GROUP 7

Dr. Wiyarni Pambudi Sp.A

Name NIM
STEPHANIE WIBISONO 405070001
MEMBER
LISA WIBOWO 405070004
MEMBER
ANDI SURYA JAYA 405070010
MEMBER
CLAUDIO UDJAJA 405070011
LEADER
FAJAR PERMATA SARI 405070032
SCRIBER
JACKY TANZIL 405070061
MEMBER
CHASTINE FAUSTINA 405070070
MEMBER
DIAN WIJAYANTI 405070076
MEMBER
ELLEN ARISTIKA G. 405070083
MEMBER
RITCHIE SANTOSO 405070115
MEMBER
FERDY SANJAYA 405070118
MEMBER
HARI DARMAWAN LEE 405070155
SECRETARY
Learning Objective
Knowing the process of normal swallow
Knowing the problem of swallow
Knowing the process of digestion and
absorption
Knowing the process of hungry and and
satisfied
Knowing the nutrition for child
CASE 3B
Jacko, a one-month-old male baby is brought to your private practice by
his parents with a chief complain of constant irritability and regurgitation.
The 2.8 kg newborn baby of an uneventful full term pregnancy and delivery,
was discharged on the second day of life. He always seems to be hungry,
and since his mother is certain that she does not produce enough breast
milk, she gives milk formula after she breastfed him. That has already
happened for two weeks.
Jacko currently breastfeeds for 10 minutes, then consumes another 60 ml
by bottle. When left with grandparents, he will finish an entire 120 ml bottle
in 5-10 minutes and they reported that he will cry if they try to cut it off at
the recommended 60 ml. Vomiting generally occurs immediately after
feedings. It is not forceful, nor it is blood or biletinged. He fills 10 diapers
with urine daily, and lately he has had watery stools, which have further
worried his grandparents. Despite all this, he weighed 3.5 kg at the two
week checkup and he now weighs 4.3 kg.
Exam: VS are unremarkable. His physical examination is notable only for
fussiness when laid supine on the table, with resolution when held upright
or in the prone position. You witness effortless regurgitation of 2-5 ml of
curdled formula every few minutes during examination since his parents
topped him off with milk formula in your waiting room before the
appointment.
Process Of Swallowing
Picture : process of swallowing
Swallowing
The movement swallowed was followed with
the rise posterior the tongue in a sudden
push food/liquid to posterior pharynx

superior&anterior larynx move, epiglotis
position courage larynx airway, nasofarynx
closed by palatum molle and uvula
The posterior esophagus sphincter relaxation
with constrictor farynx muscle, push the food into
esophagus first peristaltic wave

Second peristaltic wavelocal distention that
played a role in the evacuation esofagus from
leftovers/the contents of gasterwave this
emptied esofagus with movement efforts
encouraged
Nervus
Nervus trigeminus
Nervus glosofaringeal
Nervus vagus
Regurgitation
Definition

Regurgitation was the rise in food from throat
or the side without being accompanied by the
feeling of nausea and the contraction of the
very strong stomach muscle.
Etiology
Regurgitasi often as a result of by acid that
rose from the side (refluk acid).

Regurgitasi could be also caused by the
constriction (striktur) or the throat
obstruction.
Symptom


Acid that came from the side caused
regurgitasi from materials that were felt acid
or bitter. The constriction or the throat
obstruction caused regurgitation the liquid
had phlegm that did not feel or food that was
not yet digested.
Diagnosis

The diagnosis refluks acid was maintained was
based on results of the inspection x-rayed, the
grating of the pressure and the throat acidity
and the other inspection. The diagnosis from
the constriction or the throat obstruction was
maintained was based on results of the
inspection x-rayed or endoscopy

GER
Gastroesophageal Reflux (GER) or Reflux is the
medical term used to describe a condition in
which stomach contents - food and gastric
acid - frequently flow back up out of the
stomach into the esophagus
GERD
GERD stands for gastroesophageal reflux
disease or acid reflux disease. The problem
occurs when acid and other contents of the
stomach repeatedly flow back up into the
esophagus. This happens because the lower
esophageal sphincter (LES) either relaxes at
the wrong time, or it is weak, so it allows acid
and other stomach contents to flow back up
into the esophagus.

