Gastroenterohepat ology

By : dr Cindy Menta ri
.
t.penyakitRonggamua.GL
05 Itis

La 's BHA
Padang pd Uday
etio :
lnpeksi ,
A. def Besi .
A def ht
. B12 ,
Mero Kok ,
Allahol
DX : Lidlah atrofi papal er Hema ,
lldah : h dah hah dan mengkilat
mmmm

ldaymengkila.TW
Th : Atasi penydasar .
Smartway : Li dah Merah
f lactam / cefabspomi -

b. Parotitis -

↳ Racking
pal Kel Parotis .

,
-

Etiolklaslfikasi : ⇐ Parotitis ec viral / P epidemika

.

( virus)
"
Cth Mengenai org Sekhar
"

mumps
:

Parotitis Bakten ( Streptokokus)

'

15 Bulan Ahn ee
-

↳ leukositosis
.

FR :
Rlwayat Vatan MMR ? TE 39

DX :
BengKala di Dawah Tehnga Nyeri Ct) T ,
Saat men gunyah
Nyein T jiKa Makan Yg asam
'

-
Th : -

Virus :
Self limited disease , symptomatic Canalgeht)
-
Bak Kri : Gol P laktam + an al geht

Kompukasi
Tmarthwaysilxlumpsmf
Orkitis ( Radames

€daksinMMRy
-

: Testis)

pi pinya beng Kate

-

km

c .
Oral candidiasis Coral Thrush )
↳ etio : C AHb Kans .

FR :
Immunocompromised ( HIV , DM ) ,
Penggunaan Ks ; Asma
Dx : Mak putih Kekumngan di ron a Munt

P penuryang : KOH
.

pseudo hffa Blastospora Yeast 102 :

,
,

Th Nystatin drops 100.000 Iu G- hr) 4×2 fetes

→
:
-

Atasi perry dasari -

snmarfwaytittlbicanh
t.gg#Ee/mehthtHny:Y:uHfnFfaYih}
=p dikenk → dasan enteron

tenth!Yn:L iii. . ru

Blastospora yeast
.

In ,
 -

p
-

-0
-

X Alarm sign
→ ⑦
→
keputihan .

A albus dihdah Thika heat

 2.penyakttpdesq.at
a .

Esofagitts
↳
Racking Pd esofagus
et lo : Batten
'

,
virus ,
Tamir ,
Bahar korostf ( Cth Organ ofosfat.ca Iran :

E' Dx :
Nyeri meneian ,
suntan Yah?
"
nyeri
dike :Yah
Pakatan)

v
'I
( odlnofagla) ( DISFabia)
abut
zonieuitiylahe P penuryang Endoskopi
.

miner Bagchi -
fungal :
plat putih Retuningan Ctt di esofagos

Virus Ulkus ? Kecil di e sofa Dus

⇐
- :

-
E Koma f :
.
UlKus E le bar , erosl Ct ) ( Komphkasiistrlkturesofokus)
Id t
Sesuaietiologi
-

prisage ① mahama latalaksana :

Cain kN 5
symptomatik
-

Rico 3 Bulan
yg
Fluconazole
:

Lake -

Kerchner Burnt
-

fungal ( Candidiasis esofagus)

: Tab IX
150mg ( 14 hr )
chin
.

Bagchi
- -

Bak ten '

'
-
AB (got Rlaktam)

Korosif Slmptomatik
" "

: →
Sulfas ahpri

b . GERD ( Gastroesophageal Reflux disease)

↳ Isi lambing naik te esofaguscakibatlemahq.mg/eresofaDus Dawah )

HsemaFIbTinIRegurgitasi]
FR obesltas
:
,
BerBaring SeteIah Makan

Dx : Rasa 1erBakar di dada ( Heart Burn )

Rasa pahtt asam di hdah ( Regurgitasi)

Disfacia
P penuryang ( ) Doss
.

.
:
-
ppl Test PPI -
-

omeprazoie ,
Ian sopra tote Ganda

I -
2 Minggu - a keluhan In dgn Ppi
-

pH metro / Bernstein test dan Munch Kemba li Ilka

↳ gular pH di esoFagus Ppi dlhentikan
-
GERD Q -
: Kues loner 1
GERD G) jlka star > P
GERD
 ppfgest1-2uggn6ERDCt@AdohtTM-4MhQudms.g
"
.d .

Metode step Up Ppt

"
AR Hz 4- own
Th : l a
mulai dari tangut
.

→
-
.

