REFRAT
REFRAT BEDAH ANBEDAH ANAK AK
APENDISI
APENDISITIS
TIS PA
PADA A
DA ANAK
NAK
OLEH : OLEH :
Hanif Hary Setyawan Hanif Hary Setyawan
G99142046 G99142046 E!B"!B"NG : E!B"!B"NG : #r$ S%war#i& S'B$ S'BA #r$ S%war#i& S'B$ S'BA
KEPANITERAAN KLINIK ILMU BEDAH KEPANITERAAN KLINIK ILMU BEDAH FAKUL
FAKULTTAS KEDOKTEAS KEDOKTERAN UNRAN UNS/ RSUS/ RSUD DR D DR MOEWAMOEWARDIRDI SURAKARTA
SURAKARTA 2015 2015
APENDISITIS PADA ANAK
I. DEFINISI
A'en#i(iti( a#a)a* (%at% 'era#an+an 'a#a a'en#i,($ era#an+an ini 'a#a %-%-nya #i(e.a.,an /)e* infe,(i yan+ -eny%-.at a'en#i,($ A'en#i(iti( a,%t a#a)a* ,ea#ian a,%t a.#/-en yan+ -e-er)%,an 'e-.e#a*an (e+era %nt%, -ene+a* ,/-')i,a(i ya+ )e.i* .%r%,$
II. ANATOMI APENDIKS
A'en#i,( -er%'a,an (%at% /r+an )i-f/i# (e'erti t/n(i)& 'ayer 'at* ana)/+ #en+an B%r(a Fa.ri%(3 yan+ -e-.ent%, 'r/#%, i--%n/+)/.%)in$ A''en#i,( a#a)a* (%at% (tr%,t%r ,ei)& .er.ent%, (e'erti ta.%n+ yan+ .er,ait -ene-'e) 'a#a .a+ian awa) #ari (e,%-$ an+,a)nya ter)eta, 'a#a '/(ter/-e#ia) ae%-$ a#a ")e/aea) %nti/n ter#a'atValvula Ileocecalis (Bauhini) #an 'a#a 'an+,a) a''en#i,( ter#a'at valvula appendicularis (Gerlachi). anan+ antara 5 10 -& #ia-eter 0& -$ L%-ennya (e-'it #i .a+ian 'r/,(i-a) #an -e)e.ar #i .a+ian #i(ta)$ A''en#i,( ter)eta, #i ,%a#ran ,anan .awa* a.#/-en$ Te'atnya #i i)e/(e%- #an -er%'a,an 'erte-%an ,eti+a taenia /)i taenia )i.era& taenia /)ia& #an taenia /-ent%-3$ Dari t/'/+rafi anat/-i& )eta, 'an+,a) a''en#i,( .era#a 'a#a titi, ! B%rney& yait% titi, 'a#a +ari( antara %-.i)i%( #an S"AS
,anan yan+ .erara, 17 #ari S"AS ,anan$1
A''en#i,( 8er-if/r-i( #i(an++a /)e* -e(/a'en#i,( -e(enteri/)%-3 yan+ .er+a.%n+ #en+an -e(enteri%- %(%( *a)%( 'a#a #aera* i)e%- ter-ina)e$ !e(enteri/)%- .eri(i a$ A'en#i,%)ari( a.an+ a$ i)e//)ia3$ Orifii%-nya ter)eta, 2& - #ari ,at%' i)e/ea)$ !e(/a'en#i,nya -er%'a,an arin+an )e-a, yan+ -e-'%nyai 'e-.%)%* a''en#iea) #an ter,a#an+ %+a -e-i)i,i )i-f/n/#i ,ei)$1
Str%,t%r a'en#i,( -iri' #en+an %(%( -e-'%nyai 4 )a'i(an yait% -%,/(a& (%.-%,/(a& -%(,%)ari( e,(terna'r/'ria /t/t )/n+it%#ina) #an (ir,%)er3 #an (er/(a$ A''en#i,( -%n+,in ti#a, ter)i*at ,arena a#anya -e-.ran a,(/n yan+ -er%'a,an )a'i(an 'erit/ne%- yan+ -enye.ar #ari .a+ian )atera) a.#/-en ,e i)e%- ter-ina)& -en%t%' ae%- #an a''en#i,($ La'i(an (%.-%,/(a ter#iri #ari
arin+an i,at #an arin+an e)a(ti, -e-.ent%, arin+an (araf& 'e-.%)%* #ara* #an )y-'*e$ Antara !%,/(a #an (%.-%,/(a ter#a'at )y-'*/n/#e($ !%,/(a ter#iri #ari (at% )a'i( /))%-nar e'it*e)i%- #an ter#iri #ari ,ant/n+ yan+ #i(e.%t ry'ta )ie.er,%*n$ Din#in+ #a)a- (a-a #an .er*%.%n+an #en+an (e,%- inner circular layer 3$ Din#in+ )%ar outer longitudinal muscle3 #i)a'i(i /)e* 'erte-%an ,eti+a taenia /))i 'a#a 'erte-%an ae%- #an a'en#i,($ Taenia anteri/r #i+%na,an (e.a+ai 'e+an+an %nt%, -enari a''en#i,($2
A''en#i,( 'erta-a ,a)i ta-'a, (aat 'er,e-.an+an e-.ri/)/+i -in++% ,e5; yait% .a+ian %%n+ #ari 'r/t%.eran( (e,%-$ a#a (aat antenata) #an '/(tnata)& 'ert%-.%*an #ari (e,%- yan+ .er)e.i* a,an -ena#i a'en#i,(& yan+ a,an .er'in#a* #ari -e#ia) -en%% ,at%' i)e/(e,a)$7
a#a .ayi& a'en#i,( .er.ent%, ,er%%t& )e.ar 'a#a 'an+,a)nya #an -enye-'it ,eara* %%n+nya$ Kea#aan ini -%n+,in -ena#i (e.a. ren#a*nya in(i#en a'en#i(iti( 'a#a %(ia it%$ a#a 6 < ,a(%(& a'en#i,( ter)eta, intra'erit/nea)$ Ke#%#%,an it% -e-%n+,in,an a'en#i,( .er+era, #an r%an+ +era,nya .er+ant%n+ 'a#a 'anan+ -e(/a'en#i,( 'en++ant%n+nya$ a#a ,a(%( (e)e.i*nya& a'e#i,( ter)eta, retr/'erit/nea)& yait% #i .e)a,an+ (e,%-& #i .e)a,an+ ,/)/n a(en#en(& ata% #ite'i )atera) ,/)/n a(en#en($ Gea)a ,)ini( a'en#i(iti( #itent%,an /)e* )eta, a'en#i,($1
eni( '/(i(i1:
