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REFRESHING
APPENDISITISOleh :
Fathin Rahmani Salman(2010730135)
Pembimbing :Dr. Maya Sofa, SpB
Kepaniteraan Klinik Stase Bedah
RSUD Cianjur
2015
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ANATOMI APPENDIKS
• Berasal dari mid gut• Muncul minggu ke-8
kehamilan• Outpouching dari sekum• Secara bertahap berputar• Menetap di RLQ
Sumber : Townsend, Courtney M. 2007. Sabiston Textbook of Surgery, 18th ed. Saunders, An Imprint of Elsevier
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ANATOMI APPENDIKS
Panjang 2-22 cm (rata-rata 9
cm)
Diameter luar3-8 mm
Diameter lumen 1-3 mm
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ANATOMI APPENDIKS
Pendarahan appendiks berasal
dari a.appendikularis
Sumber : Townsend, Courtney M. 2007. Sabiston Textbook of Surgery, 18th ed. Saunders, An Imprint of Elsevier
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ANATOMI APPENDIKS
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• Mesenterium superior (T10 – L1)
Saraf simpatik
• Saraf vagus
Saraf parasimpatik
Sumber : Townsend, Courtney M. 2007. Sabiston Textbook of Surgery, 18th ed. Saunders, An Imprint of Elsevier
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ANATOMI APPENDIKS
mukosa
submukosa
muskularis eksterna/propria (otot longitudinal dan
sirkuler)
serosa
Sumber : Debas, Haile T. 2003. Gastrointestinal Surgery : Pathophysiology and Management. New York : Springer. Hal : 311
LAPISAN
APPENDIKS
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ANATOMI APPENDIKS
Lokasi ujung appendiks : Ileocecal Retrocecal Retroileal Pelvis
Sumber : Townsend, Courtney M. 2007. Sabiston Textbook of Surgery, 18th ed. Saunders, An Imprint of Elsevier
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FISIOLOGI APPENDIKS
Dahulu appendiks dipandang sebagai organ sisa dengan fungsi yang tidak diketahui
Appendiks organ imunologi yang aktif mensekresi imunoglobulin
Imunoglobulin sekretoar dihasilkan oleh GALT di sepanjang saluran cerna (termasuk appendiks) IgA proteksi terhadap infeksi
Sumber : Brunicardi, F. Charles. 2010. Schwartz’s Principles of Surgery, ninth edition. The McGraw-Hill Companies, Inc. United States of America.
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Appendisitis
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•Inflamasi pada appendiks vermiformis dan merupakan penyebab akut abdomen yang paling sering
Definisi
•Paling sering terjadi pada usia dekade 2-4, usia rata-rata 31.3 tahun dan median 22 tahun
•Rasio laki-laki : perempuan sekitar 1.2 – 1.3 : 1
Epidemiologi
Sumber : Brunicardi, F. Charles. 2010. Schwartz’s Principles of Surgery, ninth edition. The McGraw-Hill Companies, Inc. United States of America
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ETIOLOGI
Obstruksi lumen
Hiperplasia limfoid
Fecalith
Benda asingTumor
Parasit
Sumber : Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America
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ETIOLOGI
Sumber : Brunicardi, F. Charles. 2010. Schwartz’s Principles of Surgery, ninth edition. The McGraw-Hill Companies, Inc. United States of America
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PATOGENESIS
Sumber : Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America
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MANIFESTASI KLINIS
Symptoms
• Nyeri abdomen di epigastrium/umbilicalis kemudian terlokalisasi RLQ
• Mual muntah• Anoreksia• Konstipasi atau diare
Signs
• Mc.Burney’s point• Rovsing’s sign (+)• Iliopsoas sign (+)• Obturator sign (+)• Dunphy’s sign (+)
Sumber : Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America
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BLUMBERG’S SIGN
ROVSING’SSIGN
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Hiperektensi sendi panggul kanan atau fleksi aktif sendi panggul kanan, kemudian paha kanan ditahan
Bila apendiks yang meradang menempel di m. psoas mayor nyeri
ILIOPSOASSIGN
