1.

Atresia Oesophagus

1.1. Description
Definition and
Overview

Competency Area
Competency
Component
Cinical
Competency

Learning Methode
Equipment
Time
Lecturer
description

Esophageal atresia is a condition in which the proximal

and distal part of the esophagus is not connected.
Upper segment of the esophagus ends in stalemate
and the presence of hypertrophy of the muscle wall.
Most often the at level V. thoracic IV. Part of the distal
esophagus has a smaller diameter and a thin muscular
wall, located 1-2 cm above diafrgama.
Area of competence 2, of the Doctor Competencies
Standart from Indonesian Medical Council
To apply the concept and the basis of changes in the
structure and physiology of atresia oesophagus
1. Students know and understand the esophagus
atresia
2. Students are able to define what is meant by
atresia of the esophagus
3. Students know the epidemiology of atresia of
the esophagus
4. Students are able to determine the etiology of
atresia of the esophagus
5. Students know patofosiologi the esophagus
atresia
6. Students know the clinical sign of esophagus
atresia
7. Students know the investigation of cases of
atresia of the esophagus
8. Students are able to understand how to
diagnose and explain the differential diagnosis
of atresia of the esophagus
9. Students are able to understand the
management and treatment of cases of atresia
of the esophagus
10.
Students are able to explain the
prognosis, complications and prevention of
cases of atresia of the esophagus
Lecturer (Teaching Learning Process)
Classroom, Computer, LCD and Screen
100 minte : expert lecturer
This module is a part of Module on Gastrointestinal
Disorders, integratedly designs for medical student of
6th semester through Teaching Learning Process.
This part of Module will facilitate the student to
understand
the signs and symptomps of atresia

Lecturer
Evaluation
Suggested
refferences

1.2

oesophagus.
Dr. Lulik Inggarwati, Sp.BA
Dr. Widanto, Sp.BA
Ujian Blok Gastroenterohepatologi dan Ujian Akhir
Semester
1. EMBRYOLOGI FOR SURGEON The Embryologi Basis
for the Treatment of Congenital Anomalies 2nd ed
(1994), John E Skandalakis
2. Principles of PEDIATRIC SURGERY 2nd ed (2003),
James A O`Neill Jr
3. Principles and Practice of Pediatric Surgery vol 1 &
2 (2005), Keith T Oldham
4. Pediatric Surgery 5th (2009), Ashcraft

Topic
1. Definition
Esophageal atresia is a condition in which the proximal and distal part
of the esophagus is not connected. Upper segment of the esophagus ends
in stalemate and the presence of hypertrophy of the muscle wall. Most
often the at level V. thoracic IV. Part of the distal esophagus has a smaller
diameter and a thin muscular wall, located 1-2 cm above diafrgama.
2. Etiology
Unknown
3. Epidemiology
Esophageal atresia occurs 1: 3000-5000 births.
ratio of male: female = 1: 4
Case studies in California proves that white people have a higher
incidence than non-white.
4. Clinical sign
There polyhidramnion when in the womb that occur because the
infant's inability to swallow and absorb amniotic fluid in the intestine.
Infant will have a smaller stomach than normal which can be known by
ultrasound.
More often babies born prematurely or have low birth weight body.
Infants will experience hypersalivation and prone to aspiration because
it is not able to swallow.
5. Risk Factor
6. Additional examination
7. Diagnosis and differential diagnosis
Types of esophageal atresia by KLUTH

KLUTH:
1.
EA, distal TEF (+)
2.
EA, TEF (-)
3.
H Type TEF
4.
EA, proximal TEF (+)
5.
EA, upper & lower esophageal segment (+)
Prenatal: Using ultrasound while in the womb, stomach look smaller.
X-ray Inspection
8. management and therapy
9. prognosis and complication
10. prevention
1.3

Modul task
1. Describe the embryology of esophageal atresia?
2. Baby boy aged 7 days BB was born 2.3kg delivered by midwives to IRD
RSSA vomit every time given to drink from birth. Colored vomit like what you
drink. It also complained of continuous salivation. Trying to do the installation
or nasogastric orogastrik tube, the hose can not get it reaches the stomach.
a. Possible diagnosis is:
3. The type of investigation required to establish the diagnosis is
4. Mention handling esophageal atresia based on clinical criteria.