r/-/nt/ri, : %%n+ a''en#i,( -en%n%, ,e ara* 'r/-/nt/ri%- (ari
Retr//)i : a''en#i,( .era#a #i .e)a,an+ ,/)/n a(en#en #an .ia(anya retr/'erit/nea)$
Anteaea) : a''en#i,( .era#a #i #e'an ae%-$
araaea) : a''en#i,( ter)eta, */ri=/nta) #i .e)a,an+ ae%-$ e)8i #e(en#en : a''en#i,( -en++ant%n+ ,e ara* 'e)8i( -in/r
Retr/aea) : intra'erit/nea) ata% retr/'erit/nea)> a''en#i,( .er'%tar ,e ata( ,e .e)a,an+ ae%-$
Ga-.ar 1$ ?aria(i '/(i(i a''en#i,($
A''en#i,( #i'er(arafi /)e* 'ara(i-'ati( #an (i-'ati($ er(arafan 'ara(i-'ati( .era(a) #ari a.an+ ner8%( 8a+%( yan+ -en+i,%ti arteri -e(enteri,a (%'eri/r #an arteri a''en#i,%)ari(& (e#an+,an 'er(arafan (i-'ati( .era(a) #ari ner8%( t*/ra,a)i( @$ O)e* ,arena it%& nyeri 8i(era) 'a#a a''en#i(iti( .er-%)a #i (e,itar %-.i)i,%($1
en#ara*an a''en#i,( .era(a) #ari arteri A''en#i,%)ari(& a.an+ #ari a$ ")e/ea)i(& a.an+ #ari a$ !e(enteria (%'eri/r$ A$ A''en#i,%)ari( -er%'a,an arteri tan'a ,/)atera)$ i,a arteri ini ter(%-.at& -i(a)nya ,arena tr/-./(i( 'a#a infe,(i& a''en#i,( a,an -en+a)a-i +an+ren$1
III. FISIOLOGI APPENDIKS
A''en#i,( -en+*a(i),an )en#ir 152 -) 'er*ari$ Len#ir #i%ra*,an ,e #a)a- )%-en #an (e)an%tnya -en+a)ir ,e (e,%-$ Ha-.atan a)iran )en#ir #i -%ara a''en#i,( ta-'a,nya .er'eran 'a#a 'at/+ene(i( a''en#i(iti($4
Din#in+ a''en#i,( ter#iri #ari arin+an )y-'*e yan+ -er%'a,an .a+ian #ari (i(te- i-%n #a)a- 'e-.%atan anti./#i$ "--%n/+)/.%)in (e,ret/ar yan+ #i*a(i),an /)e* GALT gut associated lymphoid tissue3 yan+ ter#a'at #i (e'anan+ (a)%ran erna ter-a(%, a''en#i,(& ia)a* "+A$ "-%n/+)/.%)in ter(e.%t (an+at efe,tif (e.a+ai 'e)in#%n+ ter*a#a' infe,(i$ Na-%n #e-i,ian& 'en+an+,atan a''en#i,( ti#a, -e-'en+ar%*i (y(te- i-%n t%.%* ,arena %-)a* arin+an )i-f/n/#i #i (ini ,ei) (e,a)i i,a #i.an#in+,an #en+an %-)a*nya #i (a)%ran erna #an #i (e)%r%* t%.%*$4
arin+an )y-'*/i# 'erta-a ,a)i -%n%) 'a#a a'en#i,( (e,itar 2 -in++% (ete)a* )a*ir$ %-)a*nya -enin+,at (e)a-a '%.erta(& #an -eneta' (aat #ewa(a #an ,e-%#ian .er,%ran+ -en+i,%ti %-%r$ Sete)a* %(ia 60 ta*%n& ti#a, a#a arin+an )y-'*/i# )a+i #i a'en#i,( #an tera#i /.)itera(i )%-en a'en#i,( ,/-')it$4
IV. ETIOLOGI
A'en#i(iti( a,%t #a'at #i(e.a.,an /)e* .e.era'a (e.a. tera#inya 'r/(e( ra#an+ .a,teri yan+ #iet%(,an /)e* .e.era'a fa,t/r 'enet%( #iantaranya Hi'er')a(ia arin+an )i-fe& fe,a)it*& t%-/r a'en#i,(& #an ain+ a(,ari( yan+ -eny%-.at$ )(era(i -%,/(a -er%'a,an ta*a' awa) #ari ,e.anya,an 'enya,it ini$ na-%n a#a .e.era'a fa,t/r yan+ -e-'er-%#a* tera#inya ra#an+ a'en#i,(& #iantaranya :
1$ Fa,t/r (%-.atan /.(tr%,(i3
Fa,t/r /.(tr%,(i -er%'a,an fa,t/r ter'entin+ tera#inya a'en#i(iti( 90<3 yan+ #ii,%ti /)e* infe,(i$ Se,itar 60< /.(tr%,(i #i(e.a.,an /)e* *y'er')a(ia arin+an)y-'*/i# (%. -%,/(a& 7< ,arena (ta(i( fe,a)& 4< ,arena .en#a a(in+ #an (e.a. )ainnya 1< #iantaranya (%-.atan /)e* 'ara(it #an ain+$ O.(tr%,(i yan+ #i(e.a.,an /)e* fe,a)it* #a'at #ite-%i 'a#a .er-aa-5-aa- a'en#i(iti( a,%t #iantaranya > fe,a)it* #ite-%,an 40< 'a#a ,a(%( a'en#i(iti( ,a(%( (e#er*ana& 6< 'a#a ,a(%( a'en#i(iti( a,%t +an++ren/(a tan'a r%'t%r #an 90< 'a#a ,a(%( a'en#i(iti( a,%t #en+an r%'t%re$
2$ Fa,t/r Ba,teri
"nfe,(i enter/+en -er%'a,an fa,t/r 'at*/+ene(i( 'ri-er 'a#a a'en#i(iti( a,%t$ A#anya fe,/)it* #a)a- )%-en a'en#i,( yan+ te)a* terinfe,(i -e-'er.%r%, #an -e-'er.erat infe,(i& ,arena tera#i 'enin+,atan (ta+na(i fe(e( #a)a- )%-en a'en#i,(& 'a#a ,%)t%r #i#a'at,an ter.anya, #ite-%,an a#a)a* ,/-.ina(i antara Bateri/#e( fra+i)i)i( #an E$/)i& )a)% S')an*i%(& )at/5.ai)%(& (e%#/-/na(& Bateri/#e( (')ani%($ Se#an+,an ,%-an yan+ -enye.a.,an 'erf/ra(i a#a)a* ,%-an anaer/. (e.e(ar 96< #an aer/.10<$
7$ Keen#er%n+an fa-i)iar
