Hematemesis Melena et causa Ulkus Peptik

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Hematemesis Melena et causa Ulkus Peptic

Kelompok PBL C3: Kelompok PBL C3:

Terry Reniban (102010352) Terry Reniban (102010352) Joceline

Joceline VValencia alencia (10201302)(10201302) !n"ra #$r %n&&i !n"ra #$r %n&&i (10201'01)(10201'01) Polikarp$ %ri*in ( Polikarp$ %ri*in (10201'0')10201'0') Jane La$ra Jane La$ra (10201'122)(10201'122) Kar+ika ,e-i (10201'220) Kar+ika ,e-i (10201'220) .abriel /eekia (10201'221) .abriel /eekia (10201'221)

ak$l+a Ke"ok+eran ni4eri+a

ak$l+a Ke"ok+eran ni4eri+a Kri+en Kri"a Kri+en Kri"a acanaacana Jalan %r6$na +ara #o708 Jakar+a Bara+

Jalan %r6$na +ara #o708 Jakar+a Bara+ 1151011510 T

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Abstrak

/ema+emei (m$n+a "ara) "an melena mer$pakan kea"aan yan& "iakiba+kan ole per"araan al$ran cerna ba&ian a+a (CB%)7 %"a empa+ penyebab CB% yan& palin& erin& "i+em$kan8 yai+$ $lk$ pep+ik$m8 &a+ri+i eroi*8 4arie eo*a&$8 "an r$p+$r m$koa eo*a&o&a+rika7 ,i ne&ara bara+ ini"eni per"araan ak$+ CB% mencapai 100 per 1007000 pen"$"$k9+a$n8 laki;laki lebi banyak "ari -ani+a7 T$6$an pen$lian 6$rnal ini a"ala $n+$k

memaami "e*inii8 e+iolo&i8 pa+o&enei "an cara men"ia&noi ema+emei melena er+a men&e+a$i al&ori+ma pena+alakanaan "an komplikai ema+emei "an melena7

Ka+a K$nci: ema+emei8 melena

Abstract

Hematemesis (vomiting blood) and melena is a condition caused by upper gastrointestinal bleeding. There are four causes of upper gastrointestinal bleeding most common, namely peptic ulcer, erosive gastritis, esophageal varices, and rupture esofagogastrika mucosa. In western countries the incidence of upper gastrointestinal bleeding reached 1 per 1, inhabitants!year, men more than women. The purpose of writing this paper is to understand the definition, etiology, pathogenesis and diagnosis of hematemesis melena way and to know the algorithm and the management of complications hematemesis and melena.

"eywords# hematemesis, melena

Pendahuluan

/ema+emei (m$n+a "ara) "an melena (B%B "ara) mer$pakan kea"aan yan& "iakiba+kan ole per"araan al$ran cerna ba&ian a+a ($pper &a+roin+e+inal +rac+)7 Kebanyakan ka$ ema+emei a"ala kea"aan &a-a+ "i r$ma aki+ yan& menimb$lkan <; 1'= kema+ian "i r$ma aki+7 ak+or $+ama yan& berperan "alam +in&&inya an&ka kema+ian a"ala ke&a&alan $n+$k menilai maala ini eba&ai kea"aan klini yan& &a-a+ "an kealaan "ia&no+ik "alam menen+$kan $mber per"araan7 >le karena i+$ pen+in& $n+$k men&e+a$i

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karak+eri+ik "an kon"ii pa"a e+iap ka$ a&ar i"en+i*ikai "an penalakaan "apa+ "ilak$kan "apa+ e$ai "an +epa+ aaran7

Anamnesis

Pa"a ka$ ema+emei melena ki+a "apa+ menanyakan al;al eper+i berik$+1_:

e6ak kapan +er6a"i per"araan8 perkiraan 6$mla8 "$rai "an *rek$eni per"araan8 ri-aya+ per"araan ebel$mnya "an ri-aya+ per"araan "alam kel$ar&a8 a"a +i"aknya per"araan "i ba&ian +$b$ lain8 ri-aya+ m$n+a ber$lan& yan& a-alnya +i"ak ber"ara (in"rom ?allory; ei)7 Kon$mi 6am$ "an oba+ (#%!, "an an+ikoa&$lan yan& menyebabkan nyeri a+a$ pe"i "i epi&a+ri$m yan& ber$b$n&an "en&an makanan)7 Kebiaaan min$m alkool (&a+ri+i8 $lk$ pep+ic8 ka"an& 4arie) kem$n&kinan a"anya penyaki+ a+i kroni8 "emam "en&$e8 +i*oi"8 &a&al &in6al kronik8 "iabe+e melli+$8 iper+eni8 aler&i oba+ "an apaka a"a ri-aya+ +ran*$i "ara ebel$mnya7

