Septy Aulia Rahmy

0810710103

1. Mention the definition of dyspepsia

Dispepsia merupakan sensasi rasa sakit atau tidak nyaman pada abdomen bagian atas,
dan seringkali kambuh-kambuhan. Dapat digambarkan sebagai indigestion, gassiness,
early satiety, postprandial fullness, gnawing, atau burning.
Dispepsia merupakan keluhan atau kumpulan gejala yang terdiri dari nyeri atau rasa tidak
nyaman di epigastrium, mual, muntah, kembung, cepat kenyang, rasa perut penuh,
sendawa, regurgitasi dan rasa panas yang menjalar di dada. Sindrom ini dapat pula
disebabkan oleh berbagai penyakit. (Buku ajar ilmu penyakit dalam, FKUI)

2. Mention the causes of dyspepsia

Some Causes of Dyspepsia
Cause Suggestive Findings Diagnostic Approach
Achalasia Slowly progressive dysphagia, Barium swallow
sometimes nocturnal regurgitation Esophageal manometry
of undigested food, chest Endoscopy
discomfort
Cancer (eg, esophageal, Chronic, vague discomfort Upper endoscopy
gastric) Later, dysphagia (esophageal) or
early satiety (gastric)
Weight loss
Coronary ischemia Symptoms described as gas or ECG
indigestion rather than chest pain Serum cardiac markers
by some patients with coronary Sometimes stress testing
ischemia
May have exertional component,
cardiac risk factors
Delayed gastric emptying Nausea, bloating, fullness Scintigraphic test of gastric
(caused by diabetes, viral emptying
illness, drugs)
Drugs (eg, Use apparent on history, symptoms Clinical evaluation
bisphosphonates, coincident with use
erythromycin
and other macrolide
antibiotics, estrogens , iron,
NSAIDs, potassium)
Esophageal spasm Substernal chest pain with or Barium swallow
without dysphagia for liquids and Esophageal manometry
solids
Gastroesophageal reflux Heartburn, sometimes reflux of acid Clinical evaluation
disease or stomach contents into mouth Sometimes endoscopy
Symptoms sometimes triggered by Sometimes 24-h pH testing
lying down
Relief with antacids
Peptic ulcer disease Burning or gnawing pain relieved Upper endoscopy
by food, antacids
 (Buku ajar ilmu penyakit dalam, FKUI)
Penyebab Dispepsia
Esofago-gastro-duodenal Tukak peptik, gastritis kronis, gastritis NSAID, keganasan
Obat-obatan Antiinflamasi non-steroid, teofilin, digitalis, antibiotik
Hepato-bilier Hepatitis, kolesistitis, kolelitiaqsi, keganasan, disfungsi sfingter Odii
Pankreas Pankreatitis, keganasan
Penyakit sistemik lain DM, penyakit tiroid, gagal ginjal, kehamilan, PJK/ iskemik
Gangguan fungsional Dispepsia fungsional, irritable bowel syndrome

3. Mention the red flags in dyspepsia

Red flags: The following findings are of particular concern:
Acute episode with dyspnea, diaphoresis, or tachycardia
Anorexia
Nausea or vomiting
Weight loss
Blood in the stool
Dysphagia or odynophagia
Failure to respond to therapy with H2 blockers or proton pump inhibitors (PPIs)

4. What is the definition of gastritis

Gastritis merupakan inflamasi dari mukosa lambung yang dapat disebabkan oleh beberapa
kondisi, termasuk infeksi (Helicobacter pylori), obat-obatan (NSAIDs, alkohol), stress, dan
fenomena autoimun (atrophic gastritis). Diagnosis dilakukan dengan endoskopi.
Pengobatan langsung pada penyebabnya tetapi kadang termasuk supresi asam.

