Download - muntah pada anak
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Muntah pada baby.
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Definisi
• Vomiting : ejeksi secara paksa isi lambung dan usus (chyme) lewat mulut. Biasanya diransang:
- overstretching lambung dan usus- alkohol- bacterial toxins- trauma visceral ( terutama organ pelvis)- psikologis.
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Mekanisme
Stimulus stimulates emetic center in medula oblongata via afferent nerves
Nausea , retching:- Thoraxic expansion
- Abd contraction- Dilatasi esofagus
- Lower esophageal relaxes
Chyme enters esophagusRising thoraxic pressure ,
forcefullly open the upper esophageal sphincter.
Expulsion of food. ( vomiting)
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Innervation of stomach
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EtiologiInfant Child Adolescent
• Gastroenteritis• Gastroesophageal reflux• Overfeeding• Anatomic obstruction• Systemic infection• Aerophagia• Intussuseption• Pertussis syndrome• Otitis media
• gastroenteritis• Systemic infection• Gastritis• Toxic ingestion• GERD• Sinusitis
•gastroenteritis• Systemic infection• Gastritis• Toxic ingestion• GERD• Appendicitis• Migraine• Pregnancy
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Cyclic vomiting
• Syndrome with numerous episodes of vomiting interspersed with well intervals.
• Onset is usually 2-5 years of age• Frequency about 10-12 episode per year• Each episode last 2-3 days• May have prodrome: paleness, intolerance to
light and noise, nausea, lethargy• Precipitated by: infection, stress , excitement.
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Projectile vomiting
• Vomiting that occurs without nausea and retching.
• Usually have neurological causes: Increase in intracranial pressure
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Treatment • Domperidone:
- peripheral dopamine receptor antagonist- dosis : 0.25-0.6mg/ kgbb/ 3x1- vometa
• Metoclopramide:- dopamin antagonis, meransang pengosongan lambung dan peristaltik- dosis : 0.5-1mg/kgbb/ 3x1- vomitrol
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komplikasi
• Dehidration• Alkalosis, hypochloremia• Hyponatremia, hypokalemia• Malnutrisi (failure to thrive)• Malory weiss tears • Aspiration Pneumonia• Shock due to severe fluid loss during vomiting