TRAUMA ABDOMEN DAN PENATALAKSANAAN OLEH HERRY SETYA YUDHA UTAMA

PENDAHULUAN

Dibawakan pada Seminar Trauma 26 Oktober 2013 di Rumah Sakit Mitra Plumbon Cirebon

           I.I  Latar Belakang

Trauma adalah cedera fisik dan psikis, kekerasan yang mengakibatkan cedera. Trauma pada abdomen dapat di bagi menjadi dua jenis. Trauma penetrasi dan Trauma non penetrasi.

Pukulan langsung, misalnya kena pinggir bawah stir mobil atau pintu yang masuk (intruded) pada tabrakan kendaraan bermotor, dapat mengakibatkan cedera tekanan atau tindasan pada isi abdomen. Kekuatan ini merusak bentuk organ padat atau berongga dan dapat mengakibatkan ruptur, khususnya pada organ yang menggembung (misalnya uterus yang hamil), dengan perdarahan sekunder dan peritonitis. Shearing injuries pada organ isi abdomen merupakan bentuk trauma yang dapat terjadi bila suatu alat penahan (seperti sabuk pengaman jenis lap belt atau komponen sabuk bahu)dipakai dengan cara yang salah.

Penderita yang cedera dalam tabrakan kendaraan bermotor juga dapat menderita cedera deceleration karena gerakan yang berbeda dari bagian badan yang bergerak dan yang tidak bergerak, pada hati dan limpa yang sering terjadi (organ bergerak) ditempat jaringan pendukung (struktur tetap) pada tabrakan tersebut. Pada penderita yang dilakukan laparatomi oleh karena trauma tumpul (blun injury), organ yang paling sering cedera, adalah limpa (40 – 55%), hati (35 – 45%)dan hematoma retroperitoneum (15%).

I.2  Batasan Masalah

Referat ini membahas tentang anatomi abdomen, definisi, etiologi, patofisiologi, klasifikasi, diagnosis, dan penatalaksanaan trauma abdomen.

I.3  Tujuan Penulisan

Adapun tujuan penulisan referat ini adalah:

1.      Memahami  mengenai anatomi abdomen.

2.      Memahami mengenai trauma abdomen.

3.      Meningkatkan kemampuan menulis ilmiah di dalam bidang kedokteran khususnya bagian ilmu bedah.

4.      Memenuhi salah satu syarat kelulusan Kepaniteraan Klinik Senior di Bagian Bedah Fakultas Kedokteran Universitas YARSI dan RSUD Arjawingaun.

I.4  Metode Penulisan

Penulisan referat ini menggunakan metode tinjauan pustaka dengan mengacu kepada beberapa literatur.

ANATOMY FOR SURGEON AT A GLANCE / SEKILAS TENTANG ANATOMI UNTUK PARA AHLI BEDAH

Di sini saya tampilkan beberapa tampilan anatomi untuk para ahli bedah secara sepintas yang saya ambilkan sebagian besar disarikan dari Zollinger Atlas of Surgical Operations dan Thorex Surgical Anatomy

DARAH ARTERI  VISERA ABDOMEN ATAS

Abdomen memiliki suplai darah yang kaya . Pasokan darah induknya berasal dari sumbu celiac (1) dengan cara arteri lambung kiri (2). Suplai darah ke bagian paling atas, termasuk kerongkongan lebih rendah, adalah dari cabang arteri frenikus kiri rendah (3). Arteri lambung kiri membagi saat mencapai kurvatura minor tepat di bawah persimpangan esophagogastric. Satu cabang anterior (2a) dan cabang lainnya posterior sepanjang kurvatura minor. Ada area telanjang dinding perut, sekitar 1 sampai 2 cm lebar, antara kedua kapal yang tidak tercakup oleh peritoneum. Hal ini diperlukan untuk ligasi arteri lambung kiri dekat titik asal di atas permukaan superior dari pankreas dalam kinerja gastrektomi total. Hal ini juga berlaku ketika 70 persen atau lebih dari perut yang akan dihapus. Ligasi arteri di daerah ini umumnya dilakukan dalam kinerja reseksi lambung untuk keganasan sehingga penghapusan lengkap dari semua kelenjar getah bening tinggi pada curvaturemay rendah dicapai.

abdominal colic diagnostic and management

Colicky abdominal

INTRODUCTION

Before discussing the pain of colic, will be presented in advance of abdominal pain in general. Abdominal pain resulting from the three channels, namely (Mahadevan, 2005):

• Abdominal viscera
Usually caused by distension of hollow organs or the tension in the capsule of solid organs. A rare cause of ischemia when the network is experiencing congestion atau inflamasi to sensitasion end visceral nerve pain and lower pain threshold. Pain inisering an early manifestation of a disease or discomfort a sense vague until the colic. If the organ is engage affected by peristaltic movements, the pain is often intermittent described as, cramps or colic.

