Pemicu 4

Julia Jennifer M
405120053
…

GI BLEEDING
 PEPTIC ULCER
• Ulcer : hilangnya lapisan epitelial mukosa hingga
submukosa dengan kedalaman > 5mm.
• Peptic ulcer disease refers to painful sores or ulcers in
the lining of the stomach (gaster) and the beginning of
the small intestine (duodenum)
• Most ulcers are caused by an infection with a type of
bacteria called Helicobacter pylori (H. pylori)
• It is characterized by a burning sensation and occurs
after meals—classically, shortly after meals with gastric
ulcer and 2-3 hours afterward with duodenal ulcer.
 PEPTIC ULCER
Factors that can increase your risk for ulcers include:
• Excess acid production , tumors of the acid producing
cells of the stomach that increases acid output (seen in
Zollinger-Ellison syndrome)
• Infected with the H. pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen, or naproxen
• Have a family history of ulcers
• Have another illness such as liver, kidney, or lung
disease
• Drink alcohol regularly
 Peptic Ulcer

Ketidakseimbangan faktor defensif

dan faktor agresif

Faktor defensif mukosa:

• pre- epitel terdiri atas mukus dan Faktor agresif:

bikarbonat
•Eptel menghasilkan heat shock protein •Eksogen :
,trefoil factor family peptides dan NSAID,alkohol,rokok,infeks
cathelicidins __> proteksi sel dari stress i bakteri (H.pylori)
oksidatif dan agen sitotoksik dan
menstimulasi regenerasi bila terjadi •Endogen : asam lambung
kerusakan , pepsin, enzim pankreas
•Post – epitel terdapat jar. PD yang
mensuplai nutrisi O2 dan mengakut
toksik
 PEPTIC ULCER
• burning pain in the middle or upper stomach between
meals or at night
• Bloating
• Heartburn
• Nausea or vomiting

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding)
• Vomiting blood (that can look like "coffee-grounds")
• Weight loss
• Severe pain in the mid to upper abdomen
 Ulkus duodenum Ulkus Gaster

Lokasi Umumnya di proksimal Bervariasi dari kardiak hingga pilorus

duodenum
Resiko rendah tinngi
keganasan
Sekresi asam meningkat Normal atau rendah

Karakteristik Muncul saat lapar , membaik Muncul segera setelah makan

nyeri bila makan
Usia Lebih sering, dan pada usia Cenderung terjadi pada usia > 50 thn
lebih muda
 PEPTIC ULCER
• Esophogastroduodenoscopy (EGD)
• Stool culture: A stool sample is sent for lab
testing. H. pylori bacteria will grow over the
course of a few days, if present.
• Urea breath test: A urea breath test involves
swallowing a pill that contains carbon and
breathing into a bag that’s sent to a lab. High
levels of carbon dioxide can indicate presence
of H. pylori.
 PEPTIC ULCER
• H2RA , terapi supresi asam pada ulkus peptikum
(ranitidin,simetidin)
• Proton pump inhibitors (PPI). Proton pump medications reduce acid
levels and allow the ulcer to heal. They include dexlansoprazole
(Dexilant), esomeprazole
(Nexium), lansoprazole (Prevacid),omeprazole (Prilosec),
pantoprazole (Protonix), rabeprazole (Aciphex), and
omeprazole/sodium bicarbonate (Zegerid)
• Upper endoscopy , to determine the presence and degree of active
bleeding
• Surgery. Sometimes an operation is needed if the ulcer has created
a hole in the wall of the stomach, or if there is serious bleeding that
can't be controlled with an endoscope.(gastrektomi parsial)
• primary therapy for H pylori infection is proton pump inhibitor
(PPI)–based triple therapy. These regimens result in a cure of
infection and ulcer healing in approximately 85-90% of cases.
Ulcers can recur in the absence of successful H pylori eradication.

