Digestive system
Anatomi
Penyakit sistem digesti:
1.
2.
3.
4.
5.
6.
7.
8.
Oesophagus and Diaphragma
Stomach and Duodenum
Liver and Biliary system.
Pancreas.
Spleen
Colorectal and anus.
Acute Abdomen.
Abdominal Hernia.
4
Menurut ICD-10 :
K00-K14
K20-K31
K35-K38
K40-K46
K50-K52
K55-K64
K65-K68
K70-K77
K80-K87
K90-K95
Diseases of oral cavity and salivary glands
Diseases of esophagus, stomach and duodenum
Diseases of appendix
Hernia
Noninfective enteritis and colitis
Other diseases of intestines
Diseases of peritoneum and retroperitoneum
Diseases of liver
Disorders of gallbladder, biliary tract and pancreas
Other diseases of the digestive system
C15-C26 Malignant neoplasms of digestive organs
Menurut ICD-10 :
K20-K31 Diseases of esophagus, stomach and duodenum
Esophagitis
Gastro-esophageal reflux disease
Other diseases of esophagus
Disorders of esophagus in diseases classified elsewhere
Gastric ulcer
Duodenal ulcer
Peptic ulcer, site unspecified
Gastrojejunal ulcer
Gastritis and duodenitis
Functional dyspepsia
Other diseases of stomach and duodenum
Menurut ICD-10 :
K20-K31 Hernia
Inguinal hernia
Femoral hernia
Umbilical hernia
Ventral hernia
Diaphragmatic hernia
Unspecified abdominal hernia
Menurut ICD-10 :
K50-K52 Noninfective enteritis and colitis
Crohn's disease [regional enteritis]
Ulcerative colitis
Other and unspecified noninfective gastroenteritis and colitis
Menurut ICD-10 :
K55-K64 Other diseases of intestines
Vascular disorders of intestine
Paralytic ileus and intestinal obstruction without hernia
Diverticular disease of intestine
Irritable bowel syndrome
Other functional intestinal disorders
Fissure and fistula of anal and rectal regions
Abscess of anal and rectal regions
Other diseases of anus and rectum
Other diseases of intestine
Hemorrhoids and perianal venous thrombosis
Menurut ICD-10 :
K65-K68 Diseases of peritoneum and retroperitoneum
Peritonitis
Other disorders of peritoneum
Disorders of peritoneum in infectious diseases classified elsewhere
Disorders of retroperitoneum
Menurut ICD-10 :
K70-K77 Diseases of liver
Alcoholic liver disease
Toxic liver disease
Hepatic failure, not elsewhere classified
Chronic hepatitis, not elsewhere classified
Fibrosis and cirrhosis of liver
Other inflammatory liver diseases
Other diseases of liver
Liver disorders in diseases classified elsewhere
Menurut ICD-10 :
K80-K87 Disorders of gallbladder, biliary tract and pancreas
Cholelithiasis
Cholecystitis
Other diseases of gallbladder
Other diseases of biliary tract
Acute pancreatitis
Other diseases of pancreas
Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
Menurut ICD-10 :
K90-K95 Other diseases of the digestive system
Intestinal malabsorption
Intraoperative and postprocedural complications and
disorders of digestive system, not elsewhere classified
Other diseases of digestive system
Complications of artificial openings of the digestive system
Complications of bariatric procedures
Menurut ICD-10 :
C15-C26 Malignant neoplasms of digestive organs
Malignant neoplasm of esophagus
Malignant neoplasm of stomach
Malignant neoplasm of small intestine
Malignant neoplasm of colon
Malignant neoplasm of rectosigmoid junction
Malignant neoplasm of rectum
Malignant neoplasm of anus and anal canal
Malignant neoplasm of liver and intrahepatic bile ducts
Malignant neoplasm of gallbladder
Malignant neoplasm of other and unspecified parts of biliary tract
Malignant neoplasm of pancreas
Malignant neoplasm of other and ill-defined digestive organs
Penyakit :
1.
2.
3.
4.
5.
Kongenital
Trauma
Infeksi / radang.
Neoplasma.
Degeneratif
16
Disease Of The Esophagus
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
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G E R D (Gastro Esophageal Reflux Disease)
Barret’s Esophagus.
Motility Disorder ( Achalasia ect. )
Tumor of the Esophagus.
Stricture.
Diaphragmatic Hernia.
17
Diseases of the Stomach & Duodenum.
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Peptic Ulcer Disease
Gastritis and Stress Ulcer
Benigne / Malignant Neoplasma
Volvulus
GERD.
Duodenal Diverticle.
18
Achalasia (chalasia = relaxation)
Neuro muscular disorder :
 piristaltik primer menurun
 relaksasi sfingter esofagus distal menurun
= MEGA ESOFAGUS = kardiospasme
Patofisiologi
Gangguan plexus myenterik Aurbach
( hk. Cannon ) non cholinergic
Chagas disease  parasimpatis (secondary)
Karsinoma Esofagus
Epidemiologi
diet

