KMB Pencernaan II
KMB Pencernaan II
KELOMPOK 5
Gangguan pada sistem pencernaan dapat
terjadi jika salah satu / lebih proses
pencernaan tidak berjalan dengan baik.
Macam Gangguan Sistem Pencernaan
Gastritis Radang akut Hepatitis Infeksi virus Diare Iritasi pada selaput
karena pada hati, dinding kolon oleh
produksi asam sering meluas bakteri disentri, diet
lambung yang melalui air yang jelek, zat-zat
tinggi. Selain atau makanan beracun, rasa
itu, bisa yang gelisah, atau
disebabkan terkontaminasi makanan yang
oleh bakteri. oleh virus. dapat menimbulkan
iritasi pada dinding
usus.
Gastroesophageal
Reflux Disease
(GERD)
Terapi posisi
Memposisikan bayi dalam posisi tegak lurus selama 20-30 menit setelah makan dapat mengurangi 2014
regurgitasi. Posisi tidur menelungkup terbukti dapat mengurangi refluks tetapi meningkatkatkan
risiko terjadinya sudden infant death syndrome (SIDS).
Bila farmakoterapi menjadi
pilihan terapi maka
Farmakoterapi
penggunaan PPI lebih
direkomendasikan
Prokinetik
Surface agents
Bekerja dengan menciptakan pertahanan yang Peran prokinetik dalam tatalaksana GERD
04 menghalangi cedera pada mukosa yang masih terbatas karena alasan keamanan dan
diakibatkan oleh asam lambung. Hanya dua manfaat, seperti metoklopramid, cisapride atau
SA
yang telah dievaluasi sebagai terapi pada domperidon dan eritromisin. Baclofen
pasien GERD yaitu sodium alginate dan merupakan antagonis reseptor gamma-amino-
sukralfat. Sukralfat (aluminium sucrose sulfat) butyric acid B (GABA-B) yang menghambat
memberikan kesembuhan mukosa dan relaksasi transien dari sfingter bawah
melindungi kerusakan selanjutnya akibat asam esophagus. Beberapa penelitian menunjukkan
lambung. baclofen akan mengurangi gejala refluks,
mengurangi frekuensi relaksasi fingter
esophagus dan paparan asam lambung
terhadap esophagus, serta mempercepat
pengosongan lambung. Efek samping baclofen
05 seperti dyspepsia, mengantuk, dan
PK
mengurangi ambang kejang sehingga
penggunaan baclofen jarang pada anak kecuali
dengan adanya penyakit dasar neurologis.
Hasil penelitian penatalaksanaan
gangguan sistem pencernaan
Abdominal Migraine
Konstipasi
Konstipasi adalah jarangnya buang air besar atau defekasi yang nyeri,
inkontinensia fekal dan nyeri abdomen, menyebabkan distress yang
signifikan terhadap manusia
Balita dan anak
Konstipasi Berulang
Konstipasi Akut
Untuk usia anak-anak dengan feses yang
keras tetapi tidak terdapat nyeri dan
kebiasaan menahan feses, pendarahan/fisura Laksatif
ani, modifikasi diet tinggi serat sudah Pencahar berupa
mencukupi. Makanan yang dianjurkan adalah makanan atau obat-
makanan tinggi serat disertai dengan intake obatan
Konstipasi berulang
Functional Abdominal
Pain Disorder (FAPDs)
Therapeutic relationship
01 Suatu hubungan antara dokter-pasien/keluarga penting
dalam tatalaksana FAPDs. Pengertian manusia untuk
menerima bahwa nyeri tipe biopsikososial merupakan
faktor penting dalam penyembuhan.
Edukasi pasien
02 Menghindari faktor pencetusnyeri, nyeri mungkin akan tetap
ada tetapi kualitas hidup manusia dapat ditingkatkan.
Mempunyai tujuan tatalaksana yang jelas seperti
mempertahankan aktifitas normal dan meningkatkan toleransi
terhadap gejala
Modifikasi perilaku
03 Mengenal dan memberikan dukungan terhadap minat dan bakat
anak . Pola pengasuhan respon terhadap nyeri abdomen.
