05. muntah
DESCRIPTION
pptTRANSCRIPT
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MUNTAH
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MUNTAH
REFLUX YANG NYATA
ISI LAMBUNG KELUAR SAMPAI KE MULUT
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GASTROESOPHAGEAL REFLUX= GER
KEMBALINYA ISI LAMBUNGKE ESOFAGUS ATAU LEBIH PROKSIMAL
MAKANAN/MINUMAN
G A S ASAMLAMBUNG
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REFLUX
TEK.LAMBUNG = TEK.ESOFAGUS
FAAL HIATALHERNIA
TEK.LAMBUNG > TEK.ESOFAGUS
OBSTRUKSI PERISTALSIS
DALAM LUAR Lower Esophageal Sphincter (LES)
Longgar
CHALASIA
GastricOutlet
Obstruc.
Stenosis pilorus hipertrofi
TumorAbdomen
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HIATALHERNIA
=PARTIAL
THORACICSTOMACH
SLIDING HIATUSHERNIA
PARAESOPHAGEALHERNIA = ROLLING
MIXED
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REFLUX
ASAM LAMBUNG= ACID REFLUX
MAKANAN/MINUIMAM
G A S
ERUCTATION HICCUP= SINGULTUS= CEKUKAN
SENDAWA= Heart burn= Pyrosis
Metaplasiaepitelesophagus
Barret’sesophagus
ULCUS
strikturaperdarahan
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REFLUX
NYATA TIDAK NYATA
KELUAR SPKE MULUT
MUNTAH
SAMPAI KEESOPHAGUS
KE JLNNAPAS
LARINGITIS ASPIRASIPNEUMONIA
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AKIBAT GER
1.- SINGULTUS- ERUCTATION
2. HEART BURN = SENDAWA3. ESOPHAGITIS & BARRET’S ESOPHAGUS4. ASPIRASI PNEUMONIA KRONIK5. FAILURE TO THRIVE (FTT)6. LARINGITIS
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MUNTAH
KEMBALINYA MAKANAN/MINUMANDARI LAMBUNG SP KE MULUT
TRUEVOMITING
REGURTASI= MINTAR=GUMOH=SPITTING
FISIOLOGIS PATOLOGIS
RUMINASI
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TRUE VOMITING
- MUAL (NAUSEA)- RETCHING- BERTENAGA / PENINGGIAN TEKANAN
INTRA ABDOMINAL- GEJALA AUTONOMIC NERVUS SYSTEM (+)
(ANS)
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REGURGITASI
- BAYI KECIL- LES BELUM MATANG- NAUSEA (-)- TAK BERTENAGA- GEJALA ANS (-)
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RUMINASI
- MAKANAN KEMBALI KE MULUT- MAKANAN DIKUNYAH KEMBALI- MAKANAN DITELAN KEMBALI
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NAUSEA
- PERASAAN MAU MUNTAH- KONTRAKSI ANTRUM PYLORICUM- GEJALA ANS (+)
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MUNTAH PADA PE TEK. INTRA KRANIAL
- PROYEKTIL- NAUSEA (-)- RETCHING (-)
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AKIBAT MUNTAH (TRUE VOMITING)
1. Ggn. Keseimbangan cairan tubuh- dehidrasi- hiponatremia- hipokalemia- hipokloremia- hipokalsemia ==> tetani- alkalosis metabolik
2. Mallory Weiss Syndrome3. Aspirasi pneumonia4. Intake - hipoglikemia
- starvation- Failure To Thrive- Asidosis metab.
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MUNTAH
Na+
AirCl-H+ K+
Hiponatremia
Alk. met
dehidrasi Hipo-kloremia
Hipokalemia
hipovolemia
RBF
Renin
Aldosteron
Retensi Na+ & Air
Hilang K+Hilang H+
hipokalsemia
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HIPOKALEMIAPD MUNTAH
K+ KELUAR VIA MUNTAH
ALK. METABOLIK
ALDOSTERON
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ALKALOSISMETABOLIKPD MUNTAH
H+ KELUAR VIA MUNTAH
HIPOKALEMIA
ALDOSTERON
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MUNTAH
ALK METABOLIK ASIDOSISMETAB
-ADRENAL INSUFF- INBORN ERROR- RENAL FAILURE- STARVATION
> > >
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DIARE
ASIDOSIS MET. ALK. METAB
> > > Congenital Chloridorrhea
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MUNTAH
SAL. CERNA LUAR
Bedah Medik
- obstruksi- radang- perforasi
- gastritis- ulkus peptikum- Gastroenteritis
- psikogenik- neurogenik: pe tek int.cran.- sistemik:sepsis- hemodinamik
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TATALAKSANA
1. PERBAIKI KU Ggn. Keseimbangan Cairan Tubuh
2. BERSIHKAN JALAN NAFAS
3. KAUSAL
4. KALORI PROTEIN
5. KOMPLIKASI
6. OBAT ANTI MUNTAH
AKUT ABDOMEN
ASP. PNEUMONIA
EDEMA CEREBRI
TIDAK DIPAKAI
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ANTI MUNTAH ==> TDK DIPAKAI
1. DOPAMINE RECEPTOR BLOCKER- metoclopramide- domperidone
2. Cisapride3. Betanechol4. 5H3 receptor antagonist
- ondansetron5. Phenothiazine dan anti histamin
- phenergan- largactil- benadryl
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OBSTRUKSIUSUS
KOMPLET
STENOSIS PILORUSHIPERTROFI
INKOMPLET
INVAGINASI
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INVAGINASI = INTUSSUSCEPTION
USUS PROKSIMAL(INTUSSUSCEPTUM)
USUS DISTAL(INTUSSUSCIPIENS)
REDUKSI SPONTAN BERLANJUT
3 bln - 3 tahun
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JENIS INVAGINASI
- ILEOCOLIC > > >- ILEOILEIC- CECOCOLIC- COLICOCOLIC- ILEOILEOCOLIC
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GEJALA
- SUDDEN ONSET- PAROXYSMAL PAIN- MUNTAH- PERDARAHAN PER ANUM- TUMOR- SIGNE de DANCE- PERUT GEMBUNG- DEFEKASI & FLATUS (-)
- AIR & ELEKTROLIT- HIDROSTATIK- OPERATIF
Th / :
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DIAGNOSIS
KLINIS
RADIOLOGIS
FOTO POLOS ABD.
TANDA OBSTR.
BARIUM ENEMA - CUPPING - COIL SPRING