7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 1/61
GANGGUAN SALURANCERNA BAGIAN ATAS
M. Hafdz MS, dr.
Patologi Manusia asar
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 2/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 3/61
Saluran C!rna Bagian Atas
"U##!r GI Tra$t% ari &ulut'
oro(aring'
laringo(aring'!so(agus'gast!r'duod!nu&
Batas SaluranC!rna Atas'Ba)a*+Lig. Tr!itz "#ada!-ura
duod!no!unalis%
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 4/61
/ral Ca0it1
Cari!s Gingi0itis P!riodontitis A#*t*ous ul$!rs /ral *!r#!s Candidiasis L!u2o#la2ia
› &!ta#lasia
› $!lls #rodu$! 2!ratin
› asso$iat!d )it* to3a$$ous!
S4ua&ous $!ll$ar$ino&a
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 5/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 6/61
/ral Ina&&ations andIn(!$tions
Gingi0itis
/ral $andidiasis "t*rus*%
H!r#!s Si&#l!- "$old sor!% Parotitis
Sto&atitis "ina&&ation o( t*! &out*%
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 7/61
Gingi0itis
Etiolog1'› N!gl!$t!d oral *1gi!n!
›
Str!ssMani(!stations› Bl!!ding during toot* 3rus*ing
› Pus
› Loos!ning o( t!!t* "#!ridonitis%› Tr!at&!nt
Pr!0!ntion, !ntal $ar!, d!ntal rins!s,ossing
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 8/61
/ral Candidiasis "T*rus*%
Etiolog1'
› Candidiasis al3i$ans
› I&&unosu##r!ssion Mani(!stations
› 5*it! #at$*!s in oral $a0iti!s
› Tr!at&!nt
N1statin s)is* and s)allo)
A&#*ot!ri$in B
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 9/61
H!r#!s Si&#l!- "Cold Sor!%
Etiolog1'
› H!r#!s si&#l!- I or II
› Str!ss !-a$!r3at!s Mani(!stations
› 6!si$l! (or&ation
› Tr!at&!nt'anti0irals
7o0ira-
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 10/61
Parotitis
Etiolog1'
› Sta#*, Str!#,0irus
Mani(!stations› Pain in gland8!ar
› La$2 o( sali0a
› Tr!at&!nt
Anti3ioti$s, analg!ti$ Mout*)as*!s
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 11/61
Sto&atitis"Ina&&ation o( t*! Mout*%
Etiolog1'› Sid! !9!$t o( $*!&ot*!ra#1› Trau&a
› #at*og!ns Mani(!stations
› E-$!ssi0! sali0ation› Halitosis›
Sor! &out*› Tr!at&!nt R!&o0! $aus! Soot*ing &out* )as* solutions Bl!nd di!t
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 12/61
/ral Can$!r
Co&&on sit!s
› Lo)!r li#
› Lat!ral 3ord!r o( tongu!› Bu$$al &u$osa
› Etiolog1
To3a$$o us!
C*roni$ irritation U6 lig*t'Can$!r o( t*! li#
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 13/61
Mani(!stations o( /ralCan$!r
L!u2o#la2ia:;S&o2!r<s #at$*;
Er1t*ro#la2ia
Sor! t*at do!s not *!al Lat!
› Pain !s#!$iall1 &o0ing a)
› 1s#*agia› Can$!r o( t*! li#'induration
› Pain in tongu! )*!n !ating
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 14/61
isord!rs o( t*! Eso#*agus
Food
Upperesophagealsphincterrelaxes
Mout
hPharynx
Foodmovesintoesophagus
Loweresophagealsphincter(LES) relaxes
Stomach
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 15/61
ormal
Esophagu
s
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 16/61
is!as!s o( t*! Eso#*agus
Can #r!s!nt)it*› d1s#*agia
› #ain
› 3l!!ding
A$*alasia› s#as& o( t*!
