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    Stress Ulcer Ditinjau Dari Aspek Patofisiologi Dan Treatment

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    Jufri Nst
    This document discusses stress ulcer from a pathophysiological and treatment perspective. It outlines the risk factors for developing stress ulcers, including mechanical ventilation over 48 hours, coagulopathy, renal failure, hypoperfusion from sepsis or shock, high-dose corticosteroids, brain/spinal cord injuries, and significant burns. It recommends prophylaxis for those with acute risk factors using H2 blockers, sucralfate, or PPIs. For bleeding stress ulcers, it recommends endoscopic therapies or medical treatment to maintain pH above 6 using PPIs. The conclusion emphasizes understanding the pathophysiology of stress-related mucosal disease and using acid suppressants can help prevent bleeding and guide management of

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    Stress Ulcer Ditinjau Dari Aspek Patofisiologi Dan Treatment

    Uploaded by

    Jufri Nst
    186 views16 pages
    This document discusses stress ulcer from a pathophysiological and treatment perspective. It outlines the risk factors for developing stress ulcers, including mechanical ventilation over 48 hours, coagulopathy, renal failure, hypoperfusion from sepsis or shock, high-dose corticosteroids, brain/spinal cord injuries, and significant burns. It recommends prophylaxis for those with acute risk factors using H2 blockers, sucralfate, or PPIs. For bleeding stress ulcers, it recommends endoscopic therapies or medical treatment to maintain pH above 6 using PPIs. The conclusion emphasizes understanding the pathophysiology of stress-related mucosal disease and using acid suppressants can help prevent bleeding and guide management of

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    Stress Ulcer

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    This document discusses stress ulcer from a pathophysiological and treatment perspective. It outlines the risk factors for developing stress ulcers, including mechanical ventilation over 48 hours, coagulopathy, renal failure, hypoperfusion from sepsis or shock, high-dose corticosteroids, brain/spinal cord injuries, and significant burns. It recommends prophylaxis for those with acute risk factors using H2 blockers, sucralfate, or PPIs. For bleeding stress ulcers, it recommends endoscopic therapies or medical treatment to maintain pH above 6 using PPIs. The conclusion emphasizes understanding the pathophysiology of stress-related mucosal disease and using acid suppressants can help prevent bleeding and guide management of

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    186 views16 pages

    Stress Ulcer Ditinjau Dari Aspek Patofisiologi Dan Treatment

    Uploaded by

    Jufri Nst
    This document discusses stress ulcer from a pathophysiological and treatment perspective. It outlines the risk factors for developing stress ulcers, including mechanical ventilation over 48 hours, coagulopathy, renal failure, hypoperfusion from sepsis or shock, high-dose corticosteroids, brain/spinal cord injuries, and significant burns. It recommends prophylaxis for those with acute risk factors using H2 blockers, sucralfate, or PPIs. For bleeding stress ulcers, it recommends endoscopic therapies or medical treatment to maintain pH above 6 using PPIs. The conclusion emphasizes understanding the pathophysiology of stress-related mucosal disease and using acid suppressants can help prevent bleeding and guide management of

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 16

    STRESS ULCER DITINJAU

    DARI ASPEK PATOFISIOLOGI


    DAN TREATMENT

    1895LEPINESTROKE
    1955DOIG & SHAFARSTROKE

    PSMBA

    PENYAKIT KRITIS STRESS ULCER


    STRESS ULCER / SRMD (STRESS RELATED

    MUCOSAL DISEASE)

    STRESOR

    KELAINAN MUKOSA AKUT


    PADA LAMBUNG

    FISIK, KIMIA, PSIKIS, TRAUMA BERAT &


    PENYAKIT BERAT

    DEFENISI

    TUKAK STRES / STRESS ULCER


    (SRMD)

    KERUSAKAN MUKOSA LAMBUNG AKUT


    AKIBAT PADA PENDERITA CRITICAL ILL / ICU

    SRMD

    STRESS RELATED INJURY


    DIFFUSE, SUPERFICIAL MUCOSAL
    DAMAGE
    STRESS ULCER DEEP FOCAL
    PENETRATE SUB MUCOSAL

    EPIDEMOLOGI
    KEMUNGKINAN (24 JAM I ) DI ICU + 75 % - 100 %
    2 % - 6 % PENDERITA DI ICU (CRITICAL ILL)

    ETIOLOGI
    MULTIFAKTORIAL & BELUM SELURUHNYA
    DAPAT DITERANGKAN.