Ha) ini #i*%.%n+,an #en+an te#a'atnya -a)f/r-a(i yan+ *ere#iter #ari /r+an& a'en#i,( yan+ ter)a)% 'anan+& 8a(,%)ari(a(i yan+ ti#a, .ai, #an )eta,nya yan+ -%#a* tera#i a'en#i(iti($ Ha) ini %+a #i*%.%n+,an #en+an ,e.ia(aan -a,anan #a)a- ,e)%ar+a ter%ta-a #en+an #iet ren#a* (erat #a'at -e-%#a*,an tera#inya fe,/)it* #an -en+a,i.at,an /.(tr%,(i )%-en$
4$ Fa,t/r ra( #an #iet
Fa,t/r ra( .er*%.%n+an #en+an ,e.ia(aan #an '/)a -a,anan (e*ari5 *ari$Ban+(a ,%)it '%ti* yan+ #%)%nya '/)a -a,an ren#a* (erat -e-'%nyai re(i,/ )e.i* tin++i #ari ne+ara yan+ '/)a -a,annya .anya, (erat$ Na-%n (aat (e,aran+& ,ea#iannya ter.a)i,$ Ban+(a ,%)it '%ti* te)a* -er%.a* '/)a -a,an -ere,a ,e '/)a -a,an tin++i (erat$ %(tr% Ne+ara .er,e-.an+ yan+ #%)%nya -e-i)i,i tin++i (erat ,ini .era)i* ,e '/)a -a,an ren#a* (erat& -e-i)i,i re(i,/ a'en#i(iti( yan+ )e.i* tin++i$
V. PATOFISIOLOGI
A''en#i(iti( .ia(anya #i(e.a.,an /)e* 'eny%-.atan )%-en a'en#i,( /)e* *y'er')a(ia f/)i,e) )i-f/i#& fe,a)it& .en#a a(in+& (tri,t%r ,arena fi.r/(i( a,i.at 'era#an+an (e.e)%-nya& ata% ne/')a(-a$6
O.(tr%,(i )%-en yan+ tert%t%' #i(e.a.,an /)e* *a-.atan 'a#a .a+ian 'r/,(i-a)nya #an .er)an%t 'a#a 'enin+,atan (e,re(i n/r-a) #ari -%,/(a a'en#i,( yan+ #i(ten(i$ O.(tr%,(i ter(e.%t -neye.a.,an -%%( yan+ #i'r/#%,(i -%,/(a -en+a)a-i .en#%n+an$ !a,in )a-a -%%( ter(e.%t -a,in .anya,& na-%n e)a(ti(ita( #in#in+ a''en#i,( -e-'%nyai ,eter.ata(an (e*in++a -enye.a.,an 'enin+,atan intra)%-en$ Ka'a(ita( )%-en a'en#i,( n/r-a) *anya (e,itar 0&1 -)$ i,a (e,re(i (e,itar 0& #a'at -enin+,at,an te,anan inta)%-en (e,itar 60 -H20$ !an%(ia -er%'a,an (a)a* (at% #ari (e#i,it -a,*)%, *i#%' yan+ #a'at -en+,/-'en(a(i 'enin+,atan (e,re(i yan+ %,%' tin++i (e*in++a -ena#i +an+rene ata% tera#i 'erf/ra(i$6
Te,anan yan+ -enin+,at ter(e.%t a,an -enye.a.,an a'en#i,( -en+a)a-i *i'/,(ia& -en+*a-.at a)iran )i-fe& tera#i %)(era(i -%,/(a #an in8a(i .a,teri$ "nfe,(i -enye.a.,an 'e-.en+,a,an a'en#i,( .erta-.a* e#e-a3 #an (e-a,in i(,e-i, ,arena tera#i tr/-./(i( 'e-.%)%* #ara* intra-%ra) #in#in+ a'en#i,(3$ a#a (aat ini)a* tera#i a'en#i(iti( a,%t f/,a) yan+ #itan#ai /)e* nyeri e'i+a(tri%-$ Gan+ren #an 'erf/ra(i ,*a( #a'at tera#i #a)a- 24576 a-& ta'i wa,t% ter(e.%t #a'at .er.e#a5.e#a (etia' 'a(ien ,arena #itent%,an .anya, fa,t/r$6
Bi)a (e,re(i -%,%( ter%( .er)an%t& te,anan a,an ter%( -enin+,at$ Ha) ter(e.%t a,an -enye.a.,an /.(tr%,(i 8ena& e#e-a .erta-.a*& #an .a,teri a,an -ene-.%( #in#in+$ era#an+an ti-.%) -e)%a( #an -en+enai 'erit/ne%-(ete-'at (e*in++a -eni-.%),an nyeri #i#aera* ,anan .awa*$ Kea#aan ini #i(e.%t #en+anapendisitis supuratif akut $6
Bi)a ,e-%#ian arteri ter+an++% a,an tera#i infar, #in#in+ a'en#i,( yan+ #ii,%ti #en+an +an+rene$ Sta#i%- ini #i(e.%t #en+an a'en#i(iti( +an+ren/(a$ Bi)a #in#in+ yan+ te)a* ra'%* it% 'ea*& a,an tera#i apendisitis perforasi $6
Bi)a (e-%a 'r/(e( #iata( .era)an )a-.at& /-ent%- #an %(%( yan+ .er#e,atan a,an .er+era, ,eara* a'en#i,( *in++a ti-.%) (%at% -a((a )/a) yan+ #i(e.%t infiltrate apendikularis$ era#an+an a'en#i,( ter(e.%t #a'at -ena#i a.(e( ata% -en+*i)an+$6
Infiltrat apendikularis -er%'a,an ta*a' 'at/)/+i a'en#i(iti( yan+ #i-%)ai #i-%,/(a #an -e)i.at,an (e)%r%* )a'i(an #in#in+ a'en#i,( #a)a- wa,t% 2454; a- 'erta-a& ini -er%'a,an %(a*a 'erta*anan t%.%* #en+an -e-.ata(i 'r/(e( ra#an+ #en+an -en%t%' a'en#i,( #en+an /-ent%-& %(%( *a)%(& ata% a#ne,(a (e*in++a ter.ent%, -a((a 'eria'en#i,%)ar$ Di#a)a-nya #a'at tera#i ne,r/(i( arin+an .er%'a a.(e( yan+ #a'at -en+a)a-i 'erf/ra(i$ i,a ti#a, ter.ent%, a.(e(& a'en#i(iti( a,an (e-.%* #an -a((a 'eria'en#i,%)ar a,an -ena#i tenan+ %nt%, (e)an%tnya a,an -en+%rai #iri (eara )a-.at$6
