GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx

7/24/2019 GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx

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GANGGUAN SALURANCERNA BAGIAN ATAS

M. Hafdz MS, dr.

Patologi Manusia asar



Saluran C!rna Bagian Atas

"U##!r GI Tra$t% ari &ulut'

oro(aring'

laringo(aring'!so(agus'gast!r'duod!nu&

Batas SaluranC!rna Atas'Ba)a*+Lig. Tr!itz "#ada!-ura

duod!no!unalis%



/ral Ca0it1

Cari!s Gingi0itis P!riodontitis A#*t*ous ul$!rs /ral *!r#!s Candidiasis L!u2o#la2ia

› &!ta#lasia

› $!lls #rodu$! 2!ratin

› asso$iat!d )it* to3a$$ous!

S4ua&ous $!ll$ar$ino&a



/ral Ina&&ations andIn(!$tions

Gingi0itis

/ral $andidiasis "t*rus*%

H!r#!s Si&#l!- "$old sor!% Parotitis

Sto&atitis "ina&&ation o( t*! &out*%



Gingi0itis

Etiolog1'› N!gl!$t!d oral *1gi!n!

›

Str!ssMani(!stations› Bl!!ding during toot* 3rus*ing

› Pus

› Loos!ning o( t!!t* "#!ridonitis%› Tr!at&!nt

Pr!0!ntion, !ntal $ar!, d!ntal rins!s,ossing



/ral Candidiasis "T*rus*%

Etiolog1'

› Candidiasis al3i$ans

› I&&unosu##r!ssion Mani(!stations

› 5*it! #at$*!s in oral $a0iti!s

› Tr!at&!nt

N1statin s)is* and s)allo)

A&#*ot!ri$in B



H!r#!s Si&#l!- "Cold Sor!%

Etiolog1'

› H!r#!s si&#l!- I or II

› Str!ss !-a$!r3at!s Mani(!stations

› 6!si$l! (or&ation

› Tr!at&!nt'anti0irals

7o0ira-



Parotitis

Etiolog1'

› Sta#*, Str!#,0irus

Mani(!stations› Pain in gland8!ar

› La$2 o( sali0a

› Tr!at&!nt

Anti3ioti$s, analg!ti$ Mout*)as*!s



Sto&atitis"Ina&&ation o( t*! Mout*%

Etiolog1'› Sid! !9!$t o( $*!&ot*!ra#1› Trau&a

› #at*og!ns Mani(!stations

› E-$!ssi0! sali0ation› Halitosis›

Sor! &out*› Tr!at&!nt R!&o0! $aus! Soot*ing &out* )as* solutions Bl!nd di!t



/ral Can$!r

Co&&on sit!s

› Lo)!r li#

› Lat!ral 3ord!r o( tongu!› Bu$$al &u$osa

› Etiolog1

To3a$$o us!

C*roni$ irritation U6 lig*t'Can$!r o( t*! li#



Mani(!stations o( /ralCan$!r

L!u2o#la2ia:;S&o2!r<s #at$*;

Er1t*ro#la2ia

Sor! t*at do!s not *!al Lat!

› Pain !s#!$iall1 &o0ing a)

› 1s#*agia› Can$!r o( t*! li#'induration

› Pain in tongu! )*!n !ating



isord!rs o( t*! Eso#*agus

Food

Upperesophagealsphincterrelaxes

Mout

hPharynx

Foodmovesintoesophagus

Loweresophagealsphincter(LES) relaxes

Stomach



ormal

Esophagu

s



is!as!s o( t*! Eso#*agus

Can #r!s!nt)it*› d1s#*agia

› #ain

› 3l!!ding

A$*alasia› s#as& o( t*!

