(26Sept) Perdarahan Saluran Cerna - Dr. Salman

8/19/2019 (26Sept) Perdarahan Saluran Cerna - Dr. Salman

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Perdarahan Saluran

Cerna

Oleh : Salman Paris.H

Bagian Penyakit Dalam RSUD Budhi Asih/

Fakultas Kedokteran UP !eteran "akarta


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Pendahuluhan

Dibagi 2 :

1. Perdarahan saluran #erna atas atau u$$er

gastrointestinal bleeding %U&'B(. U&'B:$erdarahan $roksimal dari ligament )reit*

a. Perdarahan !arises

+.Perdarahan on !arises

,. Perdarahan saluran #erna +a-ah atau Lowergastrointestinal bleeding %&'B( : $erdarahandistal dari ligamnet )reit*


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Perdarahan saluran cerna atasatau upper gastrointestinal

bleeding (UGIB)


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Penyebab Perdarahan SCB ( !nd"s#"pidi $SC% 1&&'1&)

Persentase(*)

Pe#ahnya !arises so0agus ,1.,

Kom+inasi ,,.2

&astritis rosi3e 24.5

&astro$ati H) $ortal 22.1

)ukak duodenum 6.1

)ukak am+ung 6.6

Pe#ahnya 3arises 0undusKanker duodenunKanker lam+ungso0aginitis rosi0

2.42.25.451

Dikuti$ dari Simadi+rata 7


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%ani+estati"ns "+ ,-ert GI Bleeding

Sypt"s / Signs

Hemetemesis : !omiting o0 +lood or altered +lood %8#o9eegrounds8 a$$earan#e(

7elena

Bla#k; smelling; %?255 m +lood 0or 2 meleni#stool(

Blood in &' tra#t ? 2@ hours

Hemato#he*ia

Bright red / maroon stool; +loody diarrhea; #lots

Usually &' sour#e : U&' sour#e in 25


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Signs


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Klasikasi Perdarahan


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ndos#o$y


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0atala#san "n arises

Resus#itation in#ludes uid administration;+lood trans0usion; #ardiores$iratory su$$ort;and treatment o0 signi#ant #omor+id diseases;

su#h as se$sis or #oronary artery disease.'n $atients -ho ha3e se3ere hemodynami# or

$ulmonary insta+ility; &D should +e delayeduntil the $atient is adeEuately resus#itated and

sta+ili*ed.m$iri# $harma#othera$y +e0ore endos#o$y

Proton $um$ inhi+itor %PP'( thera$y isre#ommended +e0ore &D


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7anagement o0 Pe$ti# Ul#er


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7anagement o0 Pe$ti# Ul#erBleeding Pyramid

Dig Dis ,55G,:,42I,44


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!nd"sc"py )he $rime diagnosti# and thera$euti# tool 0or

U&'B.

)hera$euti# endos#o$y generally $rodu#eshemostasis and $re3ents re+leeding.

)he a3aila+le thera$ies in#lude inJe#tionthera$y; su#h as : inJe#tion o0 e$ine$hrineGa+lati3e thera$y; su#h as ele#tro#autery or

argon $lasma #oagulationG and me#hani#althera$y; su#h as endo#li$s or +anding.


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Surgi#al #onsultation isre#ommended 0or $atients:ho ha3e ongoing a#ti3e +leeding

7assi3e +leeding; re#urrent +leeding

Bleeding asso#iated -ith signi#anta+dominal $ain

A#ute lo-er gastrointestinal +leeding

!ari#eal +leedingA+dominal ndings suggesti3e o0 an a#ute

a+domen.


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ba3ah atau Lower


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ba3ah atau Lowergastrointestinal bleeding (4GIB)

Denisi : didenisikan : se+agai $erdarahan yangterJadi +aru saJa; yang +erasal dari distal ligamen

)reit*; yang menghasilkan ketidaksta+ilan tanda 3ital;

dengan tanda>tanda anemia dengan atau tan$a $erluuntuk trans0usi darah

'nsiden :

Sekitar ,5>CC dari e$isode $erdarahan saluran #erna.&'B L U&'B

Sekitar ,5>,1 kasus $er 255;555 / thn; $o$ulasi $adanegara>negara +arat.


