2 0 0 4 a d a l a h 4 , 8 % p e n d u d u k d a r i t o t a l p o p u l a s i . A p e n d i s i t i s
m e r u p a k a n p e n y a k i t u r u t a n k e e m p a t t e r b a n y a k d i I n d o n e s i a p a d a t a h u n 2 0 0 6 .
J u m l a h p a s i e n r a w a t i n a p k a r e n a p e n y a k i t a p e n d i k s p a d a t a h u n t e r s e b u t
2 8 . 9 4 9 p a s i e p , b e r a d a d i u r u t a n k e e m p a t s e t e l a h d i s p e p s i a , d u o d e n i t i s , d a n
p e n y a k i t s i s t ^ c e r n a l a i n n y a . P a d a r a w a t j a l a n , k a s u s p e n y a k i t a p e n d i k s
m e n d u d u k i u r u t a n k e i i m a ( 3 4 . 3 8 6 p a s i e n r a w a t j a l a n ) , s e l e l a h p e n y a k i t
p e n c e r n a a n l a i n , d i s p e p s i a , g a s t r i t i s d a n d u o d e n i t i s ( D e p k e s , 2 0 0 8 ) . J u m l a h
k a s u s a p e n d i s i t i s d i J a w a T e n g a h t a h u n 2 0 0 9 d i l a p o r k a n s e b a n y a k 5 . 9 8 0 d a n
1 7 7 d i a n t a r a n y a m e n y e b a b k a n k e m a t i a n . J u m l a h p e n d e r i t a a p e n d i s i t i s I
t e r t i n g g i a d a d i K o t a S e m a r a n g , y a k n i 9 7 0 o r a n g .
2. 1.3. Etiologi dan Faktor Risiko
A p e n d i s i t i s a k u t m e r u p a k a n i n f e k s i b a k t e r l . B c r b a g a i h a i b e r p e r a n
s e b a g a i f a k t o r p e n c e l u s n y a . S u m b a l a n l u m e n a p e n d i k s m e r u p a k a n f a k t o r
y a n g d i a j u k a n s e b a g a i f a k t o r p e n c c t u s . D i s a m p i n g h i p e r p l a s i a j a r i n g a n
l i m f o i d , f e k a l i t , t u m o r a p e n d i k s , d a n c a c i n g a s k a r i s d a p a t p u l a m e n y e b a b k a n
s u m b a t a n . P e n y e b a b l a i n y a n g d i d u g a d a p a t m e n i m b u l k a n a p e n d i s i t i s i a I a h
e r o s i m u k o s a a p e n d i k s a k i b a t p a r a s i l s e p e r t i E.histolyca. P e n e l i t i a n
e p i d e m i o l o g i m e n u n j u k k a n p e r a n k e b i a s a a n m a k a n - m a k a n a n r e n d a h s e r a t d a n
p e n g a r u h k o n s t i p a s i t e r h a d a p t i m b u l n y a a p e n d i s i t i s . K o n s t i p a s i a k a n
m e n a i k k a n t e k a j i a n i n t r a s e k a l , y a n g b e r a k i b a t t i m b u l n y a s u m b a t a n f u n g s i o n a l
a p e n d i k s d a n i m e n i n g k a t n y a p e r t u m b u h a n k u m a n f l o r a k o l o n b i a s a
( S j a m s u h i d a j a t , 2 0 1 0 ) .
P e n y e b a b a p e n d i s i t i s a d a l a h s u m b a t a n y a n g t e r j a d i p a d : i l u m e n
a p e n d i k s . A d a n y a i e n d i r p a d a l u m e n a p e n d i k s m e n y e b a b k a n b a k t e r i y a n g
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1 2
h i d u p n o r m a l d a l a m a p e n d i k s b e r k e m b a n g b i a k . A k i b a t n y a , a p e n d i k s m e n j a d i
l e r i f e k s i d a n t e r j a d i i n f l a m a s i ( M J S p i r t , 2 0 1 0 ) .
A p e n d i s i t i s d a p a t d i t e m u k a n p a d a s e m u a u m u r , h a n y a p a d a a n a k
k u r a n g d a r i s a t u t a h u n j a r a n g d i l a p o r k a n . i n s i d e n t e r t i n g g i p a d a k e l o m p o k
u m u r 2 0 - 3 0 t a h u n , s e t e l a h i t u m e n u r u n . I n s i d e n s p a d a l a k i - l a k i d a n
p e r e m p u a n u m u n y a s e b a n d i n g , k e c u a l i p a d a u m u r 2 0 - 3 0 l a h u n , k e t i k a
i n s i d e n s p a d a l a k i - l a k i l e b i h t i n g g i ( S j a m s u h i d a j a t , 2 0 1 0 ) . A p e n d i s i t i s p a d a
u m u m n y a d i d e r i t a p a d a u m u r a n l a r 1 0 - 2 0 , t e t a p i t i d a k a d a b a t a s a n u m u r .
P e r b a n d i n g a n a n t a r a l a k i - l a k i d a n p e r e m p u a n a d a l a h 1 , 4 : 1 . R e s i k o t e r k e n a
a p e n d i s i t i s s c p a n j a n g h i d u p p a d a l a k i - l a k i a d a l a h 8 , 6 % s e d a n g k a n p a d a
p e r e m p u a n 6 , 7 % d i A m e r i k a S e r i k a t ( H u m e s , 2 0 0 6 ) . P e n y a k i t i n i m e r u p a k a n
s a l a h s a t u k e a d a a n n y e r i p e r u t a k u l y a n g d i j u m p a i p a d a p e n d e r i t a y a n g
d i r a w a t h a m p i r d i s e i u r u h r u m a h s a k i t d i I n d o n e s i a ( T a n d i r o g a p g , 2 0 1 2 ) .
2. 1.4. Patogenesis
P a t o l o g i a p e n d i s i t i s a k u t b e r a w a l d a r i m u k o s a d a n k e m u d i a n
m e l i b a t k a n s e i u r u h l a p i s a n d i n d i n g a p e n d i k s v e i m i f o n n i s d a l a m w a k t t u 2 4 - 4 8
j a m p e r t a m a . J a r i n g a n m u k o s a p a d a a p e n d i k s v e r m i f o r m i s m c n g h a s i l k a n
m u k u s ( l e n d i r ) s e t i a p h a r i n y a ( S j a m s u h i d a j a t , 2 0 1 0 ) .
A d a n y a o b s t r u k s i p a d a l u m e n a p e n d i k s m e n y e b a b k a n m u k u s y a n g
d i p r o d u k s i m u k o s a m e n g a l a m i b e n d u n g a n . S e m a k i n l a m a m u k u s t e r s c b u t
s e m a k i n b a n y a k , n a m u n e l a s t i s i t a s d i n d i n g a p e n d i k s m e m p u n y a i k e l c r b a l a s a n
s e h i n g g a m e n y e b a b k a n p e n i n g k a t a n t e k a n a n l u m i n a l s e b e s a r 6 0 c m H 2 0 ,
y a n g s e h a r u s n y a h a n y a b e r k a p a s i t a s 0 , 1 - 0 , 2 m L . T e k a n a n y a n g m e n i n g k a t
t e r s e b u t a k a n m e n g h a m b a t a l i r a n l i m f e y a n g m e n g a k i b a t k a n e d e m a d a n
u l s e r a s i m u k o s a . P a d a s a a t i n i l a h t e r j a d i a p e n d i s i t i s a k u l l o k a l y a n g d i t a n d a i
o l e h n y e r i e p i g a s t r i u m . B i l a s e k r e s i m u k u s t e r u s b e r l a n j u t , t e k a n a n a k a n
t e r u s m e n i n g k a t . H a i t e r s e b u t a k a n m e n y e b k a n o b s t r u k s i v e n a , e d e m a
b e r t a m b a h , d a n b a k t e r i a k a n m e n e m b u s d i n d i n g . P e r a d a n g a n y a n g t i m b u l
m e l u a s d a n m e n g e n a i p e r i t o n e u m s e l e m p a t s e h i n g g a m e n i m b u l k a n n y e r i
d i d a e r a h k a n a n b a w a h . K e a d a a n i n i d i s e b u t a p e n d i s i t i s s u p u r a l i f a k u L B i l a
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k e m u d i a n a l i r a n a r t e r i t c r g a n g g u a k a n t e r j a d i i n f a r k d i n d i n g a p e n d i k s y a n g
d i i k u t i d e n g a n g a n g r e n . S t a d i u m i n i d i s e b u t d e n g a n a p e n d i s i t i s g a n g r e n o s a .
B i l a d i n d i n g y a n g t e l a h r a p u h i t u p e c a h , a k a n t e r j a d i a p e n d i s i t i s p e r f o r a s i
( S j a m s u h i d a j a t , 2 0 1 0 ) .
U n t u k m e m b a t a s i p r o s e s r a d a n g i n i t u b u h j u g a m e l a k u k a n u p a y a
p e r t a h a n a n d e n g a n m c n u t u p a p e n d i k s v e r m i f o r m i s d e n g a n o m e n t u m , u s u s
h a l u s , a t a u a d n e k s a s c h i n g g a t e r b e n t u k m a s s a p e r i a p c n d i k u i e r y a n g s e c a r a
s a l a h d i k e n a l d e n g a n i s t i l a h i n f i l t r a t a p e n d i k s . P a d a a n a k - a n a k d e n g a n
o m e n t u m y a n g l e b i h p e n d e k , a p e n d i k s v e r m i f o r m i s y a n g l e b i h p a n j i u i g , d a n
d i n d i n g a p e n d i k s v e r m i f o r m i s y a n g l e b i h t i p i s , s e r t a d a y a l a h a n t u b u h y a n g
m a s i h k u r a n g , d a p a t m e m u d a h k a n t e r j a d i n y a a p e n d i s i t i s p e r f o r a s i . S e d a n g k a n
p a d a o r a n g t u a , a p e n d i s i t i s p e r f o r a s i m u d a h t e r j a d i k a r e n a a d a n y a g a n g g u a n
p e m b u l u h d a r a h . A p e n d i k s v e r m i f o r m i s y a n g p e m a h m e r a d a n g t i d a k a k a n
s e m b u h s e m p u m a i c l a p i m c m b e n l u k j a r i n g a n p a r u t y a n g m e i e n g k e t d e n g a n
j a r i n g a n s c k i t a m y a . P c r l c n g k e t a n i n t d a p a t m e n i m b u l k a n k e l u h a n b e n u l a n g d i
p e r u t k a n a n b a w a h . S e h i n g g a s u a t u s a a t , o r g a n i n i d a p a t m e n g a l a m i
p e r a d a n g a n a k u t l a g i d a n d i n y a t a k a n m e n g a l a m i e k s a s c r b a . s i a k u t
( J e f f r e y , 2 0 0 2 ) .
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Gambar 2.3. Apendiks yang mengalami pcradangan Sumber: Paulina,20l5
2.1.5. Manifestasi Klinis
Riwayat dan urutan gejala yang timbul merupakan gambaran
diagnostik apendisitis yang paling penting. Gejala awal hampir selalu berupa
nyeri abdomen Jenis viseral, yang disebabkan oleh kontraksi apendiks atau
distensi lumen apeiuliks. Biasanya lokasi nyeri di daerah periumbilikus atau
epigastrium. Terkadang tidak ada nyeri pada epigastrium, tetapi terdapat
konstipasi sehingga penderita memeriukan obat pencahar. Hal ini sangat
berbahaya karena dapat mcmpermudah terjadinya perforasi. Nyeri viseral
yang dirasakan ringan, sering seperti kram, dan jarang sekali berakibat buruk,
biasanya berlangsung selama 4 sampai 6 jam. Sejalan dengan menyebamya
proses inflamasi ke permukaan peritoneum parietal, nyeri menjadi somatik,
menetap dan lebih berat, bertambah sakit bila bergerak atau batuk, dan
biasanya berlokasi di kuadran kanan bawah (Harrison, 2012).
Nyeri berpindah pada kuadran kanan bawah tepatnya di titik
M c B u m e y . Keluhan Juga sering disertai mual dan kadang muntah. Umumnya
nafsu makan berkurang (Sjamsuhidajat, 2010). Dcman dan leukositosis
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t e r j a d i p a d a a w a l p c r j a l a n a n p e n y a k i t , n a m u n s e j u m i a h b e s a r k a s u s l i d a k
m e m b e r i k a n g a m b a r a n k l a s i k ( R o b b i n s , 2 0 0 7 ) . D e m a m b i a s a n y a r i n g a n
d e n g a n s u h u 3 7 , 5 - 3 8 , 5 " C . B i l a s u h u s u d a h t i n g g i m u n g k i n t e l a h t e r j a d i
p e r f o r a s i .
B i l a a p e n d i k s t e r i e t a k r e t r o s e k a l r e t r o p e r i t o n e a l , t a n d a n y e r i p e r u t
k a n a n b a w a h t i d a k b e g i t u j e l a s d a n t i d a k a d a r a n g s a n g a n p e r i t o n e a l k a r e n a
a p e n d i k s t e r l i n d u n g o l e h s e k u m . R a s a n y e r i l e b i h k c a r a h p e r u t s i s i k a n a n a t a u
n y e r i t i m b u l p a d a s a a t b e r j a l a n k a r e n a k o n t r a k s i o t o t p s o a s m a y t ) r y a n g
m e n e g a n g d a r i d o r s a l . R a d a n g p a d a a p e n d i k s y a n g t e r i e t a k d i r o n g g a p e l v i s
d a p a t m e n i m b u l k a n g e j a l a d a n t a n d a r a n g s a n g a n s i g m o i d a t a u r e k t u m
s e h i n g g a p e r i s t a l s t i k m e n i n g k a t d a n p e n g o s o n g a n r e k t u m m e n j a d i l e b i h c e p a t
s e r t a b e r u l a n g . J i k a a p e n d i k s t a d i m e n e m p e l k e k a n d u n g k e m i h . d a p a t t e r j a d i
p e n i n g k a t a n f r e k u e n s i k e n c i n g a k i b a t r a n g s a n g a n a p e n d i k s t e r h a d a p d i n d i n g
k a n d u n g k e m i h . G e j a l a a p e n d i s i t i s a k u l p a d a a n a k t i d a k s p e s i f i k . P a d a
a w a l n y a , a n a k s e r i n g h a n y a m e n u n j u k k a n g e j a l a r e w e l d a n t i d a k m a u m a k a n .
