I L M U P E N YA K I T D A L A M
GASTROENTEROLOGY
OFFICE ADDRESS:
www.optimaprep.com
LAMBUNG
Bagian Lambung:
• Cardia
• Fundus
• Corpus
• Pylorus
Kurvatura lambung:
• Lesser curvature
• Greater curvature
DUODENUM
• Rasa tidak nyaman tersebut dapat berupa salah satu atau beberapa gejala
berikut yaitu:
– nyeri epigastrium,
– rasa terbakar di epigastrium,
– rasa penuh setelah makan, cepat kenyang, rasa kembung pada saluran cerna
atas, mual, muntah, dan sendawa.
• Symptoms:
– Heartburn; midline retrosternal burning sensation
that radiates to the throat, occasionally to the
intrascapular region.
– Others: regurgitation, dysphagia, regurgitation of
excessive saliva.
GI-Liver secrets
GERD
Clinical Presentation of GERD
Typikal Ektraesofageal
• Heartburn
• Laryngitis
• Regurgitation
• Asthma
Atypikal • Sinusitis
• Chronic cough
• Chest pain
• Aspiration pneumonia
• Nausea
• Dental erosion
• Vomiting
• Bronchospasm
• Bloating
• Sore throat
• Dyspepsia
• Epigastric pain
Seberapa sering Anda mengalami kesulitan tidur malam oleh karena rasa
5. 0 1 2 3
terbakar di dada (hearburn) dan/atau naiknya isi perut?
Seberapa sering Anda meminum obat tambahan untuk rasa terbakar di
6. dada (heartburn) dan/atau naiknya isi perut (regurgitasi), selain yang 0 1 2 3
diberikan oleh dokter Anda? (seperti obat maag yang dijual bebas)
• Erosive esophagitis
– 20-30% of GERD
– Endoscopy found mucosal break in esophagus
Indication for Endoscopy
• Endoscopy in GERD indicated for patients:
– Had alarm symptoms
– The patient does not respond to the PPI empirical
therapy with a dose of 2 times a day.
• Endoscopy in GERD
– The findings of reflux esophagitis has specificity of 90-
95% for GERD.
– Los Angeles or Savary-Miller classification for severity
of esophagitis.
LA Grade A LA Grade B
Mucosal break <5 mm Mucosal break >5 mm
Grade I Grade II
• Multiple erosive lesions,
• Single or isolated noncircumferential,
erosive lesion(s) affecting more than one
affecting only one longitudinal fold, with or
without confluence
longitudinal fold
ASGE. Gastrointest Endosc. 2007
Grade III Grade V
Circumferential • Columnar epithelium in
erosive lesions continuity with the Z-
line, noncircular, star-
shaped, or
circumferential.
Grade IV
• Chronic lesions: ulcer(s),
stricture(s) and/or short
esophagus.
Both
• most common symptom: diffuse epigastric pain
• may be pain free
• may be associated with dyspeptic symptoms
• can lead to bleeding, perforation, or obstruction
TATALAKSANA
• Medikamentosa:
ANTACID H2R Antagonis PPI SITOPROTEKTIF
• Kolitis ulseratif
– Gejala utama kolitis ulseratif adalah
diare dengan/tanpa darah.
– Gejala lainnya meliputi tenesmus,
urgency, nyeri rektal, pasase mukus
tanpa diare.
– Nyeri tekan biasanya terdapat di kiri
bawah.
– Lokasi lesi bervariasi dari
proctosigmoiditis, lef-sided disease
sampe proksimal kolon desenden,
hingga universal colitis.
• Crohn disease
– Lesi bisa di area saluran cerna manapun.
– Gejala diare, nyeri abdomen biasanya di
kanan bawah, memberat setelah makan,
– Nyeri tekan, massa akibat inflamasi di
kanan bawah
Pathophysiology of disease
Ikterus
Parenkim
Obstruksi:
- Hepatitis Hemolitik
- Intra hepatic
-Cirrhosis
- Extra hepatic
-Hepatoma
Prodromal (demam,
Nyeri kanan atas/ Transaminase, Serologi
malaise, mual) Ikterus, Hepatomegali Hepatitis Akut Suportif
epigastrium HAV, HBSAg, Anti HBS
kuning.