• PPI-based triple therapies are a 14-day regimen as shown below:

Omeprazole (Prilosec): 20 mg PO bid
or
Lansoprazole (Prevacid): 30 mg PO bid
or
Rabeprazole (Aciphex): 20 mg PO bid
or
Esomeprazole (Nexium): 40 mg PO qd
Plus
Clarithromycin (Biaxin): 500 mg PO bid
and
Amoxicillin (Amoxil): 1 g PO bid
• Quadruple therapies for H pylori infection are generally
reserved for patients in whom the standard course of
treatment has failed

Quadruple treatment includes the following drugs,

administered for 14 days:
• PPI, standard dose, or ranitidine 150 mg, PO bid
• Bismuth 525 mg PO qid
• Metronidazole 500 mg PO qid
• Tetracycline 500 mg PO qid
 Complication Cause

ulcer wears away the stomach or

bleeding small intestine and breaks the blood
vessels there

ulcer breaks through the lining and

perforation stomach wall, causing bacteria, acid,
and food to leak through

inflammation and infection of the

peritonitis
abdominal cavity due to perforation

scar tissue can form as a result of

blockage the ulcers and keep food from
leaving the stomach or duodenum

gastric ulcers can increase your risk for cancerous and

noncancerous tumor growth. Duodenal ulcers aren’t usually
associated with cancer.
..

ESOPHAGEAL VARICES
 Derajat varises esofagus
pada endoskopi :
Swelling of the veins of the esophagus or stomach -derajat 1 : varises yang
usually resulting from liver disease . kolaps bila esofagus
Varices most commonly occur in dikembangkan dengan
alcoholic liver cirrhosis. When varices bleed, the udara
bleeding can be massive, catastrophic and occur -derajat 2 : antara derajat 1
without warning. dan 3
-derajat 3 : varises yang
besar dan dapat menutup
If larger amounts of bleeding occur, symptoms lumen
may include:
•Black, tarry stools
•Bloody stools
•Lightheadedness
•Paleness
•Symptoms of chronic liver disease
•Vomiting blood / hematemesis
 Another causes for Upper GI bleeding
• Gastritis: General inflammation of the stomach
lining, which can result in bleeding. Gastritis also
results from an inability of the gastric lining to
protect itself from the acid it produces.
• Causes of gastritis include:
-NSAIDs or nonsteroidal anti-inflammatory
drugs, for example,ibuprofen
-alcohol,
-burns, and
-trauma
..

LOWER GI BLEEDING
Diverticulosis: One of the most common causes of lower GI bleeding. Small out-pockets,
or diverticula, form in the wall of the colon (large intestine), usually in a weakened area
of the bowel wall. The person may develop several pockets, which are more common in
people who have constipation and strain during a bowel movement.

Cancers: One of the early signs of colon or rectal cancers may be blood in the stool.

Inflammatory bowel disease (IBD):Flares of inflammation from IBD(Crohn's disease

and ulcerative colitis) often cause mucousy stool that has blood mixed in it.
Infectious diarrhea: Some viruses or bacteria can cause damage to the inner lining of
the intestines, which can lead to bleeding.

Angiodysplasia: Along with diverticulosis, this is one of the most common causes of
lower GI bleeding. Angiodysplasia is a malformation of the blood vessels in the wall of
the GI tract. These are most commonly in the large intestine and often bleed. The elderly
and people with chronic kidney failure develop the disease most often.
Polyps: Intestinal polyps are noncancerous
tumors of the GI tract, occurring mostly in
people older than 40 years of age. A small
proportion of these polyps may transform into
cancer. Colon polyps may bleed rapidly, or they
may bleed slowly and go undetected.