lo)!r!so#*ag!als#*in$t!r

Hiatal *!rnia› #rotrusion o(sto&a$* t*roug*!so#*ag!al*iatus



A$*alasia

In$o&#l!t! r!la-ation o( LES "r!sting#r!ssur! =>?&& Hg%

!tiolog1› idio#at*i$ ' &ost $o&&on

› C*agas dis!as! ' Latin A&!ri$a

› s!$ondar1 to $an$!r "!so#*agus, sto&a$*%



@ ?? T*o&son ' 5ads)ort*

Hiatal Hernia



R!!- Eso#*agitis Barr!ttM!ta#lasia

R!!- o( gastri$ a$id In a3out D? o( #ati!nts, d!0!lo#s into Barr!tt &!ta#lasia

› s4ua&ous $!lls d!0!lo# into a$id's!$r!ting gastri$ !#it*!liu&

› in$r!as!d ris2 (or !so#*ag!al $ar$ino&a



Barr!tt<s Eso#*agus

I. Barr!tt<s !so#*agus F ul$!ration o( #ost!rolat!ral )all

II. Mid!so#*ag!al stri$tur! (ro& *!al!d Barr!tt<s ul$!r

III. Ad!no$ar$ino&a s!$ondar1 to Barr!tt<s !so#*agus



Eso#*agitisI. Earl1 Eso#*agitis

• i9us!nodularit1 o(&u$osal sur(a$!

II. Mod. Eso#*agitis

• T*i$2!n!d (oldsand nodularit1in distal

!so#*agus

III. S!0!r! Eso#*agitis

• i9us!ul$!rations and

stri$tur!



Eso#*agitis

GER "D $aus!%

In(!$tious !so#*agitis

Pill !so#*agitis Causti$ ing!stion

Radiation

S$l!rot*!ra#1



In(!$tious !so#*agitis$lini$al &ani(!stations

/d1no#*agia

1s#*agia

› Solids li4uids !0!r "un$o&&on%

Bl!!ding "un$o&&on%



Eso#*agitis ' diagnosis

Endos$o#1

› In(!$tious

Candida F )*it! #la4u!s H!r#!s F 0!si$l!s

!fniti0! d- 0ia 3io#s1



Candidal !so#*agitis

•Co&&on in

• HI6

• Anti3ioti$s

• C*!&ot*!ra#1

•d1s#*agia• T-+ u$onazol!



HS6 Eso#*agitis

•Co&&on in+

• C*!&ot*!ra#1

• HI6

• T-+ a$1$lo0ir



R!u- !so#*agitis stri$tur!

#izza

•ood i&#a$t!d #ro-i&alto stri$tur!

•Could att!&#t glu$agon



Eso#*ag!al Stri$tur!s

I. Causti$ stri$tur!

• Narro)ing o( 8> o( !so#*agus du! to$austi$ ing!stion 1!ars ago

•

A$$id!ntal in $*ildr!n• Sui$id!

II. Radiation stri$tur!

• S&oot* &id!so#*ag!al stri$tur!



S*ar# o3!$ts› Urg!nt int!r0!ntion

› Caus! int!stinal #!r(oration in DJ'>J

Batt!ri!s› K3utton; 3att!ri!s F urg!nt r!&o0al

7n, Li, Hg F l!a2ag! $aus!s to-i$it1

Eso#*ag!al o3stru$tion(or!ign 3od1 &anag!&!nt



B!ll in !so#*agus



Mallor1'5!iss S1ndro&!

La$!ration

Usuall1 $aus!d 31s!0!r! 0o&iting

Could 3! li(!'t*r!at!ning3l!!ding



Asso$iat!d )it* $irr*osis No s1&#to&s until ru#tur!



Eso#*ag!al Car$ino&a

Aris! (ro&s4ua&ous$ar$ino&a

Ris2 (a$torsar!› to3a$$o us!

› al$o*ol a3us!

T!nds toin0ad! &!tastasiz!!arl1



A$ut! H!&orr*agi$ Gastritis

Un$o&&on

Caus!d 31› as#irin

NSAIs› al$o*ol a3us!

› *!a01 s&o2ing

U##!r

a3do&inal#ain, naus!a,0o&iting



Str!ss Ul$!rs

Su#!rf$ial d!(!$ts

Asso$iat!d )it*

str!ss(ul$onditions

› trau&a

› 3rain inur1

› al$o*ol a3us!

Call!d !rosions



P!#ti$ Ul$!r is!as!