A n a k s e r i n g t i d a k b i s a m e l u k i s k a n r a s a n y e r i n y a . B e b e r a p a j a m k e m u d i a n ,
a n a k a k a n m u n t a h s e h i n g g a m e n j a d i l e m a h d a n l e t a r g i k . K a r e n a g e j a l a y a n g
t i d a k k h a s t a d i , a p e n d i s i t i s s e r i n g b a r u d i k e t a h u i s e t e l a h p e r f o r a s i . P a d a b a y i ,
8 0 - 9 0 % a p e n d i s i t i s b a r u d i k e t a h u i s e t e l a h t e r j a d i p e r f o r a s i . P a d a b e b e r a p a
k e a d a a n , a p e n d i s i t i s a g a k s u l i t d i d i a g n o s i s s e h i n g g a d i t a n g a n i p a d a w a k t u n y a
d a n t e r j a d i k o m p l i k a s i . M i s a l n y a , p a d a o r a n g b e r u s i a l a n j u t , g e j a l a n y a s e r i n g
s a m a r - s a m a r s a j a s e h i n g g a l e b i h d a r i s e p a r u h p e n d e r i t a b a r u d a p a t
d i d i a g n o s i s s e t e l a h p e r f o r a s i . P a d a k e h a m i l a n , k c l u h a n u l a p i a a p e n d i s i t i s
a d a l a h n y e r i p e r u t , m u a l , d a n m u n t a h . H a l i n i p e r l u d i c e m i a t i k a r e m a p a d a
k e h a m i l a n t r i m e s t e r p e r t a m a s e r i n g j u g a t e r j a d i m u a l d a n m u n t a h
( S j a m s u h i d a j a t , 2 0 1 0 ) .
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2.1.6. Diagnosis
U n t u k m e n e g a k k a n d i a g n o s i s a p e n d i s i t i s a k u t d i d a s a r k a n p a d a
a n a m n e s i s d a n p e m e r i k s a a n f i s i k . S e d a n g k a n h a s i l l a b o r a t o r i u m d a n
p e m e r i k s a a n r a d i o l o g i m e r u p a k a n p e m e r i k s a a n p e n u n j a n g u n t u k m e n d u k u n g
d i a g n o s i s a p e n d i s i t i s a k u t . U n t u k d i a g n o s i s p a s t i a p e n d i s i t i s a k u t a d a l a h
d e n g a n p e m e r i k s a a n h i s t o p a t o l o g i ( J u n i a s , 2 0 0 9 ) .
A. Anamnesis
N y e r i a b d o m e n m e r u p a k a n k e l u h a n u t a m a p a s i e n d e n g a n a p e n d i s i t i s
a k u t , n y e r i a w a l n y a b e r a s a l d a r i a b d o m e n b a g i a n t e n g a h , k e m u d i a i n d a l a m
w a k t u 2 4 j a m b e r p i n d a h k e f o s a i l i a k a k a n a n , b e r s i f a t t a j a m , d a n k o n s t a n . H a l
i t u p e r t a m a k a l i d i d e s k r i p s i k a n o l e h M u r p h y . N y e r i a b d o m e n , p a n a s b a d a n ,
d a n a n o r e k s i a m e r u p a k a n g e j a l a k l a s i k d a r i a p e n d i s i t i s a k u t ( H u m e s , 2 0 ! 1 ) .
N y e r i a b d o m e n t e r s e b u t a k a n b e r s i f a t m e n e t a p d i p e r u t k a n a n b a w a h
y a n g a k a n b e r t a m b a h n y e r i b i l a p a s i e n b e r g e r a k , b a t u k a t a u b e r s i n . P a d a
p a s i e n d e n g a n a p e n d i s i t i s a k u t j u g a d i r a s a k a n p a n a s b a d a n y a n g b i a s a n y a
t i d a k t e r l a l u t i n g g i ( s e k i t a r 3 8 * ^ 0 ) . A n o r e k s i a , m u a l , d a n m u n t a h d a p a t t i m b u l
b e b e r a p a j a m k e m u d i a n ( H u m e s , 2 0 I I ) . V a r i a s i l o k a s i a n a t o m i a p e n d i k s a k a n
m e n j e l a s k a n k e l u h a n n y e r i s o m a t i k y a n g b e r a g a m . S e b a g a i c o n t o h a p e n d i k s
y a n g p a n j a n g d e n g a n u j u n g y a n g m e n g a l a m i i n f l a m a s i d i k u a t j r a n k i r i b a w a h
a k a n m e n y e b a b k a n n y e r i d i d a e r a h t e r s e b u t , a p e n d i k s r p t r o s e k t t ! a k a n
m e n y e b a b k a n n y e r i f l a n k a t a u p u n g g u n g , a p e n d i k s p e l v i k a . l a k a n
m e n y e b a b k a n n y e r i p a d a s u p r a p u b i k d a n a p e n d i k s r e t r o i l e a l b i s a
m e n y e b a b k a n t e s t i k u l e r , m u n g k i n k a r e n a i r i t a s i p a d a a r t e r i s p e r m a l i k a d a n
u r e t e r ( P e r m e n k e s , 2 0 1 4 ) .
B. Pemeriksaan Fisik
T e m u a n f i s i k d i t e n t u k a n t e r u t a m a o l e h p o s i s i a n a t o m i s a p e n d i k s
v e r m i f o r m i s y a n g m e n g a l a m i i n f l a m a s i , s e r t a o r g a n y a n g t e l a h m e n g a l a m i
r u p t u r k e t i k a p a s i e n p e r t a m a k a l i d i p e r i k s a . T a n d a v i t a l s e p e r t i p e n i n g k a t a n
s u h u j a r a n g > r c ( l . 8 " F ) d a n d e n y u t n a d i n o r m a l a t a u s e d i k i t m e n i n g k a t .
A p a b i l a t e r j a d i p e r u b a h a n y a n g s i g n i f i k a n d a r i b i a s a n y a m c n u n j u k k a i n b a h w a
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k o m p l i k a s i a t a u p e r f o r a s i t e l a h t e r j a d i a t a u d i a g n o s i s I a i n h a r u s
d i p e r t i m b a n g k a n ( B r u n i c a r d i d k k , 2 0 0 9 ) . P a d a i n s p e k s i , p e n d e r i t a f i i a s a n y a
m e n u n j u k k a n g e j a l a m c m b u n g k i i k s a m b i l m c m e g a n g i p e r u t y a n g s a k i t .
P e r f o r a s i a p e n d i k s v e r m i k u l a r i s a k a n m e n y e b a b k a n p e r i t o n i t i s p u r u l e n t a
y a n g d i t a n d a i d e n g a n d e m a m t i n g g i , n y e r i m a k i n h e b a t b e r u p a n y e r i t e k a n
d a n d e f a n s m u s k u l e r y a n g m e l i p u t i s e i u r u h p e r u t , d i s e r t a i p u n g t u m
m a k s i m u m d i r e g i o i l i a k a k a n a n , d a n p e r u t m e n j a d i t e g a n g d a n k e m b u n g .
P e r i s t a i t i k u s u s d a p a t m e n u r u n s a m p a i m e n g h i l a n g a k i b a t a d a n y a i l e u s
p a r a l i t i k . P a s i e n d e n g a n a p e n d i s i t i s b i a s a n y a b e r b a r i n g d e n g a n t e r l e n t a n g ,
k a r e n a g e r a k a n a p a s a j a d a p a t m e n i n g k a t k a n r a s a s a k i t . J i k a d i m i n i t a u n t u k
m e n g g e r a k k a n p a h a t e r u t a m a p a h a k a n a n p a s i e n a k a n m e l a k u k a n d e n g a n
p e r l a h a n - l a h a n d a n h a t i - h a t i ( B r u n i c a r d i d k k , 2 0 0 9 ) .
J i k a d i l a k u k a n p a l p a s i a k a n d i d a p a t k a n n y e r i y a n g t e r b a t a s p a d a r e g i e
i l i a k a k a n a n , b i a s a n y a d i s e r t a i n y e r i l e p a s . D e f a n s m u s k u l e r m e n u n j u k k a n
a d a n y a r a n g s a n g a n p a r i e t a l . T a n d a r o v s i n g a d a l a h a p a b i l a m e l a k u k a n
p e n e k a n a n p a d a p e r u t k i r i b a w a h m a k a a k a n d i r a s a k a n n y e r i p a d a p e r u t k a n a n
b a w a h ( S j a m s u h i d a j a t , 2 0 1 0 ) .
U j i p s o a s d a n u j i o b t u r a t o r m e r u p a k a n p e m e r i k s a a n y a n g | c b i h d i t u j u k a n
u n t u k m e n g e t a h u i l e t a k a p e n d i k s v e i m i f o r m i s . C a r a m e l a k u k a n u j i p s o a s
y a i t u d e n g a n r a n g s a n g a n o t o t p s o a s m e l a l u i h i p e r e k s t e n s i s e n d i p a n g g u l
k a n a n a t a u f l e k s i a k t i f s e n d i p a n g g u l k a n a n , k e m u d i a n p a h a k a n a n d i t a h a n .
T i n d a k a n i n i a k a n m e n i m b u l k a n n y e r i b i l a a p e n d i k s v e r m i f o r m i s y a n g
m e r a d a n g m e n e m p e l d i o t o t p s o a s m a y o r . P a d a p e m e r i k s a a n u j i o b t u r a t o r
u n t u k m e l i h a t b i l a m a n a a p e n d i k s v e r m i f o r m i s y a n g m e r a d a n g b e r s e n t u h a n
d e n g a n o t o t o b t u r a t o r i n t e m u s . K e t i k a p e r a d a n g a n a p e n d i k s v e m a i f o i m i s
t e l a h m e n c a p a i p a n g g u l , n y e r i p e r u t k e m u n g k i n a n t i d a k d i t e m u k a n s a m a
s e k a l i , y a i t u m i s a l n y a p a d a a p e n d i s i t i s ^ 1 v i k a . S e h i n g g a d i b i u t u h k a n
p e m e r i k s a a n c o l o k d u b u r . D e n g a U m e l a k u k a n p e m e r i k s a a n c o l o k d u b u r n y e r i
a k a n d i r a s a k a n p a d a d a e r a h I o k a i s u p r a p u b i k d a n r e k t u m . T a n d a - t a n d a i r i t a s i
l o k a l o t o t p e l v i s j u g a d a p a t d i r a s a k a n p e n d e r i t a ( B r u n i c a r d i d k k , 2 0 0 9 ) . P a d a
p e m e r i k s a a n p a l p a s i d i d a p a t k a n n y e r i k e t o k p o s i t i f , s e d a n g k a n a u s k u l t a s i
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t i d a k b a n y a k m e m b a n t u d a l a m m e n e g a k k a n d i a g n o s i s a p e n d i s i t i s a k u t
( P e r m e n k e s , 2 0 i 4 ) .
C . Pemeriksaan Laboratorium
P e m e r i k s a a n l a b o r a t o r i u m r u t i n s a n g a t m e m ) 5 a n t u d a l a m m e n d i i a g n o s i s
a p e n d i s i t i s a k u t , t e r u t a m a u n t u k m e n g e s a m p i n g k a n d i a g n o s i s l a i n .
P e m e r i k s a a n l a b o r a t o r i u m y a n g r u t i n d i l a k u k a n a d a l a h j u m l a h l e u k o s i t
d a r a h . L e u k o s i t b e r t u n g s i u n t u k m e m b a n t u t u b u h m e l a w a n b c r b a g a i p e n y a k i t
i n f e k s i s e b a g a i b a g i a n d a r i s i s t e m k e k c b a l a n t u b u h . l . e u k o s i t m e l i p u t i s e l
polimorfomiclear ( P M N ) d a n s e l mononuclear ( M N ) . S e l P M N m e m i l i k i
g r a n u l d i d a l a m s i t o p l a s m a d a n b e n t u k i n t i s e l y a n g b e r a g a m , t e r d i r i d a r i
b a s o f i l , e o s i n o t l l d a n n e u t r o f i l s e d a n g k a n s e l M N t i d a k m e m i l i k i g r a n u l d a n
b e n t u k i n t i s e l n y a t i d a k b e r a g a m , t e r d i r i d a r i l i m f o s i t d a n m o n o s i t . l . e u k o s i t
m e r u p a k a n p e t a n d a y a n g s e n s i t i f t e r h a d a p i n f l a m a s i . J u m l a h l e u k o s i t d a r a h
b i a s a n y a m e n i n g k a t p a d a k a s u s a p e n d i s i t i s . H i t u n g j u m l a h l e u k o s i t d a r a h
m e r u p a k a n p e m e r i k s a a n y a n g m u d a h d i l a k u k a n . P a d a k e b a n y a k a n k a s u s
t e r d a p a t l e u k o s i t o s i s , t e r l e b i h p a d a k a s u s d e n g a n k o m p l i k a s i b e r u p a p e r f o r a s i
( H a r d i y a n t i , 2 0 ! 4 ) . I l a s i l l a b o r a t o r i u m p a d a a p e n d i s i t i s a k u t b i a s a n y a
d i d a p a t k a n a n g k a l e u k o s i t d i a t a s 1 0 . 0 0 0 / m m ' ' d e n g a n p c r g e s c r a n k e k i r i p a d a
h c m o g r a m n y a ( > 7 5 % n e t r o f l l ) . P c r g e s c r a n k e k i r i a t a u .shift to the left
m e n u n j u k k a n p e n i n g k a t a n i m a t u r d a r i s e l n e u t r o f i l ( M a r i s a d k k , 2 0 1 2 ) .
