Download - Unit 2.7.1 Hernia
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SISTEM ALIMENTARISISTEM ALIMENTARI
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UNIT 2.7.1- UNIT 2.7.1- HERNIAHERNIADefinisi :- Definisi :- PENONJOLAN ORGAN PENONJOLAN ORGAN ATAU TISU DI LUAR ATAU TISU DI LUAR KAVITI TUBUH KAVITI TUBUH MELALUI MELALUI PEMBUKAAN DI PEMBUKAAN DI DINDING KAVITI DINDING KAVITI YANG ABNORMAL DI YANG ABNORMAL DI MANA SELALUNYA MANA SELALUNYA MENGANDUNGI MENGANDUNGI KANDUNGAN KAVITI KANDUNGAN KAVITI TERSEBUT.(struktur TERSEBUT.(struktur atau otot)atau otot)
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STRUKTUR HERNIASTRUKTUR HERNIA• SAK
– TERDIRI DRPD PERITONEUM
• KANDUNGAN– TERMASUK USUS,
OMENTUM (Peritoneum), PUNDI KENCING, OVARI
• DINDING ABDOMEN– KULIT, OTOT
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LOKASILOKASI
• GROIN• FEMORAL• UMBILIKAL• DIAFRAGMA• ABDOMEN(VENTRAL)
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4. 4. JENIS HERNIAJENIS HERNIA :- :-
• INGUINAL HERNIA (73%).• FEMORAL HERNIA (17%) -tend to be
irreducible and strangulate. ischaemia, tissue death (necrosis) and gangrene . requires urgent surgery.
• UMBILIKAL HERNIA (8.5%)• INCISIONAL HERNIA-11-20% of cases of
surgery • HIATUS HERNIA .
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TypesTypes
A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body
•common in women due to the strain of pregnancy. •80% of all hernias and are more
common in men.
common in women due to pregnancy, and in Chinese and black infants
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Hiatal herniaHiatal hernia
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ETIOLOGIETIOLOGI
• KONGENITAL– KECACATAN DI
DINDING ABDOMEN
• KELEMAHAN PADA DINDING KAVITI– PENINGKATAN UMUR– PENYAKIT KRONIK– OBESITI
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ETIOLOGIETIOLOGI• KENAIKAN TEKANAN INTRA ABDOMEN
– MENGANGKAT BEBANAN BERAT– BATUK YANG KUAT– MENERAN (KENCING / SEMBELIT)– KEHAMILAN– ASCITES
• TRAUMA PADA DINDING KAVITI– SELEPAS PEMBEDAHAN– KECEDERAAN SEMASA PEMBEDAHAN
ABDOMEN
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KLASIFIKASI HERNIAKLASIFIKASI HERNIA
1. REDUCIBLE2. IRREDUCIBLE3. OBSTRUCTED4. STRANGULATED
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PENYIASATANPENYIASATAN
1. PENGAMBILAN SEJARAH PESAKIT2. PEMERIKSAAN FIZIKAL
• I - INSPECTION• P - PERCUSSION• P - PALPATION• A – AUSCULTATION
3. BARIUM SWALLOW4. X-RAY5. ECG
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DIAGNOSA PERBEZAANDIAGNOSA PERBEZAAN
1. FEMORAL HERNIA2. HYDROCELE3. INCOMPLETE DESCENDING TESTIS4. SPERMATOCELE5. LIMPOMA OF THE CORD- Can be
lifted off the deep fascia
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INGUINAL HERNIAINGUINAL HERNIA• DEFINISI
– PENONJOLAN SAK PERITONEUM YG MENGANDUNGI LEMAK ATAU SEBAHAGIAN BOWEL MELALUI DINDING ABDOMEN BAWAH (INGUINAL CANAL)
– BIASA BERLAKU DAN TERTUMPU DI BAHAGIAN GROIN
• JENIS– INDIRECT– DIRECT
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INDIRECT INGUINAL HERNIAINDIRECT INGUINAL HERNIA• DEFINISI
– LALUAN KANDUNGAN ABDOMINAL (BOWEL) MENERUSI INTERNAL INGUINAL RING KE KANAL INGUINAL KE DALAM SCROTUM ATAU LABIUM MAJUS
– BIASA BERLAKU PADA LELAKI GOLONGAN MUDA
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Hernia sided.Hernia sided.
