PATOFISIOLOGI SISTEM

DIGESTIVE
BY :
AGUSLINA KIRTISHANTI
ABNORMALITIES OF THE ESOPHAGUS

1. DYSPHAGIA
Difficulty swallowing that may be caused by
obstruction of the esophagus or impaired
motility of the esophageal walls.
Obstruction may be caused by tumors,
congenital narrowing or diverticula
Neurologic disorders such as brain injury,
stroke or Parkinsons disease may affect
voluntary swallowing or peritalsis of the
esophagus
2. Achalasia

A condition caused by failure of the lower esophageal

sphincter (cardiac sphincter) to relax and allow food to
enter the stomach. It may be related to defects in neural
input to the esophagus.
Achalasia is a chronic condition that causes distention of
the lower esophagus that may lead to chronic inflammation
and eventual ulceration of the esophagus.
The condition presents with dysphagia, vomiting and chest
pain that is often exacerbated by eating.
3. Esophageal diverticulum

Diverticula are outpocketings of the esophageal

walls that occur most frequently from congenital
weakness of the esophagus walls.
Food can easily become trapped in these
divertucula, leading to inflammation and infection
of the esophagus with possible ulceration.
4. Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux is a condition caused by the

backflow of stomach contents into the esophagus.
It results from weakness or incompetence of the lower
esophageal sphincter that normally blocks reflux of
stomach contents into the esophagus.
It will cause irritation and inflammation of the
esophagus (esophagitis) that can lead to ulceration of
the esophagus
A hiatal hernia may also cause gastroesophageal
reflux.
Manifestations GERD
Heartburn that may be worsened by alcohol
consumption, caffeine, smoking, exercise and
obesity.
Esophagitis
Dysphagia, poor nutrition
Possible increased risk of esophageal cancer with
chronic esophagitis.
Treatment GERD
Consumption of frequent small meals rather than
large ones.
Sleeping with head elevated.
Comsumption of fluids with meals to wash food out
of the esophagus.
Use of antacids or proton pump inhibitors to reduce
pH of stomach contents.
Surgery if a hital hernia is present.
Hernia hiatus adalah : bentuk anatomi
abnormal lambung yang menekan diafragma
dan masuk ke dalam rongga dada.
Hernia hiatus dapat berkembang dan
memburuk pada keadaan hamil, obese, dan
penuaan (> 40 th).
Etiology of hiatal hernia :
1. Congenital abnormality
2. Trauma
3. Surgery
Sign and symptoms :
1. Heartburn
2. Sour or bitter taste in mouth
3. Belching
4. Coughng up of bloody mucus may occur when
the esophagus become irritated
5. Fullness in the upper abdomen after a meal
6. Dysphagia
7. A hourse voice
Ada 2 tipe hernia hiatus yaitu :
1. Sliding hiatal hernia
2. Rolling hiatal hernia (Paraesophageal
hernia)
 LAMBUNG
Lapisan mukosa lambung terdiri dari
beberapa kelenjar yaitu :
1. Kelenjar kardia
2. Kelenjar fundus/gastrik, terdiri dari 3 tipe
sel yaitu : sel zimogenik/chief cell, sel
parietal, sel leher.
3. Sel G menghasilkan hormon gastrin
Pengaturan Sekresi Lambung
Pengaturan sekresi lambung terbagi menjadi 3 fase yaitu
1. Fase sefalik
2. Fase gastrik
3. Fase intestinal
 Disorders of the stomach

GASTRITIS
Gastritis refers to inflammation of the gastric
mucosa
It may present as an acute or chronic disorder
 ACUTE GASTRITIS

Transient irritation and inflammation of the stomach

lining.
May be caused by factors such as alcohol
consumption, aspirin use and stress.
The inflammation associated with acute gastritis is a
self-limiting process that does not usually result in
long-term injury to the gastric mucosa.
Lanjutan gastritis akut

Tanda yang dpt terlihat pada mukosa lambung

adalah : mukosa memerah, edematosa, mukus
yang melekat, erosi kecil dan perdarahan sering
muncul.

