muntah dan kembung pada bayi dan anak
TRANSCRIPT
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Muntah dan KembungPada Bayi dan Anak
( Pendekatan Klinis )
Kustiyo Gunawan
FK Unair Surabaya
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Bilious Vomiting in the Newborn: How Often Is It Pathologic?By Prasad Godbole and Mark D. Stringer
Leeds, EnglandJ Pediatr Surg 37:909-911. Copyright 2002, Elsevier Science
(USA).
Conclusions:These data emphasize the maxim that bilious
vomiting in the newborn should be attributed to intestinal
obstruction until proved otherwise. However, in this prospective
audit, bilious vomiting was not caused by intestinalobstruction in 62% of cases, and most of these infants suffered
no further sequelae.
Intest inal malrot at ion must be excluded
specifically.
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Vomiting, Regurgitation, Rumination
Vomiting : Keluarnya isi lambung/usus dari mulut secara
sadar disertai kontraksi dinding abdomen
Regurgitation: Keluarnya makanan tanpa tenaga, biasanyaberasal dari esofagus (pseudovomiting)
Rumination : Secara sadar dan otomatis membawa makanan
ke mulut dikunyahditelandibawa ulang ke
mulut
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Kausa Mutah
Iritasi ujung saraf di peritoneum Obstruksi organ berrongga
atau mesenterium (intestine, ren, ureter, uterin canal,
vermiform appendix)
Gangrenous appendix Peristaltic contractionAcute Pancreatitis
Strangulation
Torsion of the pedicle of an ovarian cyst Stretching of the muscular
wall/spasm
Pain (colic)
Vomiting (occurs at the height
of the spasm)
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Relationship of Vomiting
Pain Frequency of Character of Nausea & loss of Others
The Vomiting The Vomiting Appetite symptoms
(no vomit)
Vomiting Directly with Duod. atr
Comming acuteness Delayed
after pain (appendicitis, H P S passages
(appendicitis) pancreatitis) of meconium
Int. obstr
Vomiting early, obstr.of the same st imulus
Sudden & violent colon no vomit dif ferent grade
(acute obst.ureter if vomit,
/Bile duct) incomp. IC valve
Vomiting after pain, Acute loss of Nausea Vomiting
depend on how high appetite &
of intestinal obst. pain
(appendicitis)
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Vomiting (Prompt Dx and Tx)
Abdominal Not Surgical indoubt indefinite
Emergencies symptoms
Extra GI origin GI origin
(inf.of the gut) Discuss
Bilious Psychogenic w a i t (discuss)CT,US
Persistent Infectious pathology
Acute loss of appetite Neuromeningeal inf
Blood Metabolic pathology improve not improve judge
Pain Intoxication
observes
Urgent need operation
Delayed Transfer correct diagnosis
Short gut survive
syndrome urgent need for operation
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Importance of evaluating for cow's milk allergy in pediatricsurgical patients with functional bowel symptoms
Kayo Ikedaa, Shinobu Idaa, Hisayoshi Kawaharab,., 1, Koji Kawamotoa,
Yuri Etania, Akio Kubotab
Journal of Pediatric Surgery (2011) 46, 23322335
Conclusions: A high index of suspicion regarding
the possibility of concurrent CMA
may be necessary to manage bowel
symptoms in pediatric surgicalpatients.
