gis156 slide prolaps_rektum
TRANSCRIPT
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PROLAPS REKTUM
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PROLAPS REKTUM
• Prolaps rektum = prosidensia � berupa
keluarnya seluruh tebal dinding rektum dari
anus
• Diagnosa :
– Penonjolan rektum dari anus
– Inkontinensia tinja partial atau total
– Pengeluaran mukus / lendir
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• Penyebab :
– ANAK
• Kelainan Bawaan
– Gangguan faal sfingter; mis :– Gangguan faal sfingter; mis :
» Meningokel
» Agenesis sakrum
– Pasca anaplastik/rektoplastik pada malformasi anorektal
– Kelainan bawaan vesika ektopik � simfisis pubis terpisah
• Hipotonik otot dasar panggul
• Obstipasi
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– DEWASA• Kurangnya daya tahan jaringan sistem penunjang rektum
– Pasca bedah perineum atau genitalia wanita
– Kelainan neurologik
– Kelemahan otot � usia lanjut, kurang gizi
• Peninggian tekanan intra abdomen• Peninggian tekanan intra abdomen
• Penunjang Rektum :– Mesenterial dorsal
– Lipatan peritoneum
– Fascia
– M.Levator Rektum
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• Penatalaksanaan :
– Konservatif :
• Laxatif
• Mengurangi tekanan saat mengedan• Mengurangi tekanan saat mengedan
• Perbaikan keadaan umum dan nutrisi
– Operatif :
• Transperineal (THIER’S)
• Laparatomi : rektopeksia, sigmoidektomi
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PROLAPS REKTUM
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HEMORRHOID
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Epidemiology
• No sex or ethnic predisposition
• Strikes in the prime of life (20-50 y.o.)
• Up to 25% of those > 30 y.o. population.
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HEMORRHOIDHEMORRHOIDStrukur anatomis normalStrukur anatomis normal
HEMORRHOIDHEMORRHOIDStrukur anatomis normalStrukur anatomis normal
8. Int. Hemorrhoidalplexus
9. Columnsof Morgagni
10. Ext. Sphincter
1. Treitz’ muscle
2. M levator ani
3. Circular muscle
4. Longitudinal
1
23
4 810. Ext. Sphincter
(deep band)
11. Anal crypt
12. Dentate line
13. Ext. Sphincter(subcutaneousband)
14. Ext. Hemorrhoidalplexus
4. Longitudinalmuscle
5. Internal sphincter
6. Conjointlongitudinal
layer
7. Parks’ ligament 14
6
5
7
10
9
11
12
13
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PRIMERPRIMER
BANTALAN BANTALAN
VASKULERVASKULER
BANTALAN BANTALAN
VASKULERVASKULER
VENOUS TONE ⇩⇩⇩⇩VENOUS TONE ⇩⇩⇩⇩
MICROSIRCULASI ⇩⇩⇩⇩MICROSIRCULASI ⇩⇩⇩⇩
CAPILLARY
RESISTANCE ⇩⇩⇩⇩
CAPILLARY
RESISTANCE ⇩⇩⇩⇩
SEKUNDERSEKUNDER
PORTAL HYPERTENSIONPORTAL HYPERTENSION
PREGNANCYPREGNANCY
CIRROSIS HEPATISCIRROSIS HEPATIS
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Etiology
• Erect posture - hydrostatic pressure from
gravitational induced pooling
• Heredity - genetic predisposition
• Pregnancy - compression of middle and • Pregnancy - compression of middle and
inferior plexus
• Anal infection - inflammation weakens vessels
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Etiology (cont.)
• Diet - more common if consuming low fiber (<14 Gm/day)
– Prolonged constipation
– Prolonged toilet time and straining increases – Prolonged toilet time and straining increases abdominal pressure
• Prolonged diarrhea - continual defecation increases abdominal pressure
• Other (CHF, Pelvic Tumors, Rectal CA)
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Classification of Hemorrhoids
• External - may thrombose (bluish nodules),
resolve after few days and retract leaving skin
tags.
• Internal - prolapse through anal sphincter may • Internal - prolapse through anal sphincter may
cause strangulation, thrombosis, gangrene.
• Mixture of both (most common).
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Signs and Symptoms
Common:
• Pain (external hemorrhoids) - usually a steady, aching discomfort vs severe, persistent pain.persistent pain.