2. Hipertofi Piloric Stenosis

2.1. Description
Definition and
Overview

Competency Area
Competency
Component
Clinical
Competency

Hypertrophic pyloric stenosis is a common cause of

intestinal obstruction in infants. This disorder has
symptoms typical of non-bilious vomiting and
projectile. The cause of HPS is a multi-factors,
including race, and familial environment. The
incidence of this disorder is 1-4: 1000 births
Area of competence 2, of the Doctor Competencies
Standart from Indonesian Medical Council
To apply the concept and the basis of changes in the
structure and physiology of hypertrophic pyloric
stenosis
1 Students know and understand hipertrophy
piloric stenosis
2 Students are able to define what is meant by
hipertrophy piloric stenosis
3 Students know the epidemiology hipertrophy
piloric stenosis
4 Students are able to determine the etiology of
stenosis piloric hipertrophy
5 Students
know
the
hipertrophy
piloric
patofosiologi stenosis
6 Students know the clinical sign of hipertrophy
piloric stenosis
7 Students know the investigation of cases of
stenosis piloric hipertrophy
8 Students are able to understand how to
diagnose and explain the diagnosis of stenosis
piloric hipertrophy
9 Students are able to understand the
management and treatment of these cases
piloric hipertrophy stenosis

10 Students are able to explain the prognosis,

Learning Methode
Equipment
Time
Lecturer
Description

Lecturer
Evaluation
Suggested
refference

2.2

complications and prevention of stenosis cases

hipertrophy piloric
Lectures (Teaching Learning Process)
Classroom, Computer, LCD and Screen
100 minute : expert lecture (teaching session)
Module hypertrophic pyloric stenosis is one of the
sections in Block gastroenterohepatologi designed for
medical students of the Faculty of Medicine Brawijaya
University 6th semester. This module will facilitate
students to understand about hypertropic pyloric
stenosis.
Dr. Lulik Inggarwati, Sp.BA
Dr. Widanto, Sp.BA
Ujian Blok Gastroenterohepatologi dan Ujian Akhir
Semester
1 EMBRYOLOGI FOR SURGEON The Embryologi Basis
for the Treatment of Congenital Anomalies 2nd ed
(1994), John E Skandalakis
2 Principles of PEDIATRIC SURGERY 2nd ed (2003),
James A O`Neill Jr
3 Principles and Practice of Pediatric Surgery vol 1 &
2 (2005), Keith T Oldham
4 Pediatric Surgery 5th (2009), Ashcraft

Topics Content
1 Definition
Hypertrophic pyloric stenosis is a common cause of intestinal
obstruction in infants. This disorder has symptoms typical of non-bilious
vomiting and projectile. The cause of HPS is a multi-factors, including
race, and familial environment. The incidence of this disorder is 1-4: 1000
births
2

Etiology
Unknown
Genetic and environment
Ratio male : female = 4:1

Epidemiology

Patophysiology
Characterized by hypertrophy and hyperplasia of
2 triggering constriction gastric antrum. Lumen
pylorus becomes thick and all. Mucosa usually
Dilatation of the stomach which had showed
complete obstruction;

Risk factor

the pylorus muscle layer

of the elongated pyloric
turn red and thickened.
signs of approaching a

Clinical sign
Nonbilous projectile vomiting 3-4 weeks
Babies feel constantly hungry and asked for a drink
Dehydration (+)
Failure growing up
Notching tumors: olive shaped

Diagnosis

Prognosis and complication

Additional examination
Photos BNO Single bubble
Ultrasound pylorus period, measuring thickness and length
Ba meal description of the bird's beak (bird peak), shoulders string
sign, umbrella / mushroom sign.

10 Differential diagnosis
gastroenteritis
Dehydration
Metabolic disorders in infants
11 Management and therapy
resuscitation to correct dehydration
Correcting the lost fluids, electrolytes, acid-base balance
Avoid giving fluids or food in by mouth
2.3

Modul Task
case:
1-month-old baby alone come into emergency surgery with complaints of
vomiting spraying since last yan 1minggu form of milk as soon as the baby is
drinking milk. Physical examination found signs of dehydration. Obtained
from the examination of the abdomen scaphoid abdomen, palpable mass in
epigatrium.
1. Are you a diagnosis on this patient?
2. How further management of this patient?

