INTESTINAL OBSTRUCTION

Disediakan Oleh : Nassruto

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

DEFINISIDEFINISI Halangan pada pergerakan kehadapan Halangan pada pergerakan kehadapan

(forward passage) makanan, najis dan flatus.(forward passage) makanan, najis dan flatus.

KLASIFIKASIKLASIFIKASI• Akut : Kronik• Tinggi: Rendah• Partial: Complete• Simple: Strangulated• Mekanikal : Functional (Dynamic) (Adynamic)

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

ETIOLOGI ETIOLOGI (according to age(according to age))

Neonates Inperforated anus Volvulus Neonatarum Congenital Atresia Meconium ileus Hirschprungs disease

Children Pyloric Stenosis Intussusception Parasites Foreign Bodies

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

ETIOLOGI ETIOLOGI (according to age(according to age))

Young & MiddleAged adults

Post-op adhesion/bands Strangulated hernia Paralytic ileus Gallstones

Elderly Impacted faeces Strangulated hernia Ca. Colon Volvulus Paralytic ileus

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

ETIOLOGI ETIOLOGI (according to site(according to site))

Intra Luminal Impacted faeces Parasites worms Meconium ileus Gallstones Foreign bodies Neoplasm

Intra Mural Congenital Atresia Tumours Strictures Diverticulitis

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

ETIOLOGI ETIOLOGI (according to site(according to site))MEKANIKALMEKANIKAL

Extra Luminal Hernia Bands, adhesions Volvulus Intussusception

FUNCTIONAL• Paralytic ileus

• Vascular occlusion

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

PATOFISIOLOGIPATOFISIOLOGI Proximal dari halanganProximal dari halangan

• Gut Kembong – cecair, makanan dan udara• Konstraksi berlebihan• Reversed peristalsis• Regurgitasi• Kurang penyerapan, gangguan cecair dan

electrolite• Dehidrasi dan hipovolumia

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

PATOFISIOLOGIPATOFISIOLOGI Di tempat halanganDi tempat halangan

• Bekalan darah berkurangan• Nikrosis• Ulser mukosa• Perforasi• Peritonitis

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PATOFISIOLOGIPATOFISIOLOGI Distal dari halanganDistal dari halangan

• Constipation• Cirit-birit jika incomplete

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MANIFESTASI KLINIKALMANIFESTASI KLINIKAL1.1. Kardinal Kardinal

• Sakit abdomenSakit abdomen• MuntahMuntah• Distensi abdomenDistensi abdomen• Constipasi/cirit-biritConstipasi/cirit-birit

2.2. Sakit AbdomenSakit Abdomen• Tiba-tiba, koliki/intermittentTiba-tiba, koliki/intermittent• Setempat di periumbilikalSetempat di periumbilikal• Radiating ke belakangRadiating ke belakang• Berterusan, gangreneBerterusan, gangrene

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

MANIFESTASI KLINIKALMANIFESTASI KLINIKAL 3. Muntah3. Muntah

• Teruk, kerapTeruk, kerap• Awal-ada halanganAwal-ada halangan• Lewat-halangan bawahLewat-halangan bawah

4. Distensi abdomen4. Distensi abdomen• Kurang- halangan atasKurang- halangan atas• Nyata – halangan bawahNyata – halangan bawah

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

PEMERIKSAAN FIZIKALPEMERIKSAAN FIZIKAL1. Inspeksi1. Inspeksi

• DistensiDistensi• PeristalsisPeristalsis• Hernial protrusionHernial protrusion• Surgical scarSurgical scar

2. Auscultasi2. Auscultasi• Bowel sounds Bowel sounds

• Hiperactive/tinklingHiperactive/tinkling• Tiada – paralytic ileusTiada – paralytic ileus

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

PEMERIKSAAN FIZIKALPEMERIKSAAN FIZIKAL3. Palpasi3. Palpasi

• Mass berbentuk sausage – intussusceptionMass berbentuk sausage – intussusception• Segment bowel kembong – halangan close-loopSegment bowel kembong – halangan close-loop• Tanderness – direct/reboundTanderness – direct/rebound• Guarding & Rigidity - peritonitisGuarding & Rigidity - peritonitis

4. Perkusi4. Perkusi• TimpanikTimpanik

5. Per-Rectal (Digital) Mengenalpasti – Intussuception, pelvic mass, ca. rectal

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

INVESTIGASIINVESTIGASI• Darah : Hb%, TWDC, BUSE, GXMDarah : Hb%, TWDC, BUSE, GXM• X-Ray : Plaib Abd. Erect/SupineX-Ray : Plaib Abd. Erect/Supine• ECGECG• CT ScanCT Scan

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

This abdominal X-ray shows a stomach filled with fluid and a swollen (distended) small bowel, caused by a

blockage (obstruction) in the intestines. A solution

containing a dye (barium) that is visible on X-rays was

swallowed by the patient (upper GI series).

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

This abdominal X-ray shows thickening of the bowel wall

and swelling (distention) caused by a blockage

(obstruction) in the intestines. A solution containing a dye

(barium), which is visible on X-ray, was swallowed by the patient (the procedure is

known as an upper GI series).

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

This abdominal X-ray shows an intestinal condition in which a loop of bowel has slipped into

another section of bowel (intussusception), causing

swelling, reduced blood flow, obstruction, and tissue damage.

Intussusception requires emergency treatment (barium enema or surgery) to prevent

intestinal tissue death (necrosis), intestinal perforation, peritonitis,

and death.

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

DIAGNOSIS PERBEZAANDIAGNOSIS PERBEZAAN

• Ac. CholecstitisAc. Cholecstitis• Ac. AppendicitisAc. Appendicitis• PGUPGU• Ac. PancreatitisAc. Pancreatitis

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

PENGENDALIANPENGENDALIAN• KonservativeKonservative• PembedahanPembedahan

• NBM• RT• VS• IV• Ix• Analgesik• AB• CBD• Laprotomi

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

KOMPLIKASIKOMPLIKASI

• DehidrasiDehidrasi• RenjatanRenjatan• PerforasiPerforasi• PeritonitisPeritonitis

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Obstruction due to hernia Obstruction due to

mesenteric occlusion

Obstruction due to volvulus

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Obstruction due to intussusception Obstruction due to

tumorObstruction due to

adhesions

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INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION