Oleh : Wenny Efrina R Pembimbing : dr. Sulastri Chen Panjaitan, Sp.Rad KEPANITRAAN KLINIK SMF RADIOLOGI RSUD ARGA MAKMUR FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS BENGKULU 2019

BAB I PENDAHULUAN

Gawat abdomen menggambarkan keadaan kli nis kegawatan di rongga abdomen yang timbul mendadak. Keadaan ini memerlukan tindakan segera misalnya pada obstrukis, perforasi ata u perdarahan, maupun pada rogga abdomen m aupun saluran pencernaan.

PENDAHULUAN Dunia kedokteran saat ini sangat maju deng an pesat terutama dengan perkembangan dan aplika-si komputer bidang kedokteran sehin gga ilmu radiologi turut berkembang pesat mulai dari pencitraan organ sampai ke pencitraan selul ar dan molekular.

BAB II TINJAUAN PUSTAKA

DEFINISI: Keadaan dimana isi lumen saluran cerna tidak bisa disalurkan ke distal atau anus karena ada nya sumbatan/hambatan mekanik yang disebabkan kelainan dalam lumen usus, dinding usus atau luar usus yang menekan atau kelainan vaskul arisasi pada suatu segmen usus yang menyebabkan nekrosis se gmen usus tersebut (Warsinggih, 2014). Ileus Obstruk si

Etiologi :  Blokade intralumen (obturasi) ex: fekalit, benda asing ataubatu empe du  Intramural/lesi intrinsik dari dinding usus ex: malignansi atau inflamasi  Kompresi lumen/konstriksi akibat lesi ekstri nsik dari intestineex: adhesi, hernia, volvulu s dan intususepsi. Ileus Obstruk si

Patofisiologi

Klasifikasi :  Berdasarkan lokasi obstruksi: Ileus letak tinggi: duodenum- yeyunum- i leum Letak rendah: kolon-sigmoid-rektum  Berdasarkan 3 jenis dasar ileus dibagi menj adi: Ileus obstruktif sederhana Ileus obstruktif strangulasi Ileus obstruktif sebagian Ileus Obstruk si

Manifetasi Klinis :  Terdapat 4 tanda kardinal gejala ileus obstr uktif : Nyeri abdomen Muntah Distensi Kegagalan buang air besar atau gas (ko nstipasi).  Gejala ileus obstruktif tersebut bervariasi ter gantung kepada: Lokasi obstruksi, lamanya obstruksi, penye babnya dan ada tidaknya iskemia usus (Ullah et al., 2009). Ileus Obstruk si

Diagnosis : Anamnesis Pada obstruksi tinggi sering dapat ditemukan penyeb ab  adhesi dalam perut karena pernah dioperasi / t erdapat hernia. Intususepsi  bayi tampak gelisah dan tidak dapat di tenangkan. Serangan klasik  nyeri perut, gelisah se waktu kolik, biasanya keluar lendir campur darah (red currant jelly) per anum  intususeptum yang tertekan, terbendung, atau mungkin sudah mengalami strang ulasi. Pada volvulus didapatkan nyeri yang bermula akut, ti dak berlangsung lama, menetap, disertai muntah heb at. Biasanya penderita jatuh dalam keadaan syok. 3 Ileus Obstruk si

Pemeriksaan Fisik : Inspeksi Distensi perut, darm kontur dan darm steifung. Benjolan pada regio inguinal, femoral dan skrotum  suatu hernia Pada Intussusepsi  massa berbentuk sosis. Adanya adhesi ada bekas luka operasi sebelumnya. Obstruksi usus halus kolik dirasakan di sekitar umbili kus, Ileus obstruksi usus besar kolik  di sekitar regi o suprapubik. Terdapat tanda-tanda dehidrasi  kehil angan turgor kulit maupun mulut terlihat kering. Ileus Obstruk si

Diagnosis : Palpasi Teraba massa (pada colok dubur teraba massa di rek tum atau terdapat darah dan lendir), invaginasi atau hernia. Adanya darah pada colok dubur  strangulasi atau neoplasma. Volvulus  teraba massa yang nyeri dan bertambah besar. Feses yang mengeras  skibala, bila feses ne gatif maka obstruksi usus diduga letaknya lebih tinggi. Ampula rekti yang kolaps  dicurigai adanya obstruk si. Palpasi juga bertujuan untuk mencari jika terdapat tanda-tanda iritasi peritonium atau nyeri tekan yaitu a danya “defance muskular”. Ileus Obstruk si

Pemeriksaan Fisik :  Perkusi Ditemukan hipertimpani pada pemeriksaan per kusi abdomen.  Auskultasi Pada auskultasi terdengar suara gemerincing log am bernada tinggi (metalic sound), borborigmi. T etapi setelah beberapa hari dalam perjalanan pe nyakit dan usus bagian atas telah berdilatasi  a ktivitas peristaltik telah menurun sehingga pada f ase lanjut bising usus dan peristaltik melemah sa mpai hilang. Ileus Obstruk si

Gambara n Radiologi Abdomen Normal

Pada kasus abdomen akut diperlukan pemeriksaan 3 posisi, yaitu :  Pada posisi terlentang (supine): sinar dari arah vertical, dengan proyek si antero-posterior (AP)  Posisi duduk atau setengah duduk atau berdiri (erect), bila memungki nkan, dengan sinar horizontal proyeksi AP  Posisi tiduran miring ke kiri (left lateral decubitus), dengan arah horizon tal, proyeksi AP.

Gambaran Ileus Obstruksi Posisi terlentang (supine). Gambaran  pelebaran usus di proksim al daerah obstruksi, penebalan dinding usus, gambaran seperti duri ikan (Herring Bone Appearance)  pengumpulan gas dalam lumen usus yang meleb ar. Posisi setengah duduk atau berdiri. Gambaran radiologis  adany a air fluid level dan step ladder appearance. Posisi LLD, untuk melihat air fluid level dan kemungkinan perforasi usus  gambaran yang diperoleh adalah adanya udara bebas infra diafragma. Bila air fluid level pendek berarti ada ileus letak tinggi, s edangkan jika panjang-panjang kemungkinan gangguan di kolon.

Ileus Obstruksi Letak Tinggi

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