3. Intutusepsi / Invaginasi

3.1. Description
Definition and
Overview
Competency Area
Competency
Component
Clinical
Competency

Learning Methode

Intestinal segment proximal segment of the distal

colon entered.
Area of competence 3B, of the Doctor Competencies
Standart from Indonesian Medical Council
To apply the concept and the basis of changes in the
structure and physiology of intussusception or
invagination
1. Students know and understand intussusception or
invagination
2. Students are able to define what is meant by
intussusception or invagination
3. Students know the epidemiology of intussusception
or invagination
4. Students are able to determine the etiology of
intussusception or invagination
5. Students know patofosiologi occurrence of
intussusception or invagination
6.
Students
know
the
clinical
picture
of
intussusception or invagination
7. Students know the investigation of cases of
intussusception or invagination
8. Students are able to understand how to diagnose
and
explain
the
differential
diagnosis
of
intussusception or invagination
9. Students are able to understand the management
and treatment of cases of intussusception or
invagination
10. Students are able to explain the prognosis,
complications
and
prevention
of
cases
of
intussusception or invagination
Lectures (Teaching Learning Process)

Equipment
Time
Lecturer
Description

Lecturer
Evaluation
Suggested
Refferences

3.2

Classroom, Computer, LCD and Screen

100 minute : expert lecture (teaching session)
Intussusception or invagination module is one part of
the Block gastroenterohepatologi designed for medical
students of the Faculty of Medicine Brawijaya
University 6th semester. This module will facilitate
students to understand about intusussepsion or
invagination.
Dr. Lulik Inggarwati, Sp.BA
Dr. Widanto, Sp.BA
Ujian Blok Gastroenterohepatologi dan Ujian Akhir
Semester
1. EMBRYOLOGI FOR SURGEON The Embryologi Basis
for the Treatment of Congenital Anomalies 2nd ed
(1994), John E Skandalakis
2. Principles of PEDIATRIC SURGERY 2nd ed (2003),
James A O`Neill Jr
3. Principles and Practice of Pediatric Surgery vol 1 &
2 (2005), Keith T Oldham
4. Pediatric Surgery 5th (2009), Ashcraft

Topic
1. Definition
Segmen usus proksimal masuk ke segmen usus distal.
2. Etiology
Thickening of the bowel wall will decrease segmental peristaltic
meyebkan
example: Meckel diverticulum, hypertrophic lymph nodes (Peyer's
patches), polyps, tumors of the intestinal wall, intestinal wall ematom
Hiperperistaltik
Examples: change of diet or food
3. Epidemiology
The incidence of intussusception 1-4 per 100 births.
Male: female = 3:2
Often occurs in infants 9-24 months of age
4. Patophysiology
5. Risk Factor
6. Clinical Sign
* Infants with:
- Age 4-18 months
- healthy
- Symptoms of mechanical strangulation intestinal obstruction

- Spots of blood mixed with mucus

* Physical
- Inspection: Bloating (when it is up)
- Auscultation: Hiperperistaltik
- Palpation: Palpable time (dances sign)
- Digital rectal: blood mixed fluid mucus, sometimes palpable times like
portio uteri (pseudo portio)
- Further Phase: Dehydration, heat, sepsis, hypovolemic shock
7. diagnosis and differential diagnosis
8. Management and Therapy
Therapy: 1. Barium inloop (diagnostic - therapeutic)
2. operation
* Milking
* Resection and end to end anastomose
9. Prognosis and Complication
Recurrent 8-12%, do it again
1. repositioning
2. Milking
3. resection
10. Prevention
3.3 Modul Task
A boy aged 9 months 10kg BB brought by his mother to IRD Surgery with the chief
complaint CHAPTER mixed with mucus and blood since 4 today. Obtained a history
of cough and cold 1 week ago with fussy children, flatulence since 5 days ago and
vomiting such as what to eat or drink. Child looks pale, the eyes cowong and
decreased consciousness. Abdominal distention. On digital rectal mucus obtained
glove with blood. Negative stool.
1. what the diagnosis of the above cases?
2. of the problems mentioned in the above case?
3.tentukan management for handling cases above!
4. What investigations can help establish the diagnosis?

