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Peptic Ulcers

Oleh:

Nurbaiti

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Pendahuluan

• Ulkus: kerusakan mukosa dari tunika

muskularis mukosa hingga ke submukosa

atau lebih.

• Disetiap daerah GI tract, >> gaster dan

duodenum

• iasan!a soliter 

• "#$ duodenum %duodenum:gaster& ':()

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Patogenesis

• tiologi:

(.2erpapar asam lambung dan pepsin

3. 4.p!lori5. N67ID

• respon berbeda terhadap setiap indi8idu

• 1arena adan!a ketidak seimbanganketahanan mukosa gastroduodenal dan

patogen.

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*an+utan4.p!lori men!ebabkan kerusakan mukosa dengan

cara:

(. 9erangsang I*(, I*, I*#, 2N; akti8asineutro<il

3. 9engasilkan amonium chloride danmonochloramine, =ac7, ag7.

5. Protease bakteri ? phospholipase merusakkompleks gl!coproteinlipid mukosamelemah

'. 9eningkatkan sekresi asam lambung@. 9enurunkan produksi bikarbonat p4

menurun

. %Diduga)7kti8asi 6el 2 dan sel  <olikel 

lim<oma

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*an+utan

• 4.p!lori peptic ulcer pada (A3A $

indi8idu.

• 6train penghasil =ac7 dan ag7 lebih

beresiko

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*an+utan

• N67ID pen!ebab lain.

• Pada (5 $ pengguna.

• 2ergantung: usia, dosis, lamapenggunaan.

• B pada penderita rheumatik kronis.

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*an+utan

• 1arena supresi sintesis prostaglandin

mukosa B as.h!droklorida C produksi

musin dan bikarbonat  barier mukosa C

 as.h!droklorida mencapai epitel.

• Pendukung lain: glutathione C,

angiogenesis C, sigaret, alkohol%0),

ollinger Ellisons s!nd.

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Ge+ala klinis

• 9ual, muntah, n!eri epigastrium, rasa

terbakar, hematemesis,

• *ebih n!eri pada malam hari

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9akroskopik

• *esi batas tegas, kemerahan, F 3' cm.

• Umumn!a lesi gaster> duodenum

• Gaster: cur8atura minor • Duodenum: proksimal %anterior,posterior)

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9akroskopik

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ndoskopi

http:images.google.comimgres0imgurl&http:upload.-ikimedia.org-ikipediacommons<<(enignHgastricHulcerH(.+pgimgre<url&http:knol.google.co.krkhelicobacterp!lorigastritisgastriccancerandulcerusg&HHd**J!hm<"KhetL35dMp=asIkdPU&h&'A#-&'AAs&3#hl&enstart&'@tbnid&thLJb/Ks@(LH9:tbnh&(3@tbn-&(35pre8&images$5;$5Dpeptic$3ulcer 

$3image$3gb8$5D3$3ndsp$5D(#$3hl$5Den$3sa$5DN$3start$5D5

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9ikroskopik

• 2ergantung lama dan dera+at prosespen!embuhan

• Pada fase aktif memperlihatkan 4 zona:

• inflammatory exudate  at the lumen %cell debrisand neutrophils)

• fibrinoid necrosis %kuning%8an Gieson) danpink%4))

• granulation tissue • mature fibrous tissue %abundant collagen red

%8an Gieson) dan pink %4).

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9ikroskopik

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9ikroskopik

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9ikroskopik

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Debris nekrotik <ibrinoid, sel radang

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Granulation tissue .neo8askularisasi, edema, sel

radang.

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;ibrosis

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 7cute Gastritis Ulceration

• 6tress ulcer 

• *esi multiple

• 1arena: trauma, urling ulcer, ushingulcer, N67ID, kortikosteroid

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Ge+ala 1linis

• 6epsis, rasa panas

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9akroskopik

• *esi sirkular, kecil, (cm, tersebar

diseluruh mukosa, multiple.

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9akroskopik

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9ikroskopik

• rosi super<icial sd lapisan diatas

muskularis propria.

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2erima kasih