Muntah Dan Kembung Pada Bayi Dan Anak

7/28/2019 Muntah Dan Kembung Pada Bayi Dan Anak

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Muntah dan KembungPada Bayi dan Anak

( Pendekatan Klinis )

Kustiyo Gunawan

FK Unair Surabaya


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Bilious Vomiting in the Newborn: How Often Is It Pathologic?By Prasad Godbole and Mark D. Stringer

Leeds, EnglandJ Pediatr Surg 37:909-911. Copyright 2002, Elsevier Science

(USA).

Conclusions:These data emphasize the maxim that bilious

vomiting in the newborn should be attributed to intestinal

obstruction until proved otherwise. However, in this prospective

audit, bilious vomiting was not caused by intestinalobstruction in 62% of cases, and most of these infants suffered

no further sequelae.

Intest inal malrot at ion must be excluded

specifically.


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Vomiting, Regurgitation, Rumination

Vomiting : Keluarnya isi lambung/usus dari mulut secara

sadar disertai kontraksi dinding abdomen

Regurgitation: Keluarnya makanan tanpa tenaga, biasanyaberasal dari esofagus (pseudovomiting)

Rumination : Secara sadar dan otomatis membawa makanan

ke mulut dikunyahditelandibawa ulang ke

mulut


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Kausa Mutah

Iritasi ujung saraf di peritoneum Obstruksi organ berrongga

atau mesenterium (intestine, ren, ureter, uterin canal,

vermiform appendix)

Gangrenous appendix Peristaltic contractionAcute Pancreatitis

Strangulation

Torsion of the pedicle of an ovarian cyst Stretching of the muscular

wall/spasm

Pain (colic)

Vomiting (occurs at the height

of the spasm)


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Relationship of Vomiting

Pain Frequency of Character of Nausea & loss of Others

The Vomiting The Vomiting Appetite symptoms

(no vomit)

Vomiting Directly with Duod. atr

Comming acuteness Delayed

after pain (appendicitis, H P S passages

(appendicitis) pancreatitis) of meconium

Int. obstr

Vomiting early, obstr.of the same st imulus

Sudden & violent colon no vomit dif ferent grade

(acute obst.ureter if vomit,

/Bile duct) incomp. IC valve

Vomiting after pain, Acute loss of Nausea Vomiting

depend on how high appetite &

of intestinal obst. pain

(appendicitis)


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Vomiting (Prompt Dx and Tx)

Abdominal Not Surgical indoubt indefinite

Emergencies symptoms

Extra GI origin GI origin

(inf.of the gut) Discuss

Bilious Psychogenic w a i t (discuss)CT,US

Persistent Infectious pathology

Acute loss of appetite Neuromeningeal inf

Blood Metabolic pathology improve not improve judge

Pain Intoxication

observes

Urgent need operation

Delayed Transfer correct diagnosis

Short gut survive

syndrome urgent need for operation


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Importance of evaluating for cow's milk allergy in pediatricsurgical patients with functional bowel symptoms

Kayo Ikedaa, Shinobu Idaa, Hisayoshi Kawaharab,., 1, Koji Kawamotoa,

Yuri Etania, Akio Kubotab

Journal of Pediatric Surgery (2011) 46, 23322335

Conclusions: A high index of suspicion regarding

the possibility of concurrent CMA

may be necessary to manage bowel

symptoms in pediatric surgicalpatients.


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I L E U SIntestinal dilatation, Hypersecretion, bacterial overgrowth

Mechanical obstruction Non mechanical obstruction

(extrinsic/intrinsic) (GI paralysis, pseudo-obstruction)

Acute/Chronis Partial/Complete Simple / Closed loop

(Traps the bowel mesentery)

Intraabdominal adhesion Blood supply compromise

Stricture

Tumor Ischemia

Congenital

Necrosis

Perforation

S t r a n g u l a t i o n

Hernia, adhesion, volvulus


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HISTORY AND CLINICAL SETTINGCC: Acute obstipation, Abdominal pain, Distention, Nausea, Vomiting