a#a ana,5ana,& ,arena /-ent%- )e.i* 'en#e, #an a'en#i,( )e.i* 'anan+& #in#in+ a'en#i,( )e.i* ti'i($ Kea#aan ter(e.%t #ita-.a* #en+an #aya ta*an t%.%* yan+ -a(i* ,%ran+ -e-%#a*,an tera#inya 'erf/ra(i$ Se#an+,an
'a#a /ran+ t%a 'erf/ra(i -%#a* tera#i ,arena te)a* a#a +an++%an 'e-.%)%* #ara*$6
Kee'atan rentetan 'eri(tiwa ter(e.%t ter+ant%n+ 'a#a 8ir%)en(i -i,r//r+ani(-e& #aya ta*an t%.%*& fi.r/(i( 'a#a #in#in+ a'en#i,(& /-ent%-& %(%( yan+ )ain& 'erit/ne%- 'arieta)e #an %+a /r+an )ain (e'erti 8e(i,a %rinaria& %ter%( t%.a& -en/.a -e-.ata(i #an -e)/,a)i(ir 'r/(e( 'era#an+an ini$ Bi)a 'r/(e( -e)/,a)i(ir ini .e)%- (e)e(ai #an (%#a* tera#i 'erf/ra(i -a,a a,an ti-.%) 'erit/niti($ Ca)a%'%n 'r/(e( -e)/,a)i(ir (%#a* (e)e(ai teta'i -a(i* .e)%- %,%' ,%at -ena*an ta*anan ata% te+an+an #a)a- a8%- a.#/-ina)i(& /)e* ,arena it% 'en#eita *ar%( .enar5.enar i(tira*at .e#re(t3$6
A'en#i,( yan+ 'erna* -era#an+ ti#a, a,an (e-.%* (e-'%rna& teta'i a,an -e-.ent%, arin+an 'ar%t yan+ -enye.a.,an 'er)en+,etan #en+an arin+an (e,itarnya$ er)en+,etan ini #a'at -eni-.%),an ,e)%*an .er%)an+ #i'er%t ,anan .awa*$ a#a (%at% ,eti,a /r+an ini #a'at -era#an+ a,%t )a+i #an #inyata,an
-en+a)a-i e,(a(er.a(i a,%t$6
VI. GEJALA KLINIS
Ga-.aran ,)ini( yan+ (erin+ #i,e)%*,an /)e* 'en#erita& antara )ain6 1$ Nyeri a.#/-ina)
Nyeri ini -er%'a,an +ea)a ,)a(i, a''en#i(iti($ !%)a5-%)a nyeri #ira(a,an (a-ar5(a-ar #an t%-'%) yan+ -er%'a,an nyeri 8i(era) #i #aera* e'i+a(tri%- ata% (e,itar %-.i)i%($ Sete)a* .e.era'a a- nyeri .er'in#a* #an -eneta' #i a.#/-en ,anan .awa* titi, ! B%rney3$ Nyeri a,an .er(ifat taa- #an )e.i* e)a( )eta,nya (e*in++a .er%'a nyeri (/-ati, (ete-'at$ Bi)a tera#i 'eran+(an+an 'erit/ni%- .ia(anya 'en#erita a,an -en+e)%* nyeri #i 'er%t 'a#a (aat .era)an ata% .at%,$
2$ !%a)5-%nta* .ia(anya 'a#a fa(e awa)$ 7$ Naf(% -a,an -en%r%n$
4$ O.(ti'a(i #an #iare 'a#a ana,5ana,$
$ De-a-& tera#i .i)a (%#a* a#a ,/-')i,a(i& .i)a .e)%- a#a ,/-')i,a(i .ia(anya t%.%* .e)%- 'ana($ S%*% .ia(anya .er,i(ar 7&57;&
Gea)a a''en#i(iti( a,%t 'a#a ana,5ana, (erin+ ti#a, ('e(ifi,$ Gea)a awa)nya (erin+ *anya rewe) #an ti#a, -a% -a,an$ Ana, (erin+ ti#a, .i(a -e)%,i(,an ra(a nyerinya$ Karena +ea)a yan+ ti#a, ('e(ifi, ini (erin+ #ia+n/(i( a''en#i(iti( #i,eta*%i (ete)a* tera#i 'erf/ra(i$ A,i.atnya )e.i* #ari (e'ar/ 'en#erita .ar% #a'at #i#ia+n/(i( (ete)a* 'erf/ra(i$6
VII. PEMERIKSAAN FISIK
De-a- .ia(anya rin+an& #en+an (%*% (e,itar 7&57;&°$ Bi)a (%*% )e.i* tin++i& -%n+,in (%#a* tera#i 'erf/ra(i$ Bi(a ter#a'at 'er.e#aan (%*% a,(i)ar #an re,ta) (a-'ai 1°$6
1$ "n('e,(i
Ka#an+ (%#a* ter)i*at wa,t% 'en#erita .era)an (a-.i) .%n+,%, #an -e-e+an+ 'er%t$ en#erita ta-'a, ,e(a,itan$ a#a in('e,(i 'er%t ti#a, #ite-%,an +a-.aran ('e(ifi,$ Ke-.%n+ (erin+ ter)i*at 'a#a 'en#erita #en+an ,/-')i,a(i 'erf/ra(i$ en/n/)an 'er%t ,anan .awa* .i(a #i)i*at 'a#a -a((a ata% a.(e( a''en#i,%)er$6
2$ a)'a(i
Den+an 'a)'a(i #i #aera* titi, !$ B%rney #i#a'at,an tan#a5tan#a 'erit/niti( )/,a) yait%6:
− Nyeri te,an #i !$ B%rney − Nyeri )e'a(
− Defan( -%(%)ar )/,a)$ Defan( -%(%)ar -en%n%,,an a#anya ran+(an+an 'erit/ne%- 'arieta)$ a#a a''en#i,( )eta, retr/'erit/nea)& #efan( -%(%)ar -%n+,in ti#a, a#a& yan+ a#a nyeri 'in++an+$
Nyeri ran+(an+an 'erit/ne%- ti#a, )an+(%n+
− Nyeri te,an ,anan .awa* 'a#a te,anan ,iri R/8(in+3
− Nyeri ,anan .awa* .i)a te,anan #i (e.e)a* ,iri #i)e'a(,an B)%-.er+3 − Nyeri ,anan .awa* .i)a 'erit/ne%- .er+era, (e'erti nafa( #a)a-&
Appendisitis infiltrat ata% a#anya a.(e( a'en#i,%)er ter)i*at #en+an a#anya 'en/n/)an #i 'er%t ,anan .awa*$2
7$ A%(,%)ta(i
eri(ta)ti, %(%( (erin+ n/r-a)$ eri(ta)ti, #a'at *i)an+ ,arena i)e%( 'ara)iti, 'a#a 'erit/niti( +enera)i(ata a,i.at a''en#i(iti( 'erf/rata$6