Metode
"
down "
dari PPI lanjut Arth
step
→
2 . → mulai

Llmumnya : PPI dog's Ganda Selama 4- 8 Mineau

Cth :
Omeprazole 2×205
Iansopratote 2x 30 y
Pantoprazole 2×408
'

Esomeprazole 2×405
Rabeprazole 2X
20J
Kompukasi : I .

Mallory was Tear ( Pecan pembuluh

-
darrah di eso Fagus

( Dx theming ):

Sthktur
"

Penyempitan
"

2 maKanan Cair
.

esofagus
:
esofqgus
3 . Barret esofagitis
:
perubahan set epitelskuamos - a Kolomnar
( Ksi pra Kanker eso Fagus)
I

AdenokarsinomaEsofapus.3.PenyakitPada6asler@q.Dys
↳
pepsin
pada Abdomen
and roma /
kompulan gejala rasa talk nyaman

Dyspepsia
-
Dyspepsia Fungsional (stress) Dyspepsia organic
-
D .

type Like Ulcer Cendoskopi Kelainanctt )

:

( ku Nyeri epigastrium)
:
-

Ulkuspeptikum
D. Type dis motility Gastritis ( Gastropat
'

-
-
erosive

Ctu Pent Kembong Began Serino , . Sendawa ) NSAID

-
D Type
.
mixed I -
Gastritis ec Helicobacter
pillory infection
Campo
donuh5← Igeiak
ran

Endoskopi : normal
① galati
-
Kanker lambing
Mixed
like ulcer
-
 -

- -

bing.IT#pugitmiD
+
-
Dx ? Heart

o
-
=
o
-

X
Dx
?GERD_
 Tanda Bahay Dyspepsia a
→
Ryuk Cendoskopi)
-
onset gejala 745 Tahu n
-

Disfagia Berat

§TTARiaManT#§a
Muntah persist en B Smart way Orang 45 than
-
:

PSMBA Hematoma's :
,
Melena
-

Anemia
-

Riw .
Ca Gaster
-

Pd Keluarga
-
Massa Ct) di Abdomen
-

Pen unman BB Ct )

Dyspepsia
t
En dos Kopi Pem , .
laboratoriom ,
Urea Breath test

-
tndoskgpi
¥uakamaf
:
normal

D. Fungsional obatnya PPE

ipwkinetikw-MUkoprotektorcsvcraf.at
th : -

Type like Ulcer : 1st PPIComeprazolelxzoy) kecuali Dysmotilib :

2nd ARHz ( Ranlhdln 2×150 y )

/
)
CES konshpasi)
:

""""""
tcmneanm
'

" "

, snap,.am,
2nd PPI
-

Type Mixed PPI t Prokinehk :

 I
Endoskopi : Klanan Ct)

D. organ IK
- .

Ulkuspephkum0
Dx :
Hematomas Melena Ctt )
Ulkus gaster Nyeri epigastrium
: Makan → -a nyer.it Pain -
food -
pain
( Hunger pain )
"
Ultus duodenum Nyeri epigastrium Nyeri too
-

:
→ makan →

Posten Terbangun pd malam hari krn nyeri)

"

sering

Endoskopi "
/ Luka
"
:
mucosal Break Ct) dalam 73 mm

Th :
ppl t Mako protektor -

69stnhserosivacbastropatinsa.ir#
↳ FR :
Rlwayat
erosion
( Dx Hematmesis Melena
NSAID

:
:

pd Gaster Ceto NSAID COX t )

-

Th :
Gant dgn NSAID COX -2 ( celecoxib) t PPI t Moko protector

mmmm

¥nusµ
 Be Smartwag :

6astnhsechteksiH.pe/ioriT Land.EE#foM
↳ UBTCT )
'
'

Urea Breath Test

-

lsttrlehoncidazokf
-

Dx CH
3rd igor A 1-
:

-
:

Eradlkasi Hipyor
-

Th : ,

1st PPI (omeprazoleft Amoxicillin Klaritromisin ( 14h r )

'

t
- -

2X I
2×208
-

000T 2×5005

2nd Bismuth + PPL + Metronidazole + Tetras Klin ( 14 hr )

2×2 Tab 2×202 311500g 4×2508
3rd PPI t Klariotromisin + Amoxicillin 1- Metronidazole ( Hbr)
2X
2×208 2X SOOT I
-000J 3×5008

4.penyakitpadalls.us#
a . IBS ( Irritable Bowel syndrome)
FR : stress
Dx : kriteria Rome III IN

Nyeri pent t 2 gejala : -

membaik Selelah defekasi
-

penbahan pola BABIFREKBAB

onset G Bulan Perubahan tonsisknsi feces
-

D. penuryang :
endoskopi normal : ( Kolonoskopi )
Th : -
IBS type C Ctonstipasi) Diet laserattlaxatif :

IBS Type D ( Diarea ) Anti blare ( Atapulgile loperamld)

:
,

IBS Type M ( Mixed )

Edukasi e Reassurance
 epigastric CH → ⑤ Egf la .

