Prepared By : YASIN W, Ns., M.Ked

MALNUTRISI ?

KemiskinanLansiaPecandu narkobaPsikiatrik Rawat inap lama

Primer

Sekunder

Gangguan metabolikKehilangan berlebihanMetabolisme meningkat

MACAM PENYAKIT NUTRISI

Malnutrisi Protein-KaloriAvitaminosisDefisiensi Trace MineralObesitas

Malnutrisi Protein-Kalori

Most frequent and most importantTerdapat 2 bentuk :MarasmusKwashiorkor Patogenesis :HatiMukosa GIHematopoiesis

Kwashiorkor

Deficiency of proteins, terutama protein hewanimost common in Africa - children, who have been weaned too early (arrival of another child) and fed by exclusively carbohydrate dietKwashiorkor lebih berbahaya dibandingkan marasmus Tanda dan gejala :loss of visceral proteins hypoalbuminemia generalized edema, ascitesskin lesions, hair changes, fatty liver, defects of immunity, secondary infections, anemia

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flaking skin , raw skin , fissures

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Marasmus

Deficiency of energy (calories) akibat dari :Kelaparan kronisTanda dan gejala :Gangguan pertumbuhanHilangnya massa ototBadan kurusAnemiaImmune deficiency (imunitas seluler)

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Vitamin

Bahan yang dibutuhkan tubuh dalam jumlah sedikitAvitaminosis Primary (dalam diet)Sekunder (malabsorption, metabolic disorders, liver diseases)Hipervitaminosis merupakan hal bahaya yang dapat meracuni tubuh !!!!!

Vitamin A

Dikenal sebagai retinolImportant for vision (visual pigment) and differentiation of some types of epithelial cells (mucus-secreting)Main sources: liver, fish, milk, eggs, butterProvitamins A- Karotenoids Bersumber pada sayuran (wortel dan bayam)

Avitaminosis Vitamin A

Mata - xerophtalmia, small corneal opaque (squamous keratinizing) plaques (Bitot's spots), keratomalacia -> total blindnessRespiratory tract - squamous metaplasia, pulmonary infectionsUrinary tract - pelvic keratinization -> stonesSkin hyperkeratosis, dermatosis folikularis

Bitots spots

Bitots spots

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Corneal clouding

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Corneal ulceration

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Hipervitaminosis Vitamin A

Peningkatan TIKHepatomegaliMalformasi kongebital pada janin

Vitamin D

Fungsi :Mempertahankan kadar kalsium dan fosfat dalam plasmaPenting untuk perkembangan dan mineralisasi tulangSumber :Endogen : sintesis di kulit dengan bantuan sinar UV melalui 7-dehydrocholesterol - jumlahnya 80% dari kebutuhanExogen : dari diet (ikan laut, tumbuhan, dan biji-bijian)

Organ yang berhubungan dg metabolisme vit D :

UsusGinjalKelenjar parathiroid

7-DEHIDROKOLESTEROL-CHOLECALSIFEROL

25(OH)-D - CALCIDIOL

1,25(OH)2D - CALCITRIOL

ABSORPSI Ca DAN P DI USUS

MATAHARI (ULTRA VIOLET)

MINERALISASI TULANG

D-25 HIDROKSILASE (HATI)

1- HIDROKSILASE (GINJAL)

METABOLISME VIT.D

HIPOKALSEMI

PTH MENINGKAT

AKTIVITAS 1- HIDROKSILASE

MOBILISASI Ca PADA TULANG

EKSKRESI Ca DI GINJAL

AKTIVITAS 1- HIDROKSILASE

CALCITRIOL

KADAR NORMAL VIT.D

PENYEBAB AVITAMINOSIS VIT.D

Penurunan sintesis endogen (paparan sinar matahari tidak adekuat)Penurunan absorpsi (kurang dlm makanan, malabsorption syndrome)Peningkatan degradasi vit.D (drugs:fenitoin)Gangguan sintesis calcidiol dan calsitriol (liver diseases, renal disorders)target resistance (congenital lack of receptors)phosphate depletion (renal tubular disorders, long-term use of antacids)