alkohol

merokok
 4% keganasan saluran cerna

Patologi
60 % skuamus sel karsinoma,
merata pada 1/3 proksimal tengah dan distal esofagus
40% adeno karsinoma terutama distal esofagus
Hernia
Diafragmatika
1.
2.
Kongenital
Akuisita
 traumatik
 hiatus esofagus
Hernia Hiatal
Type I




Esofagitis refluks –
nyeri dada terutama malam hari
waktu tidur (sudut His) regurgitasi
X - ray : lambung diatas diafragma (Trendelenburg)
Endoskopi : esofagitis
Terapi : obat-obat anti asam
H2 antagonis
Proton pump inhibitor
Type II
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
Hernia sliding (90%)  GERD
Hernia paraesofageal (5 – 10%)
Asimtomatik
Gejala obstruksi mekanis
Type III Kombinasi
Tukak Peptik
Perdarahan
20% hematemesis + melena

sering terjadi setelah obat-obat salisilat

kortikosteroid dan NSAID
40 % penyebab kematian
75 % cukup terapi medikal
Perdarahan ulang  mortalitas meningkat
Sindroma Dumping
15 menit setelah makan

Volume plasma menurun
 gg. hemodinamik

Volume usus kecil
meningkat  peristaltik
meningkat  diare

Palpitasi – tachycardia

Kesadaran menurun
Karsinoma Lambung
Insiden tinggi di:
Jepang 54,2% dari † tumor ganas ♂
39,4% dari † tumor ganas ♀
Eslandia
Chili
Hawaii
Diagnosa dini :
Kanker lambung dini
Jepang: deteksi dini 1950 (1%) – 1989 (50%)
Stress Ulcer


LESI SUPERFISIAL – MULTIPEL – MUCOSA LAMBUNG
FUNDUS – KORPUS LAMBUNG
TRAUMA
BEDAH MAJOR
CUSHING ULCER
CURLING ULCER
PATOFISIOLOGI ?

ASAM LAMBUNG

ISKEMIA MUKOSA
SYOK
SEPSIS
RUDA PAKSA
LIKA BAKAR
Divertikel Meckel
Duktus Omphalo Enterikus Persisten
Epid : insiden
laki-laki
Penyulit pada usia
persen populasi umum
kali wanita
tahun
Sering dijumpai kebetulan waktu lapatotomi
Patognomonis :
vaskularisasi eksklusif
 langsung dari arteri mesenterika superior
Ileitis Terminalis
= ENTERITIS REGIONAL = PENY. CROHN (1932)
Radang kronis granulomatik terutama ileum terminalis
Patologi : skip area (patchy)
pan-enteritis  stenosis/fistel usus
Etiologi ?
virus – mikroba – alergi
Anglo Saxon kongenital (genetik)?
Klinis : nyeri – muntah
febris – kolik – berat badan menurun – anemia
diare tanpa darah
mass + fistel usus / perineum
X – ray Ba-inloop : penebalan dinding ileum terminalis
stenosis – “cobble stone”