Wahyu Damayanti

Sub bag Gastroentero Hepatologi Anak

RSUP dr. Sardjito/FK UGM Yogyakarta
 Vomiting in Children
Vomiting is a symptom, presenting
complaint in multitude of disorders
Range from gastrointestinal pathology to
disease in distant organ (otitis media or
intracranial lesion)
In children, especially infants, must
distinguish from regurgitation
effortless expulsion of gastric contents
Integrated response to noxious stimuli,
coordinated by central nervous system
Patofisiologi
muntah

Fase muntah :
Nausea
Retching
Ekspulsif
 Diagnostic evaluation
Before finding cause of vomiting, in any
child should first
Assess hydration status, attend to life-
threatening complications
Ascertain whether
Bilious suggests gastrointestinal
obstruction
Blood is present diagnosis and
management different
If non-bilious and non-bloody, 2
important variables => temporal pattern
and age of patient
 Duration either
Acute short-term episode, abrupt
onset

Recurrent at least 3 episodes over

3-month period => chronic -
relatively mild episodes that occur
frequently
=> cyclic
recurrent, intense episodes
separated by asymptomatic periods
 Alur pendekatan Muntah:
12
 Investigations for acute vomiting
Thorough examination
Septic workup blood cultures,
urine, FBC, CRP, LP
Upper GI radiology Barium swallow/
meal, AXR, ultrasound abdomen,
endoscopy
Metabolic investigations blood gas,
ammonia, blood and urine organic
acids
 Management
Depends on specific cause
While investigating/ treating underlying
pathology replace lost fluids, maintain
hydration
If mild and child able to drink, can try
oral rehydration. Intravenous may also be
required
Pharmacologic agents not usually
recommended
May mask signs of serious disease
Undesirable side-effects in children
Komplikasi
 Terapi Farmakologis
Golongan Nama obat

Antihistamin Dimenhydrinate
Diphenhydramine
Antagonis dopamine Chlorpromazine
Metoclopramide
Domperidone
Antagonis serotonin Ondansetron
Steroid Dexamethasone
Methyl prednisolone
Kerja terapi farmakologis
 Terapi farmakologis
Antihistamin
Menghambat reseptor H1
Membatasi stimulasi pusat muntah dari sistem vestibuler
yang kaya akan histamin.
Indikasi: motion sickness, vertigo, gangguan vestibuler
(Rekomendasi C)

Antagonis dopamin
Metoclopramide: Efek samping ekstrapiramidal, distonia,
gangguan jantung sebaiknya tidak digunakan pada anak
Domperidone: Tidak ada efek ekstrapiramidal tetapi dapat
menimbulkan gangguan irama jantung penggunaannya
kontroversial
 Terapi farmakologis
Chlorpromazine (CPZ):
Efek antidopaminergik, antikolinergik, dan antihistamin
Golongan antipsikotik
Bahaya: Efek ekstrapiramidal, sedasi, konstipasi, mulut
kering, agranulositosis, gangguan reproduksi, dan aritmia
jantung

Antagonis serotonin selektif : ondansetron

Menghambat kerja serotonin pada reseptor 5-
hydroxytryptamine3 (5-HT3) di usus halus, nervus vagus, dan
CTZ
Aman
 Antiemetik pada gastroenteritis
WHO dan AAP: tidak menganjurkan antiemetik pada
gastroenteritis
Uji acak terkendali: Ondansetron dapat membantu
rehidrasi oral
Cochrane reviews:
Ondansetron menurunkan kejadian muntah selama rehidrasi
oral dan menurunkan jumlah pasien yang membutuhkan
rehidrasi intravena.
Efek samping yang dijumpai adalah diare yang diperkirakan
karena penumpukan toksin yang seharusnya keluar lewat
muntah [Level of evidence/ LoE I, Rekomendasi A]
 Antiemetik pada kemoterapi
Kombinasi antara antagonis 5-HT3 dan kortikosteroid
dianjurkan untuk diberikan pada anak yang akan
menerima kemoterapi yang memiliki risiko tinggi
menimbulkan muntah (high emetic risk
chemotherapy) [LoE III, rekomendasi B]
TERIMA KASIH