Erosion

› su#!rf$ial to &us$ularis &u$osa

›no s$arring

Ul$!r

› #!n!trat!s &us$ularis &u$osa

› s$arring



PU ' !tiolog1

Duodenal Gastric

H. pylori 90% 60%

NSAIDs 7% 35%

Stress-induced <3% <5%

Zollinger-Ellison <1% <1%



PU H. pylori

Gra& n!gati0! rod

Li0!s in u##!r GI tra$t 3!t)!!n !#it*!lial

sur(a$! and &u$us (!$al'oral trans&ission

In$r!as!s ris2 o( gastri$ $an$!r

Al&ost all non'NSAI ul$!rs ar! du! to

H.#1lori "J duod!nal, gastri$ as#!r Ros!n%

-+ s!rolog1, 3io#s1, CD 3r!at* t!st

› Not #ra$ti$al (or !&!rg!n$1 &!di$in!



PU NSAIs

ir!$t !9!$t› i9us! into &u$osal $!lls

› B!$o&! tra##!d and dir!$tl1 da&ag! $!ll In*i3ition o( #rostaglandin s!$r!tion R!du$!d &u$us #rodu$tion R!du$!d $!ll turno0!r

Indir!$t !9!$t› S1st!&i$ in*i3ition o( C/O d!$r!as!s#rodu$tion o( #rot!$ti0! #rostaglandins



PU F H- and P-

A3do&inal #ain "%

› G!n!rall1 !#igastri$

›Usuall1 )orst ' *ours a(t!r &!al

› /(t!n 3!t)!!n '>AM "HCl s!$r!tion*ig*!st%

› R!li!0!d )it* anta$ids

uod!nal ul$!r› Pain )orst 3!(or! &!al

› R!li!0!d 31 &!al



P!#ti$ Ul$!rs

!!#, solitar1 d!(!$ts Mostl1 $aus!d 31 H.

pylori A3out ? o$$ur in

duod!nu& ? in

sto&a$* Asso$iat!d )it* $*roni$

gastritis, $igar!tt!s&o2ing, long't!r&us! o( NSAIs, al$o*ol

Can 3! a9!$t!d 31› str!ss› #!rsonalit1› (a&il1 *istor1



Usuall1 as1&#to&ati$ !-$!#t (or #ainuntil *!&orr*ag! or #!r(oration d!0!lo#s



uod!nal Ul$!r

•Not! (r!s* 3l!!ding at!dg!

•=? H.#1lori

•NSAIS



Gastri$ Ul$!r•Cl!an, )!ll d!&ar$at!d,3!nign loo2ing

•All s*ould 3! 3io#si!d as*ig* ris2 o( $an$!r



Sto&a$* Ul$!r

•U##!r GI )it* 3ariu& $ontrast

•Arro) ul$!ration



Gastri$ Car$ino&a

J ar!ad!no$ar$ino&as

5orld)id! as d!adl1as lung $an$!r

Ris2 (a$tors› H. pylori $*roni$

atro#*i$ gastritis› di!t *ig* in s&o2!d,

#i$2l!d, or salt'#r!s!r0!d (ood

›

di!t lo) in (r!s* (ruit 0!g!ta3l!s Usuall1 as1&#to&ati$

until ad0an$!d

C it l A li



Cong!nital Ano&ali!s

Gastros$*isis

/&#*alo$!l

!

U&3ili$alH!rnia



6as$ular is!as!s

Is$*!&ia du! to

› at*!ros$l!rosis

› !&3olis&

›0as$ulitis

› 0ol0ulus

› s*o$2

› CH

› MI



iarr*!al is!as!s

Ma1 !-#!ri!n$!d!*1dration

Irrita3l! 3o)!ls1ndro&!› (un$tional

› a3do&inal #ain, 3loating 6iral 3a$t!rial

!nt!ro$olitis› !it*!r u#s!t o( nor&al

ora or introdu$tion o(#at*og!n

›rota0irus› Nor)al2 0irus

Protozoal in(!$tions› a&!3i$ d1s!nt!r1› giardiasis



N!$rotizing Ent!ro$olitis

=== Un2no)n

$aus! Earl1 (!!ding

)it* non3r!ast&il2 inta2!

M!l!na'*!&atos$*!zia

Ina&&ator1 Bo)!l



Ina&&ator1 Bo)!lis!as!

E#isodi$ 3lood1 diarr*!a

Autoi&&un! !tiolog1

G!n!ti$ inu!n$!

In0ol0!&!nt o( !-traint!stinal tissu!s



Ada 1ang &au nan1aQ

GANGGUAN SALURAN CERNA BAGIAN ATAS.pptx

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