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I L E U SIntestinal dilatation, Hypersecretion, bacterial overgrowth
Mechanical obstruction Non mechanical obstruction
(extrinsic/intrinsic) (GI paralysis, pseudo-obstruction)
Acute/Chronis Partial/Complete Simple / Closed loop
(Traps the bowel mesentery)
Intraabdominal adhesion Blood supply compromise
Stricture
Tumor Ischemia
Congenital
Necrosis
Perforation
S t r a n g u l a t i o n
Hernia, adhesion, volvulus
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HISTORY AND CLINICAL SETTINGCC: Acute obstipation, Abdominal pain, Distention, Nausea, Vomiting
Mechanical obstruction PseudoobstructionPain location : Middle of the abdomen Diffuse of the abdomen
Pain severity : Severe Mild
Pain character : Increase severity Increase severity
and depth overtime and depth overtime
Pain decrease (fatique)
Proximal Int. Obst. : Short periodically 3 4Periodicity of Pain
Distal small /large bowel: 15 - 20
Pain Abdominal distention_____________________________
Nausea, vomiting, cramping
Sudden Progressive partial
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CAUSE AND TYPE OF BOWEL OBSTRUCTION
In Hospital
Medical History Medical History & Courses
Previous episodes of Medication:
Bowel obst: anticoagulants
etiology ?
chemotherapyresponse of Tx ? Metabolic
Previous of abd/pelvic Abdominal radiation
Operation: Severe infection
Operative report Fluid & elect imbalance
History of malignancy Narcotic recurrence ? Intraabd. inflammation
History of intraabdominal
inflammation
@ A b d o m i n a l D i s t e n t i o n
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A b d o m i n a l P a i n
Abdominal Distention, Nausea, Vomiting
Gradual change in bowel Developing many Minimal crampy abd. In hospital
Habit weeks Nausea
Progressive abdominal Vomiting
DistentionMild /crampy pain after Longstanding intermittent
Meals mechanical obstruction
Weight loss
Chronic Partial Mechanical Chronic process/ Chronic Intestinal Gastric atony
Bowel Obstruction Progressive Partial Pseudo Obstruction Smallbowel Ileus
Bowel Obstruction (CIPO) Acute Colonic
Last flatus Pseudoobstr.
Partial @ Complete
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Cows milk protein allergy presenting with Hirschsprungsdiseasemimicking symptomsAkio Kubotaa,*, Hisayoshi Kawaharaa, Hiroomi Okuyamaa, Yoshiyuki Shimizua,
Mariko Nakachob, Shinobu Idab, Masahiro Nakayamac, Akira Okadaa
Journal of Pediatric Surgery (2006) 41, 2056 2058
Conclusion: The proportion of CMA in the cases presenting with
HD-like symptoms in the neonatal period is much
higher than what we expected, and most cases of
BTNIN (benign transient nonorganic ileus of Neonates) are
caused by CMA. If HD is ruled out, CMA
should be considered.
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Whole intestinal pattern on plain abdominal x-
ray. Both the colon and small intestine are
markedly dilated. A few air-fluid levels are
observed.
Contrast enema. The size of the rectum and colon
is normal, and no caliber change is observed, but
the rectum and ascending colon demonstrate
irregularity of the wall.
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PHYSICAL EXAMINATION AND RESUSCITATION
Sense of the Px illness INITIAL STEP Assessing the Px vital sign,
& course hydration status, CP system
Volume ? Clear
NG Tube Bilious non feculent
Physical Examination Character - Prox. SBO
-Colonic obst+comp. IC valve
Volume Feculent
Urine -Distal SBO
Character
IV line: water & electrolyte replacement
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Degree of distention: Prox little/no distention
Scar
O b s e r v a t i o n Malignancy
Asymetri AbscessClosed loop
Peristaltic waves: acute SBO
High pitch + rush + crumpy pain: Obstructive process
A u s c u l t a t i o n Bowel sound Intestinal paralysis
Intestinal fatique Longstanding
obstruction
Closed loop
obstruction
Guarding
P a l p a t i o n Rebound tenderness Strangulation
Localized tenderness
P e r c u s s i o n Dullnessmass
Tympani distended bowel
Rectum : Mass ? Fecal impaction ? Occult blood ?
T o u c h e r
Ileostomy : Exam stoma ( obstruction at the level of the stoma )
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K e s i m p u l a n:
Tidak ada pemeriksaan tambahan sebelum pertimbangan klinis
Anamnesis dan pemeriksaan fisik harus terstrukturDiagnosis dan penangana dini
Keterlambatan : kematian / sequele