Pemeriksaan fisik

Lan&ka a-al a"ala menen+$kan bera+ per"araan "en&an *ok$ pa"a +a+$ emo"inamik8 pemerikaannya melip$+i1_:

Tekanan "ara "an na"i poii barin&

Per$baan or+o+a+ik +ekanan "ara "an na"i

%"a +i"aknya 4aokon+riki peri*er (akral "in&in) Kelayakan napa "an +in&ka+ kea"aran

Per"araan ak$+ "alam 6$mla bear (@ 20= 4ol$me in+ra4ak$ler) men&akiba+kan kon"ii emo"inamik +i"ak +abil8 "en&an +an"a1 :

/ipo+eni (A090 mm/& a+a$ ?%P A0 mm/&) "en&an *rek$eni na"i @ 100 9meni+ Tekanan "ia+ole or+o+a+ik +$r$n @10 mm/&8 i+ole +$r$n @20 mm/&7

rek$eni na"i or+o+a+ik menin&ka+ @15 9meni+ %kral "in&in

Kea"aran +$r$n

%n$ria a+a$ oli&o$ria (pro"$ki $rin A30 ml96am)

elain i+$ pa"a per"araan ak$+ 6$mla bear "i+em$kan al;al berik$+1: /ema+emei

/ema+okeia

,ara e&ar pa"a apirai nao&a+rik8 "en&an la4ae +i"ak e&era 6erni /ipo+eni peri+en

Tran*$i "ara @ <00 D 1000 ml "alam 2' 6am

K$$ $n+$k penilaian emo"inamik (kea"aan irk$lai) perl$ "ilak$kan e4al$ai 6$mla per"araan8 "en&an kri+eria1_:

Perdarahan (%) Keadaan hemodinamik

A< /emo"inamik +abil

< D 15 /ipo+eni or+o+a+ik

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25 D '0 Ren6a+an E pen$r$nan kea"aran @'0 ?orib$n" (physiology futility)

elan6$+nya pemerikaan *iik yan& perl$ "ipera+ikan a"ala :

+i&ma+a penyaki+ a+i kroni (ik+er$8 pi"er nae4i8 aci+e8 plenome&ali8 eri+ema palmari8 e"ema +$n&kai)7 Colok "$b$r karena -arna *ee memiliki nilai pro&no+ik apira+ "ari nasogastric tube (#.T) memiliki nilai pro&no+ik mor+ali+a "en&an in+erpre+ai : apira+ p$+i ker$ : per"araan +i"ak ak+i*8 apira+ mera mar$n : per"araan mai* (m$n&kin per"araan ar+eri)7 $$ ba"an "an per"araan "i +empa+ lain

Tan"a k$li+ "an m$koa penyaki+ i+emik yan& bia "ier+ai per"araan al$ran cerna (pi&men+ai m$kok$+ane$ pa"a in"rom Pe$+;Je&er)

Pemeriksaan Penunjang

Te "ara : "ara peri*er len&kap8 cross$match 6ika "iperl$kan +ran*$i

/emo+ai len&kap $n+$k menyin&kirkan kelainan *ak+or pembek$an primer a+a$ ek$n"er : CTBT8 PT9PPT8 %PTT

Flek+roli+ : #a8 K8 Cl

aal a+i : coline+erae8 alb$min9 &lob$lin8 .>T9.PT

FK.G *o+o +orak: i"en+i*ikai penyaki+ 6an+$n& (ikemik)8 par$ kroni

Fn"okopi : gold standart $n+$k mene&akkan "ia&noi "an eba&ai pen&oba+an en"okopik a-al7 elain i+$ 6$&a memberikan in*ormai pro&no+ik "en&an men&i"en+i*ikai +i&ma+a per"araan2₇