Manifestasi klinis : anoreksia, mual & muntah, nyeri

epigastrium, perdarahan dan hematemesis.
 Chronic Gastritis

Chronic irritation and inflammation of the stomach

lining.
May be caused by bacterial infection, alcohol abuse
or long term aspirin and nonsteroidal anti
inflammatory drug (NSAID) use.
Can lead to atrophy and ulceration of the gastric
mucosa.
 The term peptic ulcer refers to erosion of the
mucosa lining any portion of the G.I tract. If
the ulcer occurs in the stomach lining, it is
specifically referred to as a gastric ulcer.
The causes of peptic ulcers disease :
1. Infection with the bacteria Helicobacter
pylori (80-90% patients)
2. Stress : emotional, trauma, surgical
3. Injury or death of mucus-producing cells
4. Excess acid production in the stomach. The
hormone gastrin stimulates the production of
acid in the stomach.
5. Chronic use of aspirins and NSAIDs
 PATOGENESIS TUKAK PEPTIK
NSAID, H.pylori, rokok

Penghancuran epitel sawar

Asam kembali berdifusi ke mukosa

Penghancuran sel mukosa

Sekresi PG dan histamin Perangsangan Peningkatan asam/pepsin

kolinergik

Ulcer
 Episodes or remission and exacerbation
Pain that for duodenal ulcers is often
relieved by eating or antacids
G.I bleeding and possible hemorhage (20-25%
of patients)
Perforation of ulcers with significant
mortalilty
Obstruction of G.I tract
PEPTIC ULCER
 Avoidance of alcohol, smoking and NSAIDs
Antibiotic therapy
Antacids
H2 antagonists
Mucosal protectants
Disorder of the Intestines
Irritable bowel syndrome
May be one of the most common G.I disorders
Patients present with symptoms of G.I pain, gas, bloating
and altered bowel function (diarrhea or constipation).
Most symptoms are localized to the lower intestine and
colon.
Irritable bowel syndrome.
No underlying pathophysiologic processes have yet to
be identified in these patients. Hiperreactivity and
excessive motility of the bowels may be contributing
factors.
Emotional factors and diet may exacerbate the
symptoms.
Treatment may include psychological counseling,
dietary changes such as increased fiber consumption.
Antidiarrhea, anticholinergic and antispasmodic agents
might also be of value.
Symptoms IBS :

1. Abdominal pain : the pain can occur anywhere in the

abdomen. When pain occurs in the upper abdomen, it
can be confused with peptic ulcer or gall bladder pain.
The pain can vary from person to person.
2. Bloating
3. Bowel habit : diarrhoea and constipation may occur.
There may be a feeling of incomplete emptying after a
bowel movement and may be mucus present.
4. Nausea (sometimes), vomiting (less common)
Gallstone formation (cholelithiasis)
Cholelithiasis is the most common disorder of
the G.I system.
The gallstones that form in the gall bladder
are hardened precipitates of bile that
contain predominantly cholesterol.
The size of gallstones can range from the
size of a grain of sand to several inches in
diameter.
 Factors such as aging, excess cholesterol,
obesity, sudden dietary changes or abnormal
fat metabolism may contribute to gallstone
formation.
Gallstones may be detected by a number of
techniques including radiography,
ultrasonography and cholecystoscopy.
 Symptoms of gallstone formation will
generally not occur until the stones have
reached sufficient size to block the bile
ducts.
Acute and severe abdominal pain.
Nausea, vomiting, fever, chills.
Jaundice from obstruction of bile outflow.
 Surgical removal of gall bladder
(cholecystectomy)
Endoscopic removal of gallstones
Lithotripsy : the use of sound waves to break
up the gallstones in the gall bladder.
Low fat diet for prevention of additional
stone formation
 Cholecystitis is an acute or chronic
inflammation of the gall bladder.
Caused of cholecystitis :
1. Presense of gallstones in the gall bladder
2. Infection
3. Reduced blood flow to the gall bladder
Signs and symptoms are similar to those
observed with cholelithiasis.
Treatment involves removal of gallstones
and antibiotics for treatment of infection if
present.
 Diverticular disease is a condition
characterized by the presence of diverticula,
which are multiple saclike protrusions of the
mucosa.
Individuals who consume a low fiber, low
bulk diet also appear at greater risk for the
formation of diverticula
 Often asymptomatic
Changes in bowel habits
Excess flatulence
A possible serious complication of
diverticular disease is infection or
inflammation of the diverticula
(diverticulitis) due to trapping of intestinal
contents and accumulation of intestinal
contents in the diverticula.
 Increased bulk and fiber in the diet
Antibiotics if diverticulitis is present
 HEMOROID
Hemoroid atau wasir merupakan vena
varikosa pada anus.
Hemoroid timbul akibat kongesti vena yang
disebabkan gangguan aliran balik dari
vena hemoroidalis.
Ada 2 jenis hemoroid :
1. Hemoroid internal
2. Hemoroid eksternal
HEMOROID

