atresia oesofagus
DESCRIPTION
ghchgchgcTRANSCRIPT
![Page 1: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/1.jpg)
ATRESIA OESOFAGUS
OLEH
![Page 2: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/2.jpg)
KLASIFIKASI
A. Atresia tanpa fistula ke trachea (8%)B. Proksimal fistel ke trachea, distal
buntu (4%)C. Proksimal buntu, distal fistel (86%)D. Proksimal fistel, distal fistel (4%)E. Tipe H
![Page 3: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/3.jpg)
PATOFISIOLOGI
Proksimal atresia hipertropi Saliva tertumpuk Masuk ke trachea Tipe A & B tak ada udara
dalam usus A,D & E mungkin terjadi refluk
cairan lambung ke paru
![Page 4: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/4.jpg)
KELAINAN PENYERTA
Cardiovaskuler (PDA,VSD,ASD,TF) Anus imperforatus Atresia intestinal Malrotasi HPS(Hipertrofik Pylorus Stenosis) Kel tulang belakang (hemi vert)
![Page 5: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/5.jpg)
KLINIS
Ibu polihidramnion Tertumpuk cairan di rongga mulut Regurgitasi Batuk Cyanosis Abdomen : kempis/kembung Ronchi paru Tipe H : gejala kurang jelas
![Page 6: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/6.jpg)
DIAGNOSIS
Pasang pipa lambung Mentok Foto Rontgen Thorax Foto Pada tipe H intubasi Zat kontras (hati-hati) harus
dikeluarkan lagi
![Page 7: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/7.jpg)
TERAPI
Isap cairan lendir rongga mulut Puasa Cairan intravena Antibiotika Operasi :
Usopagostomi Gastrostomi Tipe C (operasi) Bila gap panjang
Gastric tube Transposisi colon
![Page 8: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/8.jpg)
![Page 9: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/9.jpg)
Insiden 0,1% - 0,4%Insiden 0,1% - 0,4% Laki-laki >> WanitaLaki-laki >> Wanita Ibu Ibu Anak 4 kemungkinan Anak 4 kemungkinan Anak IAnak I Anak laki-lakiAnak laki-laki Etiologi tidak diketahui, kemungkinan Etiologi tidak diketahui, kemungkinan
gangguan sarafgangguan saraf
![Page 10: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/10.jpg)
PATOLOGIPATOLOGI
Hipertrofi otot circuler – oliveHipertrofi otot circuler – olive Pemanjangan pylorusPemanjangan pylorus Obstruksi / stenosisObstruksi / stenosis Sistem persarafan Sistem persarafan Sel ganglion Sel ganglion
![Page 11: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/11.jpg)
KLINISKLINIS Muntah habis minumMuntah habis minum Timbul Timbul Muntah proyektilMuntah proyektil Muntah, empedu (-)Muntah, empedu (-) Kadang seperti kopi, darah(-)Kadang seperti kopi, darah(-) HausHaus DehidrasiDehidrasi Hipokalemia, Nat, Cl-Hipokalemia, Nat, Cl- Alkalosis metabolikAlkalosis metabolik KonstipasiKonstipasi Perut cekung (scapoid)Perut cekung (scapoid)
![Page 12: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/12.jpg)
KELAINAN PENYERTAKELAINAN PENYERTA
MALROTASI USUSMALROTASI USUS ATRESIA USOFAGUSATRESIA USOFAGUS HERNIA DIAFRAGMAHERNIA DIAFRAGMA HIRSCHSPRUNGHIRSCHSPRUNG MALROTASI ANORECTALMALROTASI ANORECTAL
![Page 13: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/13.jpg)
DIAGNOSTIKDIAGNOSTIK
AnamnesaAnamnesa Peristaltik tampakPeristaltik tampak Masa EpigastriumMasa Epigastrium Ba Meal Ba Meal STRING SIGN- Mushroom SignSTRING SIGN- Mushroom Sign USG bila tak teraba USG bila tak teraba
![Page 14: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/14.jpg)
TERAPITERAPI
Koreksi Alkalosis-glukosa, hipo Koreksi Alkalosis-glukosa, hipo K,Na,ClK,Na,Cl
Pasang pipa lambungPasang pipa lambung Operasi : Pyloromyotomi (Ramstedt)Operasi : Pyloromyotomi (Ramstedt)
![Page 15: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/15.jpg)
ATRESIA DUODENI
Kegagalan pembentukan lumen (mg 6-7) Terjadi atresia Obstruksi Sering infra papila Vater
![Page 16: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/16.jpg)
PATOLOGI Obstruksi mekanik Penebalan otot Anuler pankreas Dilatasi lambung dan duodenum
![Page 17: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/17.jpg)
Kelainan penyerta
Down’s Syndrom >> Malrotasi usus halus > CHD > Trakeo usofagus fistula Anomali rektum Anus imperforasi Respiratori distress Ibu polihidramnion
![Page 18: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/18.jpg)
GAMBARAN KLINIS
Muntah billier beberapa jam sesudah menyusui/minum
Berak (-) Perut scapoid Kadang-kadang kelihatan peristalsis
pylorus
![Page 19: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/19.jpg)
PEMERIKSAAN PENUNJANG
USG Antenatal Photo polos : Double Bubble App Udara usus lain (-) Pemeriksaan fisik/anamnesa
![Page 20: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/20.jpg)
PENGOBATAN / PROGNOSA
Puasa Sonde lambung IVFD Operasi
Duodeno-duodenostomy Duodenoyeyunostomy Gastroyeyunostomy
Prognosa : tergantung kelainan penyerta
![Page 21: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/21.jpg)
ATRESIA YEYUNUM-ILEUM
Etiologi : Gangguan vaskuler intra uterin Volvulus Invaginasi Ibu makan obat spt Catergot Syok pada ibu Sering multiple (beda dengan Duodenum)
![Page 22: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/22.jpg)
KELAINAN PENYERTA
Down’s Sindrom Fibrokistik pankreas Volvulus lokal
![Page 23: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/23.jpg)
PATOLOGI
Ada 4 type1. Atresia
2. Stenosis
3. Atresia murni
4. Multiple atresia
![Page 24: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/24.jpg)
PROKSIMAL ATRESIA Dilatasi Penebalan dinding Muntah billier Pada yeyunum : perut kembung bag
epigastrium Pada ileum : gembung seluruh perut
![Page 25: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/25.jpg)
KLINIS
Bisa ada mekonium/tidak Muntah Perut kembung Dehidrasi Pemeriksaan penunjang : foto polos
abdomen tidur/LLD
![Page 26: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/26.jpg)
DIAGNOSIS/DD
Klinis Radiologis DD
Atresia kolon Atresia ani Penyakit Hirschprung
![Page 27: Atresia Oesofagus](https://reader036.vdocuments.site/reader036/viewer/2022081722/5695cf611a28ab9b028dd64a/html5/thumbnails/27.jpg)
TERAPI
Pendahuluan Puasa pipa lambung Koreksi cairan Antubiotika D. cateter
Definitif Laparatomi Anastomose usus