Diagnosis Kerja

Per"araan al$ran cerna ba&ian a+a (CB%) yai+$ per"araan yan& beraal "ari "alam l$men al$ran cerna "i a+a (prokimal) li&amen+$m Trei+8 m$lai "ari 6e6$n$m prokimal8 "$o"en$m8 &a+er8 "an eopa&$1_{7 /al +ereb$+ men&akiba+kan m$n+a "ara}

(ema+emei) "an berak "ara ber-arna i+am eper+i apal (melena)2₇

/ema+emei a"ala "im$n+akannya "ara "ari m$l$+8 "ara bia "alam ben+$k e&ar (bek$an9 &$mpalan9 cairan -arna mera cera) a+a$ ber$ba karena enim "an aam lamb$n& men6a"i kecokla+an "an berben+$k eper+i b$+iran kopi7 ?elena yai+$ kel$arnya +in6a yan& len&ke+ "an i+am eper+i apal (+er) "en&an ba$ ka8 yan& men$n6$kkan per"araan al$ran cerna a+a er+a "icernanya "ara pa"a $$ al$3₇

Penyebab pa"a ka$ a"ala akiba+ oba+;oba+an yan& men&iri+ai m$koa lamb$n& a+a$ oba+ yan& meran&an& +imb$lnya +$kak (ulcerogenic drugs)7 ?ialnya oba+;oba+ &olon&an aliila+ eper+i %pirin8 !b$pro*en8 oba+ $n+$k iper+eni "an lainnya7 >ba+;oba+an lain yan& 6$&a "apa+ menimb$lkan ema+emei yai+$ : &olon&an kor+iko+eroi"8 b$+aoli"in8

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reerpin8 pironolak+on "an lain;lain7 .olon&an oba+;oba+ +ereb$+ menimb$lkan iperai"i+a'₇

.a+ri+i eroi4a emora&ika mer$pakan $r$+an ke"$a penyebab per"araan al$ran cerna a+a7 Pa"a en"okopi +ampak eroi "i an&$l$8 an+r$m yan& m$l+ipel8 eba&ian +ampak beka per"araan a+a$ mai +erlia+ per"araan ak+i* "i +empa+ eroi7 ,i eki+ar eroi

$m$mnya iperemi8 +i"ak +erlia+ 4arie "i eopa&$ "an *$n"$ lamb$n&7 i*a+ ema+emei +i"ak mai* "an +imb$l e+ela ber$lan& kali min$m oba+;oba+an +ereb$+8 "ier+ai nyeri "an pe"i "i $l$ a+i

Manifestasi Klinis

Biaanya pen"eri+a men&alami &an&&$an pencernaan (in"i&e+i) "an raa +i"ak nyaman "i per$+ ebela a+a7 Te+api banyak pen"eri+a +i"ak meraakan nyeri7 Pen"eri+a lainnya

meraakan &e6ala yan& mirip $lk$8 yai+$ nyeri ke+ika per$+ koon&7 Bila pen"eri+a +e+ap aki+8 $lk$ bia membear "an m$lai men&alami per"araan8 biaanya "alam -ak+$ 2;5 ari e+ela +er6a"inya ce"era7 Per"araan menyebabkan +in6a ber-arna kei+aman eper+i apal8 cairan lamb$n& men6a"i kemeraan "an 6ika an&a+ bera+8 +ekanan "ara bia +$r$n7 Per"araan bia mel$a "an berakiba+ *a+al7'

Patofisiologi

m$nya >%!# beker6a "en&an men&amba+ enim cyclooi&enae 1 "an cyclooi&enae 27 Fnim Cyclooy&enae ber*$n&i eba&ai pemeca aam araki"ona+ men6a"i pro+a&lan"in "an +rombokan7 Pro+a&lan"in a"ala molek$l peran+ara pera"an&an7 elain i+$ pro+a&lan"in a"ala molek$l pro+ek+i* $n+$k m$koa lamb$n&7 Pen&ar$ pro+a&lan"in +era"ap lamb$n& a"ala men$r$nkan ekrei aam lamb$n& "an menin&ka+kan ekrei m$k$ pa"a m$koa lamb$n&7 Jika +er6a"i amba+an "alam pro"$ki pro+a&lan"in8 maka memperbear +er6a"inya ker$akan pa"a m$koa lamb$n&7 Karena m$k$ yan& berk$ran& "an aam lamb$n& yan& banyak "ipro"$ki7 ,an al ini +er6a"i pa"a paien yan& men&&$nakan oba+;oba+an an+iin*lamai non +eroi"7 F*ek ampin& oba+ an+i