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Huge inguinal Hernia.Huge inguinal Hernia.
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Patofisiologi Inguinal hernia:-Patofisiologi Inguinal hernia:-Sak hernia keluar dari kaviti abdomen melalui
pembukaan di ‘external ring’.• Sak kandungan hernia masuk ke skrotum
melalui kanal inguinal.• Sak dan kandungan hernia boleh di kembalikan
(REDUCIBLE).• Sak dan kandungan hernia tidak boleh
dikembalikan (IRREDUCIBLE).• Sak dan kandungan hernia – tersekat.• Sak dan kandungan hernia dicekik
(STRANGULATED).• Inflamasi berlaku pada kandungan hernia ( INFLAMED).
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MANIFESTASI KLINIKALMANIFESTASI KLINIKAL
1. SAKIT PADA KAWASAN GROIN• HINGGA KE BAHAGIAN SKROTUM@testis.• BERTERUSAN• BERKURANGAN APABILA HERNIA TERJADI• MENINGKAT JIKA IA TERSEKAT
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MANIFESTASI KLINIKALMANIFESTASI KLINIKAL
1. KEBENGKAKAN• PADA groin @SKROTUM• BERTAMBAH JIKA MENERAN ATAU
MENANGIS• BERKURANGAN JIKA BERBARING
2. IMPULSE OF COUGHING
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DIRECT INGUINAL HERNIADIRECT INGUINAL HERNIA• DEFINISI
– SATU BENJOLAN YANG MENGANDUNGI KANDUNGAN ABDOMEN DISEBABKAN OLEH KELEMAHAN DINDING POSTERIOR KANAL INGIUNAL UNTUK MENYOKONG DAN MEMBENARKANNYA MELALUI EXTERNAL INGUINAL RING
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PERBEZAAN ANTARA DIRECT DAN INDIRECT PERBEZAAN ANTARA DIRECT DAN INDIRECT INGUINAL HERNIAINGUINAL HERNIA
reduce the hernia, then occlude the internal reduce the hernia, then occlude the internal inguinal canal with 2 fingers. Ask the patient to inguinal canal with 2 fingers. Ask the patient to cough. If it pops out, then is direct, if it stays in cough. If it pops out, then is direct, if it stays in
then its indirect!then its indirect!
• INDIRECT INGUINAL– KERAP BERLAKU– GOLONGAN MUDA– MENURUN KE
DALAM SKROTUM– BOLEH
MENGAKIBATKAN STRANGULATION
• DIRECT INGUINAL– JARANG BERLAKU– GOLONGAN TUA– JARANG MENURUN
KE DALAM SKROTUM
– JARANG MENGAKIBATKAN STRANGULATION
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Investigasi :-Investigasi :-
• Pemeriksaan fisikal/pemeriksaan setempat.
- Pemerhatian – lokasi, kebengkakan,warna,impulse on coughing.
- Palpasi – lokasi, kandungannya, kebengkakan, tenderness, suhu, saiznya dan impulse on coughing.
• Sejarah pesakit.
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16. Diagnosa perbezaan :-16. Diagnosa perbezaan :-
• Femoral hernia.• Hydrocele.• Spermatocele.• Incomplete descenting testis.• Limpoms of the cord.
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Pengendalian/rawatan inguinal Pengendalian/rawatan inguinal hernia.hernia.
• Rawatan konservatif.- Kurangkan (reduce) hernia dgn
tekanan (by pressure).- Memakai ‘truss’… Untuk hernia yg
jenis ‘reducible.- Mengelakkan ketegangan berlaku
pada dinding abdomen – cuba elakkan ambil barang berat.
