Penyakit Pada Esofagus

Question 1

Penyakit Pada Esofagus (3)

Answer 1

Esofagitis
Akalasia
GERD

Question 2

Definisi Esofagitis

Answer 2

Radang pada esofagus

Question 3

Etio Esofagitis

Answer 3

• Infeksi
  Bakteri, virus, jamur
• Bahan korosif
  Esofagistis korosif
  • Organiklorin
    Porstex, pemutih pakaian, bayclin
  • Organofosfat
    Racun serangga

Question 4

Dx Esofagitis

Answer 4

Odinofagi → nyeri menelan
Disfagi → sulit menelan
Nyeri di dada

Question 5

Px Esofagitis

Answer 5

Endoskopi

• Fungal
• Virus/herpes
• Bakteri
• E. korosif

Question 6

Hasil Px Esofagitis Fungal

Answer 6

Plak putih kekuningan → candidiasis esofagus

Question 7

Hasil Px Esofagitis Virus/Herpes

Answer 7

Ulkus-ulkus kecil di esofagus

Question 8

Hasil Px Esofagitis Bakteri

Answer 8

Mukosa hiperemis

Question 9

Hasil Px Esofagitis Korosif

Answer 9

Ulkus lebar, erosi (+) → ruptur: emergensi

Question 10

Tx Esofagitis Fungal

Answer 10

Flukonazol tab 1x150 mg 14 hari

Question 11

Tx Esofagitis Virus/Herpes

Answer 11

Acyclovir 5x200 mg + simtomatik

Question 12

Tx Esofagitis Bakteri

Answer 12

AB B-laktam

Question 13

Tx Esofagitis Korosif → Emergensi

Answer 13

• Simtomatik → beri PPI, antimuntah (-)
• NGT → bilas lambung → jangan pernah
• Resusitasi ABCDE + Infus NaCl 0,9%
• Akut/1 jam: arang aktif (charcoal)/susu
• Sulfat atropin 3-5 amp IV bolus

Jika kejang → diazepam 10 mg bolus lambat → evaluasi/15 menit:
Target:
RR aman, suara tambahan (-)
TDS >80 mmHg
HR >80x/m
Mulut kering
Pupil midriasis
→ tidak mencapai → double dose atropin 6-10 amp

Question 14

Akalasia

Answer 14

30-40 tahun

Question 15

Etio Akalasia

Answer 15

Gangguan plexus Auerbach & Meissner di esofagus → peristaltik (-)

Question 16

Dx Akalasia

Answer 16

Disfagia → awal bisa makan lunak selanjutnya makan cair sulit
BB ↓

Question 17

DD Akalasia

Answer 17

Ca esofagus → alarm sign (+) (anemia, usia tua)

Question 18

Px Akalasia

Answer 18

Barium meal → dilatasi esofagus (bird beak app/rat tail app)
Gold Standard → manometri esofagus

Question 19

Tx Akalasia

Answer 19

Rujuk

Question 20

Definisi GERD

Answer 20

Isi lambung naik ke esofagus

Question 21

Etio GERD

Answer 21

Lemah Lower Esophagus Sphincter (LES)

Question 22

FR GERD

Answer 22

Obesitas, berbaring setelah makan

Question 23

Dx GERD

Answer 23

Heart burn → rasa terbakar di dada
Regurgitasi → rasa pahit, asam di lidah

Question 24

Px GERD

Answer 24

PPI test → sederhana/Puskesmas
pH metri/Bernstein Test
GERD-Q

Question 25

Px GERD: PPI Test

Answer 25

PPI dosis ganda 1-2 minggu
→ Keluhan ↓ dengan PPI DAN Keluhan ↑ saat PPI dihentikan → (+)

2 2

Question 26

Px GERD: pH metri/Bernstein Test

Answer 26

= Gold Standard

pH esofagus → pH <7 asam
→ jika komplikasi/alarm sign (+) → Gold Standard: Endoskopi → Esofagus hiperemis

Question 27

Px GERD: GERD-Q

Answer 27

Kuesioner skor >8

Question 28

Tx GERD

Answer 28

1. PPI (-zole)
2. Antagonis Reseptor Histamin-2 (ARH-2) (-tidin)

→ Dosis tunggal 4 minggu
→ Evaluasi

1. → Membaik → Stop → Kambuh → Ulang
2. → Gejala (+) → Dosis ganda 4-8 minggu + endoskopi

• Metode Tx
  
  • Metode Step Up
    ARH2-PPI
  • Metode Step Down → Rekomendasi
    PPI-ARH2

R O L E Play (2x1, kec. GERD dosis tunggal)
R abeprazole 20 mg
O meprazole 20 mg
L ansoprazole 30 mg
E someprazole 40 mg
P antoprazole 40 mg

Question 29

Komplikasi GERD (4)

Answer 29

Barret Esofagus
Lesi Prakanker
Striktur Esofagus
Mallory-Weiss Tear

Question 30

Barret Esofagus

Answer 30

Skuamos-kolumnar → baret esofagus

Ba Ret
Sa Kau
Barret Skuamous-Kolumnar

Question 31

Lesi Prakanker

Answer 31

Adenokarsinoma esofagus

Question 32

Striktur Esofagus

Answer 32

Penyempitan esofagus → sulit menelan

Question 33

Mallory-Weiss Tear

Answer 33

Pecahnya mukosa esofagus → muntah persisten → muntah darah