in*lamai non +eroi" (>%!#) pa"a al$ran cerna +i"ak +erba+a pa"a lamb$n&7 F*ek ampin& pa"a lamb$n& meman& palin& erin& +er6a"i7 >%!# mer$ak m$koa lamb$n& melal$i "$a mekanime8 yai+$ +opikal "an i+emik7 Ker$akan m$koa ecara +opikal +er6a"i karena >%!# beri*a+ aam "an lipo*ilik8 ein&&a memperm$"a trapping ion hydrogenma$k m$koa "an menimb$lkan ker$akan7 F*ek i+emik >%!# +ampaknya lebi pen+in& yai+$ ker$akan m$koa +er6a"i akiba+ pro"$ki pro+a&lan"in men$r$n8 >%!#

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ecara bermakna menekan pemben+$kan pro+a&lan"in7 Pro+a&lan"in "ipro"$ki melal$i "$a 6al$r yai+$ 6al$r Co1 "an 6al$r Co27 eper+i yan& "ike+a$i8 pro+a&lan"in mer$pakan $b+ani i+opro+ek+i* (yan& beraal "ari Co1) yan& ama+ pen+in& ba&i m$koa lamb$n&7 F*ek i+opro+ek+i* i+$ "ilak$kan "en&an cara men6a&a aliran "ara m$koa8 menin&ka+kan ekrei m$koa "an ion bikarbona+8 "an menin&ka+kan ephitelial defense7 Pro+a&lan"in yan& "iben+$k "ari 6al$r Co2 menimb$lkan in*lamai8 nyeri8 "an "emam8 ein&&a >%!# yan& elek+i* men&amba+ Co2 rela+i* lebi aman "i&$nakan7%liran "ara m$koa yan& men$r$n menimb$lkan a"ei ne+roli+ pa"a en"o+el pemb$l$ "ara m$koa "an memac$ lebi 6a$ proe im$nolo&i7 Ra"ikal beba "an pro+eae yan& "ilepakan akiba+ proe im$nolo&i

+ereb$+ akan mer$ak m$koa lamb$n&7 5

Diagnosis anding Kelainan di esophagus Pecanya 4arie eopa&$

Per"araan 4arie ecara ka +er6a"i men"a"ak "an mai*8 keilan&an "ara &a+roin+e+inal kronik 6aran& "i+em$kan7 Per"araan 4arie eo*a&$ a+a$ lamb$n& biaanya "iebabkan ole iper+eni por+al yan& +er6a"i ek$n"er akiba+ iroi epa+i7 ?ekip$n iroi alkoolik mer$pakan penyebab 4arie eo*a&$ yan& palin& pre4alen "i %merika erika+8 e+iap kea"aan yan& menimb$lkan iper+eni por+al "apa+ men&akiba+kan per"araan 4arie7 Lebi lan6$+8 ken"a+i a"anya 4arie berar+i a"anya iper+eni por+al yan& $"a berlan&$n& lama8 penyaki+ epa+i+i ak$+ a+a$ in*il+rai lemak yan& eba+ pa"a epar ka"an&;ka"an& menimb$lkan 4arie yan& akan men&ilan& be&i+$ abnormali+a epar "iemb$kan7 ?ekip$n per"araan ?B% pa"a paien iroi $m$mnya beraal "ari 4arie eba&ai $mber per"araan8 k$ran& lebi epar$ "ari paien ini "apa+ men&alami per"araan yan& beraal "ari $lk$ pep+ik$m a+a$ &a+ropa+i iper+eni por+al7 Kea"aan yan& "ieb$+ +erakir

ini +er6a"i akiba+ pen&&emb$n&an 4ena;4ena m$koa lamb$n&7 eba&ai konek$eninya8 an&a+ pen+in& menen+$kan penyebab per"araan a&ar penan&anan yan& +epa+ "apa+ "iker6akan5₇

