APPENDICITIS

• Oleh :
dr. Basaria Manurung

• Pembimbing:
dr. Prabudi Sp. B (K) Onk, M. Kes, FICS
 Introducation
• Appendicitis is inflammation of the vermiform
appendix. This is a hollow organ located at the tip of
the cecum, usually in the right lower quadrant of
the abdomen
• Uncomplicated appendicitis: appendicitis with no
evidence of an appendiceal fecalith, an appendiceal
tumor, or complications, such as perforation,
gangrene, abscess, or mass [1]
• Complicated appendicitis: appendicitis associated
with perforation, gangrene, abscess, an
inflammatory mass, an appendiceal fecalith, or an
appendiceal tumor
Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute
Appendicitis: The APPAC Randomized Clinical Trial.. JAMA. 2015; 313 (23): p.2340-8. doi: 10.1001/jama.2015.6154
 Anatomy
• A blind Muscular tube with
mucosal,submucosal and serosal layer
• At birth, appendix is short and broad at its
junction with the caesu, but diffeential growth
the caesum. Typikal tubullar structure by about
the age 2 years.
• During chilhood, continued growth of the
caesum commonlyrotates the appendix into a
retrocaecal but introperitoneal position.
• Position of the based the appendix is constant,
being found the confluenceof the three taeniae
coli of the caecum, which fuse to form the
outer longitudinal. Muscle coat of the
appendix.
Bailey & loves short practice of surgery 25 th ed
 Etiology
Caused by obstruction of the appendiceal lumen due to
 Lymphoid tissue hyperplasia (60% of cases): most common
cause in children and young adults
 Appendiceal fecalith and fecal stasis (35% of cases): most
common cause in adults
 Neoplasm : more likely in patients > 50 years of age
 Parasitic infestation : e.g., Enterobius vermicularis Ascaris
lumbricoides and species of the Taenia and 
Schistosoma genera
Tao Le, Vikas Bhushan, Deol M, Reyes G. First Aid for the USMLE Step 2 CK, Tenth Edition. New York: McGraw-Hill
Education ; 2018
 Pathophysiology

o Obstructed proximal appendiceal lumen (closed-loop obstruction), resulting in: 

 Stasis of mucosal secretions → bacterial multiplication and local inflammation
→ transmural spread of infection → clinical features of appendicitis
• Increased intraluminal pressure → obstruction of veins→ edema of the appendiceal
walls → obstruction of capillaries→ ischemia→ gangrenous appendicitis with/without
perforation
o Inflammation can spread to serosa, leading to peritonitis

Craig S. Appendicitis. In: Brenner BE, Appendicitis. New York, NY: WebMD. http://emedicine.medscape.com/article/773895-treatment. Updated: December 27, 2015. Accessed: December 14, 2016.
Associated nonspesific symtomps:
 Nausea
 Anorexia
 Vomiting
 Low grade fever
 Diarrhea
 Contipation
Martin RF. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. In: Post TW,
ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/acute-appendicitis-in-adults-
clinical-manifestations-and-differential-diagnosis#H5346248.Last updated: February 5, 2016. Accessed:
December 12, 2016.
Clinical signs of appendicitis 
• McBurney point (RLQ tenderness)
• RLQ guarding and/or rigidity.
• Rebound Tenderness (Blumberg
sign)
• Rovsing sign
• Psoas sign
• Obturator sign

Martin RF. Acute appendicitis in adults: Clinical manifestations and

differential diagnosis. In: Post TW, ed. UpToDate. Waltham, MA:
UpToDate. https://www.uptodate.com/contents/acute-appendicitis-in-
adults-clinical-manifestations-and-differential-diagnosis#H5346248.Last
updated: February 5, 2016. Accessed: December 12, 2016.
 Diagnostic

< 4: Low
5-6 Moderete
>7 : High
Alvarado A. A practical score for the early diagnosis of acute appendicitis.. Ann Emerg Med. 1986; 15 (5): p.557-64.
Treatment
Bowl Rest (NPO)
IV Fluid therapy
 Electrolte repletion as needed
 IV analgesic
 IV antiemetic as needed
Antipyretic therapy
Antibiotic therapy
 Pembedahan
Pemeriksaan Penunjang
• ST SCAN
• MRI
• USG ABDOMEN
LAPORAN KASUS
DENTITAS PASIEN

Nama : Tn. S
Umur : 47 Tahun
Jenis Kelamin : Laki - laki
Agama : Islam
Alamat : Kandangan
ANAMNESIS

• Keluhan utama
Nyeri Perut
• Riwayat Penyakit Sekarang
Pasien datang dengan keluhan nyeri perut dibagian kanan atas 1
minggu yang lalu, memberat 1 hari ini. Pasien sering membeliobat
untuk menghilangkan rasa nyeri. Riwayat urut pada abdomen.
Mual (-) Muntah (-)
 PEMERIKSAAN FISIK
Status Present
•Kesadaran : Kompos Mentis
•Tekanan Darah : 150/110 mmHg
•Nadi : 80 x/menit
•Pernapasan : 20 x/menit
•Suhu: 36,5
•SaO2: 100%
Status Gizi
•BB : 50 kg
•TB : 165 cm
•IMT : 16,5 kg/M2
Status General
•Abdomen : Defans Muskular (+), Nyeri Abdomen(+)
Status Lokalis
•RT DBN
•Alvarado Score +3
FOTO KLINIS
HASIL LABORATORIUM
10 Juli 2021