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Suber perdarahan :

? 46 sam$ai 41 kasus

kolonC sam$ai 6 sisanya +erasal dari usus halus

Ge5ala :

7ulai dari hemato#he*ia ringan sam$ai$erdarahan masi0 yag disertai sho#k.


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Sallintestinal bleeding

!as#ular e#tasias

)reated -ith endos#o$i# thera$y i0 $ossi+le.

Surgi#al thera$y #an +e used 0or 3as#ular e#tasias

isolated to a segment o0 the small intestine -henendos#o$i# thera$y is unsu##ess0ul.

strogen/$rogesterone #om$ounds ha3e +een

used 0or 3as#ular e#tasias; +ut a dou+le>+lind trial

0ound no +enet in $re3ention o0 re#urrent+leeding.

'solated lesions; su#h as tumors; di3erti#ula; or

du$li#ations; are generally treated -ith surgi#al

rese#tion.


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C"plicati"ns

Hy$o3olemi# sho#k and su+seEuent end>organ damage

Nom$li#ations related to +lood trans0usions;su#h as a#Euired in0e#tions or trans0usionrea#tion

Nom$li#ations related to $ro#edural

inter3entions; su#h as $er0oration andin0e#tion


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Pr"gn"sis U$$er &' +leeding 7ortality rate o0 6I25

L 2 in $atients L 5 years o0 age in thea+sen#e o0 #an#er or organ 0ailure

&' +leeding

'n#reasing age

Nomor+id #onditions Hemodynami# #om$romise %ta#hy#ardia or

hy$otension(

Other $oor $rognosti# signs: #oagulo$athy;immunosu$$ression; $resentation -ith sho#k;re+leeding; onset o0 +leeding in hos$ital; 3ari#eal+leeding; endos#o$i# stigmata o0 re#ent +leeding


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Pr"gn"sis

o Pe$ti# ul#er

Re#urrent +leeding 6 and a mortality ,.

Patients -ith a#ti3ely +leeding ul#ers at endos#o$y ha3e are+leeding rate >? 65 and a mortality 25.

o 7alloryIeiss tears

Bleeding re#urs in 5I6 o0 $atients

o so$hageal 3ari#es

Patients -ith 3ari#eal hemorrhage ha3e $oorer out#omes than$atients -ith other sour#es o0 u$$er &' +leeding.

o Stress>related gastri# mu#osal inJury 7ortality rate is high+e#ause o0 serious underlying illness.

o-er &' +leeding

o Bleeding #oloni# di3erti#ula

A$$roMimately ,5I,6 o0 $atients ha3e e$isodes o0 re+leeding.


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Suary

U&'B is a relati3ely #ommon; $otentially li0e>threatening #ondition that reEuires ra$idassessment o0 #lini#al $resentation; ra$id

resus#itati3e measures; and a$$ro$riatemedi#al triage.

Administration o0 PP's is an im$ortantadJun#ti3e measure 0or !U&'B.

&D remains the $rin#i$al diagnosti#;thera$euti#; and $rognosti# modality 0or!U&'B.


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%"nit"ring

Patients -ith a#ute &' +leeding ty$i#allyreEuire hos$itali*ation.

Patients -ith su+a#ute or #hroni# &' +leedingmay undergo out$atient e3aluation i0 they donot ha3e signi#ant #omor+id #onditions.

Patients -ho $resent -ith a#ti3e &' +leedingreEuire #lose monitoring.

'ntensi3e #are unit may +e indi#ated 0or$atients -ith hemodynami# insta+ility; thosereEuiring +lood trans0usions; and those -ith#ontinued a#ti3e +leeding.


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%"nit"ring

A0ter endos#o$y

o Patients -ith lo-er>risk endos#o$i# ndings%#lean> +ased ul#er( may +e dis#harged on

medi#al thera$y.o Patients -ith higher>risk endos#o$i# ndings

%a#ti3e +leeding or 3isi+le 3essel( reEuire#ontinued in$atient monitoring 0or se3eral days.

A0ter #olonos#o$y; the le3el o0 monitoring may+e determined +y -hether deniti3einter3ention has eliminated sour#e o0 +leeding.

(26Sept) Perdarahan Saluran Cerna - Dr. Salman

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