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ABDOMEN
Dr. Gatot Sugiharto Sp.B
I. Clinical evaluation
A. Onset and duration of the pain
1. The duration, acuity, and progression of pain should
be assessed, and the exact location of maximal pain
at onset and at present should be determined. The
pain should be characterized as diffuse or localized.
The time course of the pain should be characterized
as either constant, intermittent, decreasing, or
increasing.
2. Acute exacerbation of longstanding pain suggests a
complication of chronic disease, such as peptic ulcer
disease, inflammatory bowel disease, or cancer.
Sudden, intense pain often represents an
intraabdominal catastrophe (eg, ruptured aneurysm,
mesenteric infarction, or intestinal perforation).
Colicky abdominal pain of intestinal or ureteral
obstruction tends to have a gradual onset.
B. KARAKTER NYERI
1. Nyeri Intermittent berhubungan dgn peningkatan
tekanan spasme organ berongga.
2. Ischemik usus awal bersifat nyeri kram difus
( karna kontraksi spasme usus). Lalu nyeri menjadi
konstan dan lebih intens setelah terjadi nekrosis.
3. Nyeri konstan :
C. GEJALA TERKAIT
1.Constitutional symptoms (eg, fatigue, weight loss) suggests
underlying chronic disease.
2. Gastrointestinal symptoms
a. Anorexia, nausea vomit . frekwuensi, karakter, & waktu berhubungan
dengan nyeri kapan saat terakhir flatus/BAB perlu di catat.
b. Konstipasi, obstipasi, nyeri kram & distensi biasanya menonjol pada
obstruksi usus halus distal dan kolon . Paralytic ileus jg dapat
menyebabkan konstipasi & distensi.
c. Diare biasanya karna gastroenteritis, colitis namun bisa terjadi pula
pada obstruksi parsial usus halus.
d. Small amounts of bleeding may accompany esophagitis, diverticulitis,
inflammatory bowel disease, and left colon cancer. Right colon cancers
usually present with occult blood loss. Severe abdominal pain
accompanied by melena or hematochezia suggests ischemic bowel.
e. Jaundice with abdominal pain usually is caused by biliary stones.
Obstruction of the common bile duct by cancer may also cause pain and
jaundice.
D. Riwayat Pengobatan
1. Nonsteroidal anti-inflammatory drugs ulcer
disease.
2. Antibiotic therapy pseudomembranous colitis
may obscure the signs of peritonitis.
3. Anticoagulants Warfarin therapy predisposes to
retroperitoneal or intramural intestinal
hemorrhage.
4. Thiazide diuretics may rarely cause pancreatitis.
E. Riwayat Operasi.
Obstruksi usus halus dapat disebabkan oleh Adhesi post operative.
C. Abdominal examination
1.Inspection. (NGT, Abdomen)
Surgical scars should be noted.
Distention suggests obstruction, ileus,
or ascites. LIPAT PAHA .!!!!
Venous engorgement of the abdominal
wall suggests portal hypertension.
Masses or peristaltic waves may be
visible.
Hemoperitoneum may cause bluish
discoloration of the umbilicus (Cullens
sign).
Retroperitoneal bleeding (eg,from
hemorrhagic pancreatitis) can cause
flank ecchymoses (Turner's sign).
C. Abdominal examination
2.Auscultation.
Borborygmi. A quiet, rigid tender
abdomen may occur with generalized
peritonitis.
A tender, pulsatile mass suggests an
aortic aneurysm rupture.
C. Abdominal examination
3. Palpation & Percussion
a. Palpation should be gently started at a point
remote from the pain. Muscle spasm, tympany or
dullness, masses and hernias should be sought.
b. Peritoneal signs. Rigidityis caused by reflex
spasm of the abdominal wall musculature from
underlying inflamed parietal peritoneum. Stretch
and release of inflamed parietal peritoneum
causes rebound tenderness.
c. Common signs
(1) Murphy's sign. Inspiratory arrest from palpation in the
right upper quadrant occurs when an inflamed
gallbladder descends to meet the examiner's fingers.
(2) Obturator sign. Suprapubic tenderness on internal
rotation of the hip joint with the knee and hip flexed
results from inflammation adjacent to the obturator
internus muscle.
(3) Iliopsoas sign. Extension of the hip elicits tenderness
in inflammatory disorders of the retroperitoneum.
(4) Rovsing's sign. Referred, rebound tenderness in the
left lower quadrant suggests appendicitis.
d. Pekak Hepar
IV.Radiography
A. Plain abdominal films
1. upright PA chest, plain abdominal film (flat plate),
upright film, and a left lateral decubitus view of the
abdomen.
2. Bowel obstruction
a. Small bowel obstruction may cause multiple air-fluid levels with
dilated loops of small intestine, associated with minimal colonic
gas.
b. Colonic obstruction causes colonic dilation which can be
distinguished from small intestine by the presence of haustral
markings and absence of valvulae conniventes.
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