tubo ovarian abcess materi
TRANSCRIPT
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TOA TOA
TUBO OVARIA ABSES TUBO OVARIA ABSES
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Uterus, Bilateral Fallopian Tubes, and Ovaries
U: Uterus
C: Cervix
F: Fallopian Tube
O: Normal Ovary
M: Inflamed Tubo-
Ovarian Mass
U
C
F
OM
Note the hemorrhagi! edematous fallopian tubes! so muh so that the arhiteture of the right tube andovary is obsured" The surfae of the tubo-ovarian mass is not only red but also some#hat shaggy"
$hat ardinal signs of inflammation are present% &ubor '&edness( and Tumor ')#elling(
$hat hemial mediators inrease the blood flo# to an area of inflammation% *istamine! Nitri Oxide!
+,I! +,.! +,/
$hat is responsible for the shaggy appearane% Fibrinogen exudate deposited as fibrin" )ign of inreased
vasular permeability"
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Inflamed Fallopian Tubes
http:00###"meddean"lu"edu0lumen0Med.d0&adio0urriulum0Mehanisms0aute1salpingitis2"htm
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DEFINISI
Tubo-ovarian abscess (TOA) adalahpembengkakan yang terjad pada t!ba"#$ar!m yang dtanda dengan radang
bernanah% bak d &alah &at! t!ba"#$ar!m%ma!p!n ked!anya ('ranberg% *)+
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ETIO,O'I
Ne&&era g#n#rrhea -hlamyda tra.h#mat&Dar k!lt!r / #rgan&me an aer#b
E .#l (012)% B+ 3ragll& (2)
Ne&&era g#n#rrhea dan -hlamyda tra.h#mat& ma&!k t!ba3all#p% penetra&% han.!rkan &el eptel% nekr#&& jarngan%
de&la& m!k#&a lal! membent!k p!& ⇒ ek&!dat p!r!len
" Bakter pengn3ek& t!ba 3all#p mengha&lkan banyak 3akt#rn4ama& yang bahkan men&tm!la& re&p#n n4ama& pada
pa&en+" Reak& h#&t / edema jarngan% &kema% nekr#&& dndng t!ba+
" 5!& mengalr dar !j!ng 6mbra t!ba ke abd#men% menyebarke #$ar!m dan #rgan lan d dekatnya (#ment!m% !&!&%kand!ng kemh dan !ter!&)
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'A7BARAN 8,INIS
" Demam% 90:;-" Nyer pel$&" terdapat ma&&a pada pel$&
" D&.harge $agna (:2)" 7!al dengan ata! tanpa m!ntah (
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FA8TOR RESI8O
Banyak pa&angan &ek&!al5enyakt radang pel$& &ebel!mnya ⇒ &lent
5engg!naan alat ntra !terne ⇒ IUD / 9>2( 7. Neeley et al)
Stat!& &# ek#n#m rendah
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5E7ERI8SAAN 5ENUNAN'
,ab / D,% ,ED% -R5
US' / tran& abd#mnal dan tran&$agnal / ma&&aadnea k&tk k#mplek& dengan &epta m!ltpel
-T &.an 5el$& / ma&&a t!b!ler dbata& penp&anrendah dengan penebalan dndng yang !n3#rm
'#ld &tandart D / lapar#&k#p
" ma&&a k&tk% hp#ekh#k%berdndng tebal padaadnek&a ata! retr#!terna" ma&&a b&a berl#k!& ? l#k!&dengan &ept!m ata!k#mp#nen padat" air fuid level
" Adanya .aran beba&" Bata& !ter!& tdak jela&
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0"year"#ld C#man Cth le3t t!b##$aran
ab&.e&&+ Intal dagn#&t. tran&$agnal n#gram&h#C& Cell"de6ned t!b!lar ma&& .#ntanng l#C"le$el e.h#e& and 4!d"debr& le$el (arrow)%&tr#ngly &!gge&t$e #3 t!b##$aran ab&.e&&+
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TERA5I
5embedahan ⇒ TA dan BSO% ala&an " AB dk!atrkan tdak adek!at memba&m
beberapa ab&e&
" S!ele gnek#l#g yang memerl!kanpembedahan lebh lanj!t &erng dtem!
" Re&k# r!pt!r TOA dan perkembanganpert#nt& general&ata
♣Nam!n banyak penderta TOA ma&h dlm!&a repr#d!k&% &hg 3akt#r repr#d!k&har!& menjad pertmbangan
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8ONSERVATIF5engg!naan AB $ yang agre&$
Drana&e ab&e& dengan pembedahan bladndka&kan,apar#&k#p aCal !G drana&e ab&e% !tk
menngkatkan kee3ekt3an AB8egagalan /" Serng pada TOA blateral" 7a&&a H:.m" Nyer pel$& menngkat" Demam per&&ten" ,e!k#&t#&&
♣ S!ele jangka panjang /" Nyer pel$& kr#n&" In3ek& pel$& rek!ren" n3ertlta&
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TERA5I ANTIBIOTI8 AB dgn .ak!pan / aer#b gram neg p#&t3% an
aer#b gram neg ( Ba.ter#de& Sp )5lhan /" Se3al#&p#rn 'en II ( &pektr!m l!a& )
" 8lndam&n% &en&t3 !tk B+ 3ragl&% an aer#b gramneg lan% aer#b tertent!" 8lndam&n k#mbna& Amn#glk#&d ⇒ re&p#n 8
12" 7etr#ndaJ#l &bg bakter&d an aer#b% dpt
menemb!& ka$ta& ab&e&♣ AB $ !nt!k TOA dlanj!tkan &+d 1jam% pa&en
RaCat jalan / =@har
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REGIMEN PENGOBATAN PASIEN RAWAT INAP
Regmen A / " -e3#tetan gG=jam
" D#..ln =mg G =jam
♣Regmen B / " 8lndam.n *mgG :jam
" 'entamy.n mg G kg G BBRegmen alternat3 /
" ,e$#4#k&a&n >mgG =jam K
7etr#ndaJ#l >mg G :jam% ata!" Amp.lln G &!lbaktam 0gG
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TERA5I 5E7BEDAAN
Indka& / Terdapat tanda ak!t abd#men8e.!rgaan r!pt!r TOA
Tak re&p#n dgn peng#batan AB IV /" Uk!ran TOA menngkat" 5emb!r!kan nyer pel$&" 5a&en p#&t men#p#!&e
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TERIMA KASIHTERIMA KASIH