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Perdarahan Saluran
Cerna
Oleh : Salman Paris.H
Bagian Penyakit Dalam RSUD Budhi Asih/
Fakultas Kedokteran UP !eteran "akarta
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Pendahuluhan
Dibagi 2 :
1. Perdarahan saluran #erna atas atau u$$er
gastrointestinal bleeding %U&'B(. U&'B:$erdarahan $roksimal dari ligament )reit*
a. Perdarahan !arises
+.Perdarahan on !arises
,. Perdarahan saluran #erna +a-ah atau Lowergastrointestinal bleeding %&'B( : $erdarahandistal dari ligamnet )reit*
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Perdarahan saluran cerna atasatau upper gastrointestinal
bleeding (UGIB)
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Penyebab Perdarahan SCB ( !nd"s#"pidi $SC% 1&&'1&)
Persentase(*)
Pe#ahnya !arises so0agus ,1.,
Kom+inasi ,,.2
&astritis rosi3e 24.5
&astro$ati H) $ortal 22.1
)ukak duodenum 6.1
)ukak am+ung 6.6
Pe#ahnya 3arises 0undusKanker duodenunKanker lam+ungso0aginitis rosi0
2.42.25.451
Dikuti$ dari Simadi+rata 7
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%ani+estati"ns "+ ,-ert GI Bleeding
Sypt"s / Signs
Hemetemesis : !omiting o0 +lood or altered +lood %8#o9eegrounds8 a$$earan#e(
7elena
Bla#k; smelling; %?255 m +lood 0or 2 meleni#stool(
Blood in &' tra#t ? 2@ hours
Hemato#he*ia
Bright red / maroon stool; +loody diarrhea; #lots
Usually &' sour#e : U&' sour#e in 25
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Signs
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Klasikasi Perdarahan
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ndos#o$y
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0atala#san "n arises
Resus#itation in#ludes uid administration;+lood trans0usion; #ardiores$iratory su$$ort;and treatment o0 signi#ant #omor+id diseases;
su#h as se$sis or #oronary artery disease.'n $atients -ho ha3e se3ere hemodynami# or
$ulmonary insta+ility; &D should +e delayeduntil the $atient is adeEuately resus#itated and
sta+ili*ed.m$iri# $harma#othera$y +e0ore endos#o$y
Proton $um$ inhi+itor %PP'( thera$y isre#ommended +e0ore &D
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7anagement o0 Pe$ti# Ul#er
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7anagement o0 Pe$ti# Ul#erBleeding Pyramid
Dig Dis ,55G,:,42I,44
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!nd"sc"py )he $rime diagnosti# and thera$euti# tool 0or
U&'B.
)hera$euti# endos#o$y generally $rodu#eshemostasis and $re3ents re+leeding.
)he a3aila+le thera$ies in#lude inJe#tionthera$y; su#h as : inJe#tion o0 e$ine$hrineGa+lati3e thera$y; su#h as ele#tro#autery or
argon $lasma #oagulationG and me#hani#althera$y; su#h as endo#li$s or +anding.
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Surgi#al #onsultation isre#ommended 0or $atients:ho ha3e ongoing a#ti3e +leeding
7assi3e +leeding; re#urrent +leeding
Bleeding asso#iated -ith signi#anta+dominal $ain
A#ute lo-er gastrointestinal +leeding
!ari#eal +leedingA+dominal ndings suggesti3e o0 an a#ute
a+domen.
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ba3ah atau Lower
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ba3ah atau Lowergastrointestinal bleeding (4GIB)
Denisi : didenisikan : se+agai $erdarahan yangterJadi +aru saJa; yang +erasal dari distal ligamen
)reit*; yang menghasilkan ketidaksta+ilan tanda 3ital;
dengan tanda>tanda anemia dengan atau tan$a $erluuntuk trans0usi darah
'nsiden :
Sekitar ,5>CC dari e$isode $erdarahan saluran #erna.&'B L U&'B
Sekitar ,5>,1 kasus $er 255;555 / thn; $o$ulasi $adanegara>negara +arat.
