APENDISITIS

Ronny S,dr,SpOT
PANJANGNYA
KIRA-KIRA

ADA
KESAMAAN
Anatomi
 Berasal dari MID GUT
 Di fossa iliaka kanan  titik Mc.
Burney
 Basis di puncak sekum  pertemuan
3 taenia
 Bentuk tabung, panjang 3 – 15 cm
 Pangkal lumen sempit, distal lebar
 Lokasi : retrosekal (65%), pelvinal,
antesekal, medial, preileal,postileal, dll
 Vaskularisasi  A.apendikularis (end
arteri)
 Inervasi  N.vagus dan thorakalis X
Definition

Appendicitis is a condition
characterized by inflammation
of the appendix. It is classified
as a medical emergency and
many cases require removal of
the inflamed appendix, either by
laparotomy or laparoscopy.

Untreated, mortality is
high, mainly because of
the risk of rupture leading
to peritonitis and shock
Etiology

Foreign object

Fecalith Neoplasma

Hiperplasia Obstruksi
Lymphoid Parasit
Lumen
Patogenesis
Patogenesis
Obstru tekanan intra
ksi luminer tinggi

edema +
ulserasi mukus >>>
mukosa

gangguan
drainase
APENDISITIS AKUT limfe

Symptoms :
- Nyeri visera di epigastrium, sekitar umbilicus
- Mungkin Kolik
 Patogenesis Tekanan
Intralumen obstruksi
Appendisitis Tinggi
vena

invasi
kuman Trombosis

Iskemia
edema
semakin
APENDISITIS AKUT SUPURATIF / PURULENTA
berat
Symptoms
- Nyeri sentral berpindah ke perut kanan bawah
- Nyeri somatik ( peritonitis lokal)
- Mual dan muntah
 Gejala Klinis

Nyeri samar- Nyeri pada titik

samar dan tumpul Mcburney

Mual dan kadang

Sakit bertambah
ada muntah

Konstipasi/diare
 Pemeriksaan Fisik
KEADAAN UMUM INSPEKSI PALPASI

• Demam 0 ringan0  • Tidak tampak kelainan • Nyeri tekan perut

37,5
0 – 38,5 C (beda • Penonjolan perut kanan bawah (Mc
1 C rektal dan aksiler kanan bawah  Burney)
sudah bermakna) INFILTRAT ATAU ABSES • Massa di perut kanan
• Demam tinggi  • Cembung ikut gerak bawah  INFILTRAT
infiltrat, abses, nafas  PERFORASI ATAU ABSES
peritonitis / PERITONITIS • Defans lokal  defans
• Nadi cepat  infiltrat, menyeluruh  sudah
abses, peritonitis PERITONITIS
• Kurang bergerak, paha • BLUMBERG SIGN ,
difleksikan ROVSING SIGN
• OBTURATOR SIGN,
PSOAS SIGN
 McBurney’s Point

McBurney’s point (1) appears about one-

third of the distance along a line starting at
the right ASIS (3) and ending at the
umbilicus (2).
 The psoas sign. Pain on passive extension
Anatomic basis for the psoas sign:
of the right thigh. Patient lies on left side.
inflamed appendix is in a
Examiner extends patient's right thigh while
retroperitoneal location in contact with
applying counter resistance to the right hip
the psoas muscle, which is stretched
(asterisk).
by this maneuver.
The obturator sign. Pain on passive internal
Anatomic basis for the obturator sign:
rotation of the flexed thigh. Examiner
inflamed appendix in the pelvis is in
moves lower leg laterally while applying
contact with the obturator internus
resistance to the lateral side of the knee
muscle, which is stretched by this
(asterisk) resulting in internal rotation of
maneuver.
the femur.
 Pemeriksaan Fisik

PERKUSI AUSKULTASI COLOK DUBUR

• Nyeri ketok • Peristaltik • Nyeri pukul 10

perut kanan normal – 11  LETAK
bawah • Bising usus PELVINAL
• Pekak hepar menghilang • Sfingter
hilang   longgar 
PERFORASI PERITONITIS bila
(sering pekak PERITONITIS
ada)
 Pemeriksaan Penunjang

Laboratorium:
Peningkatan jumlah
Foto polos abdomen Ultrasonografi
leukosit
CRP, Urinalisa

CT-scan Laparoskopi Histopatologi

COMPUTED TOMOGRAPHY

In fewer than 5 percent of patients, an

opaque fecalith may be apparent in the
right lower quadrant. Plain abdominal
films generally are not recommended
unless other conditions(e.g., perforation,
intestinal obstruction, ureteral calculus)
are suspected.8 Likewise, as advanced
cross-sectional imaging techniques have
become available, barium enema is now
used infrequently.
 ULTRASONOGRAPHY

Ultrasonogram showing
longitudinal section (arrows) of
inflamed appendix.
COMPUTED TOMOGRAPHY

Computed tomographic
scan showing cross-
section of inflamed
appendix (A) with
appendicolith (a).