%n&ka ke6a"ian pecanya 4arie eopa&$ yan& menyebabkan per"araan c$k$p +in&&i yai+$ 5'8<=7 i*a+ per"araan ema+emeinya men"a"ak "an mai*8 +anpa "i"a$l$i nyeri epi&a+ri$m7 ,ara ber-arna kei+aman "an +i"ak akan membek$ karena $"a +ercamp$r aam lamb$n&7 e+ela ema+emei elal$ "i$$l "en&an melena5₇

(7)

Karinoma eopa&$ lebi erin& men$n6$kkan kel$an melena "aripa"a ema+emei7 Paien 6$&a men&el$ "i*a&ia8 ba"an men&$r$ "an anemi7 /anya eekali pen"eri+a m$n+a "ara +i"ak mai*7 Pa"a panen"okopi 6ela +erlia+ &ambaran karinoma yan& ampir men$+$p eopa&$ "an m$"a ber"ara +erle+ak "i eper+i&a ba-a eopa&$57

in"rom ?allory;ei

Ri-aya+ me"i "i+an"ai ole &e6ala m$n+a +anpa ii (4omi+$ +anpa "ara)7 ?$n+a eba+ men&akiba+kan r$p+$r m$koa "an $bm$koa "aera kar"ia a+a$ eopa&$ ba-a ein&&a m$nc$l per"araan7 Karena laerai ak+i* "ier+ai $lerai8 maka +imb$l per"araan7 Laerai m$nc$l akiba+ +erlal$ erin& m$n+a ein&&a +ekanan in+raab"ominal naik menyebabkan pecanya ar+eri "i $bm$koa eopa&$9 kar"ia7 i*a+ per"araan ema+emei +i"ak mai*8

+imb$l e+ela paien ber$lan&kali m$n+a eba+8 lal$ "i$$l raa nyeri "i epi&a+ri$m7 ?ialnya pa"a iperemei &ra4i"ar$m5₇

Fo*a&o&a+ri+i koroi4a

Perna "i+em$kan pen"eri+a -ani+a "an pria yan& m$n+a "ara e+ela +i"ak en&a6a memin$m air kera $n+$k pa+ri7 %ir kera +ereb$+ men&an"$n& aam i+ra+ "an aam /Cl yan& beri*a+ koroi* $n+$k m$koa m$l$+8 eopa&$ "an lamb$n&7 Pen"eri+a 6$&a men&el$ nyeri "an pana eper+i +erbakar "i m$l$+8 "a"a "an epi&a+ri$m5₇

Fo*a&i+i "an +$kak eopa&$

Fo*a&i+i yan& menimb$lkan per"araan lebi erin& beri*a+ in+ermi+en a+a$ kroni8 biaanya rin&an8 ein&&a lebi erin& +imb$l melena "aripa"a eme+emei7 T$kak

eopa&$ 6aran& menimb$lkan per"araan 6ika "iban"in&kan "en&an +$kak lamb$n& "an "$o"en$m5₇

Kelainan di lambung T$kak lamb$n&

T$kak lamb$n& lebi erin& menimb$lkan per"araan +er$+ama "i an&$l$ "an prepilor$ bila "iban"in&kan "en&an +$kak "$o"eni7 T$kak lamb$n& ak$+ biaanya beri*a+ "an&kal "an m$l+ipel yan& "apa+ "i&olon&kan eba&ai eroi(5)₇

Biaanya ebel$m ema+emei "an melena8 paien men&el$ nyeri "an pe"i "i $l$ a+i elama berb$lan;b$lan a+a$ ber+a$n;+a$n7 eaa+ ebel$m ema+emei raa nyeri "an pe"i "iraakan ber+amba eba+8 nam$n e+ela m$n+a "ara raa nyeri "an pe"i +ereb$+ berk$ran&7 i*a+ ema+emei +i"ak be&i+$ mai*8 lal$ "i$$l melena5₇

(8)

!ni"eninya 6aran&8 paien $m$mnya beroba+ "alam *ae lan6$+ "en&an kel$an raa pe"i "an nyeri "i $l$ a+i8 raa cepa+ kenyan&8 ba"an lema7 Jaran& men&alami ema+emei8 +e+api erin& melena5₇

