Penyakit radang panggul PELVIC INFLAMMATORY DISEASE Copy

Etiologi parametritis dapat terjadi:
a. Dari endometritis dengan 3 cara
1) Percontinuitatum: endometritis, metritis, paraetritis
2) Lymphogen
3) Haematogen: phlebitis, periphelbitis, parametritis.
b. Dari robekan servik
Perforasi uterus oleh alat-alat (sonde, kuret, IUD).
Gejala:
1) Suhu tinggi dengan demam menggigil
2) Nyeri unilateral tanpa gejala rangsangan peritoneum, seperti muntah, derense dll. Terapi antibiotic.

Lanjut..
Salpingitis akut

Infeksi dapat terjadi sebagai berikut:
a. Naik dari kavum uteri
b. Menjalar dari alat yang berdekatan seperti dari appendiks yang meradang
c. Haematogen terutama salpingitis tuberculosa. Salpingitis biasanya bilateral.
Gejala:
a. Demam tinggi dengan menggigil
b. Nyeri perut kanan kiri bawah, terutama jika ditekan
c. Defense kanan dan kiri atas ligament pourpart
d. Mual dan muntah ada gejala abdomen akut karena terjadi rangsangan peritoneum
e. Terkadang ada tendensi pada anus karena proses dekat pada rectum dan sigmoid
f. Pada periksa dalam, nyeri jika portio digoyangkan, nyeri kiri dan kanan dari uterus terkadang ada penebalan dari tuba.
Pelvioperitonitis (Perimetritis)
Biasanya terjadi sebagai lanjutan dari salpingoophoritis. Kadang – kadang terjadi dari endometritis.
Etiologi :
a. GO
b. Sepsis ( Post partum dan post abortus )
c. Dari appendicitis.
Pelvioperitonitis dapat menimbulkan perlekatan-perlekatan dari alat-alat dalam rongga panggul dengan akibat perasaan nyeri atau ileus.

Pelvioperitonitis (Perimetritis)
Dapat dibedakan menjadi 2 bentuk:
a. Bentuk yang menimbulkan perlekatan-perlekatan tanpa pembuatan nanah.
b. Bentuk dengan pembentukan nanah yang menimbulkan douglas abses.
1) Pelvioperitonitis akut
Gejala : Nyeri diperut bagian bawah.
Diagnosa :
Pada periksa dalam teraba infiltrat dalam cavum douglasi, tapi kadang-kadang hanya ada penebalan lipatan cavum douglasi yang teraba sebagai piggir yang keras. Sebagai akibat pelveoperitonitis dapat terjadi douglas abces. Douglas abcas ini dapat pecah ke dalam rectum atau ke dalam fornix posterior vaginae.

.
Salpingitis akut

Diagnose banding kehamilan ektopik, tidak ada demam, KED tidak tinggi, dan leokosite tidak seberapa. Jika tes kehamilan positif, maka adneksitis dapat dikesampingkan, tetapi jika negative keduanya mungkin.
Appendicitis tempat nyeri tekan lebih tinggi (Mc burney).
Salpingitis menjalar ke ovarium hingga terjadi oophoritis. Salpingitis dan oophoritis diberi diberi nama adnexitis.
Etiologi paling sering disebabkan oleh gonococcus, disamping itu oleh staphylococcus, streptococcus dan bactery tbc.

Parametritis yaitu radang dari jaringan longgar didalam ligament latum. Radang ini biasanya unilateral. Diagnose banding adnexitis lebih tinggi dan tidak sampai kedinding panggul biasanya bilateral.
Parametritis
(celulit pelvica)
E. GEJALA
1. Gejala biasanya muncul segera setelah siklus menstruasi.
5. Gejala lainnya yang mungkin ditemukan penderita PID, SEPERTI :
Keluar cairan dari vagina dengan warna, konsistensi, dan bau yang abnormal
Demam
Pendarahan menstruasi yang tidak teratur atau spotting (bercak – bercakkemerahan di celana dalam)
Kram karena menstruasi
Nyeri ketika melakukan hubungan seksual
Pendarahan setelah melakukan hubungan seksual
Nyeri punggung bagian bawah
kelelahan
2. Biasanya infeksi akan menyumbat tubafallopi.
3. Infeksi biasanya menyumbat ke stuktur di sekitarnya.
4. Di dalam tuba fallopi, ovarium maupun panggul bisa terbentuk abses (penimbunan nanah).

C. Faktor Resiko Terjadinya PID
Aktivitas seksual pada masa remaja
Berganti – ganti pasangan seksual
Pernah menderita PID sebelumnya
Pemakaian alat kontrasepsi yang bukan penghalang
Pernah menderita PMS
B. Penularan
Hubungan seksual
Prosedur kebidanan / kandungan, seperti :
IUD, Persalinan, keguguran, aborsi dan biopsi endometrium yang tidak steril
B. Penyebab
Peradangan biasanya disebabkan oleh infeksi bakteri, dimana bakteri masuk melalaui vagina dan bergerak ke rahim lalu ke tuba fallopi. Sekitar 90 – 95 % kasus PID disebabkan oleh bakteri yang juga menyebabkan terjadinya penyakit menular seksual (misalnya klamidia, gonore, mikoplasma, staphylococus, strepococus). Infeksi ini jarang terjadi sebelum menstruasi pertama setelasi menopause maupun selama kehamilan.
A. Pengertian

