Akut Abdomen...

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Akut Abdomen
perubahan kondisi akut pada organorgan intraabdomen
inflamasi atau infeksi
menyebabkan rasa nyeri yang hebat
dan timbul mendadak
cepat memburuk dan mengancam
nyawa
membutuhkan penegakan diagnosis
yang cepat dan tepat
Townsend et al,
2005

Etiologi Akut Abdomen

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Inflamasi
Mekanik
Neoplasma
Vaskular
Defek Kongenital
Trauma

PENYEBAB AKUT ABDOMEN

SEGALA USIA
ANAK-ANAK
APENDISITIS
INVAGINASI
PERFORASI USUS/LAMBUNG
RADANG SALURAN KEMIH
NYERI ABDOMEN NON SPESIFIK
HERNIA
(NON BEDAH)
RADANG SALURAN NAPAS ATAS
OBSTRUKSI USUS
PANKREATITIS AKUT
WANITA
KOLIK GINJAL/ URETER
RADANG PELVIS
DYSPEPSIA
RADANG SALURAN KEMIH
HERNIA
KEHAMILAN EKTOPIK
KOLESISTITIS AKUT/BILIER
KISTA OVARIUM
USIA TUA
KANKER
VASKULAR
SEBAB-SEBAB MEDIK

Chief Complaint : Abdominal Pain

History :
Where is your pain? Has it always been there?
Does the pain radiate anywhere?
How did the pain begin (sudden vs. gradual
onset)? How long have you had the pain?
What were you doing when the pain began?
What does the pain feel like?
On a scale of 010, how severe is the pain?
Does anything make the pain better or worse?
Have you had the pain before?

NYERI ABDOMEN
SARAF

RESEPTOR

SPESIFIKASI
NYERI

LOKASI

RANGSANGA
N

VISCERAL

S.OTONO
M

PERITONEUM
VISCERALIS

TAK JELAS (SUKAR

DIJELASKAN)

SUKAR

KEJANG TARIK
DISTENSI

SOMATIK

S.
SENTRAL

PERITONEUM
PARIETALIS

JELAS
TAJAM
MENUSUK

JELAS
(MENUNJUK)

SENTUH
TEKANAN
PANAS
RADANG

REVERSED PAIN
NYERI YANG DIALIRKAN KARENA KONFERGENSI SARAF PADA TRAKTUS
SPINOTALAMIK (EMBRIOLOGIS)

Visceral and NOT Referred Pain

referred to areas
corresponding to the
embryonic origin of the
affected structure. Foregut
structures (stomach,
duodenum, liver, and
pancreas) cause upper
abdominal pain. Midgut
structures (small bowel,
proximal colon, and
appendix) cause
periumbilical pain.
Hindgut structures (distal
colon and GU tract) cause
lower abdominal pain

Localizing pain -- RUQ

Hepatitis
Cholecystitis
Cholangitis
Pneumonia
Subdiaphragmatic
abscess

Localizing pain -- LUQ

Splenic infarct
Splenic abscess
Gastritis/PUD

Localizing pain -- RLQ

Appendicitis
Inguinal hernia
Nephrolithiasis
IBD
Salpingitis
Ectopic pregnancy
Ovarian pathology

Localizing pain -- LLQ

Diverticulitis
Inguinal hernia
Nephrolithiasis
IBD
Salpingitis
Ectopic pregnancy
Ovarian pathology

Localizing pain -- epigastric

PUD
Gastritis
Pancreatitis
GERD
Cardiac (MI,
pericarditis, etc)

Localizing pain -periumbilical

Pancreatitis
Obstruction
Early appendicitis
Small bowel
pathology
Gastroenteritis

Localizing pain -- pelvic

UTI
Prostatitis
Bladder outlet
obstruction
PID
Uterine pathology

Localizing pain -- diffuse

Gastroenteritis
Ischemia
Obstruction
DKA
IBS

Physical Examination Directed

General appearance
Vital Signs
Abdomen
Inspection
Auscultation
Percussion
Palpation

Physical Examination Directed

Pelvic
Genital
Back
Rectal
Head-to-toe

Differential Diagnosis
Appendicitis
Biliary colic,
cholecystitis,
cholangitis
Bowel obstruction
Diverticulitis
Ectopic pregnancy
Gastroenteritis
Intussuception
Mesenteric Ischemia
Ovarian torsion

Pancreatitis
Pelvic Inflammatory
Disease (PID)
Perforated peptic ulcer
Ruptured or leaking
abdominal aortic
aneurysm (AAA)
Testicular torsion
Ureteral colic
Volvulus

Diagnostic Testing
Laboratory Studies
CBC
Urinalysis
Pregnancy
Amylase/Lipase
Other

Electrocardiogram

Diagnostic Testing

- continued -

Radiologic Studies
Plain Films
Ultrasound
Computed Tomography

GEJALA KLINIS (PENUNJANG)

MUNTAH
NYERI MUNTAH : APENDISITIS
MUNTAH NYERI : GASTRO ENTERITIS
IKTERUS - HEPATOBILIER
HEMATURIA UROLOGI
OBSTIPASI G I
HAID

DIAGNOSA
DIAGNOSE MUST BE ESTABLISHED IN THE EARLIEST
POSSIBLE STAGE
KLINIS
SOAP
LABORATORIUM - STANDAR
Hb LEKOSIT, HCT,TROMBOSIT FAAL HEMOSTASIS
BIOKIMIA DARAH (INDIKASI)
AMYLASE
GLUKOSA
KREATININ
FAAL HEPAR

URINE
LENGKAP
RADIOLOGI
ABDOMEN POLOS BERBARING
ABDOMEN POLOS TEGAK/DEKUBITUS
DIAFRAGMA
THORAX
ULTRASONOGRAFI
ELEKTRO KARDIOGRAFI

Acute abdominal pain

Surgical

Appendicitis
Cholecystitis
Bowel obstruction
Acute mesenteric
ischemia
Perforation
Trauma
Peritonitis

Nonsurgical
Cholangitis
Pancreatitis
Nonabdominal
causes
Choledocholithiasis
Diverticulitis
PUD/-itis
gastroenteritis