&
MUNTAH
MUAL
Perasaan bahwa sebentar lagi akan muntah
Sensasinya terasa di kerongkongan atau ulu hati
MUNTAH
Pengeluaran paksa isi lambung lewat mulut dengan kuat
MEKANISME MUAL
Dapat disertai dengan fenomena objektif seperti
aktivasi sistem saraf simpatis ( hipersalivasi, pucat,
keringat, tahikardi )
Pada umunya merupakan pengalaman subjektif
Jalur neural belum disepakati oleh para ahli
MEKANISME MUNTAH
Kontraksi otot-otot perut memegang peranan efektif,
sedangkan lambung relatif berperan pasif.
Kontraksi otot-otot dinding perut diagfragma
kontraksi anular pilorus lambung dan gastroesofageal
sehingga isi perut dipaksa keluar dari lambung
esofagus mulut.
sea, vomiting and disorders of gastric emptying in motor disorder of the gastrointestinal.
what to do. Edit by Fisher Rs, et al. Acad.Prof.Information Serv.Inc., New York, 1993 : 58.(3)
Korteks serebral
B.
Aparatus vestibuler
C.
Nervus Vagus
Chemoreceptor
Trigger zone
Mid-brain ICP
receptors
Limbic
system
Vestibular
system
Emetic Center
Salivatory Center
Vasomotor Center
Respiratory Center
Cranial Nerves
Somatic
Abdominal muscles
Diaphragm
Visceral Efferents
Stomach
Esophagus
Clarfield HR, Roth JLA. Anorezia, nausea and vomiting in Bockus Gastroenterology.
Edit by Berk JR. WB Sounders Co., Philadelphia, 1985 : 48-58.
Pancreatits
Cholecystitis
Acute Hepatitis
Pancreatic carcinoma
Miscellanous causes
Posterior myocardial infarction
Congestive heart failure
Excess ethanol ingestion
Jamaican vomiting sickness
Prolonged starvation
Cyclic vomiting
DIAGNOSIS
Anamnesis
Karakter muntahan :
bau,makanan, getah lambung, mukus getah
empedu, nanah
PEMERIKSAAN
Fisis : dehidrasi, nyeri epigastrium, massa perut
Laboratorium : darah rutin, elektrolit, ureum, creatine,
gula darah, tes faal hati, tes kehamilan
Radiologi : USG, foto polos barium, CT scan perut/kepala
Endoskopi
Significant
dehydration
Intravenous hydration
possible hospital
admission
Suspect
Intra-abdominal
inflammation
Suspect
obstruction
Calcium
Glucose
CBC
Blood urea
Amylase
Nitrogen Liver chemistry studies
Creatinine
Cortisol
Thyroid Tests
Ultrasound
Pregnancy
CT
Test as
Scintigraphy
indicated
As indicated
If abnormal
Medical or surgery
therapy
Abdominal
Radiography
Upright
And supine
Suspect
neurologic
disease
Head CT or MRI
scans
If non diagnostic
And intracranial pressure
not increased
Lumbal puncture
To exclude infection
Or hemorrhage
Barium radiography
Or upper endoscopy
If abnormal
Medical or surgery
therapy
If normal
History
Reccurent
Physical examination
or
Laboratory screen
Chronic
Plain abdominal reonigenogram
Acute
(less than 24 hours)
Consider :
Endoscopy
Neurologic, muscle,
Gastrointestinal
No Mechanical
collagen, endocrine,
contrast seriesObstruction Psychiatric disease
Mechanical Obstruction
Screen for :
Metabolic
Drug
Infections
Intoxication
Therapeutic trials
Optional
If severe or nutritional
compromise
Laparatomy plus full thickness
Histology biopsy of small intestine
Electropysiology
No cause
identified
Gastric emptying
Manometry
If no response
Normal
Obtain :
Consultations
Further blood tes
Abnormal
Electrogastrography
Therapy :
Medical (liquid, meals, enteral
nutrition, prokinetic
drugs)
Surgical (antrectomy)
Thank
you
S I R .