pengkajian lanjut klien gangguan sistem pencernaan
TRANSCRIPT
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PENGKAJIAN PADA KLIEN DG GANGGUAN SISTEM PENCERNAAN
NURSISWATI
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Fungsi dari Tractus Gastrointestinal IngestiDigesti makanan Penyimpanan sisa makanan Ekskresi SekresiPertahanan tubuh
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TOPOGRAFI ANATOMI ABDOMEN
Ada dua macam cara pembagian topografi abdomen yang umum dipakai untuk menentukan lokalisasi kelainan, yaitu:
1. Pembagian atas empat kuadran, dengan membuat garis vertikal dan horizontal melalui umbilicus, sehingga terdapat daerah kuadran kanan atas, kiri atas, kanan bawah, dan kiri bawah.
2. Pembagian atas sembilan daerah, dengan membuat dua garis horizontal dandua garis vertikal.
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• Garis horizontal pertama dibuat melalui tepi bawah tulang rawan iga kesepuluh dan yang kedua dibuat melalui titik spina iliaka anterior superior (SIAS).
• Garis vertikal dibuat masing-masing melalui titik pertengahan antara SIAS dan mid-line abdomen.
• Terbentuklah daerah hipokondrium kanan, epigastrium, hipokondrium kiri, lumbal kanan, umbilical, lumbal kanan, iliaka kanan, hipogastrium/suprapubik, dan iliaka kiri.
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Digesti makanan
Kunyah
Telan
Campur
Enzim
Absorpsi
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Penyimpanan sisa makanan GasterSigmoidRektum
Eksresi Defekasi
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Sekresi Eksokrin : Saliva, HCL, Pepsin, Amilase, Lipase
Endokrin : Gastrin, Sekretin, Insulin
Parakrin : Somatostatin
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Pertahanan Tubuh Smell, asam lambung, muntah
Flora usus, mucus
Respon imun, IgA
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Kelainan/gangguan Traktus
Gastrointestinal :
Kongenital
Inflamasi /infeksi
Obstruksi
Tumor
Gangguan vaskuler
Irritable bowel syndrome
Malabsorpsi
Divertikulosis
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Kongenital Atresia ani
Divertikel meckel
Morbus Hirschprung
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Inflamasi / infeksi Disentri
Enterokolitis
Crohn’s disease
Kolitis ulseratif
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ObstruksiLesi Intrinsik (Tumor, striktur)
Lesi Ekstrinsik (Adhesi, hernia, volvulus, invaginasi)Oklusi luminal (Fecolit, polipoid)Obstruksi fungsional (M. Hirschprung)
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Gangguan Vaskuler Iskemik (trombosis, emboli)
Angiodisplasi
Hemoroid
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PENGKAJIAN FISIK:
Gejala/tanda gangguan Traktus
Gastrointestinal :
Sendawa
Halitosis
Disfagi
BB menurun
Nyeri ulu hati
Mual & muntah
Kembung
Nyeri tekan, nyeri lepas
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• Ikterik/Joundice
Pada sklera, mukosa, kulit---- berhub dg peningktn bilirubin (>2.5 mg/dL)
• Perdarahan • Diare• Konstipasi/gangguan BAB• Massa di anus• Fetor hepatikum
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Con’t……..
• Inkontinens
• Spider nevi
• Palmar eritema
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Akibat dari gangguan Traktus Gastrointestinal :
Nutrisi menurunGangguan keseimbangan cairan & elektrolitDaya tahan tubuh menurunAnemiaInfeksi Gangguan organ multipel
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AUSKULTASI
• Bising Usus• Diafragma stetoskop diletakkan pada dinding abdomen, lalu
dipindahkan keseluruh bagian abdomen. Suara peristaltic usus terjadi akibat adanya gerakan cairan dan udara dalam usus. Frekuensi normal berkisar 5-34 kali/ menit.
• Bila terdapat obstruksi usus, peristaltic meningkat disertai rasa sakit (borborigmi). Bila obstruksi makin berat, abdomen tampak membesar dan tegang, peristaltic lebih tinggi seperti dentingan keeping uang logam (metallicsound).
• Bila terjadi peritonitis, peristaltic usus akan melemah, frekuensinya lambat, bahkan sampai hilang.
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PALPASI• Pasien diusahakan tenang dan santai dalam posisi
berbaring terlentang.• Sebaiknya pemeriksaan dilakukan tidak buru-buru.• Palpasi dilakukan dengan menggunakan palmar jari dan
telapak tangan.• Sedangkan untuk menentukan batas tepi organ,
digunakan ujung jari.• Diusahakan agar tidak melakukan penekanan yang
mendadak, agar tidak timbul tahanan pada dinding abdomen.