e-eri,(aan /)/, #%.%r a,an #i#a'at,an nyeri ,%a#ran ,anan 'a#a a-9512$ a#a a''en#i(iti( 'e)8i,a a,an #i#a'at,an nyeri ter.ata( (ewa,t% #i)a,%,an /)/, #%.%r$ a#a a'en#i(iti( 'e)8i,a tan#a 'er%t (erin+ -era+%,an& -a,a ,%ni #ia+n/(i( a#a)a* nyeri ter.ata( (ewa,t% #i)a,%,an /)/, #%.%r$ /)/, #%.%r 'a#a ana, ti#a, #ian%r,an$ e-eri,(aan %i '(/a( #an %i /.t%rat/r -er%'a,an 'e-eri,(aan yan+ )e.i* #it%%,an %nt%, -en+eta*%i )eta, a'en#i,($ i '(/a( #i)a,%,an #en+an ran+(an+an -$ '(/a( )ewat *i'ere,(ten(i ata% f)e,(i a,tif$ Bi)a a'en#i,( yan+ -era#an+ -ene-'e) #i -$'(/a(& tin#a,an ter(e.%t a,an -eni-.%),an nyeri$ i /.t%rat/r #i+%na,an %nt%, -e)i*at a'a,a* a'en#i,( yan+ -era#an+ ,/nta, #en+an -$/.t%rat/r intern%( yan+ -er%'a,an #in#in+ 'an++%) ,ei)$ Den+an +era,an f)e,(i #an en#/r/ta(i (en#i 'an++%) 'a#a '/(i(i ter)entan+& 'a#a a'en#i(iti( 'e)8i,a a,an -eni-.%),an nyeri$6
Psoas s!"$ Nyeri 'a#a (aat 'a*a ,anan 'a(ien #ie,(ten(i,an$ a(ien #i-irin+,an ,e,iri$ e-eri,(a -e)%r%(,an 'a*a ,anan 'a(ien& 'a#a (aat it% a#a *a-.atan 'a#a 'in++%) 'an+,a) 'a*a ,anan$ Da(ar anat/-i #ari te( '(/a($ A'en#i,( yan+ -en+a)a-i 'era#an+an ,/nta, #en+an /t/t '(/a( yan+ -ere+an+ (aat #i)a,%,an -an%8er 'e-eri,(aan3$6 T#s O$%&'a%o'$ Nyeri 'a#a r/ta(i ,e#a)a- (eara 'a(if (aat 'a*a 'a(ien #if)e,(i,an$ e-eri,(a -en++era,,an t%n+,ai .awa* ,e)atera)& 'a#a (aat it% a#a ta*anan 'a#a (i(i (a-'in+ #ari )%t%t tan#a .intan+3& -en+*a(i),an r/ta(i fe-%r ,e#a)a-$6 Da(ar Anat/-i #ari te( /.t%rat/r : era#an+an a'en#i,( #i'e)8i( yan+ ,/nta, #en+an /t/t /.t%rat/r intern%( yan+ -ere+an+ (aat #i)a,%,an -an%8er$6
1$ e-eri,(aan
La./rat/ri%-a$ e-eri,(aan #ara* : a,an #i#a'at,an )e%,/(it/(i( 'a#a ,e.anya,an ,a(%( a''en#iiti( a,%t ter%ta-a 'a#a ,a(%( #en+an ,/-')i,a(i& 5rea,tif 'r/tein -enin+,at$ a#a a''en#i%)ar infi)trat& LED a,an -enin+,at$
.$ e-eri,(aan %rin : %nt%, -e)i*at a#anya eritr/(it& )e%,/(it #an .a,teri #i #a)a- %rin$ e-eri,(aan ini (an+at -e-.ant% #a)a- -enyin+,ir,an #ia+n/(i( .an#in+ (e'erti infe,(i (a)%ran ,e-i* ata% .at% +ina) yan+ -e-'%nyai +ea)a ,)ini( yan+ *a-'ir (a-a #en+an a''en#i(iti($
2$ A.#/-ina) @5Ray
Di+%na,an %nt%, -e)i*at a#anya fea)it* (e.a+ai 'enye.a. a''en#i(iti($ e-eri,(aan ini #i)a,%,an ter%ta-a 'a#a ana,5ana,$;
7$ SG
Bi)a *a(i) 'e-eri,(aan fi(i, -era+%,an& #a'at #i)a,%,an 'e-eri,(aan SG& ter%ta-a 'a#a wanita& %+a .i)a #i%ri+ai a#anya a.(e($ Den+an SG #a'at #i'a,ai %nt%, -enyin+,ir,an #ia+n/(i( .an#in+ (e'erti ,e*a-i)an e,t/'i,& a#neiti( #an (e.a+ainya$&;
4$ Bari%- ene-a
S%at% 'e-eri,(aan 5ray #en+an -e-a(%,,an .ari%- ,e /)/n -e)a)%i an%($ e-eri,(aan ini #a'at -en%n%,,an ,/-')i,a(i5,/-')i,a(i #ari a''en#i(iti( 'a#a arin+an (e,itarnya #an %+a %nt%, -enyin+,ir,an #ia+n/(i( .an#in+$ A''en#i/+ra- -e-i)i,i (en(iti8ita( #an tin+,at a,%ra(i yan+ tin++i (e.a+ai -et/#e #ia+n/(ti, %nt%, -ene+a,,an #ia+n/(i( a''en#i(iti( ,*r/ni($ Di-ana a,an ta-'a, 'e)e.aran'ene.a)an #in#in+ -%,/(a a''en#i,(& #i(ertai 'enye-'itan )%-en *in++a (%-.atan %(%( /)e* fe,a)it$
$ T5(an
Da'at -en%n%,,an tan#a5tan#a #ari a''en#i(iti($ Se)ain it% %+a #a'at -en%n%,,an ,/-')i,a(i #ari a''en#i(iti( (e'erti .i)a tera#i a.(e($; 6$ La'ar/(/'i
S%at% tin#a,an #en+an -en++%na,an ,a-era fi.er/'ti yan+ #i-a(%,an #a)a- a.#/-en& a''en#i,( #a'at #i8i(%a)i(a(i,an (eara
)an+(%n+$ Te*ni, ini #i)a,%,an #i .awa* 'en+ar%* ane(te(i %-%-$ Bi)a 'a#a (aat -e)a,%,an tin#a,an ini #i#a'at,an 'era#an+an 'a#a a''en#i,( -a,a 'a#a (aat it% %+a #a'at )an+(%n+ #i)a,%,an 'en+an+,atan a''en#i,($;
"@$ SISTEM SKOR ALVARADO