4. Hirschsprung Disease

4.1. Description
Definition and
Overview

Competency Area
Competency
Component
Clinical
Competency

Hirschsprung disease is a congenital disease

characterized by blockage of the large intestine due to
the muscles in the intestines move improperly. This
usually occurs in children. Hirschsprung's disease
occurs before the baby is born. Nerve cells in the
intestine atrophied before reaching the end of the
digestive tract. In people who suffer from
Hirschsprung's disease, the muscles of healthy bowel
can push the stool up to the part that does not have
the nerve cells. At this point, the stool stops moving
and causing the accumulation of feces in tow. If
Hirschsprung's disease is not treated, stool can fill up
the large intestine. This can cause serious problems
such as infection, rupture of the colon, and even
death.
Area of competence 2, of the Doctor Competencies
Standart from Indonesian Medical Council
To apply the concept and the basis of changes in the
structure and physiology of Morbus Hirschsprung
1.
Students know and understand Morbus
Hirschsprung
2. Students are able to define what is meant by
Morbus Hirschsprung
3. Students know the
epidemiology Morbus
Hirschsprung
4. Students are able to determine the etiology of
Morbus Hirschsprung
5.
Students
know
the
Morbus
Hirschsprung
patofosiologi
6. Students know the clinical sign of Morbus
Hirschsprung

Equipment

7. Students know the investigation of cases of Morbus

Hirschsprung
8. Students are able to understand how to diagnose
and explain the differential diagnosis of Morbus
Hirschsprung
9. Students are able to understand the management
and treatment of cases of Morbus Hirschsprung
10. Students are able to explain the prognosis,
complications and prevention of cases of Morbus
Hirschsprung
Lectures (Teaching Learning Process)
Classroom, Computer, LCD and Screen

Time

100 minute : expert lecture (teaching session)

Lecture Description

Morbus Hirschsprung module is one part of the Block

gastroenterohepatologi designed for medical students
of the Faculty of Medicine Brawijaya University 6th
semester. This module will facilitate students to
understand about intussusception or invagination

Learning Methode

Lecturer
Evaluation
Suggested Refferences

Dr. Lulik Inggarwati, Sp.BA

Dr. Widanto, Sp.BA
Ujian Blok Gastroenterohepatologi dan Ujian Akhir
Semester
1. EMBRYOLOGI FOR SURGEON The Embryologi Basis
for the Treatment of Congenital Anomalies 2nd ed
(1994), John E Skandalakis
2. Principles of PEDIATRIC SURGERY 2nd ed (2003),
James A O`Neill Jr
3. Principles and Practice of Pediatric Surgery vol 1 &
2 (2005), Keith T Oldham
4. Pediatric Surgery 5th (2009), Ashcraft

4.2. Topics Content

1. Definition
Hirschsprung disease is a congenital disease characterized by blockage
of the large intestine due to the muscles in the intestines move
improperly. This usually occurs in children. Hirschsprung's disease occurs
before the baby is born. Nerve cells in the intestine atrophied before
reaching the end of the digestive tract. In people who suffer from
Hirschsprung's disease, the muscles of healthy bowel can push the stool
up to the part that does not have the nerve cells. At this point, the stool
stops moving and causing the accumulation of feces in tow. If
Hirschsprung's disease is not treated, stool can fill up the large intestine.
This can cause serious problems such as infection, rupture of the colon,
and even death.
2. Etiology
Disorders neuroblast migration towards the distal bowel.

3. Epidemiology
There 1:2000-12000 birth
Male: female = 4: 1
4. Patophysiology
5. Risk Factor
6. Clinical Sign and Additional Examination
clinical:
-delay in the release of the first meconium
-abdominal distention
-vomiting billous
-peritonitis
-foul-smelling diarrhea, with or without blood
Additional Examination :
7. Cara mendiagnosis dan diagnosis banding
- Diagnosis
- Differential Diagnosis
Konstipasi
Hipotiroid
Ileus
Irritable bowel syndrome
8. Management and therapy
Medical Measures
1. irrigation of the colon to mngeluarkan fese
2. antibiotic prophylaxis for medium risk enterocolitis
Surgery
1. colostomy
2. anorectal myomectomi
Diet
1. Do not give any food in orally
2. balanced liquid electrolyte salts to prevent interference
9. Prognosis and Complication
- Prognosis
1. increased risk of enterocolitis
- complications
1. increased risk of enterocolitis
2. Over obstruksi
10.Prevention
4.3. Modul Task
1. How to diagnose Morbus Hirschsprung?
2. Typical clinical examination for Morbus Hirschsprung?
3. what management for Morbus Hirschsprung?

