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8/19/2019 Meningomyelocele SAM Power Point
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Samuel Denny Lawanto
SIMPLE CLOSURE PADAMENINGOMYELOCELE
RUPTURE
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PENGERTIAN
• Meningomyelocele aala! "uatu $e%u"a$an $ongenitalyang te%&ai i "alu%an "um"um tulang 'ela$ang antulang (unggung a$i'at a%i tia$ te%tutu( "e'elum la!i%
• Meningomyelocele menggam'a%$an 'entu$ i"%a)"meyang (aling 'e%at yang meli'at$an $olumna *e%te'%ali"an te%&ai engan in"ien "e$ita% +,+--- $ela!i%an!iu(
• S(ina 'i)a imani.e"ta"i$an (aa !am(i% "emua $a"u"
i"%a)"me "(inal yang me%u(a$an te%minologi untu$$elom(o$ $elainan "(inal yang umumnya menun&u$$an$etia$"em(u%naan menutu(nya &a%ingan me"en$im/tulang an "a%a.
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EPIDEMOLOGI
• Meningomyelocele me%u(a$an $elainan $ongenitalyang i 'awa! "e&a$ la!i%/ yang "e%ing'e%!u'ungan engan !i%o"e.alu"2 Seca%a umum/
ang$a $e&aian meningo!i%omielo$el i nega%aA"ia te%ma"u$ Inone"ia 'e%$i"a% anta%a -/+3-/0(e% +--- 'ayi la!i% !iu(/ "eang$an i nega%aE%o(a an Ame%i$a Uta%a 'e%$i"a% anta%a +34/5 (e%+--- 'ayi la!i% !iu(2
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ETIOLOGI
• 6e&aian meningomyelocele $i%a3$i%a 75 8 a%i"elu%u! (enye'a' "(ina 'i)a an(e%'aningannya aala! +9 :-- $ela!i%an !iu(
• Penye'a' meningomyelocele tia$ i$eta!ui"eca%a (a"ti/ namun "e'agaimana !alnya "emuae.e$ (enutu(an tu'a neu%ali"/ aa (%ei"(o"i"igeneti$
• Riwayat e.e$ ta'ung neu%al (aa "aua%a $anung
• ;a$to% nut%i"i
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KLASIFIKASI
• S(ina >i)a O$ulta
• S(ina >i)a Si"ti$a
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SPINA >I;IDA O6ULTA
Li(oma "(inal• Li(oma "(inal aala! $eaaan i mana te%a(at &a%ingan lema$
yang ma"u$ i alam &a%ingan "a%a./ "e!ingga te%&ai $e%u"a$anan menga$i'at$an i".ung"i neu%ologi"
Sinu" e%mal• Sinu" e%mal me%u(a$an lu'ang te%owongan
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SPINA >I;IDA SISTI6A
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PATOFISIOLOGI
• Cacat (em'ulu! neu%al aala! !a"il (%o"e" te%atogenicyang menye'a'$an $e%u"a$an (enutu(an an(e%'eaan a'no%mal (em'ulu! neu%al em'%io "elamaem(at mingu (e%tama u"ia $e!amilan
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TANDA DAN GELAJA
•Penon&olan "e(e%ti $antung i (unggung tenga!"am(ai 'awa! (aa 'ayi 'a%u la!i%
• i$a i"ina%i/ $antung te%"e'ut tia$ tem'u" ca!aya
•6elum(u!an , $elema!an (aa (inggul/ tung$aiatau $a$i
•Penu%unan "en"a"i
• In$ontinen"ia u%in mau(un in$ontinan"ia al*i
•6o%a "(inali" yang te%$ena %entan te%!aa( in.e$"i
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KOMPLIKASI
• Bi%o"e.alu"
• Meningiti"
• Bi%o"i%ingomielia
• Int%a"(inal tumo%• 6i(o"$olio"i"
• 6elema!an (e%manen atau (a%ali"i" (aa e$"te%mita"'awa!
• Se%e'%al (al"y Di".ung"i 'atang ota$
• In.e$"i (aa "i"tem o%gan lain
• Sin%oma A%nol3C!ia%i
• Gangguan (e%tum'u!an
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PEMERI6SAAN DIAGNOSTI6
• USG
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MYELOMENINGOCELE
Mana&emen a%i myelomeningocele meli(uti9
+2 Mengienti)$a"i $antung an yang mela(i"inya
42 E*alua"i neu%ologi
02 Peme%i$"aan !al lain "e(e%ti 9a2 CNS (aa $a"u" engan !i%oce(!alu"
'2 $elainan e?t%ac%anial "e(e%ti ga"t%ointe"tinal/u%ologi
12 6on"eling engan o%ang tua (a"ien
52 O(e%a"i
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MYELOMENINGOCELE
Tu&uan a%i o(e%a"i aala!9
+2 Men&aga &a%ingan neu%al an mema"u$$annya $ealam canali" inte%*e%te'%ali"
42 Mena(at$an (enutu(an yang 'agu"02 Mela(i"i $elainan te%"e'ut engan otot/ .a"cia/an $ulit
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A6TU PENUTUPAN MYELOMENINGOCELE
• Dalam 41 &am &i$a %u(tu%
• Bi%oce(!alu" 9 (e%'ai$an an shunting ila$u$an(aa tem(at yang "ama
• i$a ining yang mela(i"inya te'al tunggu"am(ai 0 'ulan
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TABAP AAL
• Mengu$u% u$u%an e.e$
• i$a %u(tu% 9 (em'e%ian anti'ioti$a
• Menutu(i le"i engan $a"a
• (o"i"i T%enelen'e%g
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OPTE6
• In"i"i $ulit i (e%'ata"an mem'%ane a%ac!noiengan $ulit
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OPTE6
• Mem'%an yang te%leta$ ianta%a te(i $ulit le"iengan neural (laFue iam'il untu$ meng!ina%ite%&ainya $i"ta in$lu"i
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OPTE6
• Du%a ii"e$"i a%i "i"i late%al otot yangmela(i"inya
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OPTE6
• Du%a itutu( engan &a!itan interrupted ataucontinuous engan 'enang 5,- mono)lamen yangabsorbable
•Sucction item(at$an i e?t%au%a
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OPTE6
• 6ulit itutu( engan &a!itan interrupted nilon 5,-
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PERAATAN POSTOPERATIE
• >ayi i%awat alam (o"i"i teng$u%a(
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6OMPLI6ASI
• In.e$"i
• oun e!i"cence
• CS; )"tule
• Bi%oce(!alu"
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TERIMAKASIH