Refrat Apendisitis Pada Anak

REFRAT BEDAH ANAK  AN AK 

APENDISITIS APENDISI TIS PADA PADA ANAK  ANAK 

OLEH : Hanif Hary Setyawan G99142046

E!B"!B"NG : #r$ S%war#i& S'B$ S'BA

KEPANITERAAN KLINIK ILMU BEDAH FAKULT FAKULTAS KEDOKTERAN KEDOKTE RAN UNS/ UN S/ RSUD RSU D DR MOEWARDI MOEWARDI SURAKARTA 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* ,ea#ian a,%t a.#/-en yan+ -e-er)%,an 'e-.e#a*an (e+era %nt%,  -ene+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 ,ei)& .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/aea) %nti/n ter#a'at Valvula Ileocecalis (Bauhini) #an 'a#a  'an+,a) a''en#i,( ter#a'at valvula appendicularis (Gerlachi). anan+ 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 /)ia& #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+ .erara, 17 #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//)ia3$ Orifii%-nya ter)eta, 2& - #ari ,at%' i)e/ea)$ !e(/a'en#i,nya -er%'a,an arin+an )e-a,  yan+ -e-'%nyai 'e-.%)%* a''en#iea) #an ter,a#an+ %+a -e-i)i,i )i-f/n/#i ,ei)$1 Str%,t%r a'en#i,( -iri' #en+an %(%( -e-'%nyai 4 )a'i(an yait% -%,/(a& (%.-%,/(a& -%(,%)ari( e,(terna'r/'ria /t/t )/n+it%#ina) #an (ir,%)er3 #an (er/(a$ 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%, -enari 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 -ena#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 -ena#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 'anan+ -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($ Gea)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%- (ari

Retr//)i

: a''en#i,( .era#a #i .e)a,an+ ,/)/n a(en#en #an .ia(anya retr/'erit/nea)$

Anteaea)

: a''en#i,( .era#a #i #e'an ae%-$

araaea)

: 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/aea)

: 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/ea)i(& a.an+ #ari a$ !e(enteria (%'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'anan+ (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 ,ei) (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 tera#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. tera#inya 'r/(e( ra#an+ .a,teri yan+ #iet%(,an /)e* .e.era'a fa,t/r 'enet%( #iantaranya Hi'er')a(ia arin+an )i-fe& fe,a)it*& t%-/r a'en#i,(& #an ain+ 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* tera#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+ tera#inya a'en#i(iti( 90