Risk: Female, Fat,
Fourty, Hamil Nyeri tekan abdomen
Nyeri kanan atas/ USG: hiperekoik dgn Kolesistektomi
Prepitasi makanan Berlangsung 30-180 Kolelitiasis
epigastrium acoustic window Asam ursodeoksikolat
berlemak, Mual, TIDAK menit
Demam
Resusitasi cairan
Nyeri epigastrik/ USG: penebalan dinding
Mual/muntah, AB: sefalosporin gen.
kanan atas menjalar Murphy Sign kandung empedu Kolesistitis
Demam 3 + metronidazol
ke bahu/ punggung (double rims)
Kolesistektomi
Kolelitiasis
• Definisi
– Batu di kandung empedu
– Empedu – garam empedu, phospholipid,
kolesterol; ↑ saturasi kolseterol di empedu +
mempercepat nukleasi + hypomotilitas kandung
empedu batu empedu
• Klinis
– Tipe: batu kolesterol 90%, batu pigmen 10%
– Kolik bilier: nyeri perut kanan atas atau
epigastrium, tiba2, bertahan 30 menit sd 3 jam,
menjalar ke scapula, mual
– Dipicu makanan berlemak
• Tata laksana
– Cholecystectomy (CCY), laparoscopic, jika
symptomatik
– Ursodeoxycholic acid (jarang) untuk batu
cholesterol jika tidak bisa operasi
• Komplikasi
– Kolsesistitis
– Koledokolitiasis kolangitis
Koledokolitiasis
• Definisi
– Batu di duktus biliaris
koledokus
• Klinis
– Asymptomatic (50%)
– Kolik bilier: nyeri perut
kanan atas atau
epigastrium, tiba2,
bertahan 30 menit sd 3
jam, menjalar ke scapula,
mual
– Obstruksi bilier ikterik,
pruritis, mual
• Tata laksana
– ERCP & papillotomy
– CCY
• Komplikasi
– Cholangitis, cholecystitis,
pancreatitis, stricture
Cholecystitis
• Cholecystitis is inflammation of the gallbladder that occurs
most commonly because of an obstruction of the cystic duct
by gallstones arising from the gallbladder (cholelithiasis).
• Clinical symptoms of acute cholecystitis include abdominal
pain (right upper abdominal pain), nausea, vomiting, and
fever
• Jaundice may be noted in approximately 15% of patients
• Murphy’s sign are the characteristic findings of acute
cholecystitis.
• A positive Murphy’s sign has a specificity of 79%–96% for
acute cholecystitis.
Penyakit Hepatobilier
• Diagnosis kolesistitis:
– Murphy sign atau nyeri tekan
abdomen kanan atas
– Demam, leukositosis, atau
peningkatan CRP
– USG: ditemukan batu (90-95%
kasus), tanda inflamasi kandung
empedu (penebalan
dinding/double rim cairan
perikolesistik, dilatasi duktus
biliaris)
• Etiologi:
– Batu duktus bilier/ koledokolitiasia (85%)
– Keganasan (biliar, pancreas) atau striktur jinak
– Infiltrasi cacing (Clonorchis sinensis,
Opisthorchis viverrini)
• Klinis
– Charcot’s triad: nyeri perut kanan atas, ikterik,
demam/menggigil; 70%
– Reynold’s pentad: Charcot’s triad + shock dan
gangguan kesadaran;15%
• Tata laksana
– Antibiotik (broad spectrum) :ampicillin +
gentamicin (atau levofloxacin) + MNZ (jika
berat); carbapenems; pip/tazo
– 20% butuh dekompresi bilier cito via ERCP
(papillotomy, extraksi, stent).
SIROSIS HEPATIS
Sirosis Hepatis
• Sirosis hepatis adalah stadium akhir fibrosis hepatik
progresif ditandai dengan distorsi arsitektur hepar dan
pembentukan nodul regeneratif.
• Terjadi akibat nekrosis hepatoseluler
– Sirosis hati kompensatabelum ada gejala klinis, namun
dapat ditemukan gejala awal mudah lelah, lemas, nafsu
makan berkurang, mual, BB turun
– Sirosis hati dekompensata gejala klinis yang jelas
(komplikasi gagal hati dan hipertensi porta)
• Etiologi:
- Alkohol, hepatitis, biliaris, gagal jantung, metabolik, obat
- Etiologi tersering di Indonesia: hepatitis B (40-50%)
• Lactulose (nonabsorbable
carbohydrate)
metabolized by microbes
acidic environment
trap ammonia as charged
NH4+ excreted by the
resultant osmotic diarrhea.