Computed tomographic
scan showing enlarged
and inflamed appendix
(A) extending from the
cecum (C).
 Alvarado Scale for the Diagnosis of Appendicitis

Manifestations Value
Symptoms Migration of pain 1
Anorexia 1
Nausea and/or vomiting 1
Signs Right lower quadrant tenderness (Nyeri 2
fossa iliaca kanan)
Rebound (Nyeri lepas) 1
Elevated temperature (> 37,30C ) 1
Laboratory values Leukocytosis (> 10×103/L ) 2
Left shift in leukocyte count 1
(neutrofil > 75% )
Total points 10

>7 : Appendiksitis akut

Modified Alvarado score (Kalan et al) tanpa observasi of
Hematogram

• Skor 1 – 4 : dipertimbangkan appendicitis

akut : Observasi
• Skor 5 – 6 : possible appendicitis tidak
perlu operasi : Antibiotik
• Skor 7 – 9 : appendicitis akut perlu
pembedahan : Operasi dini
 DIANGNOSIS BANDING
• Gastroenteritis
• Demam Dengue
• Limfadenitis Mesenterika
• Kelainan Ovulasi
• Infeksi Panggul
• Kehamilan di Luar Kandungan
• Kista Ovarium Terpuntir
• Endometriosis Eksterna
• Urolitiasis Pielum/Ureter Kanan
• Penyakit Saluran Cerna Lainnya
 Penatalaksanaan

Apendectomy Drainage Conservative

Appendectomy
An appendectomy (sometimes called appendisectomy
or appendicectomy (British English)) is the surgical
removal of the vermiform appendix

An appendectomy may be laparoscopic or traditional.

Laparoscopic surgery uses a few small incisions.

The various layers of the abdominal wall are then opened,

On entering the peritoneum, the appendix is identified,
mobilized and then ligated and divided at its base
Drainage
Drainage involves placing a needle
through the skin in the abscess,
usually under x-ray guidance. The
drain is then left in place for days
or weeks until the abscess goes
away.

PAD is performed using standard

aseptic technique and local
lidocaine anesthesia. Begin with a
diagnostic aspiration, followed by
catheter placement if fluid is
purulent
Conservative
Pada Infiltrat Appendikularis

Prosedur Oshner-Shener
1. Istirahat total
2. Posisi fowler
3. Antibiotika
4. Monitoring suhu , ukuran tumor,
Laju endap darah (led) & leukosit

Appendectomy elektif setelah 12

minggu
Posisi duduk atau setengah duduk, bagian kepala tempat tidur
lebih tinggi atau dinaikkan.
Fowler (45o-90o) dan semi fowler (15o-45o).
Dilakukan untuk mempertahankan kenyamanan, memfasilitasi
fungsi pernapasan, dan pasien pasca bedah.
 REFERENSI
1. De Jong, W. & Sjamsuhidajat, R.,2004. Buku Ajar Ilmu Bedah Edisi 2. EGC.
Jakarta.
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Pengajar Fakultas Kedokteran Universitas Indonesia. Bina Rupa Aksara. Jakarta.
3. Mansjoer, A., dkk. 2000. Kapita Selekta Kedokteran Edisi Ketiga Jilid Kedua.
Penerbit Media Aesculapius Fakultas Kedokteran Universitas Indonesia. Jakarta.
4. Bagian Ilmu bedah Fakultas Kedokteran Universitas Sumatra Utara.
http://library.usu.ac.id/ download/fk/bedah-emir%20jehan.pdf
5. Mubin, Halim. Buku Panduan Praktis : Ilmu Penyakit Dalam Diagnosis dan
Terapi Edisi 2. Jakarta : Penerbit Buku Kedokteran EGC. 2007.
6. Price, Sylvia A. Patofisiologi : Konsep Klinis Proses-Proses Penyakit, Edisi 4.
Jakarta: Penerbit Buku Kedokteran EGC. 1995.
7. Schwartz, Spencer, S., Fisher, D.G., 1999. Principles of Surgery Sevent Edition.
Mc-Graw Hill a Division of The McGraw-Hill Companies. Enigma an Enigma
Electronic Publication.
. . .TERIMA
KASIH. . .