APPENDICITIS ANAK

ANATOMI
 Bagian
pertama dari
large intestine
 Bagian dari
sekum
 Organ
rudimenter,
dangkal & tipis
 Panjang <1 -
>30 cm, rata-
rata 6-9 cm
ANATOMI

ARTERI : A. APPENDIKULARIS (CABANG A.CAECALIS

POSTERIOR)
VENA : V. APPENDIKULARIS (KE VENA CAECALIS POSTERIOR)

LIMFATIK : MESOAPPENDIX LYMPH NODE DAN ILEOCOLIC

LYMPH NODE

NERVUS : SUPERIOR MESENTERIC PLEXUS DAN NERVUS

THORACAL 10
FISIOLOGI
• Mukosa appendiks mensekresi lendir
1-2 ml per hari.
• Imunoglobulin : IgA (mencegah
infeksi)
HISTOLOGI
LAPISAN:
• MUCOSA :
• EPITHELIUM : SIMPLE COLUMNAR;
SHORTER MICROVILLI; ABUNDANT
GOBLET
• LAMINA PROPRIA : MANY
LYMPHOID NODULES
• MUSCULARIS MUCOSAE :
DISCONTINOUS
• SUBMUCOSA : LYMPHOID NODULES
• MUSCULARIS EXTERNA : VERY THIN
• SEROSA
 DEFINISI
INFLAMASI >>
APPENDIX
Epidemiologi
• Appendicitis is most common in older children, with peak
incidence between the ages of 12 and 18 yr
• Children younger than 5 yr of age (<5% of cases)
• Children younger than 3 yr of age. (<1% of cases)
Patofisiologi

Bacterial
Bacterial
invasion of the
proliferation
Obstruction of appendiceal wall
the appendiceal
lumen Continued Elevated
Lymphatic and
secretion of intraluminal
venous.
mucus pressure

Impaired Ischemia of
congestion
arterial the wall of the necrosis
and edema
perfusion appendix
Diagnosis
• Leukocyte count 11,000-16,000/mm3 in the initial 24-48 hr
• Leukocyte count may be markedly elevated
(>20,000/mm3) in perforated appendicitis
• Normal WBC count never completely eliminates
appendicitis, a count <8,000/mm3 in a patient with a
history of illness longer than 48 hr should be viewed for
an alternative diagnosis.
• Urinalysis often demonstrates a few white or red blood
cells, as a result of the proximity of the inflamed appendix
to the ureter or bladder, but it should be free of bacteria.
Scores of ≤2 suggest a very low likelihood of appendicitis, whereas scores ≥8 are highly
associated with appendicitis. Scores between 3 and 7 warrant further evaluation or diagnostic
studies. Nonetheless, no scoring system is perfectly sensitive or specific.
Ultrasound
• The ultrasound criteria for appendicitis include wall

thickness ≥6 mm, luminal distention, a complex mass in

the RLQ, or an appendicolith.

• The main limitation of ultrasound is an inability to visualize

the appendix, which is reported in up to 20% of cases.

DIAGNOSIS BANDING
• Pada anak-anak balita àntara lain intususepsi,
divertikulitis, dan gastroenteritis akut. Intususepsi paling
sering didapatkan pada anak-anak berusia dibawah 3
tahun.
TATALAKSANA
• Anak dengan apendisitis biasanya mengalami mild
dehydration sehingga memerlukan terapi cairan
• Antipiretik jika demam
• Analgetik yang dimulai bahkan sebelum diagnosis
ditegakkan.
• Tindakan bedah : appendectomy.
• Antibiotic (untuk bakteri anaerobic, dan gram negative)
KOMPLIKASI
• Angka morbiditas mencapai 10-45% terutama pada
pasien yang mengalami intaabdominal abcess atau
perforasi.
• Angka mortalitas (<0.3%)