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Gerakan fleksi & endorotasi sendi panggul pada posisi terlentang
Bila appendiks yang meradang kontak dengan obturator internus yang merupakan dinding panggul kecil nyeri
OBTURATORSIGN
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ALVARADO SCALE
Manifestations Value
Symptoms Migration of pain 1
Anorexia 1
Nausea and/or vomiting 1
Signs Right lower quadrant Tenderness
2
Rebound 1
Elevated temperature 1
Laboratory values Leukocytosis 2
Left shift in leukocyte count
1
Total points 10
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ALVARADO SCALE
•Kemungkinan besar menderita appendisitis
•Dapat langsung pembedahan tanpa pemeriksaan lebih lanjut
•Konfirmasi pemeriksaan PA
Skor >8
•Kemungkinan sedang terjadinya appendisitis
•Sebaiknya dilakukan pemeriksaan penunjang foto polos abdomen/CT scan
Skor 2-8
•Kecil kemungkinan menderita appendisitis
•Tidak perlu dievaluasi lebih lanjut dan dapat dipulangkan dengan tetap dilakukan follow up
Skor <2
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MANIFESTASI KLINIS
Sumber : Debas, Haile T. 2003. Gastrointestinal Surgery : Pathophysiology and Management. New York : Springer. Hal : 311
• Nyeri panggul dan punggung, diare, dan gejala ureter
Appendiks retrosekal
• Nyeri pada suprapubis atau inguinal atau bahkan nyeri sisi kiri, mual, muntah, diare
Appendiks pelvik
• Nyeri testicular, kemungkinan berasal dari iritasi arteri spermatika ureter
Appendiks retroileal
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PEMERIKSAAN PENUNJANG
LaboratoriumHitung Darah Lengkap
Leukositosis (10.000-18.000/mm3) dengan PMN predominan
Jika WBC > 18.000/mm3 pikirkan adanya perforasi dengan atau tanpa abses
Urinalisis WBCs atau RBCs mungkin ditemukan jika
terdapat iritasi ureter atau VU karena inflamasi appendiks
Bakteriuria
Sumber : Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America
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PEMERIKSAAN PENUNJANG
ImagingAbdominal X-Ray (AXR)
Appendicolith/fecalith
CT scan abdominal dengan kontras (+) bila ditemukan dilatasi appendiks > 6 mm,
penebalan appendiceal, perappendiceal streaking, terdapat appendicolith
USG Pembesaran appendiks (> 6 mm) Menyingkirkan patologi ginekologi
Sumber : Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America
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DIFFERENTIAL DIAGNOSIS
Sumber : Debas, Haile T. 2003. Gastrointestinal Surgery : Pathophysiology and Management. New York : Springer. Hal : 311
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TERAPI
Preoperative Resusitasi cairan
Antibiotik
Appendectomy Laparoskopi Operasi Cyto : untuk appendisitis akut, abses
dan perforasi Operasi Elektif : untuk appendisitis kronik
Sumber : Brunicardi, F. Charles. 2010. Schwartz’s Principles of Surgery, ninth edition. The McGraw-Hill Companies, Inc. United States of America
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TEKNIK PEMBEDAHAN
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TEKNIK PEMBEDAHAN
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TEKNIK PEMBEDAHAN
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TEKNIK PEMBEDAHAN
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KOMPLIKASI
Perforasi
Risiko infeksi luka post operasi
Abses intraabdominal
Abses panggul
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REFERENSI
Townsend, Courtney M. 2007. Sabiston Textbook of Surgery, 18th ed. Saunders, An Imprint of Elsevier.
Debas, Haile T. 2003. Gastrointestinal Surgery : Pathofisiology and Management. New York : Springer. Hal : 311-318
Brunicardi, F. Charles. 2010. Schwartz’s Principles of Surgery, ninth edition. The McGraw-Hill Companies, Inc. United States of America.
Stead, G. Latha. 2003. Firts Aid for the Surgery Clerkship. McGraw-Hill Companies, Inc. United States of America.
Klingensmith, Mary E dkk. 2008. Washington Manual of Surgery, 5th Edition. Lippincott Williams & Wilkins.
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