[ppt]hemoroid_blpp - fk uwks 2012 c | born to be a ... · web viewtitle hemoroid_blpp subject...
TRANSCRIPT
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PENATALAKSANAAN PENYAKIT HEMORHOID DALAM PRAKTEK
SEHARI-HARI
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BATASAN :
HEMORHOID adalah pelebaran Vena di dalam pleksus HEMORHOIDALIS yg tidak merupakan keadaan patologik , hanya apabila homorhoid ini menyebabkan keluhan atau penyulit diperlukan tindakan.
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HEMORHOID DIBEDAKAN : HEMORHOID INTERNAL
Pelebaran pleksus vena hemorhoidalis superior di atas garis mukokutan dan ditutupi oleh mukosa.
Merupakan bantalan vaskuler di dalam jaringan sub mukosa pada rektum sebelah bawah.
HEMORHOID EKSTERNAL Merupakan pelebaran dan penonjolan pleksus
hemorhoidalis inferior, terdapat di sebelah distal garis mukokutan di dalam jaringan di bawah epitel anus.
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POSISI HEMORHOID YANG PALING SERING :
. Kanan Depan . Kanan Belakang . Kiri Lateral
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PATOGENESIS
Tiga Teori :1 TEORI MEKANIKAL : 1 Dasar : Jaringan penunjang muskulo
fibroelastik hemorhoid interna, Park’s ligamen yang mengalami degeneratif kelemahan abnormal dari jaringan pergerakan
hemorhoid peninggian tekanan intra rektal peningkatan ukuran
hemorhoid.
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PATOGENESIS 2 TEORI HEMODINAMIK :
Dasar : Mikrosirkuler anal kanal mengandung arterio venus shunt yang cenderung akibat reaksi hormonal atau rangsangan fisiologikal, berdasarkan pemeriksaan mikroskop elektron dan histologi.
3 SPINCTER ABNORMAL:
Dasar : Peningkatan aktivitas spincter, menyebabkan peningkatan tekanan jaringan dalam analkanal.
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Current etiologic, pathogenic, and paathophysiological concepts of
hemorrhoidal disease
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Pathophysiology of hemorrhoids:
hemorrhoids in place but mobile
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Pathophysiolohy of hemorrhoids:
Prolapsed hemorrhoids
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Normal arteriovenous shunt function: Arteriovenous shunts
closed,
precapillary sphincter opened
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Arteriovenous shunt dysfunction:opening of arteriovenous shunts,
contraction
of precapillary sphincter
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FAKTOR RESIKO YANG DAPAT MENYEBABKAN HEMORHOID : Gangguan fungsi usus halus mis: diare, konstipasi Gangguan pengosongan rektum Kehamilan dan melahirkan Pemakaian obat-obat lokal mis: enema, supositoria,
penggunaan laksan yang berlebihan Oral kontraseptif Iritasi mukosa anal kanal Diet yang rendah serat Alkohol
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GAMBARAN KLINIK:
Nyeri Perdarahan Prolap hemorhoid Discharge / Mucus Pruritus
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DUA PRINSIP POSISI PASIEN SEWAKTU PEMERIKSAAN :
1 The Knee Elbow Position2 The Left Lateral Position
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Examination in knee-elbow
position
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Examination in left lateral
position
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PEMERIKSAAN1 Terdapat mucus pada
hemorhoid yang prolap2 Colok dubur3 Anuskopi4 Proktosigmoidoscopy
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DIAGNOSA BANDING: Karsinoma Kolorektum Penyakit Divertikel Prolap Rectum Kolitis Ulserativa Kondiloma Perianal Lipatan kulit Sentinel pada garis tengah
dorsal
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Macam Haemorhoid
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Kelainan Anorektal
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KOMPLIKASI1 Trombosis melingkar nyeri hebat nekrose mukosa dan kulit penutup (jarang)2 Emboli septik melalui sistem portal abses hati3 Anemia
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Paska Haemorhoidektomi (komplikasi)
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KLASIFIKASI Hemorhoid interna dikelompokkan dlm 4 derajat:
DERAJAT I :Perdarahan segar tanpa nyeri pada waktudefekasi. Tidak ada prolap, padapemeriksaan anuskopi terlihat hemorhoidyang menonjol ke dalam lumen.
DERAJAT II :Menonjol melalui anal kanal saat mengedan ringan, tetapi dapat masuk kembali secara spontan.