Akibat Def. Vit D

children - before closing of epiphyses - rickets (rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of the legs)adults - after closing of epiphyses - osteomalacia (impaired remodelation of bone mass, no mineralization of osteoid - microfractures (vertebral bodies, femoral necks)

Hipervitaminosis vit D

HypercalcaemiaMetastatic calcificationUrolithiasis

Vitamin E

Dalam bentuk tokoferolFungsi : Antioksidan

Vitamin K

Dibutuhkan sebagai kofaktor dalam pembentukan faktor pembekuan VII, IX, X

Penyebab avitaminosis:

Fat Malabsorption SyndromesDestruksi endogen vit. K (sintesis flora usus)Periode neonatal (low reserve, no bacterial flora)Penyakit hatiKeadaan iatrogenik (warfarin)

Avitaminosis Vit K

Bleeding diathesis (mis. Perdarahan pada neonatus : intrakranial bleeding, perdarahan kulit ; umbilikus, viseralis, dll)Pada dewasa : hematom, hematuria, melena, ekhimosis, perdarahan gusi, dsb.

Vitamins B

Merupakan coenzymesSumber utama : biji-bijian, beras, sayuran, ikan, daging, dllPada keadaan defisit mempengaruhi metabolisme tubuh terutama pada kulit, mukosa mulut, sumsum tulang, dan sistem syaraf

Vitamin B1 (thiamine)

Sumber utama pada beras berkulit ari, biji-bijianDefisit : Malnutrisi beratPenurunan absorpsi di ususGangguan syaraf perifer, jantung, dan otakBeri-beri :dry beri-beri (polyneuropathy) - degeneration of myelin sheaths and axons (motoric, sensoric and vegetative)wet beri-beri (cardiovascular syndrome) - dilatation, right heart failure, peripheral edemaSyndroma Wernicke-Korsakoff - ophthalmoplegia, nystagmus, ataxia of gait and stance, confusion, apathy, amnesia, psychosis

Vitamin B2 (riboflavin)

Defisit :Cheilosis atau cheilitisGlossitis Keratitis Dermatitis Bone marrow (erythroid hypoplasia - anemia)

Niacin (nicotinic acid)

Defisit :

Pellagra Dermatitis Diarrhea Dementia

Vitamin B12 (cyanocobalamine)

Defisit :pernicious anemia (lack of synthesis of intrinsic factor in gastric mucosa due to autoimmune inflammation)Megaloblastic anemia (decreased number of RBC, increased size; Hypersegmentasi neutrofilDemyelinization of spinal cord and peripheral nerves = neuroanemic syndrome

Vitamin C (ascorbic acid)

Sumber : fruits and vegetables - not synthesized endogenouslyBerperan pada metabolisme kolagen basic intercellular matrix terutama pada dinding pembuluh darahDefisiensi :Dewasa : ScurvyAnak-anak : Mller-Barlow disease - subperiostal hematomas

Scurvy

petechial skin bleeding, ecchymoses, epistaxis, melena, intraarticular bleedinggingival swelling, hemorrhages, secondary bacterial infection - periodontitishyperkeratotic papular rashimpaired wound healing, defective osteoid - pathologic fracturesanemia

Hypervitaminosis C

Urolithiasis Hyperacidity in stomach - mucosal erosions

Trace elements

14 anorganic elements - Fe, Cu, Co, I, Zn, Se, Mn, Mo, Cr, F, Si, Ni, Sn (tin), Vaactivity in enzymesDefisit primer : I, (thyroid gland - goiter)Defisit sekunder :Zn - skin lesions, neurological and psychiatric syndromes, growth retardation, hypogonadism in malesCu - anemia, impaired synthesis of connective tissue matrixSe - Keshan disease - dilated cardiomyopathy

Obesitas

20% of world populationPenyakit gangguan keseimbangan energiPenyebab lain bisa genetic (multifactorial disease)

Komplikasi Obesitas

Hypertensi - 6x lebih sering pada usiaDM type II. - 3x lebih seringhypercholesterolemia - AS - MIBerpotensi malignant tumors - colon ca, breast ca, gallbladder ca, endometrial caInsufisiensi respiratory pada bronkitis kronis, hipertensi pulmonercholelithiasis (gallstones) - 6x lebih sering