Jumat, 15 Januari 2010

Appendisitis Acute

A. INTRODUCTION
Appendisitis acute inflammation in the disease is appendiks vermiformis that occur in acute. Appendix umbai or worms to this function is not yet known, but often the cause of complaint. Appendix tube is long, narrow (approximately 6 - 9 cm), the mucus 1-2 ml / day. Mucus that normally be flooded in the lumen and then flowed to sekum. If there are obstacles in the slime flux will facilitate the emergence can apendisitis (inflammation in the Appendix). In Appendix, there are imunoglobulin, substance protective against infection and that there are many in the IG A. In addition there is the Appendix which is the arteria apendikularis end-artery.

B. Etiology
Apendisitis the occurrence of acute infections are generally caused by bacteria. However, there are many factors spark of a disease. Among obstruksi going on Appendix lumen. Obstruksi in Appendix lumen is usually caused due to a heap of hard feces (fekalit), hipeplasia network limfoid, hookworm disease, parasites, foreign substances in the body, the primary cancer and striktur. However, the most frequent cause is obstruksi lumen Appendix fekalit and hiperplasia network limfoid.

C. PATOGENESIS
The occurrence of acute apendisitis because bacteria in general. However, there are many factors that spark occurrence. Alerts patogenetik primary because of the alleged pile of hard feces (fekalit). Sumbatan from the lumen Appendix mukus prevent expenditure will result in swelling, infection and ulserasi. Appendix tumor is also considered to have at least mucnulnya apendisitis. Research found that last ulserasi mukosa due to parasites such as Hystolitica E, is the first step of a apendisitis in more than half the cases, even more often than sumbatan lumen. Low-fiber foods also has raised the possibility apendisitis. Hard feces that will ultimately cause constipation which increases the pressure inside the sekum that will facilitate the occurrence of the disease. Apendisitis can attack anyone, any age and gender on all
Painful APPENDICITIS
Pain from visera often simultaneously localized in two areas because the surface of the body through painful dijalarkan aches and pain over viseral direct parietal.
Mechanism:
1. Impulse aches that come from the appendix through fiber-fiber sympathetic nerve pain viseral and will next go to medulla spinalis at approximately thorakal X to XI thorakal and transferred to the regions around umbilikus (cause cramps and feeling stiff)
2. Starting in the peritoneum parietal inflame the appendix attached to the abdomen wall. This causes sharp pain in the peritoneum of teriritasi in the bottom right quadrant abdomen.

D. A Clinical
There are some early symptoms of the typical pain that is felt to be equivocal (dull pain) in the area around the navel. Often accompanied by the feeling of nausea, vomiting and even sometimes, and then the pain will move to the right under the belly with the signs of the typical apendisitis acute pain at the point Mc Burney. Stomach pain will be pain when movement occurs, such as cough, breathing in, sneezing, and untouched areas of pain. Pain that increases when there is movement, because of friction between the visera so excited cause peritonium stimulus. Besides pain, other symptoms of acute apendisitis degree of fever is low, mules, constipation or diarrhea, stomach swell, and the inability gas issue. Symptoms are usually accompany acute apendisitis the presence of these symptoms is not very important in apendisitis and increase the likelihood that the absence of these symptoms will not reduce the likelihood apendisitis.
In the case of acute apendisitis the classic, early symptoms include:
Pain or not feeling comfortable around umbilikus (dull pain). Several hours later the pain will move to the stomach right down there is painful and may press the point Mc Burney. Pain has been increasing, so that when people are running will feel the pain that will cause the body posture on the couch while running. The pain is felt depends on the location of Appendix also, whether in the pelvis or paste in the bladder so that the frequency of urine to be increased. Stomach pain will also be felt by people when moving, breathing in, walking, coughing, and mengejan. Pain when coughing can occur because of the increased pressure of intra-abdomen.
Vomiting, nausea, and no appetite.
In general, any inflammation that occurs in the channel system will cause a feeling of indigestion and nausea, vomiting. Although in this case apendisitis, not sure why you found the mechanism to stimulate the incidence of vomiting.
Mild fever (37.5 ° C - 38.5 ° C) and feel very tired
The process of inflammation that occurs will cause the occurrence of fever, especially if the bacteria is kausanya. Inflamasi going on all the walls Appendix layer. Fever appears if inflammation is not immediately get the right treatment.
Diarrhea or constipation
Inflammation in the Appendix can stimulate the increase of intestinal peristaltic so can cause diarrhea. Infection from the bacteria will be treated as foreign substances by intestinal mukosa so will automatically try to remove the intestinal bacteria through increased peristaltic. In addition, apendisitis can also occur because of the hard feses (fekolit). In the circumstances this can occur even constipation.
In some circumstances, quite difficult apendisitis diagnosed so that they can cause more serious complications.

E. Reviewing DIBUTUHKAN
Vetting fisis
Ø Inspection: on apendisitis often found the existence of acute abdominal swelling, so that the inspection found distensi normal stomach.
Ø Palpasi: apendisitis will suffer the suspicion arose when doctors do palpasi stomach and right thigh kebahagian. At the bottom of the right abdomen when pressed will often feel pain and pressure when released will also feel pain (Blumberg sign). Stomach pain right bottom is the key to the diagnosis of acute apendisitis.
Ø Sometimes doctors will perform colok rectal examination to determine the location of Appendix difficult if the location is known. If done at colok rectum and feels the pain sufferer is likely Appendix didaerah pelvis.
v Checking support
Supplementary examination can be done with the examination and laboratory examination Radiology. Laboratory examination is done in the usual patient suspected of acute apendisitis is a complete examination and blood test reaktive protein (CRP). Complete blood examination in the most number of patients usually found leukosit above 10,000 and neutrofil above 75%. While the review found the number of serum CRP is increased in the 6-12 hours after inflamasi jaringan.Pemeriksaan Radiology usual on the patient suspected of, among other apendisitisakut is Ultrasonografi, CT-scan. On examination ultrasonogarafi found on the aft section of the Appendix occurs inflamasi. Are on the CT-scan examination found that the armed apendicalith and with the expansion of the Appendix inflamasi and the widening of saekum.

F. Diagnosis
Apendisitis acute diagnosis must be done carefully and thoroughly. Error diagnosis occurs more frequently in women than men. This is because women often arise in the pain that resembles apendisitis acute, ranging from genital tool (due process ovulasi, menstruasi), pelvic inflammation in the uterus or other diseases. This often causes a terlambatnya diagnosis so that more than half the new patients can be diagnosed after perforation.
To reduce the error diagnosis, while in the hospital made observations on each of 1-2 hours. From the results of the laboratory examination, obtained an increase in white blood cell that exceeds the normal.

G. Medicine
When the diagnosis is certain, the therapy with the most appropriate action operatif. There are two techniques commonly used operations:
Open surgery: one slice will be made (about 5 cm) at the bottom right of the belly. Slice will be larger if apendisitis already experienced perforation.
Laparoskopi: cutlet made about two to four units. One near navel, the other include stomach. Laparoskopi shaped like a fine thread denagn camera that will be inserted through the slice. The camera will record in the stomach and then ditampakkan on the monitor. The resulting picture will help detract from the operation and the equipment needed for operations will be entered through the slice in place. Appendix elevation, blood vessel, and part of the Appendix leads to the large intestine will be tied.

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