Wan Nedra
wan.nedra@yarsi.ac.id
YARSI SCHOOL OF MEDICINE 2014
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OBJECTIVE:
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Mayor:
Nyeri perut di daerah epigastrium
Muntah berulang ( minimal 3x/bulan)
Evaluasi:
Minor: - 2 mayor
Gejala yg berhubungan dg makan (Anoreksia, BB menurun)
atau
Nyeri perut yg dirasa pd malam hari
Heartburn -1 mayor
Oral Regurgitasi + 2 minor
Neusia kronik
Sendawa berulang -4 minor
Nyeri perut disekitar umbilikal
Ada riwayat keluarga PUD. Dyspepsia
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ANAMNESIS
Riwayan Makan:
Makanan berlemak, makanan pedas, caffein, laktose
Penggunaan Obat-obatan:
Kortikosteroid, NSAID
Alkohol, tembakau (rokok)
Obat2 yang meransang pengeluaran
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asam lambung
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PEMERIKSAAN LABORATORIUM
Pemeriksaan awal:
Hematologi dg differential count
LFT, Elektrolit
Feses: Parasit
Urinalisis
Pemeriksaan lanjutan:
USG hati dan saluran empedu
Endoskopi
Hydrogen breath test
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PENGOBATAN
H2 reseptor antagonis:
• Cimetidine 20 – 40 mg/ kg/ hari 2 kali / hari maks: 400 mb
• Ranitidine 2- 4 mg/ kg/ hari, 2 kali sehari (mak: 150 mg)
Cytoprotective Agents:
Sukralfat 40-80 mg/ kg/ hari, 4 kali sehari ( mak 1 g)
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DEFINISI
Vomiting:
• forceful expulsion of gastrointestinal contents into the
oesophagus 8
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S.motorik somatik
S. Simpatis
Saraf otonom
S. Parasimpatis
N. Vagus
Saraf enterik
pl. mienterikus asetil kolin
pl. submukosa pleksus mienterikus
motilitas sal.cerna
S.motorik somatik
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Impuls
endogen exogen
afferen N. Vagus
Chemo-receptor
Vomiting center
Trigger Zone
Impuls
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Vomiting centre
esophagus
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LES
Fundus Tonus decrease
Corpus
Antrum Peristaltic decrease
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Vomiting
APPROACH
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ETIOLOGY
Neonates
Atresia esophagus, pylorus stenosis, spitting up
GER, NEC, chalasia, Infection (UTI, OMA, sepsis)
Infants
pylorus stenosis, intususeption, hernia
RGE, gastroenteritis, infection, drugs, aerophagia
Children
Intusuception, stricture, gastritis, apendisitis Infection, drugs
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Therapy
~ etiology
treat acid and base inbalanced
Drugs:
Domperidone
Metoclopramide
Cisapride
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Gastroesophageal reflux
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REGURGITATION
RGE
8% abnormal pH esophagus monitoring
1/300 – 1/1000 ‘severe
(Chouchou, 92; Nelson
20 et al, 1997)
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GER
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GER
Physiologic reflux
occurs mainly after meal
does not normally cause symptoms
short duration of reflux episodes
Pathologic reflux
frequent reflux episodes of longer duration
reflux episodes occuring during the day/night
may produce symptoms & inflamation/mucosal injury
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MECHANISMS OF GER
Deficient or delayed
esophageal
acid clearance
attenuated swallows,
dysfunctional peristalsis
Length of LES,
Maturation of LES
TLES relaxation
delayed
delayed gastric
gastric emptying
emptying,
distention
Incompetent distension
LES
Inadequate
ILES: Lower essophageal gravitation
sphinter
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TRIGGER FACTORS
FAVORING GER
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SYMPTOMS OF GER
(- DISEASE)
Usual manifestations
Specific manifestation
regurgitation, nausea, vomiting
Possibly related to complications
~ anaemia (iron defiency anaemia)
haematemesis & melena
dysphagia, weight loss, irritable infants
ect ~ adult
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SYMPTOMS OF GER
(- DISEASE)
Unusual presentations
~ chronic respiratory disease
apnea, apparent life threatening, SIDS
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TREATMENT
RECOMMENDATIONS
1. a. Parental reassurance
b. Milk-thickening agents (?)
2. Prokinetics
3. Positional adjuvant therapy
4. a. H2 receptor antagonist
b. Proton pump inhibitors
5. Surgery
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REGURGITATION AND
FEEDING
Frequent small feeding
Decrease the number of transient LES relaxations
Reduced volume cause of distress to infants
Restriction volume in clearly overfed babies
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Prokinetics
Reduces regurgitation
The LES pressure and motility
Esophageal peristalsis, gastric emptying
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POSITION, CRYING,
AND REFLUX
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THANK YOU
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