Pengenalan asas mengenai INTESTINAL OBSTRUCTION

1. INTESTINAL
OBSTRUCTION
Disediakan Oleh : Nassruto

2. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
DEFINISIDEFINISI
Halangan pada pergerakan kehadapanHalangan pada pergerakan kehadapan
(forward passage) makanan, najis dan flatus.(forward passage) makanan, najis dan flatus.
KLASIFIKASIKLASIFIKASI
• Akut : Kronik
• Tinggi: Rendah
• Partial: Complete
• Simple: Strangulated
• Mekanikal : Functional
(Dynamic) (Adynamic)

3. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
ETIOLOGIETIOLOGI (according to age(according to age))
Neonates
Inperforated anus
Volvulus Neonatarum
Congenital Atresia
Meconium ileus
Hirschprungs disease
Children Pyloric Stenosis
Intussusception
Parasites
Foreign Bodies

4. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
ETIOLOGIETIOLOGI (according to age(according to age))
Young & Middle
Aged adults
Post-op adhesion/bands
Strangulated hernia
Paralytic ileus
Gallstones
Elderly Impacted faeces
Strangulated hernia
Ca. Colon
Volvulus
Paralytic ileus

5. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
ETIOLOGIETIOLOGI (according to site(according to site))
Intra Luminal
Impacted faeces
Parasites worms
Meconium ileus
Gallstones
Foreign bodies
Neoplasm
Intra Mural Congenital Atresia
Tumours
Strictures
Diverticulitis

6. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
ETIOLOGIETIOLOGI (according to site(according to site))
MEKANIKALMEKANIKAL
Extra Luminal Hernia
Bands, adhesions
Volvulus
Intussusception
FUNCTIONAL
• Paralytic ileus
• Vascular occlusion

7. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PATOFISIOLOGIPATOFISIOLOGI
Proximal dari halanganProximal dari halangan
• Gut Kembong – cecair, makanan dan udara
• Konstraksi berlebihan
• Reversed peristalsis
• Regurgitasi
• Kurang penyerapan, gangguan cecair dan
electrolite
• Dehidrasi dan hipovolumia

8. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PATOFISIOLOGIPATOFISIOLOGI
Di tempat halanganDi tempat halangan
• Bekalan darah berkurangan
• Nikrosis
• Ulser mukosa
• Perforasi
• Peritonitis

9. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PATOFISIOLOGIPATOFISIOLOGI
Distal dari halanganDistal dari halangan
• Constipation
• Cirit-birit jika incomplete

10. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
MANIFESTASI KLINIKALMANIFESTASI KLINIKAL
1.1. KardinalKardinal
• Sakit abdomenSakit abdomen
• MuntahMuntah
• Distensi abdomenDistensi abdomen
• Constipasi/cirit-biritConstipasi/cirit-birit
2.2. Sakit AbdomenSakit Abdomen
• Tiba-tiba, koliki/intermittentTiba-tiba, koliki/intermittent
• Setempat di periumbilikalSetempat di periumbilikal
• Radiating ke belakangRadiating ke belakang
• Berterusan, gangreneBerterusan, gangrene

11. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
MANIFESTASI KLINIKALMANIFESTASI KLINIKAL
3. Muntah3. Muntah
• Teruk, kerapTeruk, kerap
• Awal-ada halanganAwal-ada halangan
• Lewat-halangan bawahLewat-halangan bawah
4. Distensi abdomen4. Distensi abdomen
• Kurang- halangan atasKurang- halangan atas
• Nyata – halangan bawahNyata – halangan bawah

12. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PEMERIKSAAN FIZIKALPEMERIKSAAN FIZIKAL
1. Inspeksi1. Inspeksi
• DistensiDistensi
• PeristalsisPeristalsis
• Hernial protrusionHernial protrusion
• Surgical scarSurgical scar
2. Auscultasi2. Auscultasi
• Bowel soundsBowel sounds
• Hiperactive/tinklingHiperactive/tinkling
• Tiada – paralytic ileusTiada – paralytic ileus

13. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PEMERIKSAAN FIZIKALPEMERIKSAAN FIZIKAL
3. Palpasi3. Palpasi
• Mass berbentuk sausage – intussusceptionMass berbentuk sausage – intussusception
• Segment bowel kembong – halangan close-loopSegment bowel kembong – halangan close-loop
• Tanderness – direct/reboundTanderness – direct/rebound
• Guarding & Rigidity - peritonitisGuarding & Rigidity - peritonitis
4. Perkusi4. Perkusi
• TimpanikTimpanik
5. Per-Rectal (Digital)
Mengenalpasti – Intussuception, pelvic mass, ca. rectal

14. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
INVESTIGASIINVESTIGASI
• Darah : Hb%, TWDC, BUSE, GXMDarah : Hb%, TWDC, BUSE, GXM
• X-Ray : Plaib Abd. Erect/SupineX-Ray : Plaib Abd. Erect/Supine
• ECGECG
• CT ScanCT Scan

15. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
This abdominal X-ray shows
a stomach filled with fluid
and a swollen (distended)
small bowel, caused by a
blockage (obstruction) in the
intestines. A solution
containing a dye (barium)
that is visible on X-rays was
swallowed by the patient
(upper GI series).

16. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
This abdominal X-ray shows
thickening of the bowel wall
and swelling (distention)
caused by a blockage
(obstruction) in the intestines.
A solution containing a dye
(barium), which is visible on
X-ray, was swallowed by the
patient (the procedure is
known as an upper GI series).

17. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
This abdominal X-ray shows an
intestinal condition in which a
loop of bowel has slipped into
another section of bowel
(intussusception), causing
swelling, reduced blood flow,
obstruction, and tissue damage.
Intussusception requires
emergency treatment (barium
enema or surgery) to prevent
intestinal tissue death (necrosis),
intestinal perforation, peritonitis,
and death.

18. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
DIAGNOSIS PERBEZAANDIAGNOSIS PERBEZAAN
• Ac. CholecstitisAc. Cholecstitis
• Ac. AppendicitisAc. Appendicitis
• PGUPGU
• Ac. PancreatitisAc. Pancreatitis

19. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
PENGENDALIANPENGENDALIAN
• KonservativeKonservative
• PembedahanPembedahan
• NBM
• RT
• VS
• IV
• Ix
• Analgesik
• AB
• CBD
• Laprotomi

20. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
KOMPLIKASIKOMPLIKASI
• DehidrasiDehidrasi
• RenjatanRenjatan
• PerforasiPerforasi
• PeritonitisPeritonitis

22. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
Obstruction due to
hernia Obstruction due to
mesenteric occlusion
Obstruction due to
volvulus

23. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION
Obstruction due to
intussusception Obstruction due to
tumor
Obstruction due to
adhesions

24. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

25. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

26. INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION