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44 tahun IKA RSAA, 7 April 2019

Update Meeting off Pediatric in Arifin Achmad Hospital /


1 UMPin PAAH/ 7 April '19
th

MUNTAH PADA ANAK

Deddy Satriya Putra


Subdivisi, Gastrohepatologi IKA RSUD Arifin Achmad / FK UNRI

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DEFINITION

Vomiting is forceful
retrograde expulsion of
gastric contents ….

Venkatassubramani N, BUK Li, pediatric practice Gastroenterology 2010

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Different Descriptions

• Nausea may occur separately or together


• Retching
• Regurgitation must be differentiated
• Rumination

Venkatassubramani N, BUK Li, pediatric practice Gastroenterology 2010

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Vomiting

surgery Non surgery


1. Projectile
2. Bilious, distension
(medic)
3. persistent/severe abd pain
4. Headache, neck pain
5. weakness

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Vomiting (Medic)
• Blood (hematemesis)

• Gastric content (food)

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Diagnosis Approach

• Age
• Diet
• Onset and duration of vomiting
• Associated symptoms

Pediatric Gastroeintestinal Disease. Pathophysiology, Diagnosis, Management 1993

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New born/Infant

• Kongenital anomaly
• Gastroenteritis
• GER/CMA
• Over feeding
• Sistemic infections

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Children and adolescent

• Gastroenteritis
• Systemic infection
• Intoxicasi/poisoning/drugs
• Cyclic vomiting
• Pregnancy

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Diet

• Food allergy / intolerance


• Infant celiac disease
• Enzyme deficiency diseases such as galactosemia and fructosemia

First Principles of Gastroenterology, the basis of disease and an approach to management 2000

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Onset and duration of vomiting

• Acute onset and short duration suggest a transient


illness, while a longer history of vomiting suggests
chronic disease, especially if associated with growth
failure.

First Principles of Gastroenterology, the basis of disease and an approach to management 2000

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Associated symptoms
fever
Diarrhea
abdominal pain,
jaundice
Neurologic symptoms
headaches (IC Pressure )
confusion
weakness
delay the development
Migraine
Psychogenic
First Principles of Gastroenterology, the basis of disease and an approach to management 2000

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Red Flags that Need Further Evaluation

Symptoms Causes
Projectile PS,GOO,malrotation
Bilious obstruc distal AV,CVS
Blood VE, peptic injury,
Severe,persistent abd pain intussception.pancreatitis,apencitis,
peptic ulcer, cholelithiasis
Headache,neckpain,weakness SOL,Migraine,Chiari
malformation
Polydipsia DKA
Dysuria UTI,Renal stones

Venkatassubramani N, BUK Li, pediatric practice Gastroenterology 2010


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Cont

Signs Causes
Bulging antor fontanella Meningitis, hydrocephalus,
subdural hemorrhage
Nuchal rigidity Meningitis, intracranial
hemorrhagie
Papilledema Increased intracranial pressure
Hyperreflexia or hypertonia Metabolic problems, upper motor
lesion

Venkatassubramani N, BUK Li, pediatric practice Gastroenterology 2010

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Non surgery vomiting

Neurology Toxic/metabolic psychogenic


Infection

Obat-obat Fisik dan lab normal


Demam UUB tegang/meninjol
Nyeri perut ringan Penurunan kesadaran Poliuria,
Disuria Kaku kuduk Gukosauria
Leukositosis darah, Papil edema Gejala sitemik lain
urine kelumpuhan Jaundice
Dysmorphic
Unusual odor
Hepatomegali
Splenomegali
Gagal tumbuh dll

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ETIOLOGI (tersering ditemukan)

Neonatus • Kelainan kongenital


• Necrotizing enterokolitis
• Gangguan metabolik
(<2 minggu) • Kelainan neurologi

Bayi • Stenosis pilorus


• GER
(2 mg- 12 bl) • Alergi

Anak • Ulkus peptikum


• Pankeatitis
• Kelainanan susunan saraf pusat

(>12 bulan) • Cyclic vomiting, abdominal epilepsi


• Psikologis

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DIAGNOSIS
Anamnesis
• Usia, jenis kelamin
• Kapan mulai
• Sifat muntahan:bentuk, bau dan warna
• Frekuensi
• Kekuatan
• Ada/tidaknya gejala lain
• Gejala akut abdomen

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DIAGNOSIS
Pemeriksaan Fisik :
•Keadaan umum
•Status gizi
•Tanda-tanda vital
•Tanda dehidrasi
•Peristaltik usus, massa/distensi
abdomen

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DIAGNOSIS
Pemeriksaan Penunjang
• Laboratorium
• Radiologis
Foto polos abdomen
USG
CT-Scan
• Endoskopi

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Muntah

ALGORITME MUNTAH Manifestasi Klinis


(Stevens & Henretig, 2000)

Usia

Neonatus Bayi Anak


0-2 minggu 2 minggu-12 bulan > 12 bulan

Obstruksi Obstruksi Obstruksi

Tidak Ya Tidak Ya Tidak Ya

Penemuan Intestinal stenosis Penemuan Stenosis pilorus Penemuan Intususepsi


ekstra GI Atresia ekstra GI Malrotasi ekstra GI Malrotasi
Malrotasi Intususepsi Divertikulum
Plak mekonium Hernia inkarserata Meckel
Hirschprung Hirschprung Hernia inkarserata
Tidak Ya Tidak Ya Tidak Ya Hirschprung
Adesi

Enterokolitis Kelainan CNS Gastroenteritis Kelainan CNS Gastroenteritis Kelainan CNS


nekrotikans Kelainan ginjal GERD Kelainan ginjal Apendisitis Kelainan ginjal
GERD Infeksi non Refluks fisiologis Infeksi non Ulkus peptikum Infeksi non
Refluks enteral Penyakit seliak enteral Pankreatitis enteral
fisiologis Gangguan Ileus paralitik Gangguan Peritonitis Toksin
Alergi susu sapi metabolisme metabolisme Ileus paralitik Sindrom Reye
Keracunan obat Kehamilan
Psikologis 20
t
h

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