→ Mixed
\ -0 → like ulcer
-
.

T
-

=
←

X -
Dx ? :Rspepait

O @
-

X
 Fm

b .
IBD ( informatory Bowel Disease)
↳ etio :
ldiopatikfoenehk
Dx : Dare Kunis Bulan )

Klas#Kasi
--
Chron disease Colitis Ulcerate
KU -
Nyeri penetcttt) -
BAB Berdarah >>

-
blare > 3 Bulan
-
blare 73 Bulan
-

BAB Berdarahcttt -

Nyeri pent Ctfit )

Kolonoskopi :
Skip lesson -

Continuous lesion
Cobblestone Ct) -
Pseudopolyp
Barium "
lead pipe
" "

String
"
enema sign colon
,
Hilangnya
Hausfra
Biopsi PA Granuloma Ct) Absesknpta CD
(Gold standart )

Th :
Rujuk
5- ASA ( Sulfasalazine ) : Salo Falk

c. Keracvnan Maranan
-

Bachus cereus : MaKanan Basi -

E.coli : Blare pd Tons ( Travelers Diarrhea)
Thi Quinton :( ciprofloxacin hr)
.

Clostridium Botulinum : Makanan Kaleng 2×50085-7

-

Clostridium Petfnrigens : -
Makanan Yg Kerrang Matane
penye BAB dari Gas gangren
-
" "

-
Clostridium difficile ( Kohles Pseudomembrane )

www.sina?.;:.ien:.:m:mY::n+Diare-I
""

Th : -

Stop AB ! ! !
Rangan ( metronidazole) dehidrasi ringan
-

Berat ( Van Komi siri ) idehidrasi Berat tbemam

 -

←"
 Padang =p.
tis -
④demam .

5.PenyakttpadaBlT Bake tian's @ deman .

Kotesistitis •
KoLangit 's

# -
Kolelitiasis µ #
- &: :O
.
-

Cdikoledokosl
Koledokolitiasis
( CBD stone )

fesesberwarna →

LIF ( Female Forty fertile Fatty )

penuthanomtttasm-yakdesiLrBABDempul
stih.s}k/yeripenh-
FR : . , +
Nyeri
,

Wt
Demamttkkrik
Kanan Alas peoiangifis
#
Demamc -

j Batu → tiasis Demain

'
Ct )
-- --
Kolehhasis Kokdokdlhasis Kolesishhs Kolangitis
↳ ↳ Batucttdi CBD ↳ ↳
Batuctdiempedu lnteksipd lnfeksipada CBD

Dx Nyeri
"
Jaundice "
kandumlempedu Jaundice att)
:
penethilangtimbul
BAB dempulct)
" " "

Tllmbuljlkamakan Blldlrek > Induct Murphy signal

" "

Benenati lkterikctf) Trias

" " "
"
BAB
"

dempul Charcot

lngat
"
Pentad Reynold
" "
Af "

Ikterikc Deman

4¥.¥¥÷÷÷:*
i.
s
mmmm
-

:c
::
Ewe
:* times
OBE lkolelitiasis 2-
Jaundice ← BAB dempul
. ""
 * A
4Fa¥#÷mc+, } kolesisfhi ✓ HEISEIah
Faint
=
E¥T
-

P penuryang
.
:
456 Sal .
Hmmm
Biller
.

Ram deputes
H
Acoustic Shadow Ct) Batu a u

methane
- -

Double Riinslpenebalan Anding

"

Radioing
"
- - a

Th
-
: -

RYUK
÷ gkoleslshhs ekolangitis : AB Spektrum was ( CefaloSporn)
Colehhasis :
Kolesiskktomi

G.penyakltpdpancreasf-aypankreath.is
Alkohohk
" "
FR :
Pesta miras

Dx : Nyeri epigastrium ygmenetapsampaitembuskpunggung.mual

muntah
PF : Hematoma di reg .

per umbilicus
: Cullen sign

Gray
"
di
"
"
reg flank
:
Turner sign
P penuryang
-
: Amitaset Lipaset > zx
FOX sign : medial paha

Th : Rehldrasi ABC t AB ( Cefalo Spohn )

ca -
pancreas ± Anemia Iv BB I ,
'
,

Massa Benjol

t.penyakttpadatteparfkeras.ua/AbsesHepar tumor marker

ca -
19-9

/ Kompllkasi dari Disentri amoeba

A
Dx Demain I

pf.i.lt?Yyteiiean#EEvIrI
E . : - Ct )

Histolytica -

Nyeri peanut Kanan Alas Tropcroit

ad .
Insects
.eu#uasicthHepaiomegalikista
intr g .
.