Dia+n/(i( a''en#i(iti( a,%t 'a#a ana, ti#a, -%#a* #ite+a,,an *anya .er#a(ar,an +a-.aran ,)ini(& *a) ini #i(e.a.,an (%)itnya ,/-%ni,a(i antara ana,& /ran+ t%a #an #/,ter$ Ana, .e)%- -a-'% %nt%, -en#i(,ri'(i,an ,e)%*an yan+ #ia)a-i& (%at% *a) yan+ re)atif )e.i* -%#a* 'a#a %-%r #ewa(a$ Kea#aan ini -en+*a(i),an an+,a a''en#i,t/-i ne+atif (e.e(ar 20< #an an+,a 'erf/ra(i (e.e(ar 20570<$ Sa)a* (at% %'aya -enin+,at,an ,%a)ita( #an ,%antita( 'e)ayanan -e#i( ia)a* -e-.%at #ia+n/(i( yan+ te'at$ Te)a* .anya, #i,e-%,a,an ara %nt%, -en%r%n,an in(i#en(i a'en#i,t/-i ne+atif& (a)a* (at%nya a#a)a* #en+an in(tr%-en (,/r A)8ara#/$
S,/r A)8ara#/ a#a)a* (i(te- (,/rin+ (e#er*ana yan+ .i(a #i)a,%,an #en+an -%#a*& e'at #an ,%ran+ in8a(if$ A)fre#/ A)8ara#/ ta*%n 19;6 -e-.%at (i(te- (,/r yan+ #i#a(ar,an 'a#a tiga gejala , tiga tanda dan dua temuan laboratorium$ K)a(ifi,a(i ini .er#a(ar,an 'a#a te-%an 'ra /'era(i #an %nt%, -eni)ai #eraat ,e'ara*an a'en#i(iti($ Da)a- (i(te- (,/r A)8ara#/ ini -en++%na,an fa,t/r ri(i,/ -e)i'%ti -i+ra(i nyeri& an/re,(ia& na%(ea #an ata% 8/-it%(& nyeri te,an #i a.#/-en ,%a#ran ,anan .awa*& nyeri )e'a( te,an& Te-'erat%r )e.i* #ari 7&20& )e,/(it/(i( #an netr/fi) )e.i* #ari <$ Nyeri te,an ,%a#ran ,anan .awa* #an )e,/(it/(i( -e-'%nyai ni)ai 2 #an ,eena- (i(anya -a(in+5-a(in+ -e-'%nyai ni)ai 1& (e*in++a ,e#e)a'an fa,t/r ini -e-.eri,an %-)a* (,/r 10$9
S(o' A)*a'a+o %nt%, #ia+n/(i( a''en#i(iti( a,%t:9
G#,a)a +a" %a"+a- S(o'
Nyeri .er'in#a* 1
An/re,(ia 1
Nyeri f/((a i)ia,a ,anan 2 Nyeri )e'a( 1 enin+,atan (%*% 7&70 1 %-)a* )e%,/(it 10107L 2 %-)a* ne%tr/fi) < 1 T/ta) (,/r: 10
Keteran+an A)a8ara#/ (/re :9
Dinyata,an a''en#iiti( a,%t .i)a '/int
!/#ifie# A)8ara#/ (/re Ka)an et a)3 tan'a /.(er8a(i /f He-at/+ra-: 1 4 #i'erti-.an+,an a''en#iiti( a,%t
6 '/((i.)e a''en#iiti( ti#a, 'er)% /'era(i 9 a''en#iiti( a,%t 'er)% 'e-.e#a*an enan+anan .er#a(ar,an (,/r A)8ara#/ :
1 4 : /.(er8a(i 6 : anti.i/ti, 10 : /'era(i #ini
. DIAGNOSIS BANDING
1$ Ga(tr/enteriti(
a#a +a(tr/enteriti(& -%a)5-%nta* #an #iare -en#a*%)%i ra(a (a,it$ Sa,it 'er%t )e.i* rin+an #an ti#a, .er.ata( te+a($ Hi'er'eri(ta)ti, (erin+ #ite-%,an$ ana( #an )e%,/(it/(i( ,%ran+ -en/n/) #i.an#in+,an #en+an a''en#i(iti($
2$ Li-fa#eniti( -e(enteria
Bia(anya #i#a*%)%i /)e* enteriti( ata% +a(tr/enteriti($ Ditan#ai #en+an nyeri 'er%t yan+ (a-ar5(a-ar ter%ta-a #i(e.e)a* ,anan& #an #i(ertai #en+an 'era(aan -%a)5-%nta*$
7$ ")eiti( a,%t
Ber,aitan #en+an #iare #an (erin+ ,a)i riwayat ,r/ni(& teta'i ti#a, aran+ an/reia& -%a)& -%nta*$ i,a #ite-%,an 'a#a )a'ar/t/-i&
a''en#i,t/-i in(i#enta) #iin#i,a(i,an %tnt%, -en+*i)an+,an +ea)a yan+ -e-.in+%n+,an$
4$ DHF
a#a 'enya,it ini 'e-eri,(aan #ara* ter#a'at tr/-./(it/'eni& )e%,/'eni& r%-')e )ee# I3& *e-at/,rit -enin+,at$
$ era#an+an 'e)8i(
T%.a fa))/'i ,anan #an /8ari%- ter)eta, #e,at a''en#i,($ Ra#an+ ,e#%a /r+an ini (erin+ .er(a-aan (e*in++a #i(e.%t (a)'in+/5//f/riti( ata% a#neiti($ nt%, -ene+a,,an #ia+n/(i( 'enya,it ini #i#a'at,an riwayat ,/nta, (e%a)$ S%*% .ia(anya )e.i* tin++i #ari'a#a a''en#i(iti( #an nyeri 'er%t .a+ian .awa* )e.i* #if%($ Bia(anya #i(ertai #en+an ,e'%ti*an$ a#a
/)/, 8a+ina) i,a %ter%( #iay%n,an -a,a a,an tera(a nyeri$ 6$ Di8erti%)iti(
!e(,i'%n #i8er%)iti( .ia(anya ter)eta, #i 'er%t .a+ian ,iri& teta'i ,a#an+5,a#an+ #a'at %+a tera#i #i (e.e)a* ,anan$ i,a tera#i 'era#an+an #an r%'t%r 'a#a #i8erti%)%- +ea)a ,)ini( a,an (%,ar #i.e#a,an #en+an +ea)a5+ea)a a''en#i(iti($
$ Bat% %reter ata% .at% +ina)
A#anya riwayat ,/)i, #ari 'in++an+ ,e 'er%t -ena)ar ,e in+%ina) ,anan -er%'a,an +a-.aran yan+ ,*a($ He-at%ria (erin+ #ite-%,an$ F/t/ '/)/( a.#/-en ata% %r/+rafi intra8ena #a'at -e-a(ti,an 'enya,it ter(e.%t$
I. TATA LAKSANA
