referat muntah pada anak adi

8/16/2019 Referat Muntah Pada Anak Adi

1/30

REFERAT

MUNTAH PADA ANAK

Disusun Oleh:

Ainur Adi 13710546/09700105

PEMBIMBING

dr. . !"er#$%&"n"' !(. A

SMF Ilmu Kesehatