gastritis presentasi 1.ppt
TRANSCRIPT
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GASTRITIS
Dr Masrul Lubis SpPD
Divisi Gastroenterologi dan Hepatologi FK USU/RSUP Adam Malik
PERDANA SIDAURUK080100395
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• Gastritis Inflamasi pada mukosa dan submukosa lambung
• Secara histopatologi dapat dibuktikan dengan adanya infiltrasi sel-sel radang pada daerah tersebut.
• manifestasi klinik gastritis dapat dibagi menjadi akut dan kronik
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Acute Gastritis Acute Gastritis Acute H. pylori gastritisAcute H. pylori gastritisOther acute infectious gastridesOther acute infectious gastrides
Bacteria (other than H.pylori)Bacteria (other than H.pylori)Helicobacter helmanniHelicobacter helmanniPhlegmonousPhlegmonousMycobacterialMycobacterialSyphiliticSyphilitic
ViralViralParasiticParasiticFungalFungal
Chronic Atrophic gastritisChronic Atrophic gastritisType A : Body -predominant, autoimmuneType A : Body -predominant, autoimmuneType B : Antral –predominan, H.pylori related, environmentalType B : Antral –predominan, H.pylori related, environmentalType ABType ABIndeterminant typeIndeterminant type
Uncommon forms of gastritisUncommon forms of gastritisLymphocytic gastritisLymphocytic gastritisEosinophilic gastritisEosinophilic gastritisCrohn’s diseaseCrohn’s diseaseSarcoidosisSarcoidosisIsolated granulomatous gastritisIsolated granulomatous gastritis
Harrison’s Principles of Internal Medicine 1998Harrison’s Principles of Internal Medicine 1998
Classification of gastritis
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Gastritis Akut
• Inflamasi akut pada mukosa lambung• Termasuk gastritis erosif dan gastritis
hemorragik• Etiologi: Trauma, operasi, gagal ginjal, gagal
nafas, penyakit hati berat, renjatan, luka bakar, septikemia, NSAIDs
ICU/ICCU Gastritis akut stress• H.pylori
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Patogenesis
• Iskemia mukosa gaster, pepsin, refluks empedu.
• Aspirin, NSAIDs menghambat aktivitas siklooksigenase mukosa, menurunkan sekresi bikarbonat dan mukus lambung.
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Gambaran Klinik
• Epigastric pain• Asimptomatik• Hematemesis melena
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Diagnosis
• Gastroduodenoskopi• Radiologi dengan zat kontras kurang
bermanfaat.
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Pengobatan
• Pencegahan : Hindari NSAIDs, Aspirin• PPI• Mukoregulator :Sukralfat, misoprostol• Endoskopi skleroterapi• Embolisasi a. gastrika• Gastrektomi.
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Gastritis Kronik
• Infiltrasi sel-sel radang yang terjadi pada lamina propia dan daerah intraepitelial terutama terdiri atas sel-sel radang, yaitu limfosit dan sel plasma.
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H.Pylori infectionH.pylori
Weeks-months
Chronic superficial gastritis
Years -decades
Peptic ulcer diseaseChronic superficial
gastritisLymphoproliferative
disease
ChronicAtropicgastritis
Gastric adenocarsinomaHarrison’s Principle internal Medicine 2007
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Klasifikasi
• Klasifikasi histologi:1. Gastritis kronik superfisilalis2. Gastritis kronik aktif3. Atrofi lambung4. Metaplasia intestinal
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Diagnosis
• Endoskopi• Histopatologi
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Pengobatan
• Pencegahan : Hindari NSAIDs, Aspirin• PPI• Mukoregulator :Sukralfat, misoprostol• Eradikasi Hp
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Pengobatan• H.pylori eradikasi ------------------------------------------------------------------------------------------------------- Tabel 1. Contoh Regimen Eradikasi Infeksi Helicobacter pylori ------------------------------------------------------------------------------------------------------- Obat1 Obat 2 Obat 3 Obat 4 -------------------------------------------------------------------------------------------------------• PPI Dosis ganda Klarithomisiin Amoksisilin• (2 x 500 mg) (2 x 1000 mg)• PPI Dosis ganda Klarithomisin Metronidazol• (2 x 500 mg ) (2 x 500 mg )• PPI Dosis ganda Tetrasiklin Metronidzol
(4 x 500 mg) (2 x 500 mg) subsalisilat/subsirat
----------------------------------------------------------------------------------------- Regimen diberikan selama 1 minggu
• Gastritis kronik autoimun ditujukan pada anemia pernisiosa. Vit.B12 yang diberikan parental dapat memperbaiki anemianya.