    ISCHEMIA REPERFUSIONRUSAK FAKTOR DEFENSES

    MUCOSAL INJURY & ULCERATION

    FACTOR SRMD :
    BLOOD FLOW MICROCIRCULATION
    MUCOSAL ISCHEMIA ELIMINASI H+, OX RAD
    HYPOPERFUSION NO OX RAD
    REPERFUSION INJURY CELL DEATH, INFLAM,
    DISMOTILITY

    PATOFISIOLOGI
    - DIKTUM SCHWARTZ 1910 : NO ACID NO ULCER
    - ERA THN 80 TEORI KESEIMBANGAN
    FAKTOR DEFENSIF DAN AGRESIF

    FAKTOR AGRESIF

    FAKTOR DEFENSIF

    - ASAM LAMBUNG

    - ALIRAN DARAH MUKOSA


    (MIKROSIRKULASI)

    - PEPSIN

    - SEL EPITEL PERMUKAAN

    - REFLUKS C.EMPEDU
    - NIKOTIN
    - ALKOHOL
    - NSAID
    - KORTIKOSTEROID
    -

    HELIKOBACTER PYLORI

    - PROSTAGLANDIN
    - FOSFOLIPID/SURFACTANS
    - MUCIN
    - BIKARBONAT
    - MOTILITAS

    EMOTIONAL MOTOR SYSTEM (EMS) PATHWAYS


    LIFE
    EVENTS

    STRESS
    EXTEROCEP
    TIVE

    al
    n
    re
    Ad

    AUTONOMIC
    RESPONSE

    in e

    VIGILANCE
    AROUSAL

    EMOTIONAL
    FEELINGS

    EMS

    STRESS
    INTEROCEP
    TIVE

    Co
    rtis

    SENSORY
    MODULATION

    ol

    NEUROENDO
    CRINE
    RESPONSE

    GI PATHOPHYSIOLOGY
    SYMPTOMS

    es
    n
    ki
    o
    t
    Cy

    RISK FACTOR FOR STRESS ULCER


    ACUTE :

    MECHANICAL VENTILATION ( > 48 hours)


    COAGULOPATHY
    RENAL FAILURE
    HYPOPERFUSION ( SEPSIS, SHOCK)
    HIGH-DOSE CORTICOSTEROID (> 250 mg/day )
    BRAIN / SPINAL CORD INJURY
    SIGNIFICANT BURN INJURY (> 35 %)

    POTENTIAL:
    CONCOMITANT NSAID
    CONCOMITANT CORTICOSTEROID
    HISTORY GASTRIC BLEEDING, PEPTIC ULCER,

    STRESS ULCER PROPHYLAXIS


    Consider stress
    ulcer prophylaxis

    Are any acute risk


    factors present ?

    Yes
    No

    No therapy Indicated

    Yes

    Is patient on home
    proton pump inhibitor
    therapy ?

    No
    Initiate enteral or Parenteral
    H2 blocker therapy
    or surcralfate

    Yes

    Initiate enteral or Parenteral


    Proton pump inhibitor
    No
    Is patient tolerating
    H2 RA therapy ?

    RECOMMENDATION :
    LEVEL 1

    ACUTE RISK FACTORS (+) H2RA


    (ORAL / IV)
    ACUTE RISK FACTORS (-) H2RA
    (STOP)

    LEVEL 2

    ACUTE RISK FACTORS (+)


    ALTERNATIF H2RA & SUCRALFATE
    BILA H2RA & SUCRALFATE X
    PPI

    LEVEL 3

    POTENTIAL RISK FACTORS H2RA


    (ORAL / IV)

    TREATMENT FOR BLEEDING


    STRESS ULCER
    ENDOSCOPIC THERAPEUTIC
    THERMAL COAGULATION
    MULTIPOLAR ELECTROCOAGULATION,
    HEATER PROBE, LASER THERAPY, CLIPPING
    INJECTION THERAPY
    EPINEPHRINE, ALCOHOL
    COMBINATION THERAPY ; THERMAL COAGULATION
    AND INJECTION

    MEDICAL TREATMENT
    - MAINTAIN pH > 6 ( 3 - 4 days )
    - PPI (OMEPRAZOLE,PANTOPRAZOLE :80mg IV BOLUS
    CONTINUOUS INFUSION OF 8 mg/h

    KESIMPULAN
    PEMAHAMAN PATOFISIOLOGI DARI
    STRESS RELATED MUCOSAL DISEASE ,
    DAN PENDARAHAN SALURAN CERNA
    ATAS
    DAN
    PENGGUNAAN
    OBAT
    PENEKAN
    SEKRESI
    ASAM
    UNTUK
    MENCEGAH PERDARAHAN, MEMBERI
    PEGANGAN
    PENATALAKSANAAN
    PENDERITA
    GAWAT
    DARURAT
    /
    CRITICALLY ILL DI ICU.

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