Bi)a #ia+n/(i( ,)ini( (%#a* e)a( -a,a tin#a,an 'a)in+ te'at a#a)a* a'en#e,t/-i #an -er%'a,an (at%5(at%nya 'i)i*an yan+ ter.ai,$ en%n#aan a'en#e,t/-i (a-.i) -e-.eri,an anti.i/ti, #a'at -en+a,i.at,an a.(e( ata% 'erf/ra(i$ "n(i#en(i a''en#i,( n/r-a) yan+ #i)a,%,an 'e-.e#a*an (e,itar 20<$
a#a a''en#i(iti( a,%t tan'a ,/-')i,a(i ti#a, .anya, -a(a)a*$
era)anan 'at/)/+i( 'enya,it #i-%)ai 'a#a (aat a'en#i,( -ena#i #i)in#%n+i /)e* /-ent%- #an +%)%n+an %(%( *a)%( #i#e,atnya$ !%)a5-%)a& -a((a yan+ ter.ent%, ter(%(%n ata( a-'%ran -e-.in+%n+,an .an+%nan5.an+%nan ini #an arin+an +ran%)a(i #an .ia(anya #a'at (e+era #ira(a,an (eara ,)ini($ i,a
'era#an+an 'a#a a'en#i,( ti#a, #a'at -en+ata(i rintan+an5rintan+an (e*in++a 'en#erita ter%( -en+a)a-i 'erit/niti( %-%-& -a((a ta#i -ena#i teri(i nana*&
(e-%)a #a)a- %-)a* (e#i,it& teta'i (e+era -ena#i a.(e( yan+ e)a( .ata(nya$ r%t5%r%tan 'at/)/+i( ini -er%'a,an -a(a)a* .a+i a*)i .e#a*$ !a(a)a* ini a#a)a* .i)a-ana 'en#erita #ite-%i )ewat (e,itar 4; a-& a*)i .e#a* a,an -en+/'era(i %nt%, -e-.%an+ a'en#i,( yan+ -%n+,in +an+rene #ari #a)a--a((a 'er)e,atan rin+an yan+ )/n++ar #an (an+at .er.a*aya& #an .i)a-ana ,arena -a((a ini te)a* -ena#i )e.i* terfi,(a(i #an 8a(%)ar& (e*in++a -e-.%at /'era(i .er.a*aya -a,a *ar%( -en%n++% 'e-.ent%,an a.(e( yan+ #a'at -%#a*
#i#raina(e$
!a((a a'en#i,( tera#i .i)a tera#i a'en#i(iti( +an+ren/(a ata% -i,r/'erf/ra(i #it%t%'i ata% #i.%n+,%( /)e* /-ent%- #an ata% )e,%, %(%( *a)%($ a#a -a((a 'eria'en#i,%)ar yan+ 'en#i#in+annya .e)%- (e-'%rna& #a'at tera#i 'enye.aran '%( ,e(e)%r%* r/n++a 'erit/ne%- i,a 'erf/ra(i #ii,%ti 'erit/niti( '%r%)enta +enera)i(ata$ O)e* ,arena it%& -a((a 'eria'en#i,%)ar yan+ -a(i* .e.a( #i(aran,an (e+era #i/'era(i %nt%, -ene+a* 'eny%)it ter(e.%t$ Se)ain it%& /'era(i )e.i* -%#a*$ a#a ana,& #i'er(ia',an %nt%, /'era(i #a)a- wa,t% 257 *ari$
!a((a a'en#i,( #en+an 'r/(e( ra#an+ yan+ -a(i* a,tif (e.ai,nya #i)a,%,an tin#a,an 'e-.e#a*an (e+era (ete)a* 'a(ien #i'er(ia',an& ,arena #i,%atir,an a,an tera#i a.(e( a'en#i,( #an 'erit/niti( %-%-$ er(ia'an #an 'e-.e#a*an *ar%( #i)a,%,an (e.ai,5.ai,nya -en+in+at 'eny%)it infe,(i )%,a
)e.i* tin++i #ari'a#a 'e-.e#a*an 'a#a a'en#i(iti( (e#er*ana tan'a 'erf/ra(i$ a#a 'eria'en#i,%)ar infi)trat& #i)aran+ %nt%, -e-.%,a 'er%t& tin#a,an .e#a* a'a.i)a #i)a,%,an a,an )e.i* (%)it #an 'er#ara*an )e.i* .anya,& )e.i*5)e.i* .i)a -a((a a'en#i,( te)a* ter.ent%, )e.i* #ari (at% -in++% (ea, (eran+an (a,it 'er%t$ e-.e#a*an #i)a,%,an (e+era .i)a #a)a- 'erawatan tera#i a.(e( #en+an
ata% '%n tan'a 'erit/niti( %-%-$6
Tera'i (e-entara %nt%, ;512 -in++% a#a)a* ,/n(er8atif (aa$ a#a ana, ,ei)& i,a (eara ,/n(er8atif ti#a, -e-.ai, ata% .er,e-.an+ -ena#i a.(e(& #ian%r,an /'era(i (ee'atnya$6
Bi)a 'a#a wa,t% -e-.%,a 'er%t ter#a'at 'eria'en#i,%)ar infi)trat -a,a )%,a /'era(i #it%t%' )a+i& a'en#i,( #i.iar,an (aa$ Tera'i ,/n(er8atif 'a#a 'eria'en#i,%)ar infi)trat :
1$ T/ta) .e# re(t '/(i(i faw)er a+ar '%( ter,%-'%) #i a8%- #/%+)a((i$ 2$ Diet )%na, .%.%r (arin+
7$ Anti.i/ti,a 'arentera) #a)a- #/(i( tin++i& anti.i/ti, ,/-.ina(i yan+ a,tif ter*a#a' ,%-an aer/. #an anaer/.$ Sete)a* ,ea#aan tenan+& (e,itar 65; -in++% ,e-%#ian& #i)a,%,an a'en#i,t/-i$ A'a.i)a tera#i a.(e(& #ian%r,an #raina(e (aa$ i,a ternyata ti#a, a#a ,e)%*an ata% +ea)a a'a'%n& #an 'e-eri,(aan a(-ani #an )a./rat/ri%- ti#a, -en%n%,,an tan#a ra#an+ ata%
a.(e(& #a'at #i'erti-.an+,an -e-.ata),an tin#a,an .e#a*$
en#erita 'eria'en#i,%)ar infi)trat #i/.(er8a(i (e)a-a 6 -in++% tentan+ :
• LED
• %-)a* )e%,/(it
• !a((a
eria'en#i,%)ar infi)trat #ian++a' tenan+ a'a.i)a :
1$ Ana-e(a : 'en#erita (%#a* ti#a, -en+e)%* (a,it ata% nyeri a.#/-en 2$ e-eri,(aan fi(i, :