Kelainan di duodenum T$kak "$o"eni

T$kak "$o"eni yan& menyebabkan per"araan panen"okopi +erle+ak "i b$lb$7 eba&ian paien men&el$kan ema+emei "an melena8 e"an&kan eba&ian kecil men&el$ melena

a6a7 ebel$m per"araan8 paien men&el$ nyeri "an pe"i "i per$+ a+a a&ak ke kanan7 Kel$an ini 6$&a "iraakan -ak+$ +en&a malam aa+ e"an& +i"$r p$la ein&&a +erban&$n7 n+$k men&$ran&i raa nyeri "an pe"i8 paien biaanya men&kon$mi ro+i a+a$ $$5₇

Karinoma papilla Va+eri

Karinoma papilla Va+eri mer$pakan penyebaran karinoma "i amp$la menyebabkan peny$mba+an al$ran empe"$ "an al$ran pancrea yan& $m$mnya $"a "alam *ae lan6$+7 .e6ala yan& +imb$l elain kole+a+ik ek+raepa+al8 6$&a "apa+ menimb$lkan per"araan +eremb$nyi (occult bleeding)8 an&a+ 6aran& +imb$l ema+emei7 elain i+$ paien 6$&a men&el$ ba"an lema8 m$al "an m$n+a5₇

Penatalaksanaan 17 Ta+alakana m$m

Tin"akan $m$m +era"ap paien "i$+amakan airway$breathing$circulation (%BC)7 Tera"ap paien yan& +abil e+ela pemerikaan mema"ai8 e&era "ira-a+ $n+$k +erapi lan6$+an a+a$ periapan en"okopi₇

,alam melakanakan +in"akan $m$m ini8 paien "apa+ "iberikan +erapi_: Tran*$i $n+$k memper+aankan ema+okri+ @ 25=

Pemberian 4i+amin K 31 amp

>ba+ penekan in+ea aam lamb$n& (PP!) 27 Ta+alakana K$$

Terapi me"ikamen+oa

PP! (proton pump inhibitor) : oba+ an+i ekrei aam $n+$k mence&a per"araan $lan&7 ,ia-ali "oi bol$ >mepraol <0 m&9i4 lal$ per in*$e < m&9k&BB96am elama 2 6am7 %n+ai"a8 $kral*a+8 "an an+a&oni reep+or /2 mai bole "iberikan $n+$k +$6$an penyemb$an lei m$koa per"araan₇

(9)

!n6eki : peny$n+ikan $bm$koa eki+ar +i+ik per"araan "en&an a"renalin (1:10000) ebanyak 085D1 ml9$n+ik "en&an ba+a 10 ml a+a$ alcool abol$+e (<=) +i"ak melebii 1 ml

Termal : koa&$lai8heatprobe8 laer ?ekanik : emoklip8 +apler 

Terapi #on ?e"ikamen+oa

Pa"a pena+alakaanaan non me"ika men+oa8 Paien "apa+ "iberikan e"$kai "an pen&araan a&ar ebia m$n&kin men&in"ari makanan;makanan yan& "apa+ menin&ka+kan aam lamb$n&7 Kem$"ian8 elain men&in"ari makanan meran&an& aam lamb$n& yan& +er$+ama "an +erpen+in& a"ala paien ar$ men&in"ari *ak+or reiko +er6a"inya "ipepia eper+i alkool8 makanan;makanan yan& pe"a8 oba+;oba+an yan& berlebian +er$+ama &olon&an >%!# (6ika meman& ar$ men&kon$mi >%!# pili 6eni Co2)8 niko+in pa"a rokok8 "an +re *iik "an men+al7 elain i+$ "apa+ 6$&a "i e"$kai pa"a paien ep$+ar pola makan yan& +era+$r "an paien ar$ men&a+$r pori "an pola makan "ari makanan yan& "imakannya eari;ari7 

H%l&ori+ma Pena+alakanaan Pen"eri+a Per"araan CB%

Komplikasi

Komplikai yan& erin& +er6a"i a"ala per"araan akiba+ "ari "ek$amai m$koa &a+er yan& ber$6$n& pa"a pemben+$kan $lk$ (l$ka) pa"a &a+er7 Komplikai akiba+ $lk$ +ereb$+ 6$&a

(10)

