Download - PENYAKIT NUTRISI.ppt
-
Prepared By : YASIN W, Ns., M.Ked
-
MALNUTRISI ?
KemiskinanLansiaPecandu narkobaPsikiatrik Rawat inap lamaPrimer
Sekunder
Gangguan metabolikKehilangan berlebihanMetabolisme meningkat -
MACAM PENYAKIT NUTRISI
Malnutrisi Protein-KaloriAvitaminosisDefisiensi Trace MineralObesitas -
Malnutrisi Protein-Kalori
Most frequent and most importantTerdapat 2 bentuk :MarasmusKwashiorkor Patogenesis :HatiMukosa GIHematopoiesis -
Kwashiorkor
Deficiency of proteins, terutama protein hewanimost common in Africa - children, who have been weaned too early (arrival of another child) and fed by exclusively carbohydrate dietKwashiorkor lebih berbahaya dibandingkan marasmus Tanda dan gejala :loss of visceral proteins hypoalbuminemia generalized edema, ascitesskin lesions, hair changes, fatty liver, defects of immunity, secondary infections, anemia -
*
-
*
-
*
-
flaking skin , raw skin , fissures
*
-
Marasmus
Deficiency of energy (calories) akibat dari :Kelaparan kronisTanda dan gejala :Gangguan pertumbuhanHilangnya massa ototBadan kurusAnemiaImmune deficiency (imunitas seluler) -
*
-
Vitamin
Bahan yang dibutuhkan tubuh dalam jumlah sedikitAvitaminosis Primary (dalam diet)Sekunder (malabsorption, metabolic disorders, liver diseases)Hipervitaminosis merupakan hal bahaya yang dapat meracuni tubuh !!!!! -
Vitamin A
Dikenal sebagai retinolImportant for vision (visual pigment) and differentiation of some types of epithelial cells (mucus-secreting)Main sources: liver, fish, milk, eggs, butterProvitamins A- Karotenoids Bersumber pada sayuran (wortel dan bayam) -
Avitaminosis Vitamin A
Mata - xerophtalmia, small corneal opaque (squamous keratinizing) plaques (Bitot's spots), keratomalacia -> total blindnessRespiratory tract - squamous metaplasia, pulmonary infectionsUrinary tract - pelvic keratinization -> stonesSkin hyperkeratosis, dermatosis folikularis -
Bitots spots
Bitots spots
*
-
Corneal clouding
*
-
Corneal ulceration
*
-
*
-
Hipervitaminosis Vitamin A
Peningkatan TIKHepatomegaliMalformasi kongebital pada janin -
Vitamin D
Fungsi :Mempertahankan kadar kalsium dan fosfat dalam plasmaPenting untuk perkembangan dan mineralisasi tulangSumber :Endogen : sintesis di kulit dengan bantuan sinar UV melalui 7-dehydrocholesterol - jumlahnya 80% dari kebutuhanExogen : dari diet (ikan laut, tumbuhan, dan biji-bijian) -
Organ yang berhubungan dg metabolisme vit D :
UsusGinjalKelenjar parathiroid -
7-DEHIDROKOLESTEROL-CHOLECALSIFEROL
25(OH)-D - CALCIDIOL
1,25(OH)2D - CALCITRIOL
ABSORPSI Ca DAN P DI USUS
MATAHARI (ULTRA VIOLET)
MINERALISASI TULANG
D-25 HIDROKSILASE (HATI)
1- HIDROKSILASE (GINJAL)
METABOLISME VIT.D
-
HIPOKALSEMI
PTH MENINGKAT
AKTIVITAS 1- HIDROKSILASE
MOBILISASI Ca PADA TULANG
EKSKRESI Ca DI GINJAL
AKTIVITAS 1- HIDROKSILASE
CALCITRIOL
KADAR NORMAL VIT.D
-
PENYEBAB AVITAMINOSIS VIT.D
Penurunan sintesis endogen (paparan sinar matahari tidak adekuat)Penurunan absorpsi (kurang dlm makanan, malabsorption syndrome)Peningkatan degradasi vit.D (drugs:fenitoin)Gangguan sintesis calcidiol dan calsitriol (liver diseases, renal disorders)target resistance (congenital lack of receptors)phosphate depletion (renal tubular disorders, long-term use of antacids) -
Akibat Def. Vit D
children - before closing of epiphyses - rickets (rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of the legs)adults - after closing of epiphyses - osteomalacia (impaired remodelation of bone mass, no mineralization of osteoid - microfractures (vertebral bodies, femoral necks) -
