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Faktor-Faktor yang Mempengaruhi

Motilitas Gastrointestinal
Mira Dewi Prawira

Pembimbing : dr. Made Agus Dwiantara Sueta, Sp.B-KBD

Program Pendidikan Dokter Spesialis – I


Program Studi Ilmu Bedah
Fakultas Kedokteran - Universitas Udayana
Denpasar 2019
Pendahuluan

Anatomi Sistem
Pencernaan

Fisiologi Saluran
Pencernaan

Mekanisme Sistem
Pencernaan
Pendahuluan

Pengaturan Fungsi Motilitas :


1. Fungsi otonom otot polos
2. Pleksus saraf intrinsik
3. Saraf ektrinsik
4. Hormon saluran pencernaan
Lapisan dinding usus halus
Basic
Electrical
Rhythm
Tipe
Motilitas
Gastro-
intestinal
Plexus Saraf
Intrinsik
dan
Ekstrinsik
Neural dan
Hormonal pada
Motilitas
Gastro-
intestinal
Pengaruh Aksis
Hipotalamus Pituitari
Gangguan Motilitas Usus

Obstruksi
Ileus paralitik
mekanik
(adinamik)
(dinamik)
Etiopatogenesis Obstruksi Mekanik
Patofisiologi
Obstruksi
Mekanik
Trauma abdomen

Post operasi laparotomy


Etio-
patogenesis
Serum elektrolit abnormal
Ileus
Paralitik • Hipokalemia
• Hiponatremia
• Hipomagnesemia
• Hipermagnesemia
Medikamentosa Mempengaruhi
Motilitas Intestinal
Nama Obat Cara Kerja Efek
Acarbose Hormon ↓Motilitas usus
Ace- Inhibitor Aktivitas kolinergik ↑Motilitas usus
Angiotensin -2 Aktivitas kolinergik ↑Motilitas usus
antagonist
Antibiotik-Macrolid Lokal ↑Motilitas usus
Antibiotik- Hormon ↑Motilitas usus
Amoxicilin
Clavulanat
Antikolinergik Aktivitas kolinergik ↓Motilitas usus
Anti psikotik- Aktivitas kolinergik ↓Motilitas usus
Clozapine
Nama Obat Cara Kerja Efek
Proton pump Lokal ↑Motilitas usus
inhibitors
Opiat Aktivitas kolinergik ↓Motilitas usus
SSRI - setraline Aktivitas kolinergik ↓Motilitas usus
Ticlopidine Hormon ↑Motilitas usus
Levothyroxine Hormon ↑Motilitas usus
Verapamil Aktivitas kolinergik ↑Motilitas usus
β-blockers Otonom ↑Motilitas usus
Metoclopramide Parasimpatik sentral ↑Motilitas usus
dan perifer
Kesimpulan

1. Pengaturan fungsi motilitas dipengaruhi oleh fungsi otonom otot


polos, saraf intrinsik, saraf ekstrinsik dan hormon saluran
pencernaan
2. Terdapat 3 tipe motilitas yaitu mixing, propulsion dan separation.
3. Secara umum obstruksi intestinal dibagi menjadi 2 tipe, antara
lain; obstruksi mekanik (dinamik) dan ileus paralitik (adinamik).
4. Gangguan motilitas usus bisa mengakibatkan hipoperistaltik
dan hiperperistaltik.

5. Obat golongan opioid, antikolinergik, antidepresan trisiklik,


anti neoplasma hipomotilitas.

6. obat golongan ace-inhibitors, angiotensin-2-antagonists,


antibiotika golongan makrolid, antibiotika amoxicillin-
clavulanate, proton pump inhibitors, ticlopidine,
levothyroxime, verapamil, β-blockers dan golongan prokinetik
(metoklorpamid) hipermotilitas usus.
• Ahmad, MS., Shadab, M., Omar, S., Mallik, AZ., Ansari, MA. 2015. Casues, evaluation and surgical
management of mechanical small bowel obstruction. Int Surg J, Vol. 2, pp.492-95.
• Bahtia, V., & Tandon, RK. 2005. Stress and the gastrointestinal tract. Journal of Gastroenterology
and hepatology, vol. 20, pp. 332-339.
• Browning, KN., & Travagli, RA. 2014. Central nervous system control of gastrointestinal motility and
secretion and modulation of gastrointestinal functions, American Physiological Society, Compr
Physiol, vol. 4, pp.1339-1368.
• Boeckxstaens, G., Camilleri, M., Sifrim, D. 2016. Fundamentals of neurogastroenterology:
physiology / motility – sensation, Gastroenterology, vol. 150, pp.1292–1304.
• Carraboti, M., & Scirocco, A. 2015. The gut-brain axis: interactions between enterik microbiota,
central and enterik nervous sistems, Annals of Gastroenterology, vol. 28, pp. 203-209.
• Cappell, MS., Batke, M. 2008. Mechanical obstruction of the small bowel and colon. Med Clin N A,
Vol.92, pp. 575-97.
• Chang, EB., & Leung, PS. 2014, Gastrointestinal motility, Springer, pp. 32-63.
• Chick, JFB., Mandell, JC., Mullen, KM., Khurana, B. 2013. Classic signs of close loop bowel

Daftar •
obstruction. Intern Emerg Med, Vol.8, pp. 263-64.
Chalya, PL., Mabula, JB., Chandika, AB., Giiti, G. 2014. Dynamic bowel obstruction: aetiology, clinical
presentation, management and outcome at Bugando Medical Centre, Mwanza, Tanzania. Tanzania
Journal of Health Research, Vol. 16, pp.1-10.

Pustala •



Elsevier. 2012. Intestinal and colonic motility, pp. 711-720.
Guyton, AC. 2002, Buku Ajar Fisiologi Kedokteran, Edk 9, EGC, Jakarta.
Hasen, MB. 2003. Neurohumoral control of gastrointestinal, Physiol. Res, vol. 52, pp. 1-30.
McCallion, K. 2016. Instestinal obstruction. Gastrointestinal emergencies. Jhon wiley & Sons, pp.
220-224.
• Maniselvi, S., & Gayathre, SP. 2018. Etiology and outcome of intestinal obstruction: an institutional
prospective study. Int Surg J, vol.5, pp.1341-44.
• Paine, P., McLaughlin, J., Lal, S. 2013. Review article: the assessment and management of chronic
severe gastrointestinal dysmotility in adults. Aliment Pharmacol Ther, Vol.38, pp. 1209-29.
• Pillai, V., Benjamin, RK., Chisthi, MM. 2017. A pattern of intestinal obstruction cases – a tertitary
care canter study. Ann. Int. Med. Den. Res, Vol.3, pp.41-5.
• Sherwood, L. 2001, Fisiologi Manusia : dari sel ke sistem. Edk 2, EGC, Jakarta
• Syaifuddin. 2001, Fungsi Sistem tubuh Manusia. Widya Medika, Jakarta.
• Vilz, T.O., Stoffels, B., Strassburg, C., Schild, H.H. and Kalff, J.C., 2017. Ileus in Adults: Pathogenesis,
Investigation and Treatment. Deutsches Ärzteblatt International, 114(29-30), p.508.

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