Mechanical obstruction PseudoobstructionPain location : Middle of the abdomen Diffuse of the abdomen

Pain severity : Severe Mild

Pain character : Increase severity Increase severity

and depth overtime and depth overtime

Pain decrease (fatique)

Proximal Int. Obst. : Short periodically 3 4Periodicity of Pain

Distal small /large bowel: 15 - 20

Pain Abdominal distention_____________________________

Nausea, vomiting, cramping

Sudden Progressive partial


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CAUSE AND TYPE OF BOWEL OBSTRUCTION

In Hospital

Medical History Medical History & Courses

Previous episodes of Medication:

Bowel obst: anticoagulants

etiology ?

chemotherapyresponse of Tx ? Metabolic

Previous of abd/pelvic Abdominal radiation

Operation: Severe infection

Operative report Fluid & elect imbalance

History of malignancy Narcotic recurrence ? Intraabd. inflammation

History of intraabdominal

inflammation

@ A b d o m i n a l D i s t e n t i o n


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A b d o m i n a l P a i n

Abdominal Distention, Nausea, Vomiting

Gradual change in bowel Developing many Minimal crampy abd. In hospital

Habit weeks Nausea

Progressive abdominal Vomiting

DistentionMild /crampy pain after Longstanding intermittent

Meals mechanical obstruction

Weight loss

Chronic Partial Mechanical Chronic process/ Chronic Intestinal Gastric atony

Bowel Obstruction Progressive Partial Pseudo Obstruction Smallbowel Ileus

Bowel Obstruction (CIPO) Acute Colonic

Last flatus Pseudoobstr.

Partial @ Complete


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Cows milk protein allergy presenting with Hirschsprungsdiseasemimicking symptomsAkio Kubotaa,*, Hisayoshi Kawaharaa, Hiroomi Okuyamaa, Yoshiyuki Shimizua,

Mariko Nakachob, Shinobu Idab, Masahiro Nakayamac, Akira Okadaa

Journal of Pediatric Surgery (2006) 41, 2056 2058

Conclusion: The proportion of CMA in the cases presenting with

HD-like symptoms in the neonatal period is much

higher than what we expected, and most cases of

BTNIN (benign transient nonorganic ileus of Neonates) are

caused by CMA. If HD is ruled out, CMA

should be considered.


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Whole intestinal pattern on plain abdominal x-

ray. Both the colon and small intestine are

markedly dilated. A few air-fluid levels are

observed.

Contrast enema. The size of the rectum and colon

is normal, and no caliber change is observed, but

the rectum and ascending colon demonstrate

irregularity of the wall.


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PHYSICAL EXAMINATION AND RESUSCITATION

Sense of the Px illness INITIAL STEP Assessing the Px vital sign,

& course hydration status, CP system

Volume ? Clear

NG Tube Bilious non feculent

Physical Examination Character - Prox. SBO

-Colonic obst+comp. IC valve

Volume Feculent

Urine -Distal SBO

Character

IV line: water & electrolyte replacement


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Degree of distention: Prox little/no distention

Scar

O b s e r v a t i o n Malignancy

Asymetri AbscessClosed loop

Peristaltic waves: acute SBO

High pitch + rush + crumpy pain: Obstructive process

A u s c u l t a t i o n Bowel sound Intestinal paralysis

Intestinal fatique Longstanding

obstruction

Closed loop

obstruction

Guarding

P a l p a t i o n Rebound tenderness Strangulation

Localized tenderness

P e r c u s s i o n Dullnessmass

Tympani distended bowel

Rectum : Mass ? Fecal impaction ? Occult blood ?

T o u c h e r

Ileostomy : Exam stoma ( obstruction at the level of the stoma )


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K e s i m p u l a n:

Tidak ada pemeriksaan tambahan sebelum pertimbangan klinis

Anamnesis dan pemeriksaan fisik harus terstrukturDiagnosis dan penangana dini

Keterlambatan : kematian / sequele

Muntah Dan Kembung Pada Bayi Dan Anak

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