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    Buku Saku Urologi

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    sitisarah
    This document discusses hemorrhoids, including: 1. Hemorrhoids are vascular cushions located in the lower rectum and anus that can become enlarged. They can be internal or external. 2. Risk factors include constipation, pregnancy, obesity, lack of exercise, and certain occupations. 3. Treatment depends on the degree of hemorrhoids and may include dietary changes, medications, non-surgical procedures like rubber band ligation, or surgery for severe cases. Prevention focuses on avoiding constipation and a high-fiber diet.

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    Buku Saku Urologi

    Uploaded by

    sitisarah
    53 views33 pages
    This document discusses hemorrhoids, including: 1. Hemorrhoids are vascular cushions located in the lower rectum and anus that can become enlarged. They can be internal or external. 2. Risk factors include constipation, pregnancy, obesity, lack of exercise, and certain occupations. 3. Treatment depends on the degree of hemorrhoids and may include dietary changes, medications, non-surgical procedures like rubber band ligation, or surgery for severe cases. Prevention focuses on avoiding constipation and a high-fiber diet.

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    Hemoroid

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    This document discusses hemorrhoids, including: 1. Hemorrhoids are vascular cushions located in the lower rectum and anus that can become enlarged. They can be internal or external. 2. Risk factors include constipation, pregnancy, obesity, lack of exercise, and certain occupations. 3. Treatment depends on the degree of hemorrhoids and may include dietary changes, medications, non-surgical procedures like rubber band ligation, or surgery for severe cases. Prevention focuses on avoiding constipation and a high-fiber diet.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    53 views33 pages

    Buku Saku Urologi

    Uploaded by

    sitisarah
    This document discusses hemorrhoids, including: 1. Hemorrhoids are vascular cushions located in the lower rectum and anus that can become enlarged. They can be internal or external. 2. Risk factors include constipation, pregnancy, obesity, lack of exercise, and certain occupations. 3. Treatment depends on the degree of hemorrhoids and may include dietary changes, medications, non-surgical procedures like rubber band ligation, or surgery for severe cases. Prevention focuses on avoiding constipation and a high-fiber diet.

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    HEMOROID

    Diagnosis dan Penatalaksanaan


    Hemoroid :

    Yunani : Haima (darah)+Rhoos (aliran) Aliran


    darah

    Galen dan Hippocrates : Varices


    HEMORRHOID
    ☞ Merupakan bantalan vaskular yang
    membesar dibagian bawah rektum
    dan anus.
    ☞ Hemorrhoid Interna.
    ☞ Hemorrhoid Externa.
    ☞ Hemorrhoid Interna dan Externa.
    ANATOMI
    HEMORRHOID
    1. M submucosae (Treitz’ muscle)
    2. Circular muscle of the rectum
    1 3. Longiitudinal muscle of the rectum
    4. M levator ani
    2 5. Conjoint longitudinal layer
    3 6. Parks’ ligament
    4 7. External anal sphincter (deep band)
    13 8. External anal sphincter (subcutaneous
    band)
    9 9. Internal anal sphincter
    12 10 14 10. Internal hemorrhoidal plexus
    7
    5 11. External hemorrhoidal plexus
    6 12. Dentate line
    11 13. Columns of Morgagni
    8
    14. Anal crypt
    BANTALAN VENOUS TONE ⇩
    VASKULER
    MICROSIRCULASI ⇩
    PRIMER
    CAPILLARY
    RESISTANCE ⇩
    Hemorrhoid

    PORTAL CIRROSIS
    HYPERTENSION HEPATIS
    SEKUNDER

    PREGNANCY
    INSIDEN

    • Bernstein : 50 – 80 % orang dewasa

    • Gold berg : 5% penduduk barat Wanita


    > Pria

    • Hunt dan Johansen : kaitan dengan


    hipertensi portal diragukan

    • Lurz dan Golzner : wanita multipara 46%


    HEMORRHOID
    Strukur anatomis normal

    1. Treitz’ muscle 8. Int. Hemorrhoidal


    1 plexus
    2. M levator ani
    3
    9. Columns
    3. Circular muscle 2 of Morgagni
    4 8 10. Ext. Sphincter
    4. Longitudinal
    muscle (deep band)
    9 11. Anal crypt
    5. Internal 5
    sphincter 1 12. Dentate line
    1 0
    6. Conjoint 1 1 13. Ext. Sphincter
    6 7 2
    longitudinal (subcutaneous
    layer band)
    1 14. Ext. Hemorrhoidal
    7. Parks’ ligament 3
    14 plexus
    Teori Anal Cushions