• In this pain, bilateral pain due to nerve fibers, not myelin and entering spinal cord at varying levels, the viscera and abdominal pain is usually felt dull, hard to be localized and felt the middle body. Pain comes from the region of the abdominal viscera are referring origin of the embryonic organ. Foregut structures such as the stomach, duodenum, liver, biliary tract and pancreas produce upper abdominal pain, often perceived as pain epigastric region. Midgut structures such as the jejunum, ileum, appendix, and ascending colon causing pain periumbilikus. While the structure of the hindgut as the transverse colon, genitourinary system kolon desendens and cause lower abdominal pain.


• Abdominal pain parietal (somatic)
Parietal or somatic abdominal pain resulting from ischemia, inflamasiatau tension of the parietal peritoneum. Afferent nerve fibers that transmit pain stimulus bermielinisasi to the dorsal root ganglion and at the same dermatomal of origin of the pain. For this reason Yeri parietal  this is in contrast with visceral pain, can often be painful stimuluslocalized to the homelands. Is perceived to be a sharp pain, like a knife wound and survive; coughing and movement can trigger pain it. These conditions resulted in signs of physical examination can be searched delicate flavor, guarding, rebound pain and stiffness padaabdomen are palpable. Clinical presentation of appendicitis can of pain visceral and somatic. Pain in early appendicitis pain often in the form of periumbilikus (viscera), but localized in the region of the right quadrant bawahketika inflammation spreads to the peritoneum (parietal).

• Referred pain
Referred pain is pain that is felt at a distance from the diseased organ. This pain is produced from neuronal pathways afferent central terbagiyang from different locations. Examples are patients with pneumonia may experience abdominal pain due to neuron T9 distribution divided by the lungs and abdomen. Another example is the epigastric pain associated with myocardial infarction, pain in the shoulder associated with irritation of the diaphragm (eg, splenic rupture), nyeriinfrascapular pool associated with the disease and testicular pain associated with urethral obstruction.


Colicky abdominal pain

DEFINITION

Colicky abdominal pain is a pain in the form of intermittent severe attacks that can be localized and felt like a sharp feeling. The mechanism of this pain is due to either partial or total obstruction of hollow organs which contain smooth muscle tissue or organ involved is influenced peristalsis.
Classification of colicky abdominal
Classification based on etiology of some of them:

TRAUMATOLOGY SERIES : UPDATED ABDOMINAL TRAUMA AT AGLANCE. (definition, diagnosis, clinical overview, sign, symptom, and management )

ABDOMINAL TRAUMA

CHAPTER I

INTRODUCTION

I. Anatomy of the abdomen

I. 1 Anatomy of the external abdominal

a. Front abdominal

Front abdominal definition is a restricted area in the superior by intermamaria line, in inferior limited by the inguinal ligament and lateral to the pubic symphysis and both anterior axillary line.

b. Waist

Is an area that lies between the anterior axillary line and posterior axillary line, from between the ribs to 6 above, down sampaicrista iliaca. At this location there is a thick wall of the abdominal muscles, as opposed to the thinner wall of muscle on the front, especially tterhadap menjadipelindung stab wounds.

c. Back

This area is located in the back of the posterior axillary line, from the lower end of the scapula to the crista iliaca. As with daerak flank, here back muscles and paraspinal muscles to protect against sharp trauma. (1)

I. 2 Anatomy of the abdomen in

There are three rooms, the peritoneal cavity, retroperitoneal cavity and pelvic cavity. The pelvic cavity contains the parts of the peritoneal cavity or retroperitoneal cavity.

a. Peritoneal cavity

Simply the peritoneal cavity is divided into two parts, the top and bottom. The peritoneal cavity is protected by the bottom of the thoracic wall which includes the diaphragm, liver, spleen, gastric and transverse colon. This section is also called a thoracoabdominal components of the abdomen. At the time of the diaphragm rises up between the ribs IV at full expiration, each rib fracture or penetrating stab wound below the intermamaria can injure organs in the abdomen. The peritoneal cavity contains the small intestine, the colon ascendens and colon descendens, sigmoid colon, and in women, internal reproductive organs.

b. Retroperitoneal cavity

Potential cavity is a cavity behind the peritoneum lining the abdominal wall, and includes the abdominal aorta, inferior vena cava, a large part of duodenoum, pancreas, kidney and ureter and the posterior part of the colon ascendens and colon descendens, and also the retroperitoneal pelvic cavity. Injury to the retroperitoneal organs are difficult to identify because this area is far from the reach of regular physical examinations, and also here in the first injury will not show any signs or symptoms of peritonitis. In addition, the cavity is not included in the sample examined in diagnostic peritoneal lavage (DPL).

c. The pelvic cavity

Pelvic cavity, which is protected by the bones of the pelvis, is actually the bottom of the intraperitoneal cavity, while the bottom of the retroperitoneal cavity. Contained therein rectum, vesica urinary, iliaca vessels, and in women, internal reproductive organs. As with the thoracoabdominal, examination of pelvic organs obstructed by parts of the bones on it. (1)

I. Regio-3 region of the abdomen

The abdomen is divided into nine regions, namely:

1. Epigastrica Regio (right and left)

2. Hipocondria Regio (right and left)

3. Umbilical region (right and left)

4. Region of the lateral (right and left)

5. Pubica Regio (right and left)

6. Inguinal region (right and left)