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GATRO LO 3 WEEK 4

1. Proses sel normal menjadi sel kanker


Normal epitel (jumlah sel mitosis seimbang dengan sel apoptosis)  ada tumor suppressor gene
namanya APC gene yang bakal naikin jumlah sel apoptosis biar gajadi kanker, kalo APC gene bermasalah
bakal jadi  dysplastic epithelium  early adenoma  ada proto oncogene namanya KRAS gene yang
bakal bind ke GTP untuk hidrolisis GTP jadi GDP dan bisa inactivate G protein, kalo bermasalah jadi 
intermediate adenoma  late adenoma  ada tumor suppressor gene lagi namanya P53 yang bakal
bikin sel apoptosis, kalo bermasalah  cancer  metastasis

2. Volvulus
- Part of the colon twists on its mesentery, bikin acute, subacute, or chronic colonic obstruction.
- Main types: sigmoid volvulus, cecal volvulus
- Main cause: birth defect called malrotation, which the bowel becomes misaligned during fetal
development. Bowelnya ga attach ke abdominal wall, jadi bisa bikin bowels shift out of their normal
position or to rotate
- Symptoms:
o Abdominal tenderness
o Nausea or vomiting (vomit green bile looking material)
o Bloody or dark red stool
o Konstipasi
o Distended abdomen
o Shock

3. Paralytic ileus
- Inability of the intestine to contract normally and move waste out of the body.
- Patof:
o Postoperative / postoperative ileus: terjadi karna aktivasi inhibitory reflex arc dari spinal.
 Ultra-short reflex: kesalahan di nerve di bowel wall
 Short reflex: terjadi di pre vertebral ganglia
 Long reflex: terjadi di spinal cord
 Yang paling berperan si long reflex  mgkn ada kesalahan di operasi
- Penyembuhan dengan cara abdominal sympatectomy: pengambilan nerve simpatetik dari abdomen.
Pake spinal anastesi
- Causes:
o Most cases of ileus occur after intra-abdominal operations. Normal resumption of bowel
activity after abdominal surgery follows a predictable pattern: the small bowel typically
regains function within hours; the stomach regains activity in 1-2 days; and the colon regains
activity in 3-5 days
- Symptoms:
o Distended abdomen
o Constipation
o Diarrhea
o Fullness
o Gas
o Abdominal spasm
o Foul smelling breath  ada flora normal yang tumbuh berlebihan. Bikin pembentukan gas
berlebihan

4. Diverticulitis
- Inflammation of one or more diverticula  small pouches created by the herniation of the mucosa
into the wall of the colon
- Symptoms:
o Left lower quadrant pain
o Change in bowel habits
o Nausea and vomiting
o Flatulence
o Bloating
- Diverticula are small mucosal herniations protruding through the intestinal layers and the smooth
muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the
colon. True diverticulae contain all layers of the gastrointestinal wall (mucosa, muscularis propria,
and adventitia) (eg, Meckel diverticulum). False diverticulae, or pseudo-diverticulae do not contain
the muscular layers or adventitia, and they only involve the submucosa and mucosa. Diverticula can
occur anywhere in the gastrointestinal tract but are usually observed in the colon. The sigmoid colon
has the highest intraluminal pressures and is most commonly affected.

5. BNO IVP (blass nier overzicht intera venous pyelography) / KUB IVP (kidney ureter and bladder intera
venous pyelography)
- IVP adalah x ray exam that uses an injection of contrast material to evaluate kidney, ureter, and
bladder, and health diagnose blood in the urine, or pain in your side, and lower back.
- Pake iodinated contrast material yang dimasukin lewat vein
- Cara:
o Sebelum penyuntikan media kontras ,terlebih dahulu dilakukan skin test terhadap pasien.
o Penyuntikan urografi intra vena mempunyai dua cara : langsung dan drip infus
o Penyuntikan src langsung dilakukan melalui pembuluh darah vena dengan cara memasukkan
jarum wing needle ke dalam vena mediana cubiti
o Penyuntikan scr drip infus adalah media kontras dicampur dgn larutan fisiologis kmd
dimasukkan melalui slang infus
- Hasil
o Foto 5 menit setelah penyuntikan
 Untuk melihat fungsi ginjal dan untuk melihat pengisian media kontras pada
pelvicocalises

o foto 15 menit setelah penyuntikan


 untuk melihat pengisian media kontras pada ureter
o foto 30 menit setelah penyuntikan
 untuk melihat pengisian ureter bagian bawah dan kandung kencing

6. intussusception
- process in which segment of intestine invaginates into the adjoining intestinal lumen causing bowel
obstruction
- biasanya infant
- symptoms:
o Vomiting: Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction
occurs, vomiting becomes bilious
o Abdominal pain: Pain in intussusception is colicky, severe, and intermittent
o Passage of blood and mucus: Parents report the passage of stools, by affected children, that
look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood; diarrhea
can also be an early sign of intussusception
o Lethargy: This can be the sole presenting symptom of intussusception, which makes the
condition’s diagnosis challenging
o Palpable abdominal mass
- believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. In
enteroenteral intussusception, this imbalance can be caused by a mass acting as a lead point or by
a disorganized pattern of peristalsis (eg, an ileus in the postoperative period).

7. IBD vs IBS
- Inflammatory bowel disease
o In ammatory bowel diseases are a group of in amma- tory conditions in which the body’s
own immune system attacks parts of the digestive system. The two most com- mon in
ammatory bowel diseases are Crohn’s disease (CD) and ulcerative colitis (UC). IBD affects as
many as 1.4 million Americans, most of whom are diagnosed before age 35. There is no cure
for IBD but there are treatments to reduce and control the symptoms of the disease.
o CD and UC cause chronic in ammation of the GI tract. CD can affect any part of the GI tract,
but frequently affects the end of the small intestine and the beginning of the large intestine.
The in ammation in CD can affect all layers of the intestinal lining. Ulcerative colitis (UC) is
characterized by in ammation in the large intestine (colon) and the rectum. The in
ammation in UC occurs only in the innermost layer of the intestinal lining.
- Irritable bowel syndrome
o Irritable bowel syndrome is a condition that affects the function and behavior of the
intestines. Normally, the mus- cles lining the intestines intermittently contract and relax
to move food along the digestive tract. In IBS, this pattern is disturbed, resulting in
uncomfortable symptoms. More than 40 million people are affected by IBS. It is important
to remember that patients with IBD can also have IBS.