B e r d a s a r k a n p e n e l i t i a n G u r a y a pada t a h u n 2 0 0 5 d i R u m a h S a k i t
U n i v e r s i t a s K i n g K h a l i d d i d a p a t k a n b a h w a p e n i n g k a t a n j u m l a h l e u k o s i t
d a r a h y a n g t i p g g i m e r u p a k a n i n d i k a t o r y a n g d a p a t m c n c n t u k a n d e r a j a t
k e p a r a h a n a p e n d i s i t i s . L e u k o s i t o s i s r i n g a n , m u l a i d a r i 1 0 . 0 0 0 - 1 8 . 0 0 0
s e l / m m , b i a s a n y a t e r d a p a t p a d a p a s i e n a p e n d i s i t i s a k u t . L e u k o s i t o s i s y a n g
l e b i h b e s a r d a r i 2 0 . 0 0 0 s e l p e r m i k r o l i t e r h e n d a k n y a m e m b e r i t a n d a p a d a
d o k t e r k e m u n g k i n a n t e r j a d i n y a p e r f o r a s i ( H a r r i s o n , 2 0 1 2 ) .
P e m e r i k s a a n u r i n a l i s i s d a p a t m e n g e s a m p i n g k a n a t a u m e n i a d a k a n
g a n g g u a n u r o g e n i t a l y a n g m e i i y e r u p a i a p e n d i s i t i s a k u t ( H a r r i s o n , 2 0 1 2 ) .
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D. Pemeriksaan Radiologi
P e m e r i k s a a n r a d i o l o g i t e r d i r i d a r i p e m e r i k s a a n u l t r a s o n o g r a f i ( U S G ) ,
C T - S c a n , d a n M R I . U S G d i r e k o m e n d a s i k a n u n t u k m e n g e v a l u a s i n y e r i p e r u t
k a n a n b a w a h . s e d a n g k a n C T - S c a n d i r e k o m e n d a s i k a n u n t u k n y e r i p a d a
k u a d r a n k a n a n d a n k i r i b a w a h . A k u r a s i d a l a m m e n e g a k k a n d i a g n o s i s
a p e n d i s i t i s a k u t m e l a l u i U S G b e r k i s a r a n t a r a 7 1 - 9 7 % . M a i i n i t e r g a n t u n g
d a r i p a d a k e m a m p u a n o p e r a t o r . U S G m a m p u m e n u n j u k k a n d i a g n o s a l a i n
p a d a p a s i e n d e n g a n y e r i p e r u t k a n a n b a w a h d a n m e n u r u n k a n a n g k a k e j a d i a n
l a p a r o t o m i n e g a t i f . P a d a t a h u n 2 0 1 0 - 2 0 1 1 d i R u m a h S a k i t I s l a m A i s y i y a h
M a l a n g s e b a n y a k 1 0 4 p a s i e n y a n g d i c u r i g a i a p e n d i s i t i s d i l a k u k a n
p e m e r i k s a a n U S G a b d o m e n d a n h a s i l U S G y a n g p o s i t i s a p e n d i s i t i s 7 4 p a s i e n
( 7 1 , 1 % ) , n e g a t i f 3 0 p a s i e n ( 2 8 , 8 ) . P e n e l i t i a n i n i m e n u n j u k k a n s e n s i t i v i t a s d a n
s p e s i f i t a s U S G a b d o m e n u n t u k d i a g n o s i s a p e n d i s i t i s y a n g c u k u p t i n g g i y a i t u
8 4 , 1 % d a n 1 0 0 % ( H a l i m , 2 0 1 2 ) .
P a d a p e m e r i k s a a n U S G , a p e n d i k s y a n g m e n g a l a m i i n f l a m a s i a k a n
m e m i l i k i d i a m e t e r 6 m m a t a u l e b i h . D i t e m u k a n j u g a a d a n y a p e r u b a h a n
i n f l a m a s i p a d a j a r i n g a n s e k i t a r k h u s u s n y a p a d a j a n n g a n l e m a k y a n g
m e n g e l i l i n g i n y a ( H u m e s d a n S i m p s o n , 2 0 1 1 ) . P a d a p e m e r i k s a a n U S G
m e m p e r l i h a t k a n a p e n d i k s y a n g m e m b e s a r d e n g a n d i n d i n g n y a t i p i s , n a m u n
b i l a a p e n d i k s t i d a k d i t e m u k a n , d i a g n o s i s t i d a k d a p a t d i t i a d a k a n
( H a r r i s o n , 2 0 ] 2 ) . P a d a a p e n d i k s y a n g m e n g a l a m i p e r f o r a s i g a m b a r a n U S G
m e n u n j u k k a n a d a n y a p e n u m p u k a n c a i r a n d i s e k i t a r s e k u m ( H u m e s , 2 0 1 1 ) .
P a d a p e m e r i k s a a n C T - S c a n , a p e n d i k s y a n g m e n g a l a m i i n f l a m a s i a k a n
m e m i l i k i d i a m e t e r l e b i h b e s a r d a r i 6 m m d a n c e n d e r u n g m e n g a l a m i
p e r u b a h a n i n f l a m a s i p a d a j a r i n g a n s e k i t a m y a . P e m e r i k s a a n C T - S c a n
m e m i l i k i a k u r a s i a n t a r a 9 3 - 9 8 % y a n g l e b i h s u p e r i o r d a l a m m e n d i a g n o s i s
a p e n d i s i t i s a k u t D i k a r e n a k a n o r g a n y a n g t e r l i h a t l e b i h j e l a s , s e h i n g g a d a p a t
m e n y i n g k i r k a n d i a g n o s i s b a n d i n g y a n g a d a . P e m e r i k s a a n i n i j u g a d a p a t
m e m b e d a k a n p e n y e b a b a p e n d i s i t i s s e p e r t i o b s t r u k s i l u m e n a k i b a t m a i i g n a n s i
( H u m e s , 2 0 I I ) .
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2. 1. 7. Skor Alvarado
P a d a t a h u n 1 9 8 6 , s e l e l a h m e n g a d a k a n p e n e l i t i a n p a d a 3 0 5 k a s u s
p a s i e n b e r u s i a 4 - 8 0 t a h u n y a n g d i d u g a m e n d e r i t a a p e n d i s i t i s a k u t , A l v a r a d o
m e m p c r k e n a l k a n s u a t u s i s t e m s k o r i n g u n t u k m e n d i a g n o s i s a p e n d i s i t i s a k u t
y a n g t e r d i r i d a r i 3 g e j a l a , 3 t a n d a d a n 2 h a s i l l a b o r a t o r i u m . S k o r A l v a r a d o
m e m u d a h k a n , d i k e n a l d e n g a n s i n g k a t a n M A N T R E L S ( M i g r a t i o n o f p a i n .
A n o r e x i a , N a u s e a / v o m i t t i n g , T e r d e m e s s i n t h e r i g h t l o w e r q u a d r a n t / i l i a c
f o s s a . R e b o u n d p a i n , l d e v a t i o n o f t e m p e r a t u r e , I , e u c o c y t o s i s , S h i f t t o t h e l e f t ) .
P e m e r i k s a a n i n i m u d a h d i l a k u k a n d a n m u r a h k a r e n a d i d a p a t d a r i a n a m n e s i s ,
p e m e r i k s a a n f i s i k d a n p e m e r i k s a a n l a b o r a t o r i u m ( S u g i a r t o , 2 0 0 9 ) .
T a b e l 2 . 1 . S i s t e m s k o r i n g A l v a r a d o
Gambaran Skor
G e j a l a K l i n i s
N y e r i p i n d a h k e f o s s a i l i a k a k a n a n I
A n o r e k s i a / n a f s u m a k a n m e n u r u n I
M u a l a t a u m u n t a h 1
T a n d a K l i n i s
N y e r i l e p a s 1
N y e r i t e k a n f o s s a i l i a k a k a n a n 2
D e m a m ( s u h u > 3 7 , 2 " C ) 1
P e m e r i k s a a n L a b o r a t o r i u m
L e u k o s i t o s i s ( l e u k o s i t > I O . O O O / m l ) ^ ' 2
S h i f t t o t h e l e f t ( n e u t r o f i l > 7 5 % ) 1
T o t a l 10
N i l a i s k o r A l v a r a d o :
7 - 1 0 : a p e n d i s i t i s a k u t
5 - 6 : c u r i g a a p e n d i s i t i s a k u t
1-4 : b u k a n a p e n d i s i t i s a k u l
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2 1
B e r b a g a i p e n e l i t i a n t e l a h d i l a k u k a n d i b e b e r a p a n e g a r a d e n g a n
m e n g g u n a k a n s k o r A l v a r a d o . D i S i n g a p u r a s e b a n y a k 1 4 8 p a s i e n , y a n g
d i d u g a a p e n d i s i t i s , d i d a p a t k a n 4 4 p a s i e n d e n g a n s k o r 7 - 8 , 3 0 p a s i e n ( 6 8 % )
p o s i t i f a p e n d i s i t i s . D i s i m p u l k a n b a h w a s k o r A l v a r a d o s a n g a t b e r g u n a u n t u k
d i a g n o s i s a p e n d i s i t i s a k u t t e r u t a m a b i l a s k o r > 7 ( C h a n , 2 0 0 3 ) . M e n u r u t S a m a d
d k k y a n g m e l a k q k a n p e n e l i t i a n p a d a 1 0 0 o r a n g p a s i e n , b e r u s i a 1 5 - 3 0 t a h u n
, t e r d i r i a t a s 6 9 l a k i - l a k i d a n 3 1 p e r e m p u a n y a n g d i d u g a a p e n d i s i t i s
d i d a p a t k a n p a s i e n d e n g a n s k o r A l v a r a d o < 4 t i d a k m e m e r i u k a n o p e r a s i ,
s e d a n g k a n p a s i e n d e n g a n s k o r A l v a r a d o > 8 s e t e l a h d i o p e r a s i , t e r b u k t i
a p e n d i k s n y a m e r a d a n g ( S u g i a r t o , 2 0 0 9 ) .
2.1.8. Pemeriksaan Histopatologi
P e m e r i k s a a n d e n g a n m e m p e r h a t i k a n p e r u b a h a n h i s l q p a t o l o g i y a n g
t e r j a d i p a d a s t r u k t u r j a r i n g a n a p e n d i k s , d a p a t m e n i n g k a t k a n a k u r a s i d i a g n o s i s
d a r i s u a t u a p e n d i s i t i s a k u l , y a n g t i d a k h a n y a b e r d a m p a k b a g i p e n a t a l a k s a n a a n
y a n g l e b i h b a i k t e t a p i j u g a b a g i k o m p l i k a s i y a n g d a p a t l e r j a { | i , s e r t a t i n g k a t
m o r b i d i t a s d a n m o r t a l i t a s n y a ( H e ! l e n , 2 0 0 5 ) .
P a d a s t a d i u m d i n i , h a n y a s e d i k i t e k s u d a t n e u t r o f i l d i t e m u k a n d i
s e i u r u h m u k o s a , s u b m u k o s a , d a n m u s k u l a r i s p r o p r i a . P e m b u l u h s u b s e r o s a
m e n g a l a m i b e n d u n g a n , d a n s e r i n g t e r d a p a t i n f i l l r a t n e t r o f l l i k p e r i v a s k u l a r
r i n g a n . R e a k s i p e r a d a n g a n m e n g u b a h s e r o s a y a n g n o r m a l n y a m e n g k i l a p
m e n j a d i m e m b r a n y a n g m e r a h , g r a n u l a r d a n s u r a m . P e r u b a h a n i n i
m e n a n d a k a n a p e n d i s i t i s a k u t d i n i p a d a d o k t e r b e d a h . K r i t e r i a h i s t o l o g i k
u n t u k d i a g n o s i s a p e n d i s i t i s a k u t a d a l a h i n f i l t r a s i n e u t r o f l i k m u s k u l a r i s
p r o p r i a . B i a s a n y a n e u t r o f i l d a n u l s e r a s i j u g a t e r d a p a t d i d a l a m m u k o s a
( R o b b i n s , 2 0 0 7 ) .
T e r l i h a t k o n g e s t i d a n e d e m a ( j a r i n g a n m e r e n g g a n g k a r e n a
m e n g a n d u n g c a i r a n y a n g b e r s a l d a r i p e m b u l u h d a r a h ) p a d a s e m u a l a p i s a n
a p e n d i k s d e n g a n s e b u k a n P M N p a d a l a p i s a n m u k o s a y a n g y a n g m e m b a t a s i
l u m e n a p e n d i k s . M u k o s a d i s e b u k o l e h s e l r a d a n g P M N . S e b u k a n P M N j u g a
d i t e m u k a n d i t u n i k a m u s k u l a r i s . P e m b u l u h d a r a h d i d a e r a h s u b s e r o s a
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m e n g a l a m i k o n g e s t i d e n g a n s e b u k a n s e t P M N p e r i v a s k u l a r ( S u d i o n o d k k ,
2 0 0 8 ) .
