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Oleh:
Diah Anis Naomi, S.Ked
Dicky Aditya Dwika, S.Ked
Fadia Nadila, S.Ked
Maradewi Maksum, S.Ked
Denotes any
sudden,
spontaneous,
nontraumatic
disorder
whose
manifestatio
n is in the
abdomen
area
Clinical Evaluation
Mode of onset
Duration
Character
Location
Intensity
Chronology
Frequency
Radiation
History
Location
Viceral pain
The centrally perceived sensation is generally slow in onset,
dull, poorly localized, and protracted. Visceral pain is most
often felt in the midline because of the bilateral sensory
supply to the spinal cord.
Parietal pain
More acute, sharper, better-localized pain sensation.
The cutaneous distribution of parietal pain corresponds to
the T6L1 areas. Abdominal parietal pain is conventionally
described as occurring in one of the four abdominal
quadrants or in the epigastric or central abdominal area.
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Referred pain
Denotes noxious (usually cutaneous) sensations
perceived at a site distant from that of a strong
primary stimulus.
Spreading or shifting pain
Parallels the course of the underlying condition.
The site of pain at onset should be distinguished
from the site at presentation.
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Characteristic of Pain
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Intensity
Related to the magnitude of the
underlying insult.
It is important to distinguish between
the intensity of the pain and the
patient's reaction
Pain that is intense enough to awaken
the patient from sleep usually
indicates a significant underlying
organic cause.
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Physical Examination
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INVESTIGATIVES STUDIES
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Urin
LABORATORIUM
Biakan urin
LABORATORIUM
Darah
Hb anemia fungsi ginjal
kronis
Lekositosis infeksi
Ureum kreatinin fungsi
ginjal
Ca, fosfor dan asam urat
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LABORATORIUM
Radiologis
BNO-IVP lokasi batu, besar batu,
bendungan
Gangguan fungsi ginjal IVP tidak
dilakukan lakukan Retrograde
pielografi/antergrad pielografi
BNO batu radio-opak (dilihat),
radiolusen (tidak tampak)
Urutan batu paling opak hingga radiolusen
kalsium fosfat, kalsium oksalat, magnesium
amonium fosfat, sistin, asam urat, xantine
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DIFFERENTIAL DIAGNOSIS
Kuadran kanan atas:
Kuadran kiri atas:
1. Cholecystitis acute
1. Ruptur lienalis
2. Perforasi tukak duodeni
2. Perforasi tukak lambung
3. Pancreatitis acute
3. Pancreatitis acute
4. Hepatitis acute
4. Ruptur aneurisma aorta
Paraumbilical:
5. Acute congestive
1. Ileus obstruksi 5. Perforasi colon (tumor/corpus
hepatomegaly
alineum)
2. Appendicitis
6. Pneumonia + pleuritis
6. Pneumonia + pleuritis
3. Pancreatitis acute
7. Pyelonefritis acute
7. Pyelonefritis acute
4. Trombosis A/V mesentrial
8. Abses hepar
8. Infark miokard akut
5. Hernia Inguinalis strangulata
Kuadran kanan bawah:6. Aneurisma aorta yang pecah
7. Diverculitis (ileum/colon)
Kuadran kiri bawah:
1. Appendicitis
2.
3.
4.
5.
6.
7.
8.
9.
1. Sigmoid diverculitis
Salpingitis acute
2. Salpingitis acute
Graviditas axtra uterine yang pecah
3. Graviditas axtra uterine yang pecah
Torsi ovarium tumor
4. Torsi ovarium tumor
Hernia Inguinalis incarcerata,strangulata
5. Hernia Inguinalis incarcerata,strangulata
Diverticulitis Meckel
6. Perforasi colon descenden (tumor, corpus
Ileus regionalis
alineum)
Psoas abses
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7. Psoas abses
Batu ureter (kolik)
RIGHT HYPOCONDRIAC
Right
lower
EPIGASTRIC
lobe
LEFT HYPOCONDRIAC
pneumonia/embolism
Pancreatitis
Cholecystitis
Gastritis
Biliary colic
Pepti colic
Hepatitis
Myocardial infarction
RIGHT LUMBAR
Left
lower
pneumonia/embolism
UMBILICAL
LEFT LUMBAR
Renal colic
Renal colic
Appendicitis
Intestinal ischaemia
Aortic aneurysm
Gastroenteritis
Crohns disease
RIGHT ILIAC
lobe
HYPOGASTRIC
LEFT ILIAC
Appendicitis
Cystitis
Sigmoid diverticulitis
Crohns disease
Urinary Retention
Dysmenorrhea
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SURGICAL TREATMENT
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PRE-OPERATIVE MANAGEMENT
1. After initial assessment, parenteral analgesics for pain relief
should not be withheld. In moderate doses, analgesics neither
obscure useful physical findings nor mask their subsequent
development.
2. Resuscitation of acutely ill patients should proceed based on
their intravascular fluid deficits and systemic diseases.
Medications should be restricted to only essential
requirements. Particular care should be given to use of cardiac
drugs and corticosteroids and to control of diabetes.
Antibiotics are indicated for some infectious conditions or as
prophylaxis during the perioperative period.
3. A nasogastric tube should be inserted in patients likely to
undergo surgery and for those with hematemesis or copious
vomiting, suspected bowel obstruction, or severe paralytic
ileus.
4. A urinary catheter should be placed in patients with systemic
hypoperfusion. In some elderly patients, it eliminates the
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cause of pain (acute bladder distention) or unmasks relevant
Erect Abdomen
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Small Bowel
Obstructions
Supine
Erect
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Gallstone ileus
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Abdominal radiograph
demonstrating incidental
radioopaque gallstone (black
arrow) and bladder calculus
(white arrow).
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Cholelithiasis
USG
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ACUTE APPENDICITIS
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THANK
YOU!
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