5. What is the difference between erosive and non erosive gastritis

Erosive gastritis merupakan erosi mukosa lambung disebabkan karena kerusakan pada
pertahanan mukosa. Biasanya akut, bermanifestasi dengan pendarahan, tetapi dapat
menjadi subakutatau kronik dengan sedikit atau tidak ada simptom. Diagnosis didapatkan
melalui endoskopi. Pengobatan berupa pengobatan suportif, yaitu menghilangkan
penyebab. Penyebab dari erosive gastritis termasuk NSAIDs, alkohol, stress dan jarang
radiasi, infeksi virus, vascular injury dan trauma langsung.
Non-erosive gastritis merupakan berbagai macam kelainan histologis yang merupakan
hasil dari infeksi H. Pylory. Kebanyakan pasien asimptomatik. Diagnosis didapat dengan
endoskopi. Terapi dengan eradikasi dari H. Pylori dan kadang supresi dari asam lambung.

6. What is zollinger Ellison syndrome

Merupakan trias yang terdiri dari (1) ulkus peptikum yang membandel, kadang-kadang sangat
berat, dan banyak yang atipik, (2) hiperasiditas lambung yang berlebihan, dan (3) tumor sel-
sel nonbeta pankreas yang mensekresi gastrin, yang mungkin bersifat tunggal atau multipel,
kecil atau besar, jinak atau ganas. (Dorland)

7. Mention the definition of peptic ulcers

Peptic ulcer merupakan erosi pada segment dari mukosa GI, umumnya pada lambung
(gastric ulcer) atau pada beberapa sentimeter pertama dari duodenum (duodenal ulcer),
 yang berpenetrasi melalui mukosa muskularis. Hampir semua ulser disebabkan infeksi oleh
H.pylori atau penggunaan NSAID. Simptom umumnya berupa rasa sakit terbakar pada
epigastrikyang seringkali sembuh dengan makan. Diagnosis didapat melalui endoskopi dan
testing H.pylori. pengobatan berupa supresi asam, eradikasi H.pylori, dan menghindari
NSAIDs.

8. What is the etiology of peptic ulcers

H.pylori dan NSAIDs dapat menggangu pertahanan dan perbaikan mukosa normal,
membuat mukosa lebih peka terhadap acid.
H. pylori infection is present in 50 to 70% of patients with duodenal ulcers. NSAIDs now
account for > 50% of peptic ulcers. Merokok merupakan faktor resiko berkembangnya ulser
dan komplikasinya. Family history exists in 50 to 60% of children with duodenal ulcer.

9. What is the complication of severe peptic ulcers

Perdarahan: Mild to severe hemorrhage is the most common complication of peptic ulcer
disease. Symptoms include hematemesis (vomiting of fresh blood or coffee ground
material); passage of bloody stools (hematochezia) or black tarry stools (melena); and
weakness, orthostasis, syncope, thirst, and sweating caused by blood loss
Perforasi: There is sudden, intense, continuous epigastric pain that spreads rapidly
throughout the abdomen, often becoming prominent in the right lower quadrant and at times
referred to one or both shoulders. The patient usually lies still because even deep breathing
worsens the pain. Palpation of the abdomen is painful, rebound tenderness is prominent,
abdominal muscles are rigid (boardlike), and bowel sounds are diminished or absent.
Shock may ensue, heralded by increased pulse rate and decreased BP and urine output.
Stenosis pilorik/ gastric outlet obstruction: Obstruction may be caused by scarring, spasm,
or inflammation from an ulcer. Symptoms include recurrent, large-volume vomiting,
occurring more frequently at the end of the day and often as late as 6 h after the last meal.
Loss of appetite with persistent bloating or fullness after eating also suggests gastric outlet
obstruction. Prolonged vomiting may cause weight loss, dehydration, and alkalosis.

10. How to treat severe shock due to massive upper GI bleeding due to peptic ulcers
If these signs of hypovolemia are present, the initial management focuses on treating shock
and on improving oxygen delivery to the vital organs. This involves repletion of the
intravascular volume with intravenous infusions or blood transfusions. Supplemental oxygen
also is useful, especially in elderly patients with heart disease