p 3b perdarahan gastrointestinal.ppt
TRANSCRIPT
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Perdarahan Gastrointestinal
(LK-3B)
Rendri Bayu Hansah
Modul Ilmu Penyakit DalamFakultas Kedokteran Universitas Baiturrahmah
Padang 1
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Perdarahan gastrointestin
al
Perdarahan SCBA
Perdarahan SCBB
Hematemesis Melena Hematokezi
aSamar
(Occult)
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• Batas SCBA – SCBBLigamentum Treitz
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Gambar 1. Ligamentun Treitz
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• Perdarahan SCBA kehilangan darah dari saluran cerna atas, di mana saja, mulai dari esofagus sampai dengan duodenum dg manifestasi klinis berupa hematemesis, melena, hematoskezia atau kombinasi
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Perkumpulan Gastroenterologi Indonesia (PGI). Konsensus Nasional Penatalaksanaan Perdarahan Saluran Cerna Atas non Varises di
Indonesia. 2012
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• Insiden 48-160/100.000 penduduk
• Mortalitas 6-14%
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Perkumpulan Gastroenterologi Indonesia (PGI). Konsensus Nasional Penatalaksanaan Perdarahan Saluran Cerna Atas non Varises di
Indonesia. 2012
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Perdarahan SCBA
Ruptur Varises
Esofagus
Perdarahan Non Varises
Esofagus
Sirosis Hepatis
- Ulkus peptikum- Gastritis erosif- Esofagitis- Keganasan
Perkumpulan Gastroenterologi Indonesia (PGI). Konsensus Nasional Penatalaksanaan Perdarahan Saluran Cerna Atas non Varises di
Indonesia. 2012
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El-Tawil (2012)Etiologi perdarahan SCBA:- Perdarahan ulkus peptikum 31-67%- Gastritis erosif- Perdarahan varises- Esofagitis- Keganasan
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Perkumpulan Gastroenterologi Indonesia (PGI). Konsensus Nasional Penatalaksanaan Perdarahan Saluran Cerna Atas non Varises di
Indonesia. 2012
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Syam dkk (2005)Dari 807 pasien perdarahan SCBA (2001-
2005) - Ruptur varises esofagus (33,4%)- Perdarahan ulkus peptikum (26,9%)- Gastritis erosif (26,2%)
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Perkumpulan Gastroenterologi Indonesia (PGI). Konsensus Nasional Penatalaksanaan Perdarahan Saluran Cerna Atas non Varises di
Indonesia. 2012
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Gambar 2. Varises esofagus10
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Gambar 3. Varises Esofagus (Endoskopi)11
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Gambar 4. Gastritis erosif (Endoskopi)12
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• DiagnosisAnamnesis– Hematemesis (30% perdarahan ulkus peptikum)
– Melena (20% perdarahan ulkus peptikum)
– Hemmel (50% perdarahan ulkus peptikum)
– Hematoskezia (5% perdarahan ulkus peptikum)
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• Pemeriksaan Fisik- Gangguan hemodinamik? Tekanan darah, denyut nadi
- Status kesadaran?- Konjunctiva- Stigmata sirosis hati?- Anemia
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• Penatalaksanaan– Penilaian awal (Tanda vital)– Resusitasi
cairan intravena– Pemeriksaan lanjutan
Tergantung anamnesis, PF, Labor- Transfusi darah
Hb ≤ 7 gr/dl atau ada perdarahan yg terus berlangsung
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• Terapi– Non-endoskopi– Endoskopi– Radiologi– Pembedahan
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• Terapi non-endoskopi– Puasa– Injeksi Proton Pump Inhibitor (PPI)
dosis tinggi– Naso-gastric tube (NGT)
mencegah aspirasi dekompresi lambung menilai perdarahan
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Gambar 5. Pemasangan NGT18
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Gambar 6. Darah mengalir melalui NGT19
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Terapi non-endoskopi– Octrotide varises esofagus– Somatostatin varises & non-varises– Vitamin K gangguan fungsi hati– Vasopresin– Sengstaken-Blakemore tube (SB tube)
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Gambar 7. SB tube
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Gambar 8. Pemasangan SB tube
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• Terapi endoskopi• Tukak
– Contact thermal dipanaskan– Non-contact thermal laser– Non-thermal adrenalin
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• Varises–Ligasi–Skleroterapi
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Gambar 9. Ligasi varises esofagus25
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Gambar 10. Skleroterapi varises esofagus26
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• Komplikasi– Syok hipovolemik– Anemia berat
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•Perdarahan SCBB– Hematokezia
darah segar melalui anus– Occult (Samar)
perdarahan ringan yg tidak mengubah warna feses
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• 15% perdarahan hebat
• Mortalitas3,6%
• 11% SCBA
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• Etiologi– Hemoroid– Polip colon– Ca colon– Colitis– Infeksi– Angiodisplasia 10-40%– Diverkulosis– dll
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Gambar 11. Polip colon31
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Gambar 12. Angiodisplasia32
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• Diagnosis– Darah segar dari anus– Darah samar tes guaiac (tes benzidine)– Anamnesis
Nyeri abdomen?Diare?Demam?dll
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• Penatalaksanaan– Penilaian awal (Tanda vital)– Resusitasi– Pemeriksaan lanjutan
Berdasarkan anamnesis, PF, Labor (Fe)
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• Terapi– Medikamentosa anti perdarahan– Endoskopi– Embolisasi– Bedah
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• TerapiTergantung etiologi
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• Pemeriksaan penunjang– Colonoscopy– Barium enema– Tergantung etiologi
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Gambar 13. Barium meal38
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• Komplikasi– Syok hipovolemik– Anemia berat
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Terima Kasih
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