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INFEKSI DAN HIPOTERMIA
PADA ILEUS
dr. Santi Rini, SpBA
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SYNOPSIS
Morbus
HIrschsprung Ileus
Congenital
anomaly
Ileus Strangulation(Vascular compromise)
Peritonitis Acute Abdomen(Emergencies)
Obstipation
Distention
Vomiting
Upper ileus:-vomiting>-mild distention(epigastric)
Pylorus (Gastric outlet)
Duodenum Obstructions
Lower Ileus:-vomiting130/min
tachypnea
Hypotensive systolic 3 seconds
Lethargic
Mottled
Tenting
Cool,clammy
Doughy
Sunken
Parched
Sunken
Intense if conscious
Minimal
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HIGH GIT OBSTRUCTION
GASTRIC OUTLET OBSTRUCTION
- HPS ( HYPERTROPHIC PYLORIC STENOSIS )
- ANTHRAL WEB- PYLORIC MUCOSA PROLAPS
DUODENAL OBSTRUCTION
- ATRESIA/STENOSIS DUODENUM- PANCREAS ANNULARE
- LADD`S MEMBRANE
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MECHANICAL LOWER GIT
OBSTRUCTION
MECONIUM ILEUS MECONIUM PLUG SYNDROME
NEONATAL SMALL LEFT COLON SYNDROME MALROTATION WITH VOLVULUS INCARCERATED HERNIA JEJUNOILEAL ATRESIA COLONIC ATRESIA INTESTINAL DUPLICATION INTUSSUSCEPTION HERNIA INGUINALIS
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FUNCTIONAL LOWER GIT
OBSTRUCTION
SEPSIS
NEC (NECROTICANS ENTERO COLITIS)
INTRACRANIAL HEMORRHAGEHYPOTHYROIDISM
MATERNAL DRUG INGESTION ORADDICTION
HYPERMAGNESEMIAHYPOKALEMIA
MORBUS HIRSCHSPRUNG
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GIT HAEMORHAGE
UPPER : MELENA
LOWER : HEMATOCHEZIA
RECTAL BLEEDING
LIGAMENTUM TREITZ LIMITED
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COMMON CAUSES OF
GASTROINTESTINAL HEMORRHAGE
Patient < 1 Year Patient > 1 Year
Upper
Gastritis
Swallowed maternal blood
Peptic ulcer(duodenal andgastric)
Malrotation and volvulus
Lower
Anal fissure
Intussusception
Necrotizing enterocolitis
Meckels diverticulum
Malrotation and volvulus
Upper
Peptic ulcer
Varices
Lower
Colonic polyps
Intussusception
Meckels diverticulum
Infections diarrhea
Inflammatory bowel disease
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FLUIDS RESUSCITATION
PROGRAMS
The fluids compartement :
-First : Intracellular
-Seconds : Extracellular :-Plasma intravascular
-Interstitial cell
-Non Functional
Thirds space : 1. Cavum intra peritoneal (abdomen)
2. Cavum inra pleural (thorax)
The Fluids: Resusitations:-Kristaloid: ringer Lactate, asering,saline
-Koloid: plasbumin
Nutrisions: Dextrose 5%,Aminofusin 5%, Intralipid 20%
Physiologist
circulatory
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TERAPI NUTRISI PARENTERAL
EBB PHASE :-HIPOVOLEMIA
- CAIRAN RESUSITASI RL/ ASERING
FLOW PHASE : NORMOVOLEMIACAIRAN NUTRISI:
KH : D5, D10
PROTEIN : ASAM AMINO 2,5%, 5%,10%
LEMAK : LIPID 20%
ELEKTROLIT: KAEN I B, 3A, 3B
MINERAL
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REASONING
FLUIDS PROGRAM 6 HOURS
Gold standart periodic ileus
Intra vascular Ringers lactate are to resist
in oncotyic pressure poor conditions
(hypo albuminemia)
Shock 1 hour program
Fourth step management:
1. The kind fluids
2. The fluids quantity
3. The giving methode of fluid : intravenous perifir
or central
4. Monitoring evaluations every 1 hours
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Jumlah cairan :
1. Defisit cairan / dehidrasi
a. Dehidrasi Ringan : 5% ( 50ml/kgbb x TBW )
b . Dehidrasi Sedang : 10% (100ml/kgbb x TBW )
c. Dehidrasi Berat : 15% (150ml/kbbb x TBW )* Tonisitas darah:Hipotonis,isotonis,hipertonis
2. Maintenance
Neonatus: 24 jam post operatif dikurangi 30%
3. Perkiraan cairan hilang dalam 24 jam( on going loss )
2&3 modification to Fluid intake ( see table )
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TOTAL BODY WATER ( ASHCRAFT)
UMUR %
Gestasional12 minggu 94
12 minggu 32 minggu 80
Aterm
3-5 hari 78
-3 5
Neonatus 75 - 80
Children 65 - 75
Young Man 60Young Woman 50
Over 60 years man 50
Over 60 years women 45
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MAINTENANCE ( ASHCRAFT )
* Daily Fluid Requirements
Weight Volume
Premature (< 2kg ) 150 ml / kg
Neonatus & infant (2-10 kg ) 100ml/kg for first 10kg
Infant & children (10-20kg ) 1000ml+50ml/kg over 10 kg
Children ( > 20 kg ) 1500ml+20ml/kg over 20 kg
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TABLE : MODIFICATION TO FLUID INTAKE
Decrease Adjustment
Humidified Inspired air X 0.75
Basal state (eg pa ralysed ) X 0.7
High ADH (IPPV,brain injury ) X 0.7
Hypothermia - 12 % per C
High room humidity x 0.7
Renal failure x 0.3 (+urine output )
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Increase
Full activity + oral feeds X 1.5
Fever + 12 % per C
Room temperature > 31 C + 30 % per C
Hyperventilation X 1.2Neonate - preterm (1-1.5 kg ) X 1.2
- radiant heater X 1.5
- photo terapy X 1.5
Burn - first day + 4% per 1%
area burn- Subsequently + 2% per 1%
area burn
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KASUS
PASIEN BAYI USIA 1 tahun(BB 10 KG) DENGAN ILEUS DISERTAI
DEHIDRASI BERAT DAN FEBRIS SUHU 400C, ASIDOSIS
METABOLIK DAN ANEMIA. HASIL LAB.HB 8G%, ALBUMIN 2G/DL, K+2 MEQ/L, NA+160 MEQ/L, TROMBOSIT 50000
MM2/DL.( TBW 70%, t normal 36,5C)
TERANGKAN PENATALAKSANAAN LENGKAP dalam 6 jam?
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