Etiologi : konstipasi, diare, kongesti pelvis pada

kehamilan, pembesaran prostat, tumor rektum.
Hemoroid eksternal diklasifikasikan dalam bentuk akut
dan kronik.
Hemoroid eksternal akut merupakan hematoma (hemoroid
trombosis akut) dengan manifestasi nyeri, gatal, sensasi
terbakar dan bengkak.
Hemoroid eksterna kronis berupa satu atau lebih lipatan
kulit anus yang terdiri dari jaringan penyambung dan
sedikit pembuluh darah.
Lanjutan

Hemoroid internal diklasifikasikan dalam :

Derajat I : tidak menonjol mll anus dan tidak
menimbulkan gejala.
Derajat II : dapat mengalami prolapsus mll anus stl
defekasi, jenis ini dpt mengecil scr spontan atau
direduksi scr manual.
Derajat III : mengalami prolapsus scr permanen

Gejala hemoroid internal : perdarahan tanpa nyeri

karena tidak ada serabut pada daerah itu.
 TERAPI HEMOROID

1. Kompres duduk panas

2. Analgesik (suppositoria), topical
steroid, local anaesthetics,counter
irritants.
3. Pembedahan (perdarahan menetap,
prolapsus, nyeri anus yang tidak
dapat diatasi).
HEMORRHOID
 JAUNDICE/IKTERUS
Penimbunan pigmen empedu dalam tubuh
menyebabkan warna kuning pada jaringan
yang dikenal sebagai ikterus.

Warna kuning dapat terlihat pada : sklera,

kulit atau kemih yang menjadi gelap bila
bilirubin serum mencapai 2-3 mg/100 ml.

Bilirubin serum normal : 0,2-0,9 mg/100 ml.

 IKTERUS
4 Mekanisme umum terjadinya ikterus yaitu :
1. Pembentukan bilirubin secara berlebihan
2. Gangguan pengambilan bilirubin tak
terkonjugasi oleh hati
3. Gangguan konjugasi bilirubin
4. Penurunan ekskresi bilirubin terkonjugasi
dalam empedu karena obstruksi
fungsional maupun mekanik.
 IKTERUS
Etiologi :
1. Viral infection
2. Alcoholism
3. Cancer : hepatocellular carcinoma
4. Gall stones : obstruction of the bile
duct.
 CIRRHOSIS
Cirrhosis is a chronic destruction of liver cells, it occurs
when normal liver cells are damaged and replaced by
scar tissue.
This decreases the amount of normal liver tissue and can
therefore limit blood flow through the liver and restrict
liver cell function.
What causes cirrhosis ?
1. Long term alcohol abuse (most common)
2. Chronic hepatitis
3. Obstruction of the bile duct
4. Certain inherited metabolic disorders (hemochromatosis
and Wilsons disease)
5. Exposure to certain toxins
6. Adverse reaction to certain medications
7. Alpha 1-antitrypsin deficiency
 CIRRHOSIS
What are the symptoms of cirrhosis?
Early symptoms :
Loss of appetite
Nausea and vomiting
Weight loss
Weakness and fatigue
Later symptoms :
Jaundice (yellow skin)
Fluid accumulation/swelling in the abdomen and legs
Bleeding
Gallstone formation
Intense itching
Accumulation of toxins in the brain,resulting in :
unresponsiveness, forgetfulness, poor concentration,
changes in sleeping habits,and coma.
 CIRRHOSIS
How is cirrhosis treated? Scarring of the liver is
irreversible. Therefore, treatment focuses on
preventing further damage to the liver, may include :
Abstinence from alcohol
Dietary modifications
Use of steroids or anti-viral drugs, to reduce liver
damage due to hepatitis.
Medications to treat the symptoms of cirrhosis, i.e :
diuretics to reduce fluid retention and swelling.
If necessary, surgery may be performed to control
any internal bleeding.
In critical cases, liver transplant may be necessary.