pscb dr femiko

7/23/2019 Pscb Dr Femiko

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Perdarahan saluran cernabagian bawah

Adam Bachtiar

030.09.001

FK. Trisakti


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Lower gastroinstestinal bleeding(LGIB) :

Perdarahan pada bagian distal Ligamen Treitzsampai dengan anus

Defnisi


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Anatomi


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Anatomi


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Etiologi


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Etiologi

Table 1. Common Causes of Lower Gastrointestinal Bleedingin Adults

Lower Gastrointestinal Bleeding in Adults

Percentage ofPatients

i!erticular diseasei!erticulosis"di!erticulitis o# small intestinei!erticulosis"di!erticulitis o# colon

6!

$n#lammator% bowel disease&rohn disease o# small bowel' colon' or both

(lcerati!e colitis)onin#ectious gastroenteritis and colitis

"#!

Benign anorectal diseases*emorrhoidsAnal #issureFistula+in+ano

""!

)eo,lasia-alignant neo,lasia o# small intestine-alignant neo,lasia o# colon' rectum' and anus

$!

&oagulo,ath% %!

Arterio!enous mal#ormations A/-s #!


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&meri'a seri'at: % 'asus dari "populasi de*asa

Indonesia: +# 'asus dari " populasi

Pria , *anita

Pen-ebab terban-a': Di.erti'ulitis

Epidemiologi


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+ *erniasi mukosa" submukosa dan han%a dila,isi oleh tunikaserosa ,ada lokasi dinding kolon %ang lemah %aitu tem,atdimana !asa rekta menembus dinding kolon

Pen%akit i!ertikular


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1. False di!erticulae ,seudo+di!erticulae do not contain the

muscular la%ers or ad!entitia2 onl% the submucosa and mucosa.

. True di!erticulae all la%ers o# the gastrointestinal wallmucosa' muscularis ,ro,ria' and ad!entitia

3. i!erticula small mucosal herniations ,rotruding through theintestinal la%ers and the smooth muscle along the natural o,enings

created b% the !asa recta or nutrient !essels in the wall o# the colon

4. i!erticulosis the condition o# ha!ing unin#lamed di!erticula

5. i!erticulitis an in#lammation o# one or more di!erticula



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Epidemiologi:

+ Pria 6 ,erem,uan 161

+ $nsiden tertinggi usia tua

780 th 50+:

+ ;okasi di!ertikel6

Kolon sigmoid


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Etiologi dan Patogenesis


-akanan rendah

serat

-akanan olahan

Per,an=ang

waktu transit

#eses

klusi

Tekanan

meningkat

*erniasi


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Clinical Symptoms

Uncomplicated dierticular disease !"#+abdominal ,ain+#e!er+leucoc%tosis+anore?ia"obsti,ation

Complicated dierticular disease $"#

+abscess+,er#oration+stricture+#istula


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Diagnosis:

Gambaran 'linis

Barium enema / Dilatasi usus0 tanda+tanda

obstru'si0 densitas 1ar lema'

23G abdomen / Penebalan dinding 'olon0massa 'isti'

4T+35an abdomen / Penebalan dinding 'olon0tanda+tanda abses0 inamasi pada 1ar lema'

7olonos'opi / 'ontraindi'asi relati8



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Klasi#ikasi stadium klinik di!ertikulitis akut menurut

*inche%



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Tatalaksana: Tera,i simtomatis' diet tinggi serat

i!ertikulitis akut6 mengurangi intake oral' Pemberian cairan

$/' antibiotik

>,erati#6 @ika terda,at kom,likasi

Komplikasi:

Peritonitis Abses

Fistula



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Pen-a'it inamasi 'roni' -ang melibat'ansaluran 5erna

1enis : 7olitis 2l5erati80 Pen-a'it 4rohn

Epidemiologi:

2sia muda (9+# tahun)

Pria/perempuan

$n#lammator% bowel disease


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Signs and symptoms that are common to bothCrohn's disease and ulcerative colitis include:

%iarr&ea.'eer and fatigue.Abdominal pain and cramping.Blood in (our stool.)educed appetite.

Unintended weig&t loss.


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Gambaran 'linis



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7riteria dera1at 'lini' 'olitis ulserati8



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4rohns Disease &5ti.it- Inde;



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7ompli'asi:

+ perdarahan < anemia

+ per8orasi

+ 'olitis to'si'

+ 5a 'olon

Inammator- bo*el

disease


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Diagnosis:

1. ambaran klinis

. ;aboratorium

3. Endosko,i

4. adiologi6 Barium kontras

5. *isto,atologi

C Kolitis ulserati#6 abses kri,ti' distorsi kri,ti' in#iltrasiP-) di lamina ,ro,ria

C Pen%akit &rohn6 ulserasi dalam' in#iltrasi makro#ag dan

lim#osit



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Gambaran lesi endos'opi IBD

Inammator- bo*el

disease


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7umpulan pelebaran " segmen atau lebih .enahemoroidalis di daerah anore'tal

=emoroid


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A. Hemoroid internal

Prola,s dan keluarn%a mukus

Perdarahan

asa tak n%aman

atal

B. Hemoroid eksternal

asa terbakar

)%eri =ika mengalami trombosis

atal

*emoroid


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*emoroid

Hemoroid interna

+Pelebaran ,le?us hemoroidalisinternus dan dili,uti olehmukosa+Batas ,ada atas linea dentata

Hemoroid eksterna

+Pelebaran ,le?us hemoroidaliseksterna %ang terletak ,ada

,inggir anus. u,tur ,adacabang+cabang !ena rektalisin#erior+Batas ,ada bawah line dentata


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*emoroid


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Diagnosis

e=ala klinis

Pemeriksaan #isik2 ectal Toucher

Anosko,i

Tatalaksana

)on+#armakologis6 ,erbaikan ,ola hidu,

Pembedahan6 sklerotera,i' ligasi gelang karet' cr%othera,%'

#otokoagulasi in#ramerah

*emoroid


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*emoroid


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A


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Etiologi

)eo,lasma karsinoma

kolorektal

2sia

Geneti'

>besitas

7urang 'onsumsi serat

?ero'o'

7onsumsial'ohol


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Gambaran klinis:

Perubahan ,ola BAB diare

Berat badan menurun

*ematocheDia

Anemia

)%eri ,erut

@eoplasma ('arsinoma

'olore'tal)


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)eo,lasma karsinoma kolorektal


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Diagnosis:

&namnesis

Pemeri'saan fsi' Pemeri'saan penun1ang

@eoplasma ('arsinoma

'olore'tal)


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Tatala'sana

" Aadiasi

Pembedahan

# 7emoterapi

@eoplasma

('arsinoma'olore'tal)


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T&an+ ,ou

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