Hemorrhoids and fissures: Hemorrhoids are

swollen veins in and around the anus.
Repeated stretching from straining during
bowel movements causes them to bleed.
Bleeding from hemorrhoids is usually mild,
intermittent, and bright red. Anal fissures, or
tears in the anal wall, also may trigger small
amounts of bright red bleeding from the anus.
Forceful straining during passage of hard stool
usually causes such tears, which can be very
painful and may require surgery.
…

ACID-BASE
ASIDOSIS ASIDOSIS METABOLIK
RESPIRATORIK • Akut :
• Akut : – pCO2 normal
– pCO2 ↑ – HCO3- ↓
– HCO3- normal – pH darah <
– pH darah < • Kompensasi tidak
• Kompensasi tidak sempurna :
sempurna : – pCO2 ↓
– pCO2 ↑ – HCO3- ↓
– HCO3- ↑ – pH darah <
– pH darah < • Kompensasi
• Kompensasi sempurna :
sempurna : – pCO2 ↓
– pCO2 ↑ – HCO3- ↓
– HCO3- ↑ – pH darah normal
– pH darah normal
ALKALOSIS ALKALOSIS
RESPIRATORIK METABOLIK
• Akut : • Akut :
– pCO2 ↓ – pCO2 normal
– HCO3- normal – HCO3- ↑
– pH darah > – pH darah >
• Kompensasi tidak • Kompensasi tidak
sempurna : sempurna :
– pCO2 ↓ – pCO2 ↑
– HCO3- ↓ – HCO3- ↑
– pH darah > – pH darah >
• Kompensasi • Kompensasi
sempurna : sempurna :
– pCO2 ↓ – pCO2 ↑
– HCO3- ↓ – HCO3- ↑
– pH darah normal – pH darah normal
…

ELECTROLYTE DISTURBANCES
…

ANEMIA PENYAKIT KRONIS

 Anemia penyakit kronik adalah anemia yang
timbul setelah terjadinya proses infeksi atau
inflamasi kronik

Diagnosis anemia penyakit kronik dapat ditegakkan melalui

beberapa pemeriksaan, antara lain dari:
1. Tanda dan gejala klinis anemia yang mungkin dapat dijumpai,
misalnya muka pucat, konjungtiva pucat, cepat lelah, lemah, dan
lain–lain.
2. Pemeriksaan laboratorium, antara lain:
a. Anemianya ringan sampai dengan sedang, dimana
hemoglobinnya sekitar 7–11 gr/dL.
b. Gambaran morfologi darah tepi: biasanya normositik-
normokromik atau mikrositik ringan. Gambaran mikrositik ringan
dapat dijumpai pada sepertiga pasien anemia penyakit kronik.
c. Volume korpuskuler rata–rata (MCV: Mean Corpuscular
Volume): normal atau menurun sedikit (= 80 fl).
d. Besi serum (Serum Iron): menurun (< 60 mug / dL).
e. Mampu ikat besi (MIB = TIBC: Total Iron Binding Capacity):
menurun (< 250 mug / dL).
f. Jenuh transferin (Saturasi transferin): menurun (< 20%).
g. Feritin serum: normal atau meninggi (> 100 ng/mL).
No Infeksi kronik Inflamasi kronik Lain–lain Idiopatik

Infeksi paru: abses,emfisema, Penyakit hati

1 tuberkulosis, bronkiektasis Artritis reumatoid alkaholik
Gagal jantung
2 Endokarditis bakterial Demam reumatik kongestif

Lupus eritematosus
3 Infeksi saluran kemih kronik sistemik (LES) Tromboplebitis
Penyakit jantung
4 Infeksi jamur kronik Trauma berat iskemik
Human immunodeficiency virus
5 (HIV) Abses steril
6 Meningitis Vaskulitis
7 Osteomielitis Luka bakar
Osteoartritis
8 Infeksi sistem reproduksi wanita (OA)

Penyakit vaskular
Penyakit inflamasi pelvik (PID: kolagen (Collagen
9 pelvic inflamatory disease) vascular disease)
10 Polimialgia
11 Trauma Panas

12 Ulcus dekubitus
13 Penyakit Crohn