Hipervitaminosis vit D
HypercalcaemiaMetastatic calcificationUrolithiasis -
Vitamin E
Dalam bentuk tokoferolFungsi : Antioksidan -
Vitamin K
Dibutuhkan sebagai kofaktor dalam pembentukan faktor pembekuan VII, IX, XPenyebab avitaminosis:
Fat Malabsorption SyndromesDestruksi endogen vit. K (sintesis flora usus)Periode neonatal (low reserve, no bacterial flora)Penyakit hatiKeadaan iatrogenik (warfarin) -
Avitaminosis Vit K
Bleeding diathesis (mis. Perdarahan pada neonatus : intrakranial bleeding, perdarahan kulit ; umbilikus, viseralis, dll)Pada dewasa : hematom, hematuria, melena, ekhimosis, perdarahan gusi, dsb. -
Vitamins B
Merupakan coenzymesSumber utama : biji-bijian, beras, sayuran, ikan, daging, dllPada keadaan defisit mempengaruhi metabolisme tubuh terutama pada kulit, mukosa mulut, sumsum tulang, dan sistem syaraf -
Vitamin B1 (thiamine)
Sumber utama pada beras berkulit ari, biji-bijianDefisit : Malnutrisi beratPenurunan absorpsi di ususGangguan syaraf perifer, jantung, dan otakBeri-beri :dry beri-beri (polyneuropathy) - degeneration of myelin sheaths and axons (motoric, sensoric and vegetative)wet beri-beri (cardiovascular syndrome) - dilatation, right heart failure, peripheral edemaSyndroma Wernicke-Korsakoff - ophthalmoplegia, nystagmus, ataxia of gait and stance, confusion, apathy, amnesia, psychosis -
Vitamin B2 (riboflavin)
Defisit :Cheilosis atau cheilitisGlossitis Keratitis Dermatitis Bone marrow (erythroid hypoplasia - anemia) -
Niacin (nicotinic acid)
Defisit :
Pellagra Dermatitis Diarrhea Dementia -
Vitamin B12 (cyanocobalamine)
Defisit :pernicious anemia (lack of synthesis of intrinsic factor in gastric mucosa due to autoimmune inflammation)Megaloblastic anemia (decreased number of RBC, increased size; Hypersegmentasi neutrofilDemyelinization of spinal cord and peripheral nerves = neuroanemic syndrome -
Vitamin C (ascorbic acid)
Sumber : fruits and vegetables - not synthesized endogenouslyBerperan pada metabolisme kolagen basic intercellular matrix terutama pada dinding pembuluh darahDefisiensi :Dewasa : ScurvyAnak-anak : Mller-Barlow disease - subperiostal hematomas -
Scurvy
petechial skin bleeding, ecchymoses, epistaxis, melena, intraarticular bleedinggingival swelling, hemorrhages, secondary bacterial infection - periodontitishyperkeratotic papular rashimpaired wound healing, defective osteoid - pathologic fracturesanemia -
Hypervitaminosis C
Urolithiasis Hyperacidity in stomach - mucosal erosions -
Trace elements
14 anorganic elements - Fe, Cu, Co, I, Zn, Se, Mn, Mo, Cr, F, Si, Ni, Sn (tin), Vaactivity in enzymesDefisit primer : I, (thyroid gland - goiter)Defisit sekunder :Zn - skin lesions, neurological and psychiatric syndromes, growth retardation, hypogonadism in malesCu - anemia, impaired synthesis of connective tissue matrixSe - Keshan disease - dilated cardiomyopathy -
Obesitas
20% of world populationPenyakit gangguan keseimbangan energiPenyebab lain bisa genetic (multifactorial disease) -
Komplikasi Obesitas
Hypertensi - 6x lebih sering pada usiaDM type II. - 3x lebih seringhypercholesterolemia - AS - MIBerpotensi malignant tumors - colon ca, breast ca, gallbladder ca, endometrial caInsufisiensi respiratory pada bronkitis kronis, hipertensi pulmonercholelithiasis (gallstones) - 6x lebih sering