    ▶ THOMSON (1975)
    ▶ Anal cushions (AC) telah ada sejak
    lahir
    ▶ AC terdiri dari pembuluh darah, M.
    Treitz, jaringan ikat
    ▶ 3 AC left lateral, right postero lateral,
    right antero lateral
    ▶ HAAS (1983) hemoroid adalah proses
    degeneratif dari aparatus yang
    menyokong mukosa dan sub mukosa
    Anal Cushions
    Arterio-venous channels
    HAEMORRHOIDS
    Anal cushion Function: defecation process
    anal continence seal anal outlet
    11

    Anal cushion position


    3,7,11 direction Anal cushion
    HAEMORRHOIDS
    Etiology :

    Faeces
    compression

    Anal
    rotation
    Function of Anal
    Cushions
    Control faecal continence
    ▶ External anal sphincter (solids)
    ▶ Internal anal sphincter (liquids)
    ▶ Anal cushions (liquids & gas)
    HEMORRHOID
    1. Faktor mekanik

    Degenerasi ligamen penyangga: Ligamentum Parks

    Hemorrhoid yang Hemorrhoid yang


    mobil prolaps
    Rupture of
    Mobilizati anchoring
    on tissue
    of plexus
    Stretching of Permanent int.
    anchoring hemorrhoidal
    tissue prolapse

    Internal Stretching or
    hemorrhoidal rupture of
    plexus prolapsing Parks’
    on straining ligament

    Parks’ Lateralization
    ligament of ext. hemorrhoidal
    functional plexus
    HEMORRHOID
    2. Faktor Hemodinamik

    Increased
    arterial flow

    Disfunction of
    arteriovenous shunt
    Extended
    venous back
    flow
    Microvascular stastis

    Venous
    stasis

    ↑ Capillary fragility
    ↑
    Hyperpermeability

    Local
    inflammatory
    process
    HEMORRHOID
    Derajat

    ▶ Hemorrhoid Derajat I
    Terdapat pelebaran plexus hemorrhoidalis internus tidak
    sampai menonjol keluar dari anus.

    ▶ Hemorrhoid derajat II
    Penonjolan keluar dari anus bila mengejan,dapat masuk
    kembali sendiri.

    ▶ Hemorrhoid derajat III


    Penonjolan keluar dari anus,harus didorong dengan
    tangan baru masuk kembali.

    ▶ Hemorrhoid Derajat IV
    Penonjolan tidak dapat masuk kembali (= incarcerata)
    HEMORRHOID
    Faktor-faktor risiko

    ▶ Yang diketahui:
    ▶ Gangguan BAB/ mengejan
    ▶ Kehamilan, melahirkan
    ▶ Obat-obatan lokal/pencahar (supositoria,
    enemas)
    ▶ Yang diduga:
    ▶ Gangguan Mikrosirkulasi
    ▶ Menstruasi
    ▶ Gaya hidup yang kurang aktivitas
    ▶ Olah raga tertentu (berkuda, bersepeda)
    ▶ Pekerjaan tertentu (supir, pilot)
    ▶ Alkohol, kopi, dan makanan pedas
    HEMORRHOID
    Diagnosis

    Gambaran Klinis

    • Nyeri
    • Perdarahan
    • Bengkak/tonjolan
    • Prolaps
    • Keluarnya lendir
    • Gatal/Pruritus ani
    • Inkontinensia feses
    Pemeriksaan klinis