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Gastropati
• Refluks empedu setelah gastrektomi parsial• Refluks empedu dismotilitas
gastrointestinal• Pengguna NSAIDs• Hipertensi porta
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Gastropati NSAIDs
• Epigastric pain• Riwayat minum NSAIDs first line therapy
arthritis• Komplikasi PSMBA
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Tabel 2. Faktor Risiko untuk Mendapatkan Efek Samping OAINS
Terbukti sebagai faktor risikoUsia lanjut > 60 tahun
Riwayat pernah menderita tukakDigunakan bersama-sama dengan steroidDosis tinggi atau menggunakan 2 jenis OAINSMenderita penyakit sistemik yang berat
Mungkin sebagai faktor risikoBersama-sama dengan infeksi Helicobacter pyloriMerokokMeminum alcohol
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Diagnosis
• Klinis bervariasi• Endoskopi Kongesti mukosa, erosi,
perdarahan• Histopatologi tidak khas
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Pengelolaan
• Menghentikan NSAIDs• PPI, sitoprotektif• Mukoregulator Misoprostol
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Klasifikasi gastritis Sydney Endoscopic
Criteria of gastritis Classification according to etiology• 1. erythematous/exudative gastritis • 2. superficially erosive gastritis • 3. polypoid gastritis with erosions • 4. atrophic gastritis • 5. hemorrhagic gastritis • 6. bile gastritis • 7. giant folds gastritis
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Classification according to etiology
• 1. Autoimmungastritis (type A) • 2. Bacteria related gastritis (type B) • 3. gastritis induced by Chemotoxic agents (type C) • 4. distinct forms of gastritis
Classification according to localisation• 1. Pangastritis • 2. gastritis of the body • 3. antral gastritis
Histomorphologic criteria• 1. acute • 2. chronic • 3. chronically-active
Gradingnormal, low-, middle-, high- grade
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Normal Images of the Stomach
Image 1
Image 2
Image 3
Image 1 is a picture of the fundus or upper portion of the stomach. You see the endoscope has entered the stomach and then has made a U-turn to take the picture. Image 2 is the antrum with the pylorus in the distance. Image 3 is a close up of the pylorus which normally continuously opens and closes.
© Copyright 2006 Jackson Siegelbaum Gastroenterology. All Rights Reserved
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Bentuk gastritis ini ditandai oleh bintik-bintik merah kadang-kadang konfluen yang mengenai berbagai bagian mukosa lambung. Atlas Endoskopi Gastrointestinal
Gastritis eritematosus
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Erosive gastritis
Tanda khas gastritis erosif adalah lesi mukosa yang tidak menembus lapisan muskularis mukosa. Erosi ada sebagai laserasi, kadang-kadang ditutupi hematin seperti pada foto ini. Atlas Endoskopi Gastrointestinal
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Gambar tambahan dari gastritis erosif dengan hematin menutupi bagian-bagian mukosa .Atlas Endoskopi Gastrointestinal
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Polypoid gastritis with erosions
Foto ini memperlihatkan gastritis polipoid yang sangat jelas. Beberapa pseudopolip berdekatan satu sama lain. Atlas Endoskopi Gastrointestinal
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Perhatikan perubahan mukosa yang meninggi dan keputihan dengan aspek hiperplasia sebagai tanda jelas dari bentuk gastritis ini. Atlas Endoskopi Gastrointestinal