lo)!r!so#*ag!als#*in$t!r
Hiatal *!rnia› #rotrusion o(sto&a$* t*roug*!so#*ag!al*iatus
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 17/61
A$*alasia
In$o&#l!t! r!la-ation o( LES "r!sting#r!ssur! =>?&& Hg%
!tiolog1› idio#at*i$ ' &ost $o&&on
› C*agas dis!as! ' Latin A&!ri$a
› s!$ondar1 to $an$!r "!so#*agus, sto&a$*%
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 18/61
@ ?? T*o&son ' 5ads)ort*
Hiatal Hernia
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 19/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 20/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 21/61
R!!- Eso#*agitis Barr!ttM!ta#lasia
R!!- o( gastri$ a$id In a3out D? o( #ati!nts, d!0!lo#s into Barr!tt &!ta#lasia
› s4ua&ous $!lls d!0!lo# into a$id's!$r!ting gastri$ !#it*!liu&
› in$r!as!d ris2 (or !so#*ag!al $ar$ino&a
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 22/61
Barr!tt<s Eso#*agus
I. Barr!tt<s !so#*agus F ul$!ration o( #ost!rolat!ral )all
II. Mid!so#*ag!al stri$tur! (ro& *!al!d Barr!tt<s ul$!r
III. Ad!no$ar$ino&a s!$ondar1 to Barr!tt<s !so#*agus
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 23/61
Eso#*agitisI. Earl1 Eso#*agitis
• i9us!nodularit1 o(&u$osal sur(a$!
II. Mod. Eso#*agitis
• T*i$2!n!d (oldsand nodularit1in distal
!so#*agus
III. S!0!r! Eso#*agitis
• i9us!ul$!rations and
stri$tur!
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 24/61
Eso#*agitis
GER "D $aus!%
In(!$tious !so#*agitis
Pill !so#*agitis Causti$ ing!stion
Radiation
S$l!rot*!ra#1
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 25/61
In(!$tious !so#*agitis$lini$al &ani(!stations
/d1no#*agia
1s#*agia
› Solids li4uids !0!r "un$o&&on%
Bl!!ding "un$o&&on%
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 26/61
Eso#*agitis ' diagnosis
Endos$o#1
› In(!$tious
Candida F )*it! #la4u!s H!r#!s F 0!si$l!s
!fniti0! d- 0ia 3io#s1
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 27/61
Candidal !so#*agitis
•Co&&on in
• HI6
• Anti3ioti$s
• C*!&ot*!ra#1
•d1s#*agia• T-+ u$onazol!
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 28/61
HS6 Eso#*agitis
•Co&&on in+
• C*!&ot*!ra#1
• HI6
• T-+ a$1$lo0ir
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 29/61
R!u- !so#*agitis stri$tur!
#izza
•ood i&#a$t!d #ro-i&alto stri$tur!
•Could att!&#t glu$agon
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 30/61
Eso#*ag!al Stri$tur!s
I. Causti$ stri$tur!
• Narro)ing o( 8> o( !so#*agus du! to$austi$ ing!stion 1!ars ago
•
A$$id!ntal in $*ildr!n• Sui$id!
II. Radiation stri$tur!
• S&oot* &id!so#*ag!al stri$tur!
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 31/61
S*ar# o3!$ts› Urg!nt int!r0!ntion
› Caus! int!stinal #!r(oration in DJ'>J
Batt!ri!s› K3utton; 3att!ri!s F urg!nt r!&o0al
7n, Li, Hg F l!a2ag! $aus!s to-i$it1
Eso#*ag!al o3stru$tion(or!ign 3od1 &anag!&!nt
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 32/61
B!ll in !so#*agus
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 33/61
Mallor1'5!iss S1ndro&!
La$!ration
Usuall1 $aus!d 31s!0!r! 0o&iting
Could 3! li(!'t*r!at!ning3l!!ding
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 34/61
Asso$iat!d )it* $irr*osis No s1&#to&s until ru#tur!
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 35/61
Eso#*ag!al Car$ino&a
Aris! (ro&s4ua&ous$ar$ino&a
Ris2 (a$torsar!› to3a$$o us!
› al$o*ol a3us!
T!nds toin0ad! &!tastasiz!!arl1
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 36/61
A$ut! H!&orr*agi$ Gastritis
Un$o&&on
Caus!d 31› as#irin
NSAIs› al$o*ol a3us!
› *!a01 s&o2ing
U##!r
a3do&inal#ain, naus!a,0o&iting
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 37/61
Str!ss Ul$!rs
Su#!rf$ial d!(!$ts
Asso$iat!d )it*
str!ss(ul$onditions
› trau&a
› 3rain inur1
› al$o*ol a3us!
Call!d !rosions
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 38/61
P!#ti$ Ul$!r is!as!
