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APPENDISITIS
STELLA ARZSA SARAHNAZ
1410211052

ANATOMI

Panjang

= 3 15 cm
Pangkal sekum
Lumen sempit melebar (pd bayi kebalikannya)

 Inervasi

Parasimpatis = cabang N.Vagus yg mengikuti a.mesenterica

superior &a.apendikularis
Simpatis = dari N. Thorakalis X nyeri visceral pd
appendicitis bermula di sekitar umbilikus

Vaskularisasi

A.apendikularis tanpa kolateral jika infeksi

thrombosis tersumbat gangren

FISIOLOGI
Lendir(mucus)
GALT

= 1-2 ml/day ke sekum

(Gut associated lymphoid tissue) ada di sepanjang

sal.cerna, termasuk appendiks Imunoglobulin sekretoar IgA

Jar.limfe

di appendiks sedikit diangkat no problem

DEFINISI

inflammation of the
inner lining of the vermiform appendix that
Appendicitis is defined as an

spreads to its other parts.

remains a clinical emergency and is one of the more

common causes of acute abdominal pain

ETIOLOGI
OBSTRUKSI

Hiperplasia dr folikel limfoid (terbanyak)

Faekolit dlm lumen appendiks
Benda asing : biji2an
Striktura lumen krn fibrosa akibat peradangan sebelumnya
tumor apendiks
Erosi mukosa oleh cacing askaris dan E.histolytica.

INFEKSI

Infeksi m.o dr kolon : E.coli, Streptococcus

EPIDEMIOLOGI

SU
,

10-30 th (: = 2:1)
Jarang <1 th

WHO

2002: mortalitas 22.000 ( =

12.000)
Negara maju >>>
Apendisitis perforata

18

50

KLASIFIKASI(Histopatologis)
Apendisitis

Sedikit eksudat neutrofil di M,SM,MP

Lumen eritem, bergranular
Infiltrasi netrofil di PD ringan

Apendisitis

akut stadium dini

supuratif akut

Byk eksudat netrofil

Ulseratif, & focus nekrosis di mukosa

Appendisitis

gangrenosa akut

Ulkus kehijauan di mukosa

Nekrosis gangrenosa hijau tua di seluruh lap. dinding mudah rupture peritonitis

PATOGENESIS

Apendisitis
Akut stadium dini

Apendisitis
supuratif akut

Apendisitis
gangrenosa

MANIFESTASI KLINIS
Nyeri

abd KKB
Demam, mual, muntah
nafsu makan
Appendiks melingkar di belakang sekum, nyeri tekan dapat terasa
di lumbal
Bila ujungnya ada pada pelvis, tanda2 ini hanya dpt diket.pd
pex.rektal
Appendiks rupture = appendiks perforate nyeri lebih
menyebar bahkan ke seluruh region abdomen + distensi abd +
kondisi memburuk

PEMERIKSAAN FISIK
Demam

tdk terlalu tinggi

37.5 38.5
>>> = perforasi

Inspeksi

Abdomen datar / sedikit cembung

Perforasi distensi abdomen

Palpasi

Muscular rigidity (+) pd bag.bawah otot rectum dpt terjadi

Nyeri tekan (+) Mc.Burney, bs jg nyeri lepas
Rovsing Sign (+)
Psoas sign (+)
Obturator Sign (+)
Dunphy Sign (+)
Blomberg Sign (+)

Mc.Burneys Point
McBurney's point is the most tender area of the abdomen of patients in the early stage
of appendicitis
appendicitis could be detected by applying pressure to a particular point in the right
lower abdomen / seat of greatest pain
One third distance along the line, closest to iliac spine

Rovsings Sign
Nyeri alih
Palpasi abdomen kiri bawah lepas cepat2 nyeri abdomen kanan bawah
Kalo sakit = an inflamed organ/tissue in that quadrant
While this maneuver stretches the entire peritoneal lining, it only causes pain
in any location where the peritoneum is irritating the muscle.
Direct contact between the parietal peritoneum of the abdominal wall and the
inflamed appendix
Tekan di kuad kiri bawah (kolon desenden) gas menujuke ileusekum tek.
di sekitar apendiks sakit
Kalo nyeri di kiri/kanan-kiri related to the bladder, uterus, ascending (right)
colon, fallopian tubes, ovaries

Video
http://www.medical-institution.com/rovsing-sign-video-

physical-exam-usmle-step-2-cs/
Size

kegedean lama uploadnya maap

Psoas Sign

Obturator Sign

Bloombergs Sign

Dunphy Sign
Sharp pain in the RLQ elicited by a voluntary cough
Suggests localized peritonitis

PEMERIKSAAN PENUNJANG
Lab

Leukositosis
10.000

18.000
Perforata > 18.000
Radiologi
Colok

dubur (Rectal Touche)

CT Scan
Laparoscopi

Radiologi
Barium appendiks (appendicogram) liat kotoran dalam
lumen appendiks

Foto

Colok Dubur (Rectal Touche)

Nyeri

Kuadran kanan pd jam 9 12

Pd Appendisitis pelvika nyeri terbatas saat dilakukan
colok dubur

CT-Scan
Tanda2

appendicitis
Melihat komplikasi , ex : abses

Laparoskopi
Dapat

sekaligus langsung pengangkatan appendiks

DIAGNOIS SKOR ALVORADO

PENATALAKSANAAN

PreOperatif

Dirawat, bedrest
Antibiotik
Antipiretik
Puasa

Operatif appendiktomi
PostOperatif

Duduk tegak di tempat tidur selama 2 x 30 menit

Next day = makanan lunak, diri tegak di luar kamar
7th day = luka jahitan diangkat, pulang

KOMPLIKASI
Appendicular

infiltrate
Infiltrat / massa yg terbentuk akibat
mikro/makroperforasi, kemudian tertutupi oleh
omentum/usus halus/usus besar
Perforasi
Peritonitis
Syok septik
GG.peristaltic
Ileus

PROGNOSIS
sembuh spontan tanpa penyulit
Menunda pengobatan / operasi perforasi peritonitis
Appendiktomi

REFERENSI
http://

www.nhs.uk/Conditions/appendicitis/Pages/Introduction.aspx
http://
www.mayoclinic.org/diseases-conditions/appendicitis/basics/def
inition/con-20023582
Dorland
http://
www.medicinenet.com/script/main/art.asp?articlekey=8346
http://www.fpnotebook.com/surgery/exam/McbrnysPnt.htm
http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2034810/pdf/brmedj031
62-0029.pdf
http://www.medical-institution.com/rovsing-sign-video-physicalexam-usmle-step-2-cs/