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KLASIFIKASI
DERAJAT III :Menonjol saat mengedan dan harus didorong kembali sesudah defekasi.
DERAJAT IV :Menonjol keluar dan tidak dapat
didorong masuk, biasanya timbul gejala nyeri.
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Staging of hemorrhoids
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PENANGGULANGANA . Secara umumB . Terapi obat-obatanC . SkeleroterapiD . Ligasi dengan gelang karetE . Bedah bekuF . Infrared coagulasiG . Metode lainH . Hemorhoidektomi
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Sclerotherapy equipment
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Injection sclerotherapy
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Sclerotherapy technique
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Rubber and ligator with its cone engabling fitting of a rubber
band
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Cryode with its nitrous oxid cylindeer
and pressure adjuster
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Infrared coagulation apparatus
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Indikasi metode pengobatan berbagai derajat hemorhoidDerajat Hemorhoid Pengobatan
I - Terapi obat-obatan- Sklerosing metode- Foto coagulasi- Bipolar coagulasi diatermi
II - Terapi obat-obatan- Ligasi gelang karet- Heater probe- Sklerosing metode
III - Ligasi gelang karet- Operasi- Terapi obat-obatan
IV - Operasi- Terapi obat-obatan
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SURGICAL
MEDICALMEDICAL OFFICE
PRACTICE
SURGICAL
TRADITIONAL MODERN
I0
III0
IV0
II0
I0
II0
IV0
III0
PILIHAN TERAPI
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PARADIGMA BARU
1. DIAGNOSA HEMORRHOID INTERNA HARUS DILENGKAPI PEMERIKSAAN PROKTOSKOPI
2. TENTUKAN : LETAK, JUMLAH DAN BESARNYA
MASING- MASING BENJOLAN (PENTING UNTUK EVALUASI PROKTOSKOPI)
3. DERAJAT 3 : BISA DIBAGI MENJADI 3A DAN 3B
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PARADIGMA BARU
DERAJAT 3A : SEPERTI KRITERIA 3 TETAPI BILA BENJOLAN 2
DERAJAT 3B : SEPERTI KRITERIA 3 BILA BENJOLANNYA >2 ATAU SIRKULER
DERAJAT 3B : BIASANYA AKAN TURUN KE DERAJAT 4.
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PARADIGMA BARU : KONSERVATIF ----> TRIO
1. PENGATURAN DIET --> BAB LUNAK 2. OBAT-OBAT PER-ORAL
3. SUPPOSITORIA.
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PARADIGMA BARU : PENGATURAN DIET
1. MINUM AIR PUTIH 1 - 1½ LITER/HARI
2. BUAH-BUAHAN : PEPAYA, PISANG
3. SAYURAN
4. LARANGAN MAKAN.
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LARANGAN MAKAN
1. DAGING KAMBING
2. PEDAS
3. DURIAN
4. NANAS
5. CUKAK
6. SALAK
7. NANGKA
LAMANYA SAMPAI 6 MINGGU (1 ½ BULAN)
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PARADIGMA BARU
1. PENGOBATAN KONSERVATIF SELAMA 6 MINGGU
2. GEJALA HILANG TIDAK BERARTI SEMBUH.
3. SEMUA GEJALA RATA-RATA HILANG DALAM SEMINGGU PERTAMA BEROBAT.
4. EVALUASI HARUS DENGAN PROKTOSKOPI MINIMAL 2 MINGGU SEKALI 3 X BERTURUT-TURUT.
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HEMORHOID EKSTERNAL YANG MENGALAMI TROMBOSIS :
1. Rendam duduk menggunakan larutan hangat, salep yang mengandung analgetik. 2. Istirahat di tempat tidur, untuk mempercepat berkurangnya pembengkakan.3. Kurang dari 48 jam dapat ditolong : segera mengeluarkan trombus atau eksisi lengkap dengan anastesi lokal.
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KESIMPULAN Hemorhoid suatu keadaan normal dari anatomi
manusia, jika mengalami perubahan diperlukan tindakan.
Dengan bertambahnya usia terjadi perubahan hemorhoid yang membesar dan turun dalam lumen anal kanal.
Vena-vena menjadi tegang dan perubahan ini meningkat setelah dekade ke-3 dalam kehidupan.
Dengan meningkatnya pengetahuan struktur anatomi dan prevalensi penyakit, akan memudahkan cara pencegahan dan pengobatan simptomatis penyakit ini.