Pemeriksaan Hasil Nilai Rujukan Satuan

HEMATOLOGI
Hemoglobin 11,3 12,00 – 15,60 g/dL Nilai Laboratorium :
Bilirubin Total : 0.41
leukosit 6,21 3,50-9.50 ribu/uL
Bilirubin indirect : 0.33
Eritrosit 3.92 4,00 – 5,30 juta/uL Albumin : 2,97
SGOT : 28
Hematokrit 34.0 37,00 – 47,00 vol% SGPT: 14
150.000 – ureum : 53,6
Trombosit 355.000 /ul creatini :1,04
450.000
PEMERIKSAAN PENUNJANG
• DIAGNOSIS

Appendisitis Perforasi

• TATALAKSANA

Laparatomi Appendektomi
LAPORAN OPERASI
 Tanggal 10 Juli 2021
• S : Nyeri Bekas post Op (+)
FOLLOW UP
• O : TD : 150/110, N : 80, R : 24, T : 36,5
• Kepala : anemis (-/-)
• Abdomen : Nyeri Tekan (+) 
• A : Appencitis Perforasi Post Laparatomy appendectomy
ascites
Hipertensi
• P : - IVFD RL 20 gtt s/d Nacl 0,5 20 gtt.
• Inj. Ceftriaxone 1 x 12 jam
• Drip Metronidazol 500 mg/8 jam
• Inj. Ketorolac 1 amp/8 jam
• Inj. Ranitidin 1 gr/12 jam
• Drip Tramadol 1amp/8 jam
• Rawat luka
• Evaluasi Drain
• Cek Albumin dan Fungsi hati
Tanggal 11 Juli 2021
• S : Nyeri Perut Berkurang, Kentut(+) BAB (-)
• O : KU : Sedang
• TD : 100/70, N : 84, R : 21, T : 36,5
status abdomen
I : Kembung (-)
Luka dibalut perban
Draine 500cc kuning
NGT Residu 100 cc Kuning
A: Bu (+)
P : Soepel, nyeri pada luka operasi
P : timpani
• A : -Appendicitis Perforasi Post Appendectomy laparatomy
- Hipoalbumin
-Ascites
• P : evaluasi draine dan KU
Klaim NGT evaluasi
VIP Albumin tab 2x1
Stop Tramadol Drip
Tanggal 12 Juli 2021
• S : Nyeri Perut Berkurang, Kentut (+)
• O : TD : 133/93, N : 78, R : 20, T : 36,3
I : Soepel, Nyeri Bekas opeasi tertutup kassa. Draine 150cc
A: BU (+)
P : Nyeri Tekan (+)
P: Timpani
• A : Appencitis Perforasi Post Appendectomy laparatomy
• P : terapi lanjut
Draine evaluasi
AFF NGT
Mobilisasi berjalan dan duduk
Inj. Metcloperamid 1 amp/12 jam
Konsul Kardio dengan hipertensi
Diet Bubur
Tanggal 13 Juli 2021
• S : Nyeri Perut Berkurang, Kentut (+)
• O : TD : 133/93, N : 78, R : 20, T : 36,3
I : Soepel, Nyeri Bekas opeasi tertutup
kassa. Draine 300cc
A: BU (+)
P : Nyeri Tekan (+)
P: Timpani
• A : Appencitis Perforasi Post
Appendectomy laparatomy
• P : terapi lanjut
mobilisasi Berjalan
TATALAKSANA

• IVFD RL 20 TPM
• Inj. Ceftriaxone 2x 1 gr
• Inj. Metronidazole 3x500 mg
• Inj. Ranitidine 2x 1 amp.
• Inj. Ketorolac 3x 1 amp.
• VIP albumin 2x 1 caps
• Metcloperamid 1 amp/12 jam
• Advice dr. Lina Sp.JP :
Tidak ada kardiomegali
Observasi Tekanan Darah
 Kriteria Diagnosis
TEORI
Pada karateristik dari appendiks akut akan ditemukan
beberapa gejala dengan menggunakan alvarado score
dengan pemeriksaan penunjang seperti USG Abdomen.

Kasus
Pada kasus diatas Pasien sering mengalami nyeri perut dibagian
kanan atas dan kanan bawah dengan sering meminum obat
antinyeri. Dan pada usg abdomen ditemukan appendicitis
dengan cairan bebas sampai acites.
CONCLUSION

• Appendisitis adalah peradangan yang terjadi pada

appendix vemicularis.
• Appendix dapat diukur dengan menggunakan
alvarado score. Tapi yang paling terpenting adalah
pemeriksaan fisik.
• Pemeriksaan penunjang appendix adalah usg
Abdomen, CT.Scan, maupun MRI
• Untuk tatalaksana appendix dapat diberikan
analgetik, antibiotik, dan dapat dilakukan
pembedahan.
THANK YOU