Penyakit Radang Panggul (Pelvic Inflammatory Disease - PID) adalah infeksi pada alat genital atas. Proses penyakitnya dapat meliputi endometrium, tubafalopii, ovarium, miometrium, parametria, dan peritonium panggul. PID adalah infeksi yang paling penting dan merupakan komplikasi infeksi menular seksual yang paling biasa
(Sarwono,2011; h.227)
Penyakit radang panggul
(PELVIC INFLAMMATORY DISEASE – PID)

E. GEJALA
F. Akibat Lanjut PID
Kehamilan ektopik / hamil diluar kandungan. Untuk medeteksi kemungkinan hal ini terjadi segera lakukan pemerikasaan USG apabila terjadi kehamilan setelah menderita PID
Bayi cacat atau meninngal. Jika bayi dilahirkan lewt vagina yang memiliki banyak kuman, maka kuman – kuman itupun akan ikut dengan bayi. Akibat lain dari peradangan saat hamil adalah bayi terlahir prematur, terjadi penyebaran kuman pada tubuh bayi, serta jika infeksi parah, bayi dalam rahim bisa meninggal.
Infertilitas. Penyakit radang panggul dapat meningkat pada penderita hingga 17%. Hal ini karena terjadi perubahan pada anatomi tubafallopi.
G. DIAGNOSIS

Diagnosis ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik. Dilakukan pemeriksaan panggul dan perabaan perut. Pemeriksaan lainnya yang bisa dilakukan adalah sebagai berikut :
Pemeriksaaan darah lengkap
Pemeriksaan cairan dari serviks
Kuldosentesis
Raparoskopi
USG Panggul
Endometritis paling sering ditemukan terutama:
Setelah seksio sesarea
Partus lama atau pecah ketuban yang lama
Diagnosa banding endometritis meliputi infeksi traktus urinarius,infeksi pernafasan, septicemia, tromboflebitis pelvis, dan abses pelvis.

Endometritis adalah suatu peradangan pada endometrium yang biasanya disebabkan oleh infeksi bakteri pada jaringan di lapisan endometrium.
Endometritis

BAGIAN BAGIAN penyakit peradangan panggul
Endometritis
Myometritis
Parametritis
Perimetritis
ooforitis
H. Pengobatan
PID tanpa komplikasi bisa diobati dengan antibiotik dan penderita tidak perlu dirawat
Jika terjadi komplikasi atau penyebaran infeksi, maka penderita harus dirawat di rumah sakit
Antibiotik diberikan secara intravena lalu diberikan peroral
Jika tidak ada respon terhadap pemberian antibiotik, perlu diakukan pembedahan
Pasangan seksual penderita sebaiknya juga menjalani pengobatan secara bersamaan dan selama menjalani pengobatan jika melakukan hubugan seksual, pasangan penderita sebaiknya menggunakan kondom.
Kelompok 5 :
Qifti Dyah AA
Ratnawati
Sarinih
Siti Afni Zulfah
Siti Marinda
~Kesehatan Reproduksi~
Penatalaksanaan pada endometritis :
Pemberian antibotika dan drainase yang memadai
Pemberian cairan intra vena dan elektrolit
Penggantian darah
Tirah baring dan analgesia
Tindakan bedah
Pengobatannya tergantung pada penyebabnya, endometritis kronika ditemukan :
Pada tuberculosis
Pada sisa-sisa abortus atau partus yang tertinggal
Terdapat corpus alineum di cavum uteri
Pada polip uterus dengan infeksi
Pada tumor ganas uterus
Pada salpingo ooforitis dan selulitis pelvic

Gejala-gejala klinis endometritis kronika :
Leukorea
Kelainan haid seperti menorhagie dan metrorhagie.

Penatalaksanaan
Dalam pengobatan endometritis akut yang paling penting adalah berusaha mencegah agar infeksi tidak menjalar.
Adapun pengobatannya adalah:
a) Uterotonik
b) Istirahat, letak fowler
c) Antibiotik

Gejala-gejala :
a) Demam
b) Lochia berbau
c) Lochia lama berdarah bahkan metrorhagia
d) Tidak menimbulkan nyeri jika radang tidak menjalar ke parametrium atau perimetrium

Pada endometritis akut endometrium mengalami endema dan hiperemi terutama terjadi pada post partum dan post abortus.
Penyebab :
a) Infeksi gonorhoe dan infeksi pada abortus dan partus
b) Tindakan yang dilakukan di dalam uterus seperti pemasangan IUD, kuretase
Endometritis akut
Myometritis
Biasanya tidak berdiri sendiri tetapi lanjutan dari endrometritis, maka gejala-gejala dan terapinya sama dengan endrometritis. Diagnosa hanya dapat dibuat secara patologi anatomis.

Endometritis tidak sering ditemukan. Pada pemeriksaan microscopic ditemukan banyak sel-sel plasma dan limfosit

Endometritis Kronik
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19/04/2016

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19/04/2016

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19/04/2016

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19/04/2016

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Penyakit radang panggul PELVIC INFLAMMATORY DISEASE Copy

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