2. 1. 9. Tatalaksana
B i l a d i a g n o s i s k l i n i s s u d a h j e l a s , t i n d a k a n p a l i n g t e p a t d a n m e r u p a k a n s a t u -
s a t u n y a p i l i h a n ' t e r b a i k a d a l a h a p e n d e k t o m i . P a d a a p e n d i s i t i s t a n p a
k o m p l i k a s i , b i a s a n y a t i d a k p e r l u d i b e r i k a n a n t i b i o t i k , k e c u a l i p a d a a p e n d i s i t i s
g a n g r e n o s a a t a u a p e n d i s i t i s p e r f o r a t a . P e n u n d a a n t i n d a k b e d a h s a m b i l
m e m b e r i k a n a n t i b i o t i k d a p a t m e n g a k i b a t k a n a b s e s a t a u p e r f o r a s i .
A p e n d e k t o m i b i s a d i l a k u k a n s e c a r a t e r b u k a a t a u d e n g a n l a p a r o s k o p i . B i l a
a p e n d e k t o m i t e r b u k a , i n s i s i M c B u m e y p a l i n g b a n y a k d i p i l i h a h l i b e d a h . P a d a
p e n d e r i t a y a n g d i a g n o s i s n y a t i d a k j e l a s , s e b a i k n y a d i l a k u k a n o b s e r v a s i
l e r l e b i h d a h u l u . A p e n d e k t o m i t e r b u k a p a l i n g b a n y a k d i p i l i h o l e h a h H b e d a h
s e d a n g k a n a p e n d e k t o m i d e n g a n l a p a r o s k o p i d i l a k u k a n a p a b i l a t e r s e d i a
l a p a r o s k o p d a n t e r d a p a t k a s u s y a n g m e r a g u k a n ( S j a m s u h i d a j a t , 2 0 1 0 ) . P a d a
p a s i e n y a n g m e n d a p a t k a n l e r a p i b e d a h k o n v e s i o n a l a t a u a p e n d e k t o m i t e r b u k a
a k a n m e n d a p a t k a n l u k a o p e r a s i y a n g l e b i h b e s a r s e h i n g g a p e n y e m b u h a n p a d a
p a s i e n t e r s e b u t l e b i h l a m a s e r t a t i n g g i n y a r i s i k o t e r j a d i i n f e k s i , s e d a n g k a n
p a d a p a s i e n y a n g m e n d a p a t k a n t e r a p i b e d a h a p e n d e k t o m i l a p a r o s k o p i
m e n d a p a t l u k a o p e r a s i y a n g l e b i h k e c i l s e h i n g g a p e n y e m b u h a n n y a p u n l e b i h
c e p a t d a n r i s i k o t e r j a d i i n f e k s i l e b i h r e n d a h ( A c h m a d , 2 0 l l ) . A p e n d e k t o m i
t e r b u k a d i l a k u k a n d e n g a n m e m b u a n g a p e n d i k s y a n g t e r i n f e k s i d e n g a n s a t u
i n s i s i b e s a r s e k i t a r 5 - 7 , 5 c m p a d a a b d o m e n k u a d r a n k a n a n b a w a h . K e m u d i a n
d i l a k u k a n p e n g a n g k a l a n a p e n d i k s d e n g a n m e l e p a s k a n a p e n d i k s d a r i
p e r l e k a t a n n y a d e n g a n m c s e n t e r i u m a b d o m e n d a n k o l o n , m c n g g u n t i n g
a p e n d i k s d a r i k o l o n , d a n m e n j a h i t l u b a n g p a d a k o l o n t e m p a t a p e n d i k s
s e b e l u m n y a . A p e n d e k t o m i d e n g a n l a p a r o s k o p i a d a l a h t e k n i k p e m b e d a h a n
a b d o m e n d e n g a i ^ i n s i s i k e c i l s c p a n j a n g 0 , 5 - 1 , 5 c m . D e n g a n p e m b e d a h a n i n i
d a p a t d i l i h a t l a n g s u n g a p e n d i k s , o r g a n a b d o m e n d a n p e l v i s y a n g l a i n . J i k a
a p e n d i s i t i s d i t e m u k a n , a p e n d i k s d a p a t l a n g s u n g d i a n g k a t m e l a l u i i n s i s i k e c i l
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2.1.11. Komplikasi
P e r a d a n g a n a k u t a p e n d i k s t e r s e b u t m e m e r i u k a n p e n a t a l a k s a n a n y a n g
t e p a t b e r u p a t i n d a k a n b e d a h s e g e r a u n t u k m e n c e g a h k o m p l i k a s i y a n g
b e r b a h a y a ( T a n d i r o g a n g , 2 0 1 2 ) . S a l a h s a t u k o m p l i k a s i b e r b a h a y a y a i n g a k a n
t i m b u l b i l a a p e n d i s i t i s a k u t t i d a k d i t a t a i a k s a n a s e g e r a y a i t u p e r f o r a s i
a p e n d i k s y a n g d a p a t b e r k e m b a n g m e n j a d i p e r i t o n i t i s a t a u a b s e s ( P a p a n d r i a
d k k , 2 0 1 3 ) . T a n p a t i n d a k a n y a n g c e p a t t e r h a d a p p e r i t o n i t i s a k a n
m e n y e b a b k a n k e m a t i a n ( M J S p i r t , 2 0 1 0 ) .
K o m p l i k a s i y a n g m e m b a h a y a k a n a d a l a h p e r f o r a s i , b a i k b e r u p a
p e r f o r a s i b e b a s m a u p u n p e r f o r a s i p a d a a p e n d i k s y a n g t e l a h m e n g a l a m i
p e n d i n d i n g a n s e h i n g g a b e r u p a m a s s a y a n g t e r d i r i a t a s k u m p u l a n a | > e n d i k s ,
s e k u m , d a n l e k u k u s u s h a l u s ( S j a m s u h i d a j a t , 2 0 1 0 ) .
T e r j a d i p e n i n g k a t a n a n g k a k e s a k i t a n d a n k e m a t i a n p a d a k e a d a a n I
p e r f o r a s i . T a n d a - t a n d a p e r f o r a s i m e l i p u t i m e n i n g k a t n y a n y e r i , s p a s m e o t o t
d i n d i n g p e r u t k u a d r a n k a n a n b a w a h d e n g a n t a n d a p e r o t o n i f i s u m u m a t a u
a b s e s y a n g t e r l o k a l i s a s i , d e m a m , l e u k o s i t o s i s s e m a k i n j e l a s , m a l a i s e
( S j a m s u h i d a j a t , 2 0 1 0 ) .
O l e h k a r e n a i t u u p a y a u n t u k m e n g u r a n g i a n g k a k e s a k i t a n d a n a n g k a
k e m a t i a n d e n g a n c a r a m e n i n g k a t k a n k u a l i t a s d a n k u a n t i t a s p e l a y a n a i n m e d i s
y a i t u m e m b u a t d i a g n o s a y a n g t e p a t ( O m a r i d k k , 2 0 1 4 )
2. 1. 12. Prognosis
P r o g n o s i s p a d a u m u m n y a b o n a m ( P e r m e n k e s , 2 0 1 4 ) . K e b a n y a k a n
p a s i e n s e t e l a h o p e r a s i a p e n d e k t o m i s e m b u h s p o n t a n t a n p a p e n y u l i t , n a m u n
k o m p l i k a s i d a p a t t e r j a d i a p a b i l a t i d a k d i t a t a i a k s a n a s e g e r a
( P a p a n d r i a d k k , 2 0 1 3 ) .
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2.2. Kerangka Teori
S u m b a t a n l u m e n a p e n d i k s
A p e n d i s i t i s a k u l
D i a g n o s i s b e r d a s a r k a n s k o r A l v a r a d o
T a t a l a k s a n a
(ianibar: 2.4. Kcrangka Icori Sumber: Moditika.si Sjamsuhidajal-ZOIO.. Sugiarto.2(X)9
- U s i a
- J e n i s K e l a m i n
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B A B I I I
M E T O D E P E N E L I T I A N
3.1. Jenis Penelitian
J e n i s p e n e l i t i a n y a n g d i l a k u k a n a d a l a h p e n e l i t i a n d c s k r i p t i f r e t r o s p e k t i f
d e n g a n m e n g a m b i l d a t a m e l a l u i r e k a m m e d i s .
3.2. Waktu dan Tempat penelitian
P e n e l i t i a n d i l a k s a n a k a n d i RSUD P a l e m b a n g B a r i . W a k t u p e n e l i t i a n
d i l a k u k a n p a d a b u i a n O k t o b e r - D e s e m b e r 2 0 1 5 .
3.3. Populasi dan Sampei
4. 2. 1. Populasi
P o p u l a s i d a l a m p e n e l i t i a n i n i a d a l a h s e i u r u h p e n d e r i t a a p c m d i s i t i s
a k u t d i R S U D P a l e m b a n g B a r i p e r i o d e I J a n u a r i 2 0 1 1 s a m p a i
d e n g a n 3 1 D e s e m b e r 2 0 i 4 .
4. 2. 2. Sampei dan Besar Sampei
P c n e n t u a n b e s a r s a m p e i d i l a k u k a n s e c a r a t e k n i k total sampling
y a i t u s e m u a p o p u l a s i d i j a d t k a n s a m p e i .
4.2. 3. Kriteria Inklusi dan Kriteria Eksklusi
1 . K r i t e r i a I n k l u s i
S e m u a p e n d e r i t a a p e n d i s i t i s a k u t d i R S U D P a l e m b a n g B a r i
p e r i o d e 1 J a n u a r i 2 0 1 1 s a m p a i d e n g a n D e s e m b e r 2 0 1 4 .
2 . K r i t e r i a E k s k l u s i
- D a t a r e k a m m e d i s y a n g t i d a k l e n g k a p b e r u p a t i d a k a d a n y a
d a t a u s i a , j e n i s k e l a m i n , g a m b a r a n k l i n i s p a s i e n , d a n
p e n a t a l a k s a n a a n .
- P a d a r e k a m m e d i s t e r d a p a t p e n y a k i t p e n y e r t a l a i n .
26
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3.4. Variabel Penelitian
V a r i a b e l p a d a p e n e l i t i a n i n i a d a l a h s e b a g a i b e r i k u t :
- U s i a
- J e n i s K e l a m i n
- D i a g n o s i s b e r d a s a r k a n s k o r A l v a r a d o
- T a t a l a k s a n a
3.5. Definisi Operasionai
T a b e l 3 . 1 . D e f i n i s i O p e r a s i o n a i
Variabel
Penelitian
Definisi Alat
Ukur
Cara
Ukur
Skala
Ukur
Hasil Ukur
U s i a L a m a n y a R e k a m
w a k t u h i d u p m e d i s
y a i t u
t e r h i t u n g
s e j a k l a h i r
s a m p a i
d e n g a n s a a t
p e n e l i t i a n .
M e n c a t a t O r d i n a l
r e k a m
m e d i s
1 . < 2 0 l a h u n
2 . 2 0 - 3 0 t a h u n
3 . > 3 0 t a h u n
J e n i s
k e l a m i n
P e r b e d a a n
a n t a r a
p e r e m p u a n
d e n g a n l a k i -
l a k i s e c a r a
b i o l o g i s
R e k a m M e n c a t a t N o m i n a l 1 . L a k i - l a k i
m e d i s r e k a m 2 . P e r e m p u a n
m e d i s
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S k o r S k o r y a n g R e k a m A n a l i s i s O r d i n a l
A l v a r a d o d i g u n a k a n m e d i s r e k a m
u n t u k m e d i s
d i a g o s i s
a p e n d i s i t i s
7 - 1 0 : A p e n d i s i t i s
a k u t
5 - 6 : C u r i g a
a p e n d i s i t i s
a k u l
1 -4 : B u k a n
a p e n d i s i t i s
a k u t
T a t a l a k s a n a T i n d a k a n
a t a u
p e n g o b a t a n
y a n g
d i b e r i k a n
p a d a p a s i e n
R e k a m M e n c a t a t N o m i n a ! 1 . A p e n d e k t o m i
m e d i s r e k a m t e r b u k a
m e d i s 2 . A p e n d e k t o m i
d e n g a n
l a p a r a s k o p i
3.6. Cara pengumpulan Data
J e n i s d a t a y a n g d i k u m p u l k a n a d a l a h d a t a s e k u n d e r y a n g t e r c a t a t p a d a
rekam m e d i s d i R S U D P a l e m b a n g B a r i p e r i o d e 1 J a n u a r i 2 0 1 1 - 3 1
D e s e m b e r 2 0 1 4 .
3 .7 . Metode Teknis Analisis Data
3. 7.1 Data Primer
P a d a p e n e l i t i a n m e n g g u n a k a n d a t a s e k u n d e r b e r u p a r e k a m m e d i s .
3. 7 . 2 Data sekunder
D a t a y a n g d i a m b i l d a r i d a t a r e k a m m e d i s d i R S U D P a l e m b a n g B a r i
p e r i o d e 1 J a n u a r i 2 0 1 1 - 3 1 D e s e m b e r 2 0 1 4 .
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3. 7.3 Cara Pengolahan dan Analisis Data
1 . Editing
M e l a k u k a n p e n g e c e k a n t e r h a d a p d a t a p e n d e r i t a a p e n d i s i t i s d a r i
r e k a m m e d i s , a p a k a h d a t a s u d a h l e n g k a p , b i l a t e r d a p a t k e s a l a h a n
a t a u k e k u r a n g a n m a k a d i l a k u k a n p e n g e c e k a n u l a n g .