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Suber perdarahan :
? 46 sam$ai 41 kasus
kolonC sam$ai 6 sisanya +erasal dari usus halus
Ge5ala :
7ulai dari hemato#he*ia ringan sam$ai$erdarahan masi0 yag disertai sho#k.
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Sallintestinal bleeding
!as#ular e#tasias
)reated -ith endos#o$i# thera$y i0 $ossi+le.
Surgi#al thera$y #an +e used 0or 3as#ular e#tasias
isolated to a segment o0 the small intestine -henendos#o$i# thera$y is unsu##ess0ul.
strogen/$rogesterone #om$ounds ha3e +een
used 0or 3as#ular e#tasias; +ut a dou+le>+lind trial
0ound no +enet in $re3ention o0 re#urrent+leeding.
'solated lesions; su#h as tumors; di3erti#ula; or
du$li#ations; are generally treated -ith surgi#al
rese#tion.
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C"plicati"ns
Hy$o3olemi# sho#k and su+seEuent end>organ damage
Nom$li#ations related to +lood trans0usions;su#h as a#Euired in0e#tions or trans0usionrea#tion
Nom$li#ations related to $ro#edural
inter3entions; su#h as $er0oration andin0e#tion
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Pr"gn"sis U$$er &' +leeding 7ortality rate o0 6I25
L 2 in $atients L 5 years o0 age in thea+sen#e o0 #an#er or organ 0ailure
&' +leeding
'n#reasing age
Nomor+id #onditions Hemodynami# #om$romise %ta#hy#ardia or
hy$otension(
Other $oor $rognosti# signs: #oagulo$athy;immunosu$$ression; $resentation -ith sho#k;re+leeding; onset o0 +leeding in hos$ital; 3ari#eal+leeding; endos#o$i# stigmata o0 re#ent +leeding
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Pr"gn"sis
o Pe$ti# ul#er
Re#urrent +leeding 6 and a mortality ,.
Patients -ith a#ti3ely +leeding ul#ers at endos#o$y ha3e are+leeding rate >? 65 and a mortality 25.
o 7alloryIeiss tears
Bleeding re#urs in 5I6 o0 $atients
o so$hageal 3ari#es
Patients -ith 3ari#eal hemorrhage ha3e $oorer out#omes than$atients -ith other sour#es o0 u$$er &' +leeding.
o Stress>related gastri# mu#osal inJury 7ortality rate is high+e#ause o0 serious underlying illness.
o-er &' +leeding
o Bleeding #oloni# di3erti#ula
A$$roMimately ,5I,6 o0 $atients ha3e e$isodes o0 re+leeding.
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Suary
U&'B is a relati3ely #ommon; $otentially li0e>threatening #ondition that reEuires ra$idassessment o0 #lini#al $resentation; ra$id
resus#itati3e measures; and a$$ro$riatemedi#al triage.
Administration o0 PP's is an im$ortantadJun#ti3e measure 0or !U&'B.
&D remains the $rin#i$al diagnosti#;thera$euti#; and $rognosti# modality 0or!U&'B.
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%"nit"ring
Patients -ith a#ute &' +leeding ty$i#allyreEuire hos$itali*ation.
Patients -ith su+a#ute or #hroni# &' +leedingmay undergo out$atient e3aluation i0 they donot ha3e signi#ant #omor+id #onditions.
Patients -ho $resent -ith a#ti3e &' +leedingreEuire #lose monitoring.
'ntensi3e #are unit may +e indi#ated 0or$atients -ith hemodynami# insta+ility; thosereEuiring +lood trans0usions; and those -ith#ontinued a#ti3e +leeding.
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%"nit"ring
A0ter endos#o$y
o Patients -ith lo-er>risk endos#o$i# ndings%#lean> +ased ul#er( may +e dis#harged on
medi#al thera$y.o Patients -ith higher>risk endos#o$i# ndings
%a#ti3e +leeding or 3isi+le 3essel( reEuire#ontinued in$atient monitoring 0or se3eral days.
A0ter #olonos#o$y; the le3el o0 monitoring may+e determined +y -hether deniti3einter3ention has eliminated sour#e o0 +leeding.