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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
Pen%akit i!ertikular
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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
Pen%akit i!ertikular
-akanan rendah
serat
-akanan olahan
Per,an=ang
waktu transit
#eses
klusi
Tekanan
meningkat
*erniasi
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Pen%akit i!ertikular
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
Pen%akit i!ertikular
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Klasi#ikasi stadium klinik di!ertikulitis akut menurut
*inche%
Pen%akit i!ertikular
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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
Pen%akit i!ertikular
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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
$n#lammator% bowel disease
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$n#lammator% bowel disease
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$n#lammator% bowel disease
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
$n#lammator% bowel disease
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$n#lammator% bowel disease
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7riteria dera1at 'lini' 'olitis ulserati8
$n#lammator% bowel disease
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4rohns Disease &5ti.it- Inde;
$n#lammator% bowel disease
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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
$n#lammator% bowel disease
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$n#lammator% bowel disease
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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