    ▶ Inspeksi
    ▶ Palpasi
    ▶ Pemeriksaan
    anorektal
    ▶ Colok dubur
    ▶ Proktoskopi
    Penyebab utama: Non HD Penatalaksanaan HD
    •Anal fissures
    •Prolapses
    •Eczema Terapi
    •Keganasan spesifik Derajat IV
    •Polyps •Diet &
    modifikasi
    gaya hidup
    Diagnosis •Terapi
    Farmakologi
    •Pembedahan
    Derajat I
    •Diet dan modifikasi
    gaya hidup
    •Terapi Derajat II Derajat III
    Farmakologi •Diet dan modifikasi •Diet &
    •Sclerosing gaya hidup modifikasi
    •Kemungkinan •Terapi gaya hidup
    terapi antibiotik Farmakologi •Terapi
    •Fotokoagulasi •Rubber-band Farmakologi
    •BICAP ligation •Rubber-band
    •Heater probe ligation
    •Sclerosing •Pembedahan
    Penatalaksanaan HD
    Pencegahan

    Hindari konstipasi kronik


    Hindari makanan pedas
    Diet “Bulk Laxatives” (metamucil)
    Jangan mengedan sewaktu defeksi
    Jangan memakai pencahar
    PENATALAKSANAAN
    HEMORRHOID
    Modifikasi 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
    HEMORRHOID
    Terapi invasif non bedah/instrumentasi

    Sklerotera Ligasi Karet


    pi gelang

    Bedah Cryo Infra-red Skleroterapi


    Sclerotherapy & infrared
    sclerotherapy

    Infra-red Skleroterapi
    Rubber band ligation &
    cryosurgery
    HEMORRHOID
    Terapi Bedah/ Hemorrhoidektomi

    ▶ Diindikasikan untuk
    Derajat III dan IV
    ▶ Efektif, angka kekambuhan 5%
    Teknik:
    ▶ Morgan Milligan
    ▶ Parks
    ▶ Whitehead
    ▶ Langenbeck
    ▶ Namun bisa terdapat
    komplikasi
    ▶ Nyeri
    ▶ iInkontinensia
    ▶ Perdarahan
    Haemorrhoidectomy
    Effective ~ 5% recurrence
    BUT:
    ▶ Pain
    ▶ Bleeding
    ▶ Incontinence
    – (usually
    faecal
    impaction)
    Stapled
    Haemorrhoidectomy

    Interruption of superior haemorrhoidal vessels


    –External skin tags shrivel
    – No painful perianal wounds
    Longo 6th World Congress Endosc Surg 1998
    MANAJEMEN HEMORRHOID

    I. PENCEGAHAN (PREVENTION)
    II. INVASIVE
    III. MEDIKA MENTOSA
    (NON INVASIVE)
    PENCEGAHAN

    ▶ Hindari konstipasi kronik


    ▶ HIndari makanan Pedas
    ▶ Diet “Bulk Laxatives” (metamucil)
    ▶ Jangan mengedan sewaktu defeksi
    ▶ Jangan memakai pencahar
    INVASIVE

    ▶ Skleroterapi
    ▶ Rubber band ligation
    ▶ Cyrosurgery
    ▶ Coagulation
    ▶ Doppler ultrasound guides hemorrhoid artery ligation
    ▶ Terapi operasi
    Medikamentosa (Non-invasive)

    ▶ Menghentikan perdarahan, gatal, nyeri


    ▶ Memperbaiki defekasi : suplemen fiber dan
    pelincir fecer (stool softener)
    ▶ Diosmin + Hesperidin mikronisasi
    HEMORRHOID
    Terapi farmakologis

    ▶ Stadium I & II
    ● Mengatasi gejala (rasa nyeri, perih dll)
    ● Menurunkan stadium

    ▶ Stadium III & IV :


    ● Mengurangi edema dan perdarahan, mempermudah operasi
    ● Mengurangi pendarahan sekunder
    BANTALAN VENOUS TONE ⇩
    VASKULER
    MICROSIRCULASI ⇩
    PRIMER
    CAPILLARY
    RESISTANCE ⇩
    Hemorrhoid

    PORTAL CIRROSIS
    HYPERTENSION HEPATIS
    SEKUNDER

    PREGNANCY

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