Erosion
› su#!rf$ial to &us$ularis &u$osa
›no s$arring
Ul$!r
› #!n!trat!s &us$ularis &u$osa
› s$arring
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 39/61
PU ' !tiolog1
Duodenal Gastric
H. pylori 90% 60%
NSAIDs 7% 35%
Stress-induced <3% <5%
Zollinger-Ellison <1% <1%
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 40/61
PU H. pylori
Gra& n!gati0! rod
Li0!s in u##!r GI tra$t 3!t)!!n !#it*!lial
sur(a$! and &u$us (!$al'oral trans&ission
In$r!as!s ris2 o( gastri$ $an$!r
Al&ost all non'NSAI ul$!rs ar! du! to
H.#1lori "J duod!nal, gastri$ as#!r Ros!n%
-+ s!rolog1, 3io#s1, CD 3r!at* t!st
› Not #ra$ti$al (or !&!rg!n$1 &!di$in!
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 41/61
PU NSAIs
ir!$t !9!$t› i9us! into &u$osal $!lls
› B!$o&! tra##!d and dir!$tl1 da&ag! $!ll In*i3ition o( #rostaglandin s!$r!tion R!du$!d &u$us #rodu$tion R!du$!d $!ll turno0!r
Indir!$t !9!$t› S1st!&i$ in*i3ition o( C/O d!$r!as!s#rodu$tion o( #rot!$ti0! #rostaglandins
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 42/61
PU F H- and P-
A3do&inal #ain "%
› G!n!rall1 !#igastri$
›Usuall1 )orst ' *ours a(t!r &!al
› /(t!n 3!t)!!n '>AM "HCl s!$r!tion*ig*!st%
› R!li!0!d )it* anta$ids
uod!nal ul$!r› Pain )orst 3!(or! &!al
› R!li!0!d 31 &!al
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 43/61
P!#ti$ Ul$!rs
!!#, solitar1 d!(!$ts Mostl1 $aus!d 31 H.
pylori A3out ? o$$ur in
duod!nu& ? in
sto&a$* Asso$iat!d )it* $*roni$
gastritis, $igar!tt!s&o2ing, long't!r&us! o( NSAIs, al$o*ol
Can 3! a9!$t!d 31› str!ss› #!rsonalit1› (a&il1 *istor1
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 44/61
Usuall1 as1&#to&ati$ !-$!#t (or #ainuntil *!&orr*ag! or #!r(oration d!0!lo#s
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 45/61
uod!nal Ul$!r
•Not! (r!s* 3l!!ding at!dg!
•=? H.#1lori
•NSAIS
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 46/61
Gastri$ Ul$!r•Cl!an, )!ll d!&ar$at!d,3!nign loo2ing
•All s*ould 3! 3io#si!d as*ig* ris2 o( $an$!r
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 47/61
Sto&a$* Ul$!r
•U##!r GI )it* 3ariu& $ontrast
•Arro) ul$!ration
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 48/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 49/61
Gastri$ Car$ino&a
J ar!ad!no$ar$ino&as
5orld)id! as d!adl1as lung $an$!r
Ris2 (a$tors› H. pylori $*roni$
atro#*i$ gastritis› di!t *ig* in s&o2!d,
#i$2l!d, or salt'#r!s!r0!d (ood
›
di!t lo) in (r!s* (ruit 0!g!ta3l!s Usuall1 as1&#to&ati$
until ad0an$!d
C it l A li
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 50/61
Cong!nital Ano&ali!s
Gastros$*isis
/&#*alo$!l
!
U&3ili$alH!rnia
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 51/61
6as$ular is!as!s
Is$*!&ia du! to
› at*!ros$l!rosis
› !&3olis&
›0as$ulitis
› 0ol0ulus
› s*o$2
› CH
› MI
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 52/61
iarr*!al is!as!s
Ma1 !-#!ri!n$!d!*1dration
Irrita3l! 3o)!ls1ndro&!› (un$tional
› a3do&inal #ain, 3loating 6iral 3a$t!rial
!nt!ro$olitis› !it*!r u#s!t o( nor&al
ora or introdu$tion o(#at*og!n
›rota0irus› Nor)al2 0irus
Protozoal in(!$tions› a&!3i$ d1s!nt!r1› giardiasis
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 53/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 54/61
N!$rotizing Ent!ro$olitis
=== Un2no)n
$aus! Earl1 (!!ding
)it* non3r!ast&il2 inta2!
M!l!na'*!&atos$*!zia
Ina&&ator1 Bo)!l
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 55/61
Ina&&ator1 Bo)!lis!as!
E#isodi$ 3lood1 diarr*!a
Autoi&&un! !tiolog1
G!n!ti$ inu!n$!
In0ol0!&!nt o( !-traint!stinal tissu!s
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 56/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 57/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 58/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 59/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 60/61
7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx
http://slidepdf.com/reader/full/gangguan-saluran-cerna-bagian-ataspptx 61/61
Ada 1ang &au nan1aQ