2 . Coding
D a t a y a n g t e l a h d i k u m p u l k a n k e m u d i a n d i u b a h k e d a l a m b e n t u k
a n g k a a t a u b i l a n g a n ( k o d e ) .
3 . Tabulating
M e l a k u k a n p r o s e s p c m a s u k a n d a t a y a n g t e l a h d i b e r i k o d e
k e d a l a m b e n t u k t a b e i d i s t r i b u s i d a n f r e k u e n s i d e n g a n
m e n g g u n a k a n s o f t w a r e S P S S .
4 . Cleaning
K e g i a t a n p e n g e c e k a n k e m b a l i d a t a y a n g s u d a h d i t a b u l a t i n g
a p a k a h a d a k e s a l a h a n a t a u t i d a k . P e m e r i k s a a n s e m u a d a t a k e
k o m p u t e r y a n g t e l a h d i m a s u k k a n k e d a l a m k o m p u t c r g u n a
m e n g h i n d a r i t e r j a d i n y a k e s a l a h a n d a l a m p e m a s u k k a n d a t a .
A n a l i s i s d a t a y a n g d i l a k u k a n a d a l a h a n a l i s i s u n i v a r i a t y a i t u
u n t u k m e n d e s k r i p s i k a n k a r a k t e r i s t i k m a s i n g - m a s i n g v a r i a b e l y a n g
d i t e l i l i . D a t a d i s a j i k a n d a l a m b e n t u k l a b e l d i s t r i b u s i f r e k u e n s i d a n
n a r a s i .
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3.8. Alur Penelitian
Populasi
P o p u l a s i p e n e l i t i a n a d a l a h s e m u a p e n d e r i t a a p e n d i s i t i s y a n g t e r c a t a t d a l a m r e k a m m e d i s p e r i o d e 1 J a n u a r i 2 0 1 1 - 3 ! D e s e m b e r 2 0 1 4
Sampei
S a m p e i p e n e l i t i a n a d a l a h s e m u a a n g g o t a p o p u l a s i p e n e l i t i a n (Total Sampling)
Pelaksanaan Penelitian
D a t a s e k u n d e r y a i l u m e l i h a t d a r i k a r t u s t a t u s a t a u r e k a m
V y
Pengolahan dan Analisa Data
D a t a d i t a b u l a s i , d i o l a h , d a n d i s a j i k a n d a l a m b e n t u k t a b e l d a n n a r a s i
Gamliar 3.1. Alur Penelitian
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BAB I V
H A S I L DAN P E M B A H A S A N
P e n e l i t i a n i n i m e n d e s k r i p s i k a n K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t d i
R S U D P a l e m b a n g B a r i P e r i o d e I J a n u a r i 2 0 1 1 - 3 1 D e s e m b e r 2 0 1 4 . D a t a
p e n e l i t i a n d i d a p a t k a n d a r i r e k a m m e d i k R S U D P a l e m b a n g B a r i d i t i n j a u d a r i
a s p e k u s i a , j e n i s k e l a m i n , d i a g n o s i s b e r d a s a r k a n s k o r a l v a r a d o d a n l a t s f l a k s a n a
p a d a p e n d e r i t a a p e n d i s i t i s a k u t . T e r d a p a t 5 3 p a s i e n y a n g d i d i a g n o s i s m e n d e r i t a
a p e n d i s i t i s a k u L N a m u n h a n y a 4 8 p a s i e n y a n g m e m e n u h i k r i t e r i a i n k l u s i d a n 4 8
p a s i e n i t u l a h y a n g d i j a d i k a n s a m p e i p e n e l i t i a n .
4.1 Ilasil Penelitian
4. 1. 1. Karakteristik Penderita Apendisitis Akut Berdasarkan Usia
dan Jenis Kelamin
1 . D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t
B e n l a s a r k a n U s i a
T a b e i 4 . 1 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t
B e r d a s a r k a n U s i a
Kelompok Usia
(tahun)
Frekuensi Persentase (%)
< 2 0 t a h u n 1 2 2 5 . 0
2 0 - 3 0 t a h u n 18 37.5
> 3 0 l a h u n 18 3 7 . 5
T o t a l 4 8 1 0 0 . 0
D a r i l a b e l 4 . 1 d a p a l d i b h a l b a h w a k e j a d i a n a p e n d i s i t i s
a k u t d i R S U D P a l e m b a n g B a r i P e r i o d e I J a n u a r i 2 0 1 1 - 3 1
Desember 2 0 M terbanyak pada kelompok usia 20-30 tahun
d a n u s i a > 3 0 l a h u n , y a i t u 1 8 o r a n g ( 3 7 . 5 % ) , s e d a n g k a n
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p a l i n g s e d i k i t k e l o m p o k u s i a < 2 0 t a h u n , y a i t u 1 2 o r a n g
( 2 5 . 0 % ) .
2 . D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u l
B e r d a s a r k a n J e n i s K e l a m i n
T a b e i 4 . 2 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i s A k u t
B e r d a s a r k a n J e n i s K e l a m i n
J e n i s Kelamin Frekuensi Persentase (%)
L a k i - l a k i 2 3 4 7 . U
P e r e m p u a n 2 5 5 2 . 1
T o t a l 4 8 1 0 0
D a r i t a b e ! 4 . 2 d a p a t d i l i h a t b a h w a k e j a d i a n a p e n d i s i t i s a k u t
t e r b a n y a k p a d a j e n i s k e l a m i n p e r e m p u a n y a i t u 25 o r a n g
( 5 2 . 1 % ) d a n p a d a j e n i s k e l a m i n l a k i - l a k i a d a l a h 2 3 o r a n g
( 4 7 . 9 % ) d e n g a n p e r b a n d i n g a n 1 : 1 . 0 8 .
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4. 1.2. Karakteristik Penderita Apendisitis Akut Berdasarkan
Penegakkan Diagnosis dengan Menggunakan Skor Alvarado
T a b e l 4.3 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s t i s A k u t
B e r d a s a r k a n a P e n e g a k k a n D i a g n o s i s d e n g a n M e n g g u n a k a n S k o r
A l v a r a d o
Hasil Skor Alvarado Frekuensi Persentase
( V o )
1-4 ( B u k a n A p e n d i s i t i s a k u l ) 0 t)
5-6 ( C u r i g a A p e n d i s i t i s a k u t ) 7 14.6
7-10 ( A p e n d i s i t i s A k u t ) 41 85.4
T o t a l 48 l O O
D a r i t a b e l 4 .3 d a p a t d i l i h a t b a h w a y a n g m e m i l i k i n i l a i s k o r
a l v a r a d o t e r b a n y a k a d a l a h s k o r d e n g a n J u m l a h 7-10 ( a p e n d i s i t i s
a k u t ) y a i t u 4 1 o r a n g (85 .4%), y a n g m e m i l i k i n i l a i s k o r d e n g a n
J u m l a h 5-6 ( c u r i g a a p e n d i s i t i s a k u t ) y a i t u 7 o r a n g ( 1 4 . 6 % ) d a n
t i d a k a d a y a n g m e m i l i k i h a s i l s k o r d e n g a n j u m l a h l - 4 ( b u k a n
a p e n d i s i t i s a k u t ) (0%).
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T a b e l 4 . 4 H a s i l S k o r A l v a r a d o
Skor Alvarado Jumlah
1 . N y e r i P i n d a h k e F o s s a I l i a k a K a n a n
a . Y a 48
b . T i d a k 0
2 . A n o r e k s i a
a . Y a 22
b . T i d a k 26
3 . M u a ! a t a u M u n t a h
a . Y a 4 0
b . T i d a k 8
4 . N y e r i L e p a s
a . Y a 4 8
b . T i d a k 0
5 . N y e r i T e k a n F o s s a I l i a k a K a n a n
a . Y a 48
b . T i d a k 0
6 . S u h u T u b u h
a . < 3 7 . 2 C 38
b . > 3 7 . 2 C 1 0
7 . L e u k o s i t
a . <10.000 8
b. > 10.000 40
8 . N e u t r o f i l ~
a . < 7 5 % 15
b . > 7 5 % 3 3
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4.1.3. Karakteristik Penderita Apendisitis Akut Berdasarkan
Penatalaksanaan
T a b e l 4 . 5 D i s t r i b u s i K a r a k t e r i s t i k P e n d e r i t a A p e n d i s i t i i s A k u t
B e r d a s a r k a n P e n a t a l a k s a n a a n
Tatalaksana Frekuensi Persentase (%)
A p e n d e k t o m i
T e r b u k a
4 8 m
A p e n d e k t o m i
d e n g a n
L a p a r o s k o p i
0 0
Tota] 4 8 J 0 0
D a r i t a b e ! 4 . 5 s e b a n y a k 4 8 o r a n g ( 1 0 0 % ) m e n d a p a t k a n
p e n a t a l a k s a n a a n d e n g a n c a r a a p e n d e k t o m i t e r b u k a , s e d a n g k a n
y a n g m e n d a p a t k a n p e n a t a l a k s a n a a n a p e n d e k t o m i d e n g a n
l a p a r o s k o p i t i d a k a d a ( 0 % ) .
4.2 Pembahasan
D a r i h a s i l p e n e l i t i a n m e n g e n a i u s i a m e n y a t a k a n b a h w a p e n d e r i t a
a p e n d i s i t i s l e b i h b a n y a k d i d e r i t a p a d a u s i a 2 0 - 3 0 t a h u n d a n > 3 0 t a h u n y a i t u
1 8 o r a n g ( 3 7 . 5 % ) . H a s i l t e r s e b u t t i d a k j a u h b e r b e d a d e n g a n p e n e l i t i a n I v a n
C P ( 2 0 1 0 ) , d i m a n a d a r i 6 0 o r a n g p e n d e r i t a a p e n d i s i t i s d i d a p a t k a n t e r b a n y a k
p a d a k e l o m p o k u s i a 2 1 - 3 0 t a h u n y a i t u 2 1 o r a n g ( 3 5 % ) . A p e n d i s i t i s a k u t d a p a t
d i t e m u k a n p a d a s e m u a u m u r , h a n y a p a d a a n a k k u r a n g d a r i I t a h u n j a r a n g
d i l a p o r k a n . I n s i d e n t e r t i n g g i p a d a k e l o m p o k u m u r 2 0 - 3 0 t a h u n . M e n u r u t
B r u n i c a r d i ( 2 0 0 9 ) , p e r k c m b a n g a n m a k s i m a l d a r i j a r i n g a n l i m f o i d d i m a s a
t e r s e b u t m e n j a d i f a k t o r m e n i n g k a t n y a i n s i d e n s i a p e n d i k s u n t u k t e r s u m b a t .
S e l a i n i t u j u g a d i p e n g a r u h i o l e h p o l a m a k a n y a n g t i d a k b a i k p a d a u s i a
t e r s e b u t . M a k a n a n c e p a t s a j i m e r u p a k a n m a k a n a n r e n d a h s e r a t d a n d a p a t
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m e n y e b a b k a n k e s u l i t a n b u a n g a i r b e s a r ( k o n s t i p a s i ) y a n g b e r a k i b a t
m e n i n g k a t n y a t e k a n a n intracaecal. P e n i n g k a t a n t e k a n a n i n t r a c a e c a l m e m i c u
t i m b u l n y a s u m b a l a n f u n g s i o n a l a p e n d i k s d a n a k a n m e n i n g k a t k a n
p e r t u m b u h a n f l o r a k o l o n s e h i n g g a m e m p e r m u d a h t e r j a d i n y a a p e n d i s i t i s .
J e n i s k e l a m i n p a d a k e j a d i a n a p e n d i s i t i s a k u t l e b i h b a n y a k d i d e r i t a
o l e h p e r e m p u a n y a i t u 2 5 o r a n g ( 5 2 . 1 % ) d i b a n d i n g k a n d e n g a n l a k i - l a k i y a i t u
2 3 o r a n g ( 4 7 . 9 % ) . T e r d a p a t k e s a m a a n p a d a p e n e l i t i a n y a n g d i l a k u k a n S a t r i o
( 2 0 0 9 ) , d i m a n a j u m l a h p e n d e r i t a a p e n d i s i t i s b e r j e n i s k e l a m i n p e r e m p u a n
l e b i h b a n y a k d i b a n d i n g k a n d e n g a n l a k i - l a k i . N a m u n t e r d a p a t p e r b e d a a n p a d a
l i t e r a t u r , i n s i d e n t e r j a d i n y a a p e n d i s i t i s a k u t p a d a u m u m n y a s e b a n d i n g a n t a r a
l a k i - l a k i d a n p e r e m p u a n , k e c u a l i p a d a u m u r 2 0 - 3 0 t a h u n
( S j a m s u h i d a j a t , 2 0 1 0 ) . P a d a h a s i l p e n e l i t i a n t i d a k d i k e l a h u p e n y e b a b
p e r e m p u a n l e b i h b a n y a k m e n d e r i t a a p e n d i s i t i s a k u t d i b a n d i n g k a n l a k i - l a k i .