Etiology
The position sfingter in abdomen
the Corner insertio esofagus inside gaster
Pressure sfingter
The pressure sfingter spontan mechanism
main refluks
Refluks through sfingter that was weak
chronic often happen in esofagitis
Refluks with the pressure normal,terjadi if the
stomach pressure me (cough, cry,
defecation)
Etiology
Other lifestyle contributors to GERD may include the following :
being overweight
overeating
consuming certain foods, such as citrus, peppermint, chocolate,
fatty, and spicy foods
caffeine
alcohol
smoking
use of nonsteroidal anti-inflammatory (NSAIDs) drugs such as
aspirin and ibuprofen

Other medical causes of heartburn may include the following:
gastritis - an inflammation of the stomach lining.
ulcer disease

Symptoms of GERD :
Vomit and slow gaster emptiness
Pneumonia aspiration
Chronic cough
Mengi
Relaps Pneumonia
Rumination
Failure to thrive

Symptoms of GERD :
Heartburn
Regurgitation
Difficulty swallowing
Water brash

Diagnosis
The mild case clinical value & response against therapy

Severe case
did esofagografi barium with the guidance fluoroscopy
Scintiscans show the aspirations of the contents of
gaster and show the refluks
Esofagoskopi evaluating reflux & severe strictur
Biopsy esofagus prove the existence reflux
Diagnosis
Roentgentgrafi with coventional Barium
- Exhibited the existence of the period that
disturbing in the lumen/exhibited reflux
gastroseofagus

Picture and video of esofagram
Knew the change in the pattern swallowing &
esofagus peristaltic movement

Manometri Esophagus
Evaluated the wave of the pressure in esophageal
& change in the pressure on low esophageal
sphincter

Scan radionuklid
Evaluated peristaltic efficiency in cleaned esofagus &
tested the existence refluks and aspirastion

pH in distal esophagus
Sensitive for the gaster acid refluks

Endoskopi fiberoptic
Carried out the biopsy and visualisation esofagus
without general anaesthesia , examination this to
detect and take the foreign object
Complications
include esophageal cancer, erosive
esophagitis, and Barrett's esophagus. GERD
also aggravates asthma and sleep apnea
Theraphy
Metoklopramid
Domperidone
Cisapride
Antasida
Anatgonis reseptor H2
PPI (Omeprazol)

Atresia esofagus (AE)

Esophageal atresia is a disorder of the
digestive system in which the esophagus does
not develop properly.

Variasi Atresia Esofagus
Gross of Boston :

Tipe A atresia esofagus without fistula or pure atresia esofagus (10%)
Tipe B atresia esofagus withTEF proksimal (<1%)
Tipe C atresia esofagus with TEF distal (85%)
Tipe D atresia esofagus with TEF proksimal and distal (<1%)
Tipe E TEF withoutatresia esofagus or fistula tipe H (4%)
Tipe F stenosis esofagus kongenital (<1%)

Causes
the upper esophagus ends blindly and does
not connect with the lower esophagus and
stomach
Diagnosed
blood tests
chest x-rays and other x-rays
a special chest x-ray that is done after a
nasogastric tube is put through the nose into
the esophagus to the point where the
esophagus stops
cinefluorography, a moving X-ray scan to
observe the function of the esophagus

ACHALASIA

The disturbance motility that was rare where
the relative obstruction in continuation
gastroesofagus to more badly,because the
nonexistence of the peristaltic wave in
esophageal
Symptomps
dysphagia
Regurgitation
cough
Failure to thrive
Retention in esophagusesophagitis
Diagnosis
Manometri esofagus find imperfect and the
nonexistence relaxation of lower esophagus
sphincter at the time of swallowing, dont
existence of the peristaltic wave at the time of
swallowing, no existence of the peristaltic
wave of the primary promoter / sekunder,
increase lower sphincter esophagus
Therapy
Nifedipin (channel of calsium duct)
Botulisme intrasfingter injection
Operation a gap of muscle fiber in
gastroesofagus be connected.
Balloon cateter and fluoroscopy
Hungry process
Nucleus lateral hypotalamus, as a center of
hungry
Nucleus ventromedial hypotalamus as a
center of satisfied
And sinergy with nucleus paraventrikular,
dorsomedial, dan arkuata

The Standard nutrition For Child
Kalori : 100 -120 / kg BB.
Example child with 8 kg : 8 x 100 /120 = 800/960 kkal

Protein : 1,5 - 2 g / kg BB
Example child with 8 kg : 8 x 1,5/2 = 12/16 : 4 = 3/4 gram

Karbohidrat : 50-60 % from the total calory

Lemak: 20 % from the total calory

CONCLUSIONS
Jacko maybe suffered GER (gastroesophageal
reflux) caused by overeating.
Watery stools occurs because of too much
consume milk so the digestion and absorbtion
is uncompletely
Suggestion
Give nutrition appropriate with the need and
age.
References
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL,
Jameson JL, et all, editors. Harrisons principle of internal
medicine. 17
th
ed. USA: Mc Graw Hill medical, 2008.
Wyllie R. The digestive system. In Kliengman RM, berhman RE,
Jenson HB, stanton BF. Nelsons textbook of pediatrics. 18
th

ed. Philadelphia: WB saunders Co, 2007: 1521-645
Sondheimer JM, Sundaram S. Gastrointestinal tract. In Hay
WW, Levin MJ, Sondheimer JM, Deterding RR. Current
diagnosis & treatmentpediarics. 19
th
ed. New york: the
Mcgraw-Hill Co, 2009:557-608
Departemen Farmakologi dan Terapi. Farmakologi dan Terapi.
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th
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