Ppenunjang Xray Dome Diafragma

✓
: :

USG Abdomen : lesi hipoekolkldnekolk mm

€wqsign]
Th : -
Metronidazole 3×750 mg Ct
-

lohr ) Ga Smart way is

Nyeri
-

Ryuk Insist :
draignase Abses pent Kanan atastriw
Disentri Amoeba
Komplikasi Sepsis : t

i*¥I
#
f-

¥× -
-
e
-

¥
X
X
#
I
0€ . .

. ..
t .
 b) frosts Hepatis
↳ etio :
Hep B Hep C Alkohollk Fatty
, , .
liver

Splenomegali Terman lab sinks

{
Erltema Palmar -
560 TT ,
56 PTT

Kolateral Vein ( 560T 756PM

total
→ km,

75 Ashes . .
By indirect ,
dieter ,

Spider Naevi -
Albumin t Globulin t

Inverted Globulin -
PT
memanjang
Hemalemesis Melena -

Trombosit 450.000
(Trombopoietint )
P penury ang Angst
'

. : -
DR ,
Hati
"
"
-
US 6 Abdomen :
Heparmengecil Ascites CH
Bops, Hlstopatologi :( Gold standard
-

Kompukasi : -
PHA ee Vanceal
Bleeding ( pecan varies esofagus)
1.
-

Hepatikensefalopaty ( Koma Hepatikom )

f kesadaran
-

HCC (Hepatocellular carcinoma) Palpa #

flapping tenor tlepatoren.at

-
syndrome feto protein
natas Bau peeing
* sites t creatinine > 1,5 (tumor marker)
kentcunanamoniak PS MBA Yoong

y
Heimatemesis Melena
--
teaches non.Va
SEKASIH ( Gaster ,
duodenum)
-
Pecan Ulkuspephkum ( 6gala VIRUS)
-

Gastritis eroswa ( Rw NSAID ) .

 Th : ABC
1 Rehidrasi ,
pasting NGT ,
Bikes lambing
stab,Kan Hemodlnamk
varies varies

pit
non
-

→ →
Tera Empires ( lnjeksiomeprazole ( PPI ) lnj , Vit K )
-
perdarahan Berhenti
perdarahan talk Berhenli
t o bat vasoaktif (somatostatin )
octreoh de
endosltopiatocemergency )
-

endostopiekkttf vasopressin

#
varies UlKus
esofagus
t t
↳asi Va rises lnj MorepineFran
di Ulkus

Hepatitis A CHAI CA Kut)

↳ Transmoi Fecal oral
Hepatitis Riwayatpenyalatyg
"
etio virus A di
"
:
,
: -

sama keluarga
Dx : -

Gejala prodro Mal ( Denham moat muntah) , , SMART

-
WAY

Ease Ikterik iklerik Hepatomegali A Kut

Ight IAG
-
:
, →

Fa se Resolusi (Goyala membaik ) IgG / Ab - r Konik

"

Pt Hepatomegali nyeri teKan H

Hep A # Kfohih
: "
+

P Fung hati 560T T S6 PTT

penuryang si
.
: -

serologi : IgM Anti HAV Ct) → AKut (seKarang Ig Sant )

196 Anti HAV Ct) → sembuh / Raw
lnfeksisebelumnya .

Tata laksana : - Bedrest Vaksin

-

Diet TKTP tterapi caiman

-

Symptomatik ( Ibuprofen Dom ,

pardon )
-

Hepatopndektor ( curcuma)
 *
E8EIE¥
e

¥
Dx ? ⇐ He
*I7dbu
X-__ ✓
tektite .

-0
00
¥¥wM÷a
-

X moons

u →
Hepatm i
 Hep A ,⑨c D. E ,

t
Hepatitis B ( 3A ) Kronis D④
to Trans mist
'

:
Cavan Tubuh

etio
:
Virus Hep B
Dx :
lkterlk t t natsu makan t Demain ?
Pt :
Hepalomegali Nyeri Texan Ct) t

penuryang Serologi Hepatitis B

P.
:

-
HBS Ag Ct ) - a Akut (seKarang Sant )
,
HBS Ag Ct) > 6 Bolan Kron is :

IgM Anti HBC Ct ) → AKut

-

IgG Anti HBC Ct) - a krone / Riu lnfeksisebelumnya

Hbsftb -

Anti HBS Ct) →

Raw lnfeksi CHI Riwvaksln Ct)