B e r d a s a r k a n p e n e g a k k a n d i a g n o s i s d e n g a n m e n g g u n a k a n s k o r
a l v a r a d o , h a s i l s k o r 7 - 1 0 ( a p e n d i s i t i s a k u t ) p a l i n g b a n y a k d i d a p a t k a n y a i t u
y a i t u 4 1 o r a n g ( 8 5 . 4 % ) , h a s i l p e n e l i t i a n i n i s e s u a i d e n g a n p e n e l i t i a n J a l i l e t
a l . , ( 2 0 1 1 ) y a i t u d a r i 2 6 2 p a s i e n s e b a n y a k 1 5 7 p a s i e n t e r d a p a t p a d a k e l o m p o k
I ( s k o r > 7 ) , s e d a n g k a n 1 0 5 p a s i c n t e r m a s u k k e l o m p o k I I ( s k o r 5 - 7 ) . P a s i e n
y a n g m e m i l i k i s k o r < 4 t i d a k a d a y a n g p e r l u d i o p e r a s i , s e d a n g k a n h a s i l s k o r
> 5 p e r l u d i o b s e r v a s i u n t u k r c e v a l u a s i a p a k a h t i n d a k a n o p e r a s i p e r l u
d i l a k u k a n . H a l i n i m e n u n j u k k a n b a h w a s k o r a l v a r a d o s a n g a t s e s u a i u n t u k
d i a g n o s i s a p e n d i s i t i s a k u t . S i s t e m s k o r a l v a r a d o s e d e r h a n a , c e p a t , h a i i d a l d a n
m u d a h d i g u n a k a n . P a d a h a s i l p e n e l i t i a n s k o r a l v a r a d o b e r d a s a r k a n g e j a l a
k l i n i s b e r u p a n y e r i p i n d a h k e f o s s a i l i a k a k a n a n d i d a p a t k a n s e b a n y a k 4 8
o r a n g m e n g a l a m i n y e r i p i n d a h , s e d a n g k a n y a n g t i d a k m e n g a l a m i n y e r i
p i n d a h t i d a k a d a . M e n u r u t l i t e r a t u r 9 6 % p a d a p a s i e n a p e n d i s i t i s a k a n
m e n g a l a m i r a s a n y e r i p a d a k u a d r a n k a n a n b a w a h . P a d a b e b e r a p a p a s i c n , s a k i t
b e r a w a l d a n m e n e t a p p a d a k u a d r a n k a n a n b a w a h . G e j a l a u l a m a a p e n d i s i t i s
a k u t a d a l a h s a k i t p a d a p e r u t . S a k i t b e r a w a l d i b a g i a n e p i g a s t r i u m a t a u
u m b i l i k a l . S e l e l a h 1 -12 j a m s a k i t a k a n t e r l o k a l i s i r d i k u a d r a n k a n a n b a w a h .
P a d a t a h a p a w a l a p e n d i s i t i s , s e b e l u m r a d a n g m e n c a p a i p e r m u k a a n
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37
p e r i t o n e u m , n y e r i v i s c e r a l d i r a s a k a n d i s e k i t a r p u s a t d i s e r t a i r a s a m u a l k a r e n a
a p e n d i k s t e r m a s u k u s u s t e n g a h . S e t e l a h r a d a n g t e r j a d i d i s e i u r u h d i n d i n g
t e r m a s u k p e r i t o n e u m v i s c e r a l , t e r j a d i n y e r i a k i b a t r a n g s a n g a n p e r i i t o n e u m
y a n g m e r u p a k a n n y e r i s o m a t i k . P a d a s a a t i n i , n y e r i d i r a s a k a n t e p a t p a d a
p e r i t o n e u m y a n g m e r a d a n g , y a i l u d i p e r u t k a n a n b a w a h . L a | u g e j a l a k l i n i s
a n o r e k s i a s e b a n y a k 2 6 o r a n g t i d a k m e n g a l a m i s e d a n g k a n 2 2 o r a n g
m e n g a l a m i a n o r e k s i a . M e n u r u t H u m e s ( 2 0 1 1 ) , p a d a p a s i e n d e n g a n
a p e n d i s i t i s a k u t d a p a t t i m b u l a n o r e k s i a a t a u n a f s u m a k a n m e n u r u n . A n o r e k s i a
t e r j a d i k a r e n a p e n i n g k a t a n intracaecal y a n g m e n s t i m u i a s i s a r a f e f e r e n
s e h i n g g a t i m b u l n y e r i p a d a e p i g a s t r i u m y a n g k e m u d i a n m e n y e b a b k a n
a n o r e k s i a . P a d a g e j a l a k l i n i s m u a l a t a u m u n t a h d i d a p a t k a n 4 2 o r a n g t i d a k
m e n g a l a m i , s e d a n g k a n 6 o r a n g m e n g a l a m i m u a l a t a u m u n t a h . M i i a l a t a u
m u n t a h m e r u p a k a n g e j a l a y a n g d a p a t t i m b u l p a d a a p e n d i s i t i s a k u t . H a l i n i
d i s e b a b k a n k a r e n a a d a n y a o b s t r u k s i d a n d i s t e n s i l u m e n a p e n d i k s s e h i n g g a
m e n s t i m u i a s i p e r i . s t a l t i k u s u s y a n g b e r l e b i h a n d a n m e r a n g s a n ^ n e r v u s v a g u s
y a n g m e n y e b a b k a n t i m b u l r a s a m u a l ( H u m e s , 2 0 1 1 ) . B k o r a l v a r a d o
b e r d a s a r k a n a d a n y a t a n d a k l i n i s n y e r i l e p a s d a n n y e r i t e k a n d i d a p a t k a n 4 8
o r a n g . A d a n y a n y e r i l e p a s d a n n y e r i t e k a n m e n u n j u k k a n p r o s e s i n f l a m a s i
b e r l a n j u t p a d a s e r o s a a p e n d i k s d a n l i p a t a n p e r i t o n e u m p a r i e t a l , s e h i n g g a p a d a
s a a t d i l a k u k a n p e n e k a n a n t e p a t d i t i t i k M c B u m e y d a n s e c a r a t i b a - t i b a
d i l e p a s k a n m a k a a k a n m e n i m b u l k a n r a s a n y e r i ( B r i c k l e y , 2 0 Q 9 ) . P a d a t a n d a
k l i n i s b e r u p a s u h u t u b u h d i d a p a t k a n 4 0 o r a n g m e m i l i k i s u h u < 3 7 , 2 * ' C ,
s e d a n g k a n 8 o r a n g m e m i l i k i s u h u > 3 7 , 2 * * C . P a s i e n d e n g a n a p e n d i s i t i s a k u t
d i r a s a k a n p a n a s b a d a n y a n g b i a s a n y a t i d a k t e r l a l u t i n g g i ( s e k i t a r
3 8 ' * C ) ( H u m e s , 2 0 1 1 ) . D e m a m t e r j a d i k a r e n a i n f l a m a s i a p e n d i k s y a n g
m e r a n g s a n g p e l e p a s a n s i t o k i n d a n m e n g h a s i l k a n P G E 2 k e m u d i a n
m e n i n g k a t k a n s e t p o i n t t h e r m o s t a t d a n m e n y e b a b k a n t i m b u l n y a d e m a m .
B e r d a s a r k a n h a s i l l a b o r a t o r i u m j u m l a h l e u k o s i t s e b a n y a k 4 0 o r a n g
m e n g a l a m i p e n i n g k a t a n l e u k o s i t > 1 0 . 0 0 0 a t a u l e u k o s i t o s i s , s e d a n g k a n y a n g
m e m i l i k i j u m l a h l e u k o s i t < I 0 . 0 0 0 y a i t u s e b a n y a k 8 o r a n g . L e u k o s i t
m e r u p a k a n p e t a n d a y a n g s e n s i t i f t e r h a d a p i n f l a m a s i s e b a g a ) r e s p o n i m u n .
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3 8
J u m l a h l e u k o s i t d a r a h b i a s a n y a a k a n m e n i n g k a t p a d a k a s u s a p e n d i s i l i s . H a s i l
l a b o r a t o r i u m p a d a a p e n d i s i l i s a k u t b i a s a n y a d i d a p a t k a n a n g k a l e u k o s i t d i a t a s
1 0 . 0 0 0 s e l / m m ^ ( M a r i s a d k k , 2 0 l 2 ) . L e u k o s i t o s i s r i n g a n , m u l a i d a r i 1 0 . 0 0 0 -
1 8 . 0 0 0 s e l / m m ^ , b i a s a n y a t e r d a p a t p a d a p a s i e n a p e n d i s i t i s a k u t . L e u k o s i t o s i s
y a n g l e b i h b e s a r d a r i 2 0 . 0 0 0 s e l p e r m i k r o l i t e r h e n d a k n y a m e m b e r i t a n d a
p a d a d o k t e r k e m u n g k i n a n t e r j a d i n y a p e r f o r a s i . T e r a k h i r p a d a h a s i l
l a b o r a t o r i u m j u m l a h n e u t r o f i l > 7 5 % y a i t u s e b a n y a k 3 3 o r a p g , s e d r m g a k a n
< 7 5 % y a i t u 15 o r a n g . P a d a a p e n d i s i t i s a k u t h a s i l l a b o r a t o r i u m b e r u p a
n e u t r o f i l m e n u n j u k k a n p e n i n g k a t a n b e r l e b i h a n p e r s e n t a s e y a i f u > 7 5 % {shift
to the left). A d a n y a p e r g e s e r a n k e k i r i {shift to the left) m e n g i s y a r a t k a n
t e r j a d i n y a i n f e k s i a k u t .
T a t a l a k s a n a p a d a a p e n d i s i t i s a k u t l e b i h b a n y a k m e n g g u n a k a n
t e k n i k a p e n d e k t o m i t e r b u k a ( 1 0 0 % ) d i b a n d i n g k a n a p e n d e k t o m i d e n g a n
l a p a r o s k o p i . T e r d a p a t k e s a m a a n p a d a p e n e l i t i a n y a n g d i l a k u k a n A c h m a d
( 2 0 1 1 ) , d a r i 8 7 p a s i e n a p e n d i s i t i s a k u t d i d a p a t k a n 6 5 p a s i e n m e n g g u n a k a n
t e r a p i k o n v e n s i o n a l a t a u a p e n d e k t o m i t e r b u k a , s e d a n g k a n 2 2 p a s i c n
m e n g g u n a k a n t e r a p i l a p a r o s k o p i . A p e n d e k t o m i t e r b u k a p a l i n g b a n y a k d i p i l i h
o l e h a h l i b e d a h s e d a n g k a n a p e n d e k t o m i d e n g a n l a p a r o s k o p i d i l a k u k a n
a p a b i l a t e r s e d i a l a p a r o s k o p d a n t e r d a p a t k a s u s y a n g m e i r a g u k a n
( S j a m s u h i d a j a t , 2 0 l 0 ) . M e n u r u t p e n e l i t i a n A h m a d ( 2 0 1 1 ) , d i R S U D D r .
M o e w a r d i l e b i h b a n y a k p a s i e n y a n g m e m i l i h u n t u k d i o p e r a s i m e l a k u k a n
p r o s e d u r b e d a h k o n v e n s i o n a l d i k a r e n a k a n b i a y a y a n g l e b i h m u r a h
d i b a n d i n g k a n d e n g a n p r o s e d u r b e d a h l a p a r o s k o p i . P a d a p a s i e n y a n g
m e n d a p a t k a n t e r a p i b e d a h k o n v e s i o n a l a t a u a p e n d e k t o m i t e r b u k a a k a n
m e n d a p a t k a n l u k a o p e r a s i y a n g l e b i h b e s a r s e h i n g g a p e n y e m b u h a n p a d a
p a s i e n t e r s e b u t l e b i h l a m a s e r t a t i n g g i n y a r i s i k o t e r j a d i i n f e k s i , s e d a n g k a n
p a d a p a s i c n y a n g m e n d a p a t k a n t e r a p i b e d a h a p e n d e k t o m i l a p a r o s k o p i
m e n d a p a t l u k a o p e r a s i y a n g l e b i h k e c i l s e h i n g g a p e n y e m b u h a n n y a p u n l e b i h
c e p a t d a n r i s i k o t e r j a d i i n f e k s i l e b i h r e n d a h . P e m b e d a h a n a p e n d e k t o m i
t e r b u k a d i l a k u k a n d e n g a n m e m b u a n g a p e n d i k s y a n g t e r i n f e k s i d e n g a n s a t u
i n s i s i b e s a r s e k i t a r 5 - 7 , 5 c m p a d a a b d o m e n k u a d r a n k a n a n b a w a h .
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39
P e n g a n g k a l a n a p e n d i k s d i l a k u k a n d e n g a n m e l e p a s k a n a p e n d i k s d a r i
p e r l e k a t a n n y a d e n g a n m e s e n t e r i u m a b d o m e n d a n k o l o n , m e n g g u n t i n g
a p e n d i k s d a r i k o l o n , d a n m e n j a h i t l u b a n g p a d a k o l o n t e m p a t a p e n d i k s
s e b e l u m n y a . P e m b e d a h a n t e k n i k l a p a r o s k o p i a d a l a h t e k n i k p e m l ^ e d a h a n
a b d o m e n d e n g a n i n s i s i k e c i l s c p a n j a n g 0 , 5 - 1 , 5 c m . D e n g a n p e m b e d a h a n i n i
d a p a t d i l i h a t l a n g s u n g a p e n d i k s , o r g a n a b d o m e n d a n p e l v i s y a n g l a i n . J i k a
a p e n d i s i t i s d i t e m u k a n , a p e n d i k s d a p a t l a n g s u n g d i a n g k a t m e l a l u i i n s i s i k e c i l
t e r s e b u t .
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B A B V
K E S I M P U L A N DAN SARAN
5.1 Kesimpulan
B e r d a s a r k a n h a s i l p e n e l i t i a n , d a p a t d i a m b i l k e s i m p u l a n s e b a g a i b e r i k u t ;
1 . K a r a k l e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n u s i a b a n y a k t e r j a d i
p a d a u s i a 2 0 - 3 0 l a h u n d a n u s i a > 3 0 t a h u n y a i t u 3 7 . 5 % , s e d a n g k a n
b e r d a s a r k a n j e n i s k e l a m i n p a l i n g b a n y a k t e r j a d i p a d a j e n i s k e l a m i n
p e r e m p u a n y a i t u 5 2 . 1 % .