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RAWATAN DAN PENGURUSANRAWATAN DAN PENGURUSAN
• PEMBEDAHAN – HERNIORRHAPY- no autogenous or
heterogeneous material is used for reinforcement
– HERNIOPLASTY- herniotomy is combined with a reinforced repair of the posterior inguinal canal wall with autogenous (patient's own tissue) or heterogeneous (like steel or prolene mesh)
– HERNIOTOMY-hernia sac is removed without any repair of the inguinal canal
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Rawatan selepas pembedahan :-Rawatan selepas pembedahan :-• Rehatkan pesakit.• POSISI YANG SESUAI • SOKONGAN PADA SKROTUM
• Dressing.• DRESSING• PENDIDIKAN PESAKIT
– KURANGKAN aktiviti berat.– KEBERSIHAN– DIET
– Rawatan susulan
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FEMORAL HERNIAFEMORAL HERNIA
• DEFINISI– KEMASUKAN KANDUNGAN ABDOMEN
(BOWEL) KE DALAM KANAL FEMORAL MELALUI TITIK ARTERI FEMORAL DARI ABDOMEN KE PAHA
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FEMORAL HERNIAFEMORAL HERNIA
• ETIOLOGI– KONGENITAL
• CIRI-CIRI KLINIKAL– SEKECIL BUAH ANGGUR, IRREDUCIBLE,
SUKAR DIKESAN MELALUI COUGH IMPULSE
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INCISIONAL HERNIAINCISIONAL HERNIA• DEFINISI
– PENONJOLAN SEBAHAGIAN KANDUNGAN ABDOMEN (BOWEL) MENERUSI LUKA PEMBEDAHAN
– MERUPAKAN KOMPLIKASI LEWAT PEMBEDAHAN ABDOMEN
• ETIOLOGI– KENAIKAN TEKANAN INTRA ABDOMEN– JAHITAN TIDAK SEMPURNA– INFEKSI LUKA
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CIRI-CIRI KLINIKALCIRI-CIRI KLINIKAL
• BONJOLAN YANG BESAR (DALAM ABDOMEN DI BAHAGIAN BEKAS LUKA PEMBEDAHAN)
• ASIMTOMATIK• SAKIT JIKA BERLAKU JERUTAN PADA
HERNIA
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UMBILICUS HERNIAUMBILICUS HERNIA• DEFINISI
– PENONJOLAN SEBAHAGIAN KANDUNGAN ABDOMEN (BOWEL) PADA PUSAT DAN BIASANYA BERLAKU KE ATAS KANAK-KANAK YANG BARU LAHIR
• ETIOLOGI– KONGENITAL (JIKA LAHIR PRA-MATANG)
• CIRI-CIRI KLINIKAL– BENJOLAN PADA PUSAT– HILANG SECARA SPONTAN PADA USIA
SETAHUN KELAHIRAN
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UMBILICAL HERNIA
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Hernia unbilicus repairHernia unbilicus repair
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HIATUS HERNIAHIATUS HERNIA
• DEFINISI– JENIS HERNIA DIAFRAGMA DAN GASTER– KANDUNGAN ABDOMEN (PERUT) AKAN
MENONJOL KE DALAM RUANG KAVITI DADA AKIBAT TEKANAN YANG TINGGI DALAM INTRA ABDOMEN
• ETIOLOGI– PERTAMBAHAN TEKANAN INTRA
ABDOMEN– KELEMAHAN DINDING DIAFRAGMA
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CIRI-CIRI KLINIKALCIRI-CIRI KLINIKAL
• KEBIASAANNYA PADA WANITA LANJUT USIA
• SAKIT SEPERTI TERBAKAR PADA RETROSTERNAL
• RASA PAHIT DI MULUT
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CIRI-CIRI KLINIKALCIRI-CIRI KLINIKAL
• INDIGESTION• TERUK SEMASA BARING ATAU
MEMBONGKOK• DISFAGIA• SAKIT DADA (JIKA MENJADI AKUT DAN
TERUK)
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RAWATAN DAN PENGURUSANRAWATAN DAN PENGURUSAN
• REHATKAN PESAKIT• KONSERVATIF
– KURANGKAN TEKANAN– MEMAKAI TRUSS (SOKONGAN)
• SIMTOMATIK– ANALGESIK ( Indomethacin/Tramadol)
• PRE & POST OPERATION
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TRUSS
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Inferior lumbar herniaInferior lumbar hernia