HBetty Ctl lnfeksius Bereplikasi

-

- a
,

Hbettb -

Anh '

HBE CH → Rw lnfeksilkronis
SMART WAY

}
HBSA get) -
Tentukan Hep apa ?
IgM Anti HBC Ctl Hep BAKut clan lnfeksws -
Tentoukan Kronisitas
Ese
'

tf Hep Tenhekantnfeksiusn k
¥fg¥nYjY¥ , KIK lnfeksius
B & -

IF ,
Hbeo

}
HBS AD Ct) Hep B Kunis doin non -

lhfeksius

←④manhjYYgI
IgG Anti HBC Ct ) Hhs Age, Hbs Ag Ct -

the age i -

t.igmaaYTT.EE?HepBknm-s
Abe
.

Ag Ct ,

ly
HBSAOC -
I Hep B Akut Stadium window
period Cfasejendela)
19M Anti HBC Ct )

196 Anti HBC C I - O kecuali Bagijomblo

Winpdorufod a-
-

IgM anti Hbc Ct)

Hbs #blank Hbs Cts

}
HBS Agc -
I Riwvaksih a-
-

Rew raksha,
Inna tht'sHII "
,
196 Anti HBC C- I Th Ten ofour
: Ix 300mg
Se rdogi
Hbsltgctll gm
}
÷

anti Hbc Cti

-

IgG anti Hhc Ct)

Hep B tennis hyenas ✓

ae¥,e
-

Hbs Ag C s

}
-

Hbeltg C-s

IteAb C I
-
Weiden period if
.

anti Hhc
IgG c s
-

Hbfsltg
Lg
as

Hbs Ab t)

IgM anti Hhc CH

Hep B Aleut Hewins ✓ -

Eg6anhH
I

④ly Cts

¥7::'m:c's
} "q÷÷!m
Hhshy CH

'
'

I anti HA "
①
- -

IgM auk
'
HAV C-I
Hepatitis C Anti HCV Ct )
↳ eno : virus
Transmisi :
Hep C
Cavan Tubuh
THW RNA Ct
L

Dx : Sama dengan Hep B

'

HCNU RNA 26 Akat

⇐ 76 Kwik
P penury ang Fungsi hati Scoot slept
Kiwi ufeksi
: -
:
.

Serologi Hepatitis C

YAKUT
Anti HCV Ct) -0 HCV RNA Ctt Hep C CHA Kut
HCV RNA Ct) 76 Bln - a
Hep C Kron is
Rlwlnfeksi HCV
-
a RNAC I
-
→ Raw .
Hep C
Th : Antiviral ( sofosbuur ,
Dadatasur)

A@ et)

HCV RNA
# cu RNKCH
c- '
t
a
HT > 6 Blu
< Bln
Riw.Hep① { 1
Kronk
abut
.
 000
,

D=
- - .
I

×
x
I
stomatitis Keith's
anglais
Sudut '
I
bibir

-
O
X

←
DX 's parotitis epidemic
mumps virus→
self limits durian .

X parotitis → orchitis
'
 o
-

-
a

Heartburn Regurgiks
X
-

① Alarm symptom .

Ix GERD
X : .

-
- -

X -

D
-

#
XX don-stygalq.gg#
X

Aka@ii.IooadIa.t.rHansiadkgeueran.I
-

Px :
Bdnun swallow lineal
Birds peak mousetail
-
frat tail

X S esofagus pacadiat " :korog/6ERD

-

: Rio

=¥ Figuring:m"÷hemi
O
-

Dxishihhmygn
X
 ef : Canelomash
-

XO Cayetano
:

2x soo
y
-

X
E x
-
⇐
-

-
-

D
-

Dx
Gastralgia
:

off,
-2
X

F-
Ina
-
-
" :

Bona

3rd Adora : .

*
#

# -

X - DX '
- HCC SERASIH -

vanuseayagn@gmtdahe.e
-

Dx :
finrishepats .

X
 I
-0

×
Haffey
.mg/yvarres-shy-.vitK
②
m_van ly .
.

oupuook

Xf Hipaemuis grandam
.

-
f -

X
 I
tlosh.de#fe .

x -

-0
X -

O
E
-

X
 -

of
-

'
Teth DX : Also Hepar
y

X= Dx Abas Hepar
:
.

-
Tx : Also Hepan .

x
 -

o
× hymnal
' . it "
It
.
. .

} Hep .
B C
-

X
 00
*

e-
to o

•
I
¥3.EE?isHg:.u
-

,
female Hep B -

→
-
X
X HhsA
x
-

-X

A
a e
-
- ox

x I
-