Memperbaiki coping
04 Coping adalah usaha sukarela untuk mengelola emosi, pikiran, sikap, fisiologis dan
lingkungan dalam memberikan respon terhadap kejadian berat/menyebabkan stress.
Tatalaksana Umum
Functional Abdominal Pain Disorder (FAPDs)
Terapi Perilaku Kognitif
Pendekatan psikoterapi yang mengidentifikasi
Teknik Relaksasi hubungan antara perilaku, pikiran, perasaan untuk
Terapi relaksasi dapat membantu mengurangi rasa mempengaruhi perubahan terapi meliputi berbagai
nyeri dan memperbaiki fungsional anak kombinasi dari pendidikan, relaksasi, manajemen
stress, dan modifikasi perilaku.
Hipnoterapi dapat menyertakan gambar yang o Makanan pencetus : diet bebas Laktosa
dibayangkan, suara, atau sensasi untuk selama 2 minggu, diet bebas gluten, dan
menghasilkan keadaan penerimaan, juga diet makan karbohidrat rantai pendek.
dikenal sebagai hipnoterapi "gut-directed" o Kecemasan : Mengidentifikasi adanya
yang dapat dilakukan sendiri atau dengan kecemasan pada pasien FAPDs sangat
panduan terapis. penting karena mempengaruhi sebanyak
42-85%
Tatalaksana Mengatasi Gejala
Functional Abdominal Pain Disorder (FAPDs)
Probiotik
Probiotik memperbaiki gejala dengan mengembalikan keseimbangan mikrobiota
usus melalui kompetisi metabolik dengan patogen, memperbaiki barrier mukosa
usus, atau meningkatkan respon inflamasi usus.
Serat
Serat dapat memodifikasi mikrobiota usus, meningkatkan
komposisi feses dan gas, dan mempercepat transit saluran cerna.
Minyak Peppermint/Antispasmodik
Minyak peppermint mengurangi spasme otot polos pada
saluran cerna sehingga mengurangi lama nyeri, frekuensi
dan beratnya nyeri. Sementara itu penggunaan
antispasmodik pada anak masih membutuhkan penelitian
lebih lanjut pada anak-anak.
Hasil penelitian penatalaksanaan
gangguan sistem pencernaan
Perdarahan Saluran
Cerna
Pipa Nasogastrik
Penggunaan pipa nasogastrik/orogastrik dapat
membantu menegakkan diagnosis dan menentukan
perdarahan sedang berlangsung atau tidak
04 03
Terapi lain
Hemospray merupakan Clips
serbuk yang diberikan Clips menyebabkan
melalui kateter TTS (through tamponade mekanik tanpa
the scope) dan sistem menimbulkan kerusakan
pressurized CO2. Serbuk jaringan.
mengkosentrasikan faktor
Text Text Text Text
pembekuan, membentuk
sumbatan mekanik pada
vena yang berdarah.
Contoh trend issue
pemberian prebiotik dan
probiotik dalam menangani
diare :
Pemberian lactobacillus
mampu memendekkan durasi
diare dari 3,5 hari menjadi 2,5
hari pada anak yang dirawat
di rumah sakit
Uji klinis di dua rumah sakit
Jakarta menunjukkan pemberian
probiotik Lactobacillus ramnosus
dikombinasi dengan prebiotik
01 Membantu membersihkan
saluran cerna dan
02 Meningkatkan fungsi hati
dalam membersihkan toksin
memproduksi vitamin Bakteri Protein yang terkandung
probiotik dapat membantu dalam makanan akan diuraikan
membersihkan saluran dan diserap oleh asam
pencernaan dan semua lambung
membran mukosa tempat
mereka hidup. bakteri
probiotik juga berfungsi
memproduksi berbagai jenis
vitamin B (B-3, B-5, B6, B-9
dan B12).
Probiotik dan Prebiotik memilik beberapa manfaat antara lain:
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