"apa+ men&akiba+kan per*orai "en&an peri+oni+i7 Komplikai palin& bera+ a"ala +er6a"i "e&enerai el;el m$koa &a+er men6a"i $a+$ +$mor &ana yan& ber$6$n& men6a"i karinoma elain i+$ pa"a kon"ii +er+en+$ "apa+ 6$&a +er6a"i berba&ai komplikai eper+i: yok ipo4olemik8 apirai pne$monia8 &a&al &in6al ak$+8 in"rom epa+orenal koma epa+ik$m "an anemia karena per"araan7

Prognosis

Banyak *ak+or yan& mempen&ar$i pro&noi pen"eri+a eper+i *ak+or $m$r8 ka"ar /emo&lobin (/b)8 +ekanan "ara elama pera-a+an8 "an lain;lain7 Banyak peneli+ian men$n6$kan ba-a an&ka kema+ian pen"eri+a "en&an al$ran cerna ba&ian a+a "ipen&ar$i ole *ak+or ka"ar /emo&lobin (/b) -ak+$ "ira-a+8 +er6a"i9+i"aknya per"araan $lan&8 kea"aan a+i8 eper+i ik+er$8 "an ence*alopa+i7 Pro&noi c$k$p baik apabila "ilak$kan penan&anan yan& +epa+7 ?en&in&a+ +in&&inya an&ka kema+ian "an $karnya "alam

menan&&$lan&i per"araan al$ran cerna ba&ian a+a maka perl$ "iper+imban&kan +in"akan yan& beri*a+ pre4en+i*7

Kesimpulan

Per"araan al$ran cerna ba&ian a+a (CB%) yai+$ per"araan yan& beraal "ari "alam l$men al$ran cerna "i a+a (prokimal) li&amen+$m Trei+8 m$lai "ari 6e6$n$m prokimal8 "$o"en$m8 &a+er8 "an eopa&$7 /al +ereb$+ men&akiba+kan m$n+a "ara

(ema+emei) "an berak "ara ber-arna i+am eper+i apal (melena)7 Penyebab pa"a ka$ a"ala akiba+ oba+;oba+an yan& men&iri+ai m$koa lamb$n& a+a$ oba+ yan& meran&an& +imb$lnya +$kak (ulcerogenic drugs)7 ?ialnya oba+;oba+ &olon&an aliila+ eper+i %pirin8 !b$pro*en8 oba+ $n+$k iper+eni "an lainnya7 >ba+;oba+an lain yan& 6$&a "apa+ menimb$lkan ema+emei yai+$ : &olon&an kor+iko+eroi"8 b$+aoli"in8 reerpin8 pironolak+on "an lain; lain7

Daftar Pustaka

17 %+era8 ! 7?7 G ! ,7#7 iba-a7 Ta+a Lakana Per"araan al$ran ?akan Ba&ian %+a : "alam .a-a+ ,ar$ra+ "i Bi"an& Penyaki+ ,alam7 Jakar+a: F.CI 2007p7 53D 27

(11)

27 Ric+er8 J7?7 G K7J7 !elbacer7 Per"araan al$ran ?akanan: "alam /arrion (Prinip !lm$ Penyaki+ ,alam) Jili" !7 Jakar+a: F.CI 20037p7 25D27

37 Bickley L7 Te ab"omen7 !n: Bickley L8 e"7 Ba+e &$i"e +o pyical eamina+ion an" i+ory +akin&8 <+_{e"7 Lippinco++ illiam G ilkin: #e- orkI 20027p7 31;7} '7 epe P8 acimki P8 rie"man L7 .a+roen+erolo&y7 !n: aba+ine ?8 e"7 Pocke+

me"icine8 3r"_{e"7 Lippinco++ illiam G ilkin: Pila"elpiaI 200<: 371;257}

57 ,a4ey8 P7 /ema+emei G ?elena : "alam %+ a .lance ?e"icine7 Jakar+a : Frlan&&a7 2007p7 3D7

7 Poni6an8 %7P7 Per"araan al$ran Cerna Ba&ian %+a:

repository.usu.ac.id!bitstream!1%&'*+!&1*&!'!-hapter%II.pdf 7 20127 7 PB P%P,!7 +an"ar Pelayanan ?e"ik7 Jakar+a: PB P%P,!I 20057p7 22D37