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8/17/2019 Peptic Ulcers Dr. Nurbaiti
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Peptic Ulcers
Oleh:
Nurbaiti
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Pendahuluan
• Ulkus: kerusakan mukosa dari tunika
muskularis mukosa hingga ke submukosa
atau lebih.
• Disetiap daerah GI tract, >> gaster dan
duodenum
• iasan!a soliter
• "#$ duodenum %duodenum:gaster& ':()
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Patogenesis
• tiologi:
(.2erpapar asam lambung dan pepsin
3. 4.p!lori5. N67ID
• respon berbeda terhadap setiap indi8idu
• 1arena adan!a ketidak seimbanganketahanan mukosa gastroduodenal dan
patogen.
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*an+utan4.p!lori men!ebabkan kerusakan mukosa dengan
cara:
(. 9erangsang I*(, I*, I*#, 2N; akti8asineutro<il
3. 9engasilkan amonium chloride danmonochloramine, =ac7, ag7.
5. Protease bakteri ? phospholipase merusakkompleks gl!coproteinlipid mukosamelemah
'. 9eningkatkan sekresi asam lambung@. 9enurunkan produksi bikarbonat p4
menurun
. %Diduga)7kti8asi 6el 2 dan sel <olikel
lim<oma
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*an+utan
• 4.p!lori peptic ulcer pada (A3A $
indi8idu.
• 6train penghasil =ac7 dan ag7 lebih
beresiko
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*an+utan
• N67ID pen!ebab lain.
• Pada (5 $ pengguna.
• 2ergantung: usia, dosis, lamapenggunaan.
• B pada penderita rheumatik kronis.
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*an+utan
• 1arena supresi sintesis prostaglandin
mukosa B as.h!droklorida C produksi
musin dan bikarbonat barier mukosa C
as.h!droklorida mencapai epitel.
• Pendukung lain: glutathione C,
angiogenesis C, sigaret, alkohol%0),
ollinger Ellisons s!nd.
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Ge+ala klinis
• 9ual, muntah, n!eri epigastrium, rasa
terbakar, hematemesis,
• *ebih n!eri pada malam hari
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9akroskopik
• *esi batas tegas, kemerahan, F 3' cm.
• Umumn!a lesi gaster> duodenum
• Gaster: cur8atura minor • Duodenum: proksimal %anterior,posterior)
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9akroskopik
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ndoskopi
http:images.google.comimgres0imgurl&http:upload.-ikimedia.org-ikipediacommons<<(enignHgastricHulcerH(.+pgimgre<url&http:knol.google.co.krkhelicobacterp!lorigastritisgastriccancerandulcerusg&HHd**J!hm<"KhetL35dMp=asIkdPU&h&'A#-&'AAs&3#hl&enstart&'@tbnid&thLJb/Ks@(LH9:tbnh&(3@tbn-&(35pre8&images$5;$5Dpeptic$3ulcer
$3image$3gb8$5D3$3ndsp$5D(#$3hl$5Den$3sa$5DN$3start$5D5
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9ikroskopik
• 2ergantung lama dan dera+at prosespen!embuhan
• Pada fase aktif memperlihatkan 4 zona:
• inflammatory exudate at the lumen %cell debrisand neutrophils)
• fibrinoid necrosis %kuning%8an Gieson) danpink%4))
• granulation tissue • mature fibrous tissue %abundant collagen red
%8an Gieson) dan pink %4).
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9ikroskopik
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9ikroskopik
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9ikroskopik
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Debris nekrotik <ibrinoid, sel radang
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Granulation tissue .neo8askularisasi, edema, sel
radang.
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;ibrosis
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7cute Gastritis Ulceration
• 6tress ulcer
• *esi multiple
• 1arena: trauma, urling ulcer, ushingulcer, N67ID, kortikosteroid
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Ge+ala 1linis
• 6epsis, rasa panas
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9akroskopik
• *esi sirkular, kecil, (cm, tersebar
diseluruh mukosa, multiple.
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9akroskopik
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9ikroskopik
• rosi super<icial sd lapisan diatas
muskularis propria.
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2erima kasih