• Palpasi dimulai dari daerah superficial, lalu ke bagian dalam.
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• Palpasi hati; dilakukan dengan satu tangan atau bimanual pada kuadran kanan atas. Dilakukan palpasi dari bawah ke atas pada garis pertengahan antara mid-line &SIAS. Bila perlu pasien diminta untuk menarik napas dalam, sehingga hati dapat teraba.
• Pembesaran hati dinyatakan dengan berapa sentimeter di bawah lengkung costa dan berapa sentimeter di bawah prosesus xiphoideus
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• Palpasi hepar : letakkan 1 tangan pemeriksa dibwh iga kanan, lalu tekan dg mggunakn tangan yg lain.(tekan dengan perlahan).
• Distensi abdomen• Adanya massa• Nyeri tekan/nyeri lepas• turgor• Colok dubur• Lingkar perut
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PERKUSI
• Shifting dullness : penumpukan cairan pd kavum abdomen --- acites
• Prinsipnya cairan bebas akan berpindah ke bagian abdomen terendah. Pasien tidur terlentang, lakukan perkusi dan tandai peralihan suara timpani ke redup pada kedua sisi.
• Lalu pasien diminta tidur miring pada satu sisi, lakukan perkusi lagi, tandai tempat peralihan suara timpani ke redup maka akan tampak adanya peralihan suara redup.
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PEM PENUNJANG
• Barium X-Ray– Puasa 12 jam– Minum barium liquid– Tampak pd X Ray bag dalam lambung– N: lambung kosong
• Barium beefsteak meal– Makan makanan yg mengandung barium– Radiologist akan melihat bgm lambung
melakukan digesti makanan
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Radioisotope gastric-emptying scan -You will eat food that contains a radioisotope, -The dose of radiation from the radioisotope is
small and not dangerous. -After eating, you will lie under a machine that
detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach.
-Gastroparesis is diagnosed if more than half of the food remains in the stomach after 2 hours.
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• Gastric manometry– This test measures electrical and muscular activity in the
stomach. – The doctor passes a thin tube down the throat into the
stomach. – The tube contains a wire that takes measurements of the
stomach's electrical and muscular activity as it digests liquids and solid food.
– The measurements show how the stomach is working and whether there is any delay in digestion.
• Blood tests• USG
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Upper Endoscopy• a test that is performed by inserting a thin
flexible tube through the mouth into the stomach.
• The endoscope has camera capabilities and allows the upper gastrointestinal tract to be evaluated for ulcers, inflammation, cancers, hernias or other abnormalities.
• These conditions can cause symptoms similar to gastroparesis. Upper endoscopy usually requires 10-15 minutes to complete.
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INTERVENSI:
Enteral Murah Infeksi <Pemberian lebih mudah Gut feeding
Parenteral MahalInfeksi > Lebih sulit (infus) Gut feeding (-)
NutrisiIndeks masa tubuh (BB/TB2) Albumin/prealbuminDukungan nutrisi
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Enteral
Formula rumah sakit
Formula komersial
Siap saji
Semi elemental
Elemental
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Parenteral
Kalori (Glukosa/Lipid)
Asam amino (EAA / BCAA)
Elektrolit
Trace – element
Vitamin
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Gangguan keseimbangan cairan & elektrolit
Infus NACL 0,9 %/3%
Infus Ringer lactate
Natrium
Kalium
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Daya tahan tubuh Immuno
Orginine
Omega 3
Paracetamol
Salazepyrine/mesalozine colitis
Antispasmodic mebeverine
Chenodeoxylate
Ursodeoxycilic
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Infeksi Antibiotik
Cepalosforin (generasi 1 s/d 4)
Aminoglikosid
Guinolone
Anaerobisid
Metronidazole
Educated Guess
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Anemia (perdarahan/pembentukan kurang)
H2 histamine receptor antagonists (Ranitidine)
Sucralflate (mucosal protection)
Proton-pump inhibitors (omeprazale, Lansoprazole)
Misoprostal (mucosal protective cegah ulcer pada pemakaian NSAID)
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Eradikasi Helicopted pylori
Amoxycillin, metronidazole, omeprazole
Clarithromycin, tinidazole, omeprazole
Somatostatin/octreotide
Preparat besi
Transfusi
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Cox-2 inhibitor analgetik yang tidak begitu berbahaya terhadap gaster
Salazopyrine / mesalazine kolitis
Chemodeoxylate
Ursodeoxycolic
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LaxativeBulking agents : Methylcellulose
Osmotic laxatives : Lactulose, Mg S04
Fecal Softener : Parafin, gliserin
Stimulat laxative : bisacodyl
Bowel cleansing solutions : Yal, Fosen
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THANKS