o Kea#aan %-%- 'en#erita .ai,& ti#a, ter#a'at ,enai,an (%*% t%.%* #i%,%r
reta) #an a,(i)er3
o Tan#a5tan#a a'en#i(iti( (%#a* ti#a, ter#a'at
o !a((a (%#a* -en+ei) ata% -en+*i)an+& ata% -a((a teta' a#a teta'i )e.i*
,ei) #i.an#in+ (e-%)a$
o La./rat/ri%- : LED ,%ran+ #ari 20& Le%,/(it n/r-a)
O'era(i 'eria'en#i,%)ar infi)trat #a'at #i)a,%,an a'a.i)a: 1$ Bi)a LED te)a* -en%r%n ,%ran+ #ari 40
2$ Ti#a, #i#a'at,an )e%,/(it/(i(
7$ Ti#a, #i#a'at,an -a((a ata% 'a#a 'e-eri,(aan .er%)an+ -a((a (%#a* ti#a, -en+ei) )a+i$
Bi)a #a)a- ;512 -in++% -a(i* ter#a'at tan#a5tan#a infi)trat ata% ti#a, a#a 'er.ai,an& /'era(i teta' #i)a,%,an$ Bi)a a#a -a((a 'eria'en#i,%)ar yan+ fie#& ini .erarti (%#a* tera#i a.(e( #an tera'i a#a)a* #raina(e$
APPENDEKTOMI
La'i(an ,%)it yan+ #i.%,a 'a#a A''en#e,t/-i :
1$ %ti( 6$ !O"
2$ S%. %ti( $ !$ Tran(8er(%(
7$ Fa(ia Sarfa ;$ Fa(ia tran(8er(a)i(
4$ Fa(ia a-fer 9$ re
erit/ne%-$ A'/ne%r/(i( !OE 10$
erit/ne%-Gari( in(i(i 'a#a a''en#e,t/-i10: 1$ "n(i(i Gri#ir/n
"n(i(i Gri#ir/n 'a#a titi, !B%rney$ Gari( in(i(i 'ara))e) #en+an /t/t /.)i,%( e,(terna)& -e)ewati titi, !B%rney yait% 17 )atera) +ari( yan+ -en+*%.%n+,an ('ina )ia,a anteri/r (%'eri/r ,anan #an %-.i)i,%($
2$ Lanztran(8er(e incision
"n(i(i #i)a,%,an 'a#a 2 - #i .awa* '%(at& in(i(i tran(8er(a) 'a#a +ari( -i,)a8i,%)a5-i#in+%ina)$ !e-'%nyai ,e%nt%n+an ,/(-eti, yan+ )e.i* .ai, #ari 'a#a in(i(i +ri#ir/n$
7$ "n(i(i 'ara-e#ian ,anan .awa*
"n(i(i 8erti,a) 'ara)e) #en+an -i#)ine& 2& - #i .awa* %-.i)i,%( (a-'ai #i ata( '%.i($
4$ R%t*erf/r# !/ri((/nJ( ini(i/n in(i(i (%'rain+%ina)3
!er%'a,an in(i(i 'er)%a(an #ari in(i(i !B%rney$ Di)a,%,an i,a a'en#i,( ter)eta, #i 'ara(e,a) ata% retr/(e,a) #an terfi,(ir$
II. KOMPLIKASI
K/-')i,a(i yan+ 'a)in+ (erin+ #ite-%,an a#a)a* 'erf/ra(i& .ai, .er%'a 'erf/ra(i .e.a( -a%'%n 'erf/ra(i 'a#a a'en#i,( yan+ te)a* -en+a)a-i
'en#in#in+an .er%'a -a((a yan+ ter#iri ata( ,%-'%)an a'en#i,(& (e,%-& #an )e,%, %(%( *a)%($6
erf/ra(i #a'at -enye.a.,an ti-.%)nya a.(e( )/,a) ata%'%n (%at% 'erit/niti( +enera)i(ata$ Tan#a5tan#a tera#inya (%at% 'erf/ra(i a#a)a* :6
• Nyeri )/,a) 'a#a f/((a i)ia,a ,anan .er+anti -ena#i nyeri a.#/-en
-enye)%r%*
• S%*% t%.%* nai, tin++i (e,a)i$ • Na#i (e-a,in e'at$
• Defane !%(,%)ar yan+ -enye)%r%* • Bi(in+ %(%( .er,%ran+
• er%t #i(ten#e#
A,i.at )e.i* )an%t #ari 'erit/niti( +enera)i(ata a#a)a* ter.ent%,nya :6
• e)8i A.(e(( • S%.'*reni a.(e((
• "ntra 'erit/nea) a.(e( )/,a)$43
erit/niti( -er%'a,an infe,(i yan+ .er.a*aya ,arena .a,teri -a(%, ,er/n++a a.#/-en& #a'at -enye.a.,an ,e+a+a)an /r+an #an ,e-atian$
III. PROGNOSIS
Den+an #ia+n/(i( yan+ a,%rat (erta 'e-.e#a*an tin+,at -/rta)ita( #an -/r.i#ita( 'enya,it ini (an+at ,ei)$ Keter)a-.atan #ia+n/(i( a,an -enin+,at,an -/r.i#ita( #an -/rta)ita( .i)a tera#i ,/-')i,a(i$ Seran+an .er%)an+ #a'at tera#i .i)a a''en#i,( ti#a, #ian+,at$6
DAFTAR STAKA
1$
?an De Graaff$ H%-an Anat/-y 6t* E#$New /r,: ! Graw Hi))$ 2001$ 2$ Gartner L& Hiatt L$ /)/r Tet.//, /f Hi(t/)/+y 7r# E#$ !a((a*%(et(: Sa%n#er($ 2002$7$ Sa#)er TC$ Lan+-anJ( !e#ia) E-.ri/)/+y 9t* E#$ New /r,: ! Graw Hi))$ 2002$
4$ G%yt/n A& Ha)) E$ Tet.//, /f !e#ia) *y(i/)/+y 11t* E#$ *i)a#e)'*ia: Sa%n#er($ 2006$
$ Ba(*in SK et a)$?er-if/r- A''en#i an# A%te A''en#iiti($ K Siene$200$
6$ De /n+ C& Sa-(%*i#aat R$ Buku Ajar Ilmu Bedah disi !$ a,arta : EG$ 2004$
$ rai+ S$ A''en#iiti( #i *tt':e-e#iine$-e#(a'e$/-arti)e7;95 /8er8iew
;$ H%-e( D& Si-'(/n $ A%te A''en#iiti($ B!$ 200
9$ K*an "$ A'')iati/n /f A)8ara#/ S/rin+ Sy(te- in Dia+n/(i( /f A%te A''en#iiti($ Ay%. !e#ia) /))eti/n$ 200$
10$ N//r& A$& %tra& DA$& O,ta8iati& Syaif%)& RA$& A-a)ia*& R$ 2011& "enatalaksanaan Appendisitis# a,arta: Be#a* -%-& De'arte-en ")-%