• Bleeding (internal hemorrhoids) - usually occurs intermittently with BM.
• Prolapse - induced by straining during defecation or strenuous
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Signs and Symptoms
• Occasional:
• Burning - from warmth to intense heat
• Itching - manifestation of mild inflammation
• Seepage• Seepage
• Thrombosis - acute onset of severe and
constant pain which slowly resolves over 5-7
days
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• Hemorrhoid Derajat I
Terdapat pelebaran plexus hemorrhoidalis internus tidak sampaimenonjol keluar dari anus.
• Hemorrhoid derajat II
Penonjolan keluar dari anus bila mengejan,dapat masuk kembalisendiri.
HEMORRHOIDHEMORRHOID
DerajatDerajat
HEMORRHOIDHEMORRHOID
DerajatDerajat
Penonjolan keluar dari anus bila mengejan,dapat masuk kembalisendiri.
• Hemorrhoid derajat III
Penonjolan keluar dari anus,harus didorong dengan tangan barumasuk kembali.
• Hemorrhoid Derajat IV
Penonjolan tidak dapat masuk kembali (= incarcerata)
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Pemeriksaan klinis
• Inspeksi
• Palpasi• Palpasi
• Pemeriksaan
anorektal
• Colok dubur
• Proktoskopi
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Hemorrhoids
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Diagnosis
Penyebab utama:
•Anal fissures
•Prolapses
•Eczema Terapi
•Keganasan spesifik
•Polyps
Non HDNon HD
Derajat IDerajat I
•Diet & modifikasi
gaya hidup
••Terapi Terapi Terapi Terapi Terapi Terapi Terapi Terapi
FarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologi
•Pembedahan
Derajat IVDerajat IV
Penatalaksanaan HDPenatalaksanaan HDPenatalaksanaan HDPenatalaksanaan HD
•Diet dan modifikasi
gaya hidup
•Terapi Terapi Terapi Terapi
FarmakologiFarmakologiFarmakologiFarmakologi
•Sclerosing
•Kemungkinan
terapi antibiotik
•Fotokoagulasi
•BICAP
Derajat IDerajat I
•Diet dan modifikasi
gaya hidup
•Terapi Terapi Terapi Terapi
FarmakologiFarmakologiFarmakologiFarmakologi
•Rubber-band
ligation
•Heater probe
•Sclerosing
Derajat IIDerajat II
•Diet & modifikasi
gaya hidup
••Terapi Terapi Terapi Terapi Terapi Terapi Terapi Terapi
FarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologiFarmakologi
•Rubber-band
ligation
•Pembedahan
Derajat IIIDerajat III
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Pencegahan Pencegahan Pencegahan Pencegahan
Hindari konstipasi kronik
Hindari makanan pedas
Penatalaksanaan HDPenatalaksanaan HDPenatalaksanaan HDPenatalaksanaan HD
Diet “Bulk Laxatives” (metamucil)
Jangan mengedan sewaktu defekasi
Jangan memakai pencahar
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PENATALAKSANAAN PENATALAKSANAAN
HEMORRHOIDHEMORRHOID
Modifikasi gaya hidupModifikasi gaya hidup
PENATALAKSANAAN PENATALAKSANAAN
HEMORRHOIDHEMORRHOID
Modifikasi gaya hidupModifikasi gaya hidup
• Makan makanan tinggi serat
(buah dan sayur-sayuran):
Normal 30g/hari
– Pasien hemorrhoid: min.
13g/hari
• Minum air putih yang cukup:
1½ liter/hari
• Memperbaiki kebiasaan
defekasi
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Medikamentosa (Non-invasive)
• Menghentikan perdarahan, gatal, nyeri
• Memperbaiki defekasi : suplemen fiber dan
pelincir fecer (stool softener)
• Diosmin + Hesperidin mikronisasi • Diosmin + Hesperidin mikronisasi
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• Stadium I & II• Mengatasi gejala (rasa nyeri, perih dll)
• Menurunkan stadium
HEMORRHOIDHEMORRHOID
TerapiTerapi farmakologisfarmakologis
HEMORRHOIDHEMORRHOID
TerapiTerapi farmakologisfarmakologis
• Menurunkan stadium
• Stadium III & IV :• Mengurangi edema dan perdarahan,
mempermudah operasi
• Mengurangi pendarahan sekunder
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TERIMA KASIH