2 . K a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n p e n e g a k k a n
d i a g n o s i s s k o r a l v a r a d o b a n y a k t e r j a d i p a d a h a s i l s k o r 7 - 1 0 y a i t u . S 5 . 4 % .
3 . K a r a k t e r i s t i k p e n d e r i t a a p e n d i s i t i s a k u t b e r d a s a r k a n p e n a t a l a k s a n a a n ,
b a n y a k d i l a k u k a n d e n g a n t i n d a k a n a p e n d e k t o m i t e r b u k a ( 1 0 0 % ) .
5.2 Saran
1 . U n t u k m a s y a r a k a t p e r l u d i b e r i k a n i n f o r m a s i m e n g e n a i a p e n d i s i t i s a k u t
s e r t a e d u k a s i m e n g e n a i p o l a m a k a n y a n g b a i k s e p e r t i m e m p c r b a n y a k
m e n g o n s u m s i m a k a n a n t i n g g i s e r a t d a n m e n g h i n d a r i m a k a n a n c e p a t s a j i
u n t u k m e n c e g a h t e r j a d i n y a a p e n d i s i t i s a k u t .
2 . U n t u k p r a k t i s i m e d i s p e n g g u n a a n s k o r a l v a r a d o b a i k d a l a m m e n d i i a g n o s i s
a p e n d i s i t i s a k u t k a r e n a p e n g g u n a a a n s k o r a l v a r a d o s a n g a t s e d e r h a n a ,
c e p a t , h a n d a l d a n m u d a h d i g u n a k a n . A p a b i l a s u d a h d i t e g a k k a n d i a g n o s a
a p e n d i s i t i s a k u t , p e n a t a l a k s a n a a n a p e n d e k t o m i h a r u s s e g a r a d i l a k s a n a k a n .
3 . U n t u k k e p e n t i n g a n p e n e l i t i a n d i m a s a y a n g a k a n d a t a n g d i h a r a p k a n a g a r
a d a n y a p e m e r i k s a a n h i s t o p a l o l o g i s e h i n g g a b i s a d i l a k u k a n p e n e l i t i a n
m e n g e n a i h a s i l h i s t o p a t o l o g i a p e n d i s i t i s a k u t .
4 . U n t u k p e n e l i t i a n s e l a n j u t n y a d i h a r a p k a n m e l a k u k a n p e n e l i t i a n b e r s i f a t
a n a l i t i k m e n g e n a i a p e n d i s i t i s a k u t .
40
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D A F T A R P U S T A K A
A c m a d , M u s a . 2 0 1 1 . Perbedaan Lama Rawat Inap dan Biaya Perawatan antara Terapi Teknik Konvensional dan Laparoskopi pada Pasien Apendisitis di RSUD DR Moewardi. S k r i p s i , F a k u l t a s K e d o k t e r a n U n i v e r s i t a s S e b e l a s M a r e l . ( h t t p : / / d i g i l i b . u n s . a c . i d , D i a k s e s ! 7 D e s e m b e r 2 0 1 5 ) .
B r i c k l e y , L . 2 0 0 9 . B u k u A j a r P e m e r i k s a a n F i s i k d a n R i w a y a t K e s c h a t a n E d i s i 8 . E G C . J a k a r t a I n d o n e s i a . H a l 3 5 4
B r u n i c a r d i , d k k . 2 0 0 9 . Scwartz's principles of Surgery 9th ed. U S A : M c g r a w - H i l l P r o f e s s i o n a l
B u c k i u s , d k k . 2 0 1 2 . ('hanging Epidemiology of Acute Appendicitis in The United. States. J S u r g R e s . 1 7 5 ( 2 ) : 1 8 5 - 9 0 , ( h t t p : / / w w w . n c b i . n l m . n i h . g o v , D i a k s e s 15 A g u s t u s 2 0 1 5 ) .
Chan.2003 Alvarado Score- an admission criterion in patient with right iliac fossa p a / n . S u r J R C o l l S u r g . 3 9 - 4 1
C P , I v a n . 2 0 1 0 . Karakteri.sti.sk Penderita Apendisitis di RSUP Adam Malik Medan Pada lahun 2009. S k r i p s i , F a k u l t a s K e d o k t e r a n U S U . ( h t t p : / / r e p o s i t o r y . u s u . a c . i d , D i a k s e s 15 A g u s t u s 2 0 1 5 ) .
D a h m a r d e h e i , d k k . 2 0 1 3 . Diagnostic Value of Leukocytosis. ESR and CRP in Patient With Suspected Acute Appendicitis. Z a h i n a l J o u r n a l o f R e s e a r c h i n M e d i c a l S c i e n c e s . 1 5 ( 7 ) : 5 9 - 6 3
D e p a r t e m e n K e s e h a t a n R e p u b l i k I n d o n e s i a . 2 0 0 8 . P r o f i l K e s e h a t a n I n d o n e s i a 2 0 0 7 . I n d o n e s i a : D e p k e s R e p u b l i k I n d o n e s i a .
E y l i n . 2 0 0 9 . Karakteristik Pasien dan Diagnosis Histologi pada Ka.sus Apendisitis Berda.surkan Data Registrasi di Departemen Patologi Anatomi Fakultas Kedokteran Universitas Indonesia Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo pada tahun 2 0 0 3 - 2 0 0 7 . S k r i p s i , F a k u l t a s K e d o k t e r a n U I . ( h t t p : / / l i b . u i . a c . i d , D i a k s e s 15 A g u s t u s 2 0 1 5 ) .
G u r a y a , d k k . 2 0 0 5 . Validity of Leukocyte Count to Predict the Severity of Acute Appendicitis. S a u d i M e d J . 2 6 ( 1 2 ) : I 9 4 5 - 7 , ( h t t p : / / w w w . n c b l . n l m . n i h . g o v , D i a k s e s 2 0 A g u s t u s 2 0 1 5
H a l i m , N a n a . 2 0 1 2 . Ketepatan Diagnosis Apendisitis dengan USG Abdomen.iumaX K e d o k t e r a n B r a w i j a y a . 2 7 ( 2 ) , ( h t t p : / / j k b . u b . a c . i d , D i a k s e s 4 S e p t e r m b e r 2 0 1 5 ) .
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Har&tyat)U,S'lt'i.20 \ 4.Perbedaan antara Jumlah Leukosit Darah Pada Pasien Apendisitis Akut dengan Apendisitis Perforasi di RSUP DR.KariadJ SemarangSknpsi, F a k u l t a s K e d o k t e r a n U n d i p , ( h l t p : / / e p r i n t s . u n d i p . a c . i d , D i a k s e s 2 5 A g u s t u s 2 0 1 5 ) .
H a r r i s o n . 2 0 1 2 . Prinsip-prinsip Ilmu Penyakit Dalam Edisi 14. E G C . J a k a r t a . I n d o n e s i a . H a l . 1 6 1 0 - 1 6 1 2 .
H e l l e n , C i n d y . 2 0 0 5 . G a m b a r a n H i s t o p a t o l o g i s A p e n d i s i t i s A k u t . S k r i p s i , F : i k u i t a s K e d o k t e r a n U n i v e r s i t a s K r i s t e n M a r a n a t h a . ( h t t p : / / r e p o s i t o r y . m a r a n a t h a . e d u . D i a k s e s 4 O k t o b e r 2 0 1 5 ) .
H u m e s , D J . . J . S i m p s o n . 2 0 0 6 . Acute Appendicitis. U n i v e r s i t y H o s p i t a l Q u e e n ' s . 3 3 3 , ( h t t p : / / b m j . c o m . D i a k s e s 11 A g u s t u s 2 0 0 5 ) .
H u m e s , D J . , J . S i m p s o n . 2 0 ( f . Clinical Presentation of Acute Appendicitis: Clinical Sign-Laboratory Findings-Clinical Scores, Alvarado Score and Derivate Score. G a s t r o i n t e s t i n a l S u r g e r y U n i v e r s i t y H o s p i t a l Q u e e n ' s , ( h t t p : / / s p r i n g e r . c o m , D i a k s e s 1 5 A g u s t u s 2 0 1 5 ) .
l o a n n i s e t a l . 2 0 0 8 . L a p a r o s c o p i c v e r s u s O p e n A p p e n d e c t o m y . W o r l d J o u r n a l o f G a s t r o e n t e r o l o g y . 1 4 ( 3 2 ) , ( h t t p : / / w j g n e t . c o m , D i a k s e s 1 7 D e s e m b e r 2 0 1 5 ) .
J a l i l e l a l . 2 0 1 1 . A l v a r a d o S c o r i n g S y s t e m i n P r e d i c t i o n o f A c u t e A p p e n d i c i t i s . J o u r n a l o f T h e C o l l e g e P h y s i c i a n s a n d S u r g e o n P a k i s t a . 2 1 ( 1 2 ) . 7 5 3 - 7 5 5
J e f F r e y , N o r t o n . 2 0 0 2 . Basic Science and Clinical Evidance. N e w y o r k . S p r i n g e r
J u n i a s , M a n g e m a . 2 0 0 9 . Hubungan antara Skor Alvarado dan Temuan Opt^rasi Apendilis Akut di Rumah Sakit Pendidikcm Kedokteran Universitas Sumatera Utara. S k r i p s i , F a k u l t a s K e d o k t e r a n U S U . ( h t t p : / / r e p o s i t o r y . u s u . a c . i d , D i a k s e s 15 A g u s t u s 2 0 1 5 ) .
M a r i s a , d k k . 2 0 1 2 . Balas Angka Lekosit antara Apendisitis Akut dan Apendisitis Perforasi di Rumah Sakit Umum Daerah Tugurejo Semarang selama Januari 2009-JuU 2011. ]\\ma\ K e d o k t e r a n M u h a m m a d i y a h . 1 ( 1 ) , ( h t l p : / / j u m a l . u n i m u s . a c . i d , D i a k s e s 5 S e p t e m b e r 2 0 1 5 ) .
M J , S p i r t . 2 0 1 0 . Apendicitis. N a t i o n a l D i g e s t i v e D i s e a s e I n f o r m a t i o n C l e a r i n g h o u s e . 1 2 2 ( I ) , 3 9 - 5 1 , ( H t t p : / / w w w . n i d d k . n i h . g o v , D i a k s e s 1 5 A g u s t u s 2 0 1 5 )
M o h a m m a d Z i k r u l l a h e t a l . 2 0 1 2 . Clinical Value of Leukocyte Counts in Evaluation Patients with Suspected Appendicitis in Emergency Department. T u r k i s h J o u r n a l o f T r a u m a a n d E m e r g e n c y S u r g e r y . I 8 ( 6 ) , 4 7 4 - 4 7 8
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M o o r e , K e i t h . 2 0 l 1 . Clinically Oriented Anatomy 7th e t / . P h i l a d e l p h i a . H a l . 2 - 6 0
O m a r i , d k k . 2 0 1 3 . Risk Factor for Perforation. W o r l d J o u r n a l o f E m e r g e n c y S u r g e r y . 9 ( 6 ) , ( h t t p : / / w w w . w j e s . o r g , D i a k s e s 1 4 A g u s t u s 2 0 1 5 ) .
P a p a n d r i a , d k k . 2 0 1 3 . Risk of Perforation Increase with Delay in Recognition and Surgery for Acute Appendicitis. H H S P u b l i c . 1 8 4 ( 2 ) , 7 2 3 - 7 2 ^
P a u l i n a , S a l m i n e n . 2 0 l 5 . Appendicitis.\J.S D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s , ( h t t p : / / w w w . h e a i t h f m d e r . g o v , D i a k s e s I S e p t e m b e r 2 0 1 5 ) .
P e r m e n k e s N o m o r 5 T a h u n 2 0 1 4 . P a n d u a n P r a k t i s K l i n i s B a g i D o k t e r d i E a s i l i t a s P e l a y a n a n P r i m e r
R , D a v i d . 2 0 1 5 . Appendectomy or The Antibiotic First Strategy. T h e N e w E n g l a n d J o u r n a l o f M e d i c i n e . 3 7 2 , 1 9 3 7 - 1 9 4 3 , ( h t t p : / / w w w . n e j m . o r g , D i a k s e s 1 4 A g u s t u s 2 0 1 5 ) .
R o b b i n s . 2 0 0 7 . Buku Ajar Patologi. E G C . J a k a r t a . I n d o n e s i a . H a l . 6 6 0 - 6 6 1 .
S a t r i o . 2 0 0 9 . Hubungan perubahan letak serabut saraf ektopik dengan tipe radang pada pasien yang didiagnosis apendisitis secara histopatologis di RSUPN Cipto Mangunkusumo antara lahun 2005-2007. S k r i p s i , F a k u l t a s K e d o k t e r a n U l
S h e r w o o d , L a u r a l e e . 2 0 1 1 .Fisiologi Manusia Edisi ( 5 . E G C . J a k a r t a . I n d o n e s i a . H a l . 6 8 8
S j a m s u h i d a j a t , R W i m d e J o n g . 2 0 1 0 . Buku Ajar Ilmu Bedah Edisi J . E G C . J a k a r t a . I n d o n e s i a . H a l . 7 5 5 - 7 6 2 .
S n e l l , R i c h a r d . 2 0 0 6 . Anatomi Klinik Edisi 6 . E G C . J a k a r l a . I n d o n e s i a . H a l . 2 3 0 -2 3 1 .
