ILEUS OBSTRETICUS

8/18/2019 ILEUS OBSTRETICUS

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Oleh : Intan Permata SariPembimbing : dr. Gunawan, Sp. B

ILEUSOBTRUCTIO


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IDENTITAS PASIENNama : Bpk. MSUmur : 72 thnMasuk RS tanggal : 17 F !ruar" 2#1$

Alamat : Pun%ak& BantulBangsal : M lat"


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Anamn s"s's %atang % ngan k luhan p rut t rasak m!ung %an t"%ak n(aman s )ak * 1m"nggu SMRS. +a%ang %"s rta" mual %anmuntah ,$- har". Muntah ! ruapamakanan %an t rka%ang ! rupa a"r l"ursa)a. 's )uga m ng luh m ngalam"gangguan BAB. Dalam s har" /s !"sa BAB,0- namun k/ns"st ns"n(a s %"k"t s %"k"t.B r arna kun"ng %an t%k a"r. Darah345l n%"r 345.


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P m r"ksaan F"s"k6"tal S"gn : TD : 17# #& S:08& / 9& RR: 1 -&

N: #-.P m r"ksaan F"s"kMata : +/n)ungt" a an m"s 3; ;5 skl ra"kt r"k 34 45

Mulut : 9an%"%"as" 3;5+ul"t : Turg/r kul"t ,0


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A!%/m nP r"stalt"k=#- m n"t>(p rt(mpan"

Sup l 345D"st n% % 3=$ m5NT 345


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P r"t/n"t"s

N/. I9P9 II: D?? Disease digestive system,other No. ICD X: K65.9 Peritonitis,unspeci ed Tingkat Kemampuan: 3B

Ting!at "emampuan #:mendiagn$%i%, mela!u!an

penatala!%anaan awal, dan meru&u!#'. Bu!an gawat #B.Gawat darurat


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F"s"/l/g" P r rnaan


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ME9>ANI9A@ I@EUS


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D n"s"Il us a%alah k a%aan %ar" g rakan %an

pasas usus (ang n/rmal t"%ak t r)a%". Il ust"m!ul saat u%ara %an a"ran s kr s" t"%ak%apat k luar k arah %"stal kar na ! r!aga"s !a! !a"k kar na akt/r "ntr"ns"k maupun

kstr"ns"k 3m han" al /!stru t"/n5 atauparal"s"s 3n/n m han" al /!stru t"/n ataups u%/ "l us5.

> lt/n CS& F"s" h lla PM. Int st"nal '!stru t"/n.Dalam : A9S Surg r( : Pr"n "pl san% Pra t" s. 2##=. C !MD In . 9hapt r = : $41#


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I

M han"al

Fun t"/nal

9l/sl//pS"mpl

A ut9hr/n"

Part"al9/mpl t

9ausDurat"/n E-t nt T(p


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M han" al '!stru t"/nPh(s" al Bl/kag :

1. Intramural : /ng n"tal4tum/r4h mat/ma4"n ammat/r(

2. E-tramural : a%h s"/n4 /l ulus4h rn"a a!s ss4h mat/ma

0. @um n /!stru t"/n: st/n 4m /n"um4/r "gn !/%(4 "mpa t"/n 3st//l4 /rm4

!ar"um5


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P n( !a!P n%arahan

'!struks"Usus >alus


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Et"/l/g"'. Small b$wel $b%tru(ti$n:

). 'dhe%i$n *+-. ernia -+#. e$pla%m /0. 1$l2ulu% / ./. Other%: IB34G'LL STO E45OREIG

BO364I TUSSUSCEPTIO .B. Large b$wel $b%tru(ti$n :

). Can(er *+ .-. 3i2erti(ular di%ea%e )/ .#. 1$l2ulu% )/ .0. Other%: hernia 78e(al impa(ti$n4

in9ammat$r .


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@/kas"


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PAT'GENESIS

3i%tal Pr$!%imal

+/laps B r%"ltas"P ru!ahan

Ek/l/g"

- P numpukan a"ran gas

- D"st ns" M n( luruhP rtum!uh

an kuman

P r /ras"

Isk m"k

A"r l ktr/l"t!(k%"k luarkan

Transl/kas" kuman

S(/k >"p/ /l m"k

Strangul

as"

A!s/r!s" T/ks"n

S ps"s


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DIAGN'SISISTOR6

4 = G )ala 9ar%"al '!struks" 3pa"n4 /m"t"ng4%"st ns"/n an% /!st"pat"/n5.

4 Pr/-"mal /!stru t"/n arl" r s(mpt/ms "th

pr/m"n nt /m"t"ng an% l ss %"st ns"/n. Ch"l/m"t"ng un /mm/n "n /l/n /!stru t"/n t"lllat stag

E;'


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@AB'RAT'RH :9B9: "n r as P96 3% h(%rat"/n 5 an% "n r as "nCB9.+FT: "n r as "n BUN an% r at"n"n .@a tat /n ntrat"/n4am(las 4la t"% h(%r/g nas us ul !ut n/t s ns"t" "n

aluat"/ns / !/ l /!stru t"/n sp "all( t/ rul/ut n r/s"sS rum /n ntrat"/n / ph/sphat 44"nt st"nal att(a "% !"n%"ng pr/t "n an% "s/ /rms / r at"nph/sph/k"nas 3"s/ /rm B5: "% nt" ( pr s n /"nt st"nal ll n r/s"s !ut th sp " "t( an%s ns"t" "t( st"ll n/t a urat .ABG: m ta!/l" an% r sp"rat/r( a "%/s"s.


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RADI'@'GIPh$t$ P$l$% 'bd$men #

p$%i%iM/st Sp " F"n%"ng: The Triad 1. D"lat % small4!/ l l//ps 3,0 m "n%"am t r52. A"r4Flu"% l ls /n upr"ght lms0. Pau "t( / a"r "n th /l/n.

Sen%iti2it i% =+ t$ >+ .


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Small Bowel GasPattern

Centrally locatedSoft tissue across

entire lumen

Colon Gas Pattern Peripheral Located

Mostly notoverlappingHaustra markings


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Tr atm nt'. Re%u%(itati$n.B. C$n%er2ati2e treatment

1. Pr "/us surg r(.2. In /mpl t /!stru t"/n.0. A% an % mal"gnan (.=. Un rta"n %"agn/s"s.

C. Indi(ati$n% 8$r %urger1. G n ral" % /r l/ al" % p r"t/n"t"s.2. P r /rat"/n.0. Irr %u "!l h rn"a.=. Palpa!l mass.$. 6"rg"n a!%/m n.8. 9l/s % l//p

7. Fa"lur t/ "mpr/ .


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P natalaksanaanSmall B/ l'!stru t"/nm nurutGu"% l"n /rManag m nt /Small B/ l'!stru t"/n 2## .


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T r"ma +as"h

ILEUS OBSTRETICUS

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