5. Anorectal Malformation

5.1. Description
Definition and
Overview
Competency Area
Competency
Component
Clinical
Competence

Learning Methode

Area of competence 2, of the Doctor Competencies

Standart from Indonesian Medical Council
To apply the concept and the basis of changes in the
structure and physiology of anorectal malformation
1. . Students know and understand the differences of
anorectal
2. Students are able to define what is meant by
anorectal malformation
3.
Students
learn
epidemiology
anorectal
malformation
4. Students are able to know the etiology of anorectal
malformation
5. Students learn patofosiologi occurrence of anorectal
malformation
6. Students learn a variety of clinical anorectal
7. Students find out inspection support for the case of
anorectal malformation
8. Students are able to understand how to diagnose
and explain the differential diagnosis of anorectal
malformation
9. Students are able to understand the management
and therapy in cases of anorectal malformation
10. Students are able to explain the prognosis,
complications and prevention of cases of anorectal
malformation
Lectures (Teaching Learning Process)

Equipment
Time
Lecture
Description

Classroom, Computer, LCD and Screen

100 minute : expert lecture (teaching session)
Anorectal malformation module is one part of the
Block gastroenterohepatologi designed for medical
students of the Faculty of Medicine Brawijaya
University 6th semester. This module will facilitate
students to understand about anorectal malformation

Lecturer

Dr. Lulik Inggarwati, Sp.BA

Dr. Widanto, Sp.BA

Evaluation
Suggested
Refferences

Ujian Blok Gastroenterohepatologi dan Ujian Akhir

Semester
1. EMBRYOLOGI FOR SURGEON The Embryologi Basis
for the Treatment of Congenital Anomalies 2nd ed
(1994), John E Skandalakis
2. Principles of PEDIATRIC SURGERY 2nd ed (2003),
James A O`Neill Jr
3. Principles and Practice of Pediatric Surgery vol 1 & 2
(2005), Keith T Oldham
4. Pediatric Surgery 5th (2009), Ashcraft

5.2. Topics Content

1. Definition
2. Etiology
- Genetic
- Unknown
3. Epidemiology
- 1:5000 every births
4. Patofosiology
5. Risk Factor
- Down syndrome
- Cats eye syndrome
6. Clinical Sign
General :
- Dehydration
- Hypothermia
- Multiple Anomalies
Spesific :
- Infection
- Lower intestinal obstruction
- Peritonitis
- Septic
7. Additional Examination

8. Cara mendiagnosis dan pemeriksaan penunjang

History defecation + / Physical examination:
Anal (+)
Anal (-) fistula + / Imaging / X-photo studies:
1. indication
2. timing
3. Photo: - Invertogram
- Knee Chest position (cross table lateral film)
9. Management and therapy
10. Prognosis and compication
11. Prevention
5.3. Modul Task
Baby boys aged 5 days BBL 2.5kg , was taken by his grandmother to IRD
RSSA at Asr time because it had never defecate ( BAB ) since birth . Diaper
remained dry since morning shower . Starting two days ago the baby began to
whimper , looked yellowish and flatulence . Since 1 day ago began to vomit
every time I was given to drink the vomit same as what you drink .
1 . based on the above information , what is the possibility of the diagnosis ?
2 . specify the investigations could help enforcement diagnosis !
Of hetero - anamnesis subsequent spontaneous vaginal birth assisted TBAs , first
child , gestational age at term and burst into tears . Physical examination found :
the baby looks weak , still conscious and moaning , jaundice with eyes and
mucous cowong dry lips . Positive nostril breath , 70x/menit respiratory rate ,
pulse 180x/menit . Axilla temperature of 38.5 C. Thoracic movement is
symmetrical , is not found ronkhi or abnormal heart sounds . Abdomen reddish
umbilicus not , distention , increased bowel sounds . Perineal area is not
available or anal fistula .
1 . information based on what possibilities the diagnosis ?
2 . mention any therapy that can be received at the above patient ?