S o b o t t a . 2 0 1 2 . Atlas Anatomi Manusia Edisi 23 Jilid J . E G C . J a k a r t a . l n d o n e s i a . H a l . 9 3 - 9 5 .
S u d i o n o d k k . 2 0 0 8 . Penuntun Patologi Anatomi. E G C . J a k a r t a . I n d o n e s i a . H a l . 3 2 - 3 4
Sugiarto,Sony.2009.D/«g«o.s/.v Apendisitis Akut dengan Skor Alvarado dan Modijikasinya.Jumai K e d o k t e r a n d a n K e s e h a t a n F a k u l t a s K e d o k t e r a n U n i v e r s i t a s T a r u m a n e g a r a V o l . 1 5 N o . 3 . H a l 1 6 9 - 1 7 8
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T a n d i r o g a n g , Y . , I J . B a h r u n . a n d M u t m a i n n a h . 2 0 1 2 . Neutropils Lymphocyk- Ratio In Acute Ap/iendicitis. M e d i c a l C l i n i c a l P a t h o l o g y a n d M e d i c a l L a b o r a t o r y . 1 9 ( ] ) , ( h l t p : / / w w w j o u r n a l . u n a i r . a c . i d , D i a k s e s 2 4 A g u s t u s 2 0 1 5 ) .
W o r l d H e a l t h O r g a n i t a t i o n . 2 0 0 8 . I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e l O ' * ' V o l u m e 2 . G e n e v a . S w i t z e r l a n d
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N o N a m a U s i a J K S k o r A l v a r a d o H a s i l T a t a l a k s a n a N y e r i
P i n d a h A n o r e k s i a M u a l
M u n t a h N y e r i L e p a s
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D e m a m L e u k o s i t N e u t r o f i l S k o r
! S y 2 7 P V •" V y 3 6 1 2 3 0 0 7 8 8 A p e n d e k t o m i T e r b u k a
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5 A h m a d 5 5 L V V 3 6 1 9 3 0 0 8 3 8 A p e n d e k t o m i T e r b u k a
6 D e s i 18 P — ^ V 3 8 . 2 1 8 6 0 0 8 5 9 A p e n d e k t o m i T e r b u k a
7 R o m a 2 6 L V V 3 7 1 1 4 0 0 7 7 9 A p e n d e k t o m i T e r b u k a
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10 T r i 2 9 P — ^ V V 3 6 . 3 9 5 0 0 8 0 6 A p e n d e k t o m i T e r b u k a
11 K u p r o w i 5 5 L V 3 6 9 3 0 0 8 0 6 A p e n d e k t o m i T e r b u k a
12 G i g i h 17 L V V 3 8 1 0 7 0 0 7 6 9 A p e n d e k t o m i T e r b u k a
13 S u h a y a t 3 5 L V " - 3 6 . 5 1 3 7 0 0 7 9 7 A p e n d e k t o m i T e r b u k a
14 C a m e 2 6 P V 3 8 . 3 1 2 3 0 0 8 7 8 A p e n d e k t o m i T e r b u k a
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16 F e r d i n a n 8 L - V 3 7 . 3 1 2 4 0 0 7 9 9 A p e n d e k t o m i 1 e r o u K a
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2 9 T i a r a 2 1 P - 3 8 . 3 1 2 0 0 0 7 7 9 A p e n d e k t o m i 1 e r b u k a
3 0 R m M a r d i 16 L — ^ • V V 3 5 . 1 1 1 2 0 0 6 0 8 A p e n d e k t o m i I e r n u K a
3 1 S a l m a n 12 L — ^ V V V 3 7 . 1 1 7 8 0 0 8 7 9 A p e n d e k t o m i T e r b u k a
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3 3 W a h n a 7 3 P V - - 3 6 . 2 1 6 7 0 0 8 1 7 A p e n d e k t o m i T e r b u k a
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3 6 E m i r i a t i 5 5 P V - V V 3 6 . 2 1 3 8 0 0 8 8 8 A p e n d e k t o m i T e r b u k a
3 7 L a t i f a 4 5 P y y V 3 6 . 3 8 9 0 0 5 9 6 A p e n d e k t o m i T e r b u k a
3 8 R u k i y a h 3 4 P - V y 3 7 1 3 4 0 0 8 3 8 A p e n d e k t o m i T e r b u k a
3 9 A r i f 12 L V V 3 6 . 5 2 0 7 0 0 8 8 9 A p e n d e k t o m i T e r b u k a
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1 I
I 1
L A M P I R A N
J ' e n g o l a h a n D a t a d e n g a n S P S S 1 6
Usia
Frequency Percent Valid Percent
Cumulative
Percent
Valid <20 tahun 12 25.0 25.0 25.0
20-30 tahun 18 37.5 37.5 62.5
>30 tahun 18 37.5 37.5 100.0
Total 48 100.0 100.0
Jenis Kelamin
Frequency Percent Valid Percent
Cumulative
Percent
Valid L 23 479 47.9 47,9
P 25 52,1 52.1 100.0
Total 48 100.0 100.0
Skor Alvarado
Frequency Percent Valid Percent Cumulative
Percent
Valid 5-6 7 14.6 14.6 14.6
7-10 41 85.4 85.4 100.0
Total 48 100.0 100,0
Nyeri Pindah
Frequency Percent Valid Percent Cumulative
Percent
Valid Ya 48 100.0 100.0 100.0
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I
Anoreksia
Frequency Percent Valid Percent
Cumulative
Percent
Valid Tidak 26 54.2 54.2 54.2
Ya 22 45.8 45.8 100.0
Total 48 100.0 100.0
Mual atau Muntah
Frequency Percent Valid Percent Cumulative
Percent
Valid Tidak 8 16.7 16.7 16.7
Ya 40 83.3 83.3 100.0
Total 48 100.0 100.0
Nyeri Lepas
Frequency Percent Valid Percent Cumulative
Percent
Valid Ya 48 1000 100.0 100.0
Nyeri Tekan
Frequency Percent Valid Percent
Cumulative
Percent
Valid Ya 48 100,0 100.0 100.0
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i I
Suhu Tubuh
Frequency Percent Valid Percent
Cumulative Percent
Valid <37.2 38 79.2 79.2 79.2
>37.2 10 20.8 20.8 100.0
Total 48 100.0 100.0
Jumlah Leukosit
Frequency Percent Valid Percent
Cumulative
Percent
Valid < 10000 8 16.7 16.7 16,7
>10000 40 83.3 83.3 100.0
Total 48 100.0 100,0
Jumlah Neutrofil
Frequency Percent Valid Percent
Cumulative Percent
Valid <75% 15 31.2 31.2 31.2
>75% 33 68.8 68.8 100.0
Total 48 100.0 100.0
Tatalaksana
Frequency Percent VaFid Percent
Cumulative
Percent
Valid Apendektomi Terbuka 48 100.0 ioa.o 100.0
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KARTU AKTIVITAS BIMBINGAN SKRIPS A M A H A S I S W A : ?i* icy SVPIMIT P E M B I M B I N G 1 : P t U W l y c W h ^ r , ^ . . 9 ^ ,
P E M B I M B I N G I I : c l r - ^ O C Y ^ ' ^ MI'T^S ' ' ' t ^ i e r . «
L S K R I P S I
PALP^^5AM^ E>AFi peFTioPC 1 7 f t ^ u A R . ,
A K U T
20 u - Si Ps-UD
TGL/BLNAHN KONSULTASI
TAN :
^ Y ^
Dikeluarkan di : Palembang Pada Tanggal : / ( / Tol^
^^a.n. Dekan ife^ua UPK,
J^ *
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F A K U L T A S K E D O K T E R A N UNIVERSITAS MUHAMMADIYAH PALEMBANG
SK. DIRJEN DIKTI NO. 2130 / D / T / 2008 TGL. 11 JULl 2008: IZIN PENYELENGGARA PROGRAM STUDI PENDIDIKAN DOKTER
Kampus B : Jl. KH. Bhalqi / Talang Banten 13 Ulu Telp. 0711 - 520045 Fax : 0711 516899 Palembang ( 30263 )
Nomor Lampiran Perihal
v V y y
Palembang, XO Oktober 2015. 960 /I-13/FK-UMP/X/2015
Mohon izin Pengambilan Data
Kepada :Yth. Direktur Rumah Sakit Umum Daerah BARI Palembang Di Palembang.
Assalamu'alaikum. Wr. Wb. Ba'da salam, semoga kita semua mendapatkan rahmat dan hidayah dari Allah SWT, Amin Ya Robbal Alamln.
Sehubungan dengan rencana pelaksanaan penelitian dan penyusunan skripsi mahasiswa Fakultas Kedokteran Universitas Muhammadiyah Palembang, atas nama :
Nama : Rizky Zuriati NIM : 702012 053 Jurusan : Ilmu Kedokteran Judul Skripsi : Karakteristik Penderita Apendidltis Akut di RSUD BARI Palembang
Periode 1 Januari - 31 Desember 2014.
Maka dengan ini kaml mohon kepada Saudara agar kiranya berkenan memberikan ijin pengambilan data yang dibutuhkan dalam penyusunan skripsi kepada nama tersebut diatas di Rumah Sakit Umum Daerah BARI Palembang.
Demikian, atas perhatian dan kerjasamanya dtucapkan terima kasih. Billahittaufig Walhldayah. Wassalamu'alaikum. Wr. Wb.
Tembusan; l . r t h . Wakil Oekan t. It, HI, IV FK UMP. Z.Yth. Ka. UPK FtC UMP. 3.Arsip.
•'7:;^i j^L'^Sii/NION. 1062484/0020084707
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PEMERINTAH KOTA PALEMBANG RUMAH SAKIT UMUM DAERAH
PALEMBANG BARI Jalan Panca Usaha Nomor 1, Keiurahan 5 Ulu, Kecamatan Seberang Ulu I, Kota Palembang, Provinsi Sumatera Seiatan
Telepon; (0711) 514165, 519211, Faksimile: (0711) 519212. Kode Pes: 30254 E-mail: [email protected], Website: www.rsudpbari.palembang.go.id
Palembang, 12. Nopember2015
Nomor Sifat Lampiran Hal
Biasa
Selesai melaksanakan pengambilan data
Kepada Yth. Dekan Fakultas Kedokteran
Universitas Muhammadiyah Palembang
d i -
PALEMBANG
Sehubungan dengan surat Dekan Fakultas Kedokteran Universitas
Muhammadiyah Palembang pada 10 Oktober 2015 Nomor: 960/1-13/FK-
UMP/X/2015 perihal: Mohon izin Pengambilan Data, atas nama:
Nama
NIM
Jurusan
Judul Skripsi
Rizky Zuriati
702012 053
Ilmu Kedokteran
Karakteristik Penderita Apendiditis Akut
di RSUD Palembang BARI Periode 1 Januari
s.d. 31 Desember 2014.
Dengan ini kami sampaikan bahwa mahasiswa tersebut di atas
teiah selesai melaksanakan pengambilan data awal dalam rangka
penelitian dan penyusunan skripsi mahasiswa Fakultas Kedokteran
Universitas Muhammadiyah Palembang.
Atas perhatian, kami sampaikan terima kasih.
JjjiREKTUR RSUD PALEMBANG BARI,
Pembina Tingkat I NIP 196504131996032001
![Page 65: KARAKTERISTIK PENDERITA APENDISITIS AKUT DI RSUD …](https://reader030.vdocuments.site/reader030/viewer/2022012013/6158c35b32fe4d013a0630d6/html5/thumbnails/65.jpg)
PEMERINTAH KOTA PALEMBANG RUMAH SAKIT UMUM DAERAH
PALEMBANG BARI p B ^ ^ Jalan Panca Usaha Nomor 1, Keiurahan 5 Ulu, Kecamatan Seberang Ulu I, Kota Palembang, Provinsi Sumatera Seiatan
Telepon: (0711)514165, 519211, Faksimile: (0711)519212, Kode Pes: 30254 E-mail: tu@rsudpbari,palembang.go.id, Website: w/wv/.rsudpbari,palembang.go.id
Nomor Sifat Lampiran Hal
Biasa
Selesai melaksanakan Penelitian
Palembang, "21 Nopember 2015
Kepada Yth. Dekan Fakultas Kedokteran
Universitas Muhammadiyah Palembang
d i -
PALEMBANG
Sehubungan dengan surat Dekan Fakultas Kedokteran Universitas
Muhammadiyah Palembang pada 6 Nopember 2015 Nomor: 1707/
1-13/FK-UMP/XI/2015 perihal: Mohon izin Penelitian, atas nama:
Nama
NIM
Jurusan
Judul Skripsi
Rizki Zuriati
702012053
Ilmu Kedokteran
Karakteristik Penderita Apendisitis Akut di
RSUD Palembang BARI Periode 1 Januari
2011 - 3 1 Desember 2014.
Dengan ini kami sampaikan bahwa mahasiswa tersebut di atas
telah selesai melaksanakan Penelitian dalam rangka penyusunan skripsi
mahasiswa Fakultas Kedokteran Universitas Muhammadiyah
Palembang.
Atas perhatian, kami sampaikan terima kasih.
DIREKTUR RSUD PALEMBANG BARI, U--—^2 -c'r
^ r ; " d r H j . W M ^ ^ -^'^y.^J^mbih'a Tingkat I
• NIP 196504131996032001
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B I O D A T A
R i z k y Z u r i a t i
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J a l a n G a t o t S u b r o t o P e r u m B u m i I n t a n S a r i B l o k
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S M A N c g c r i 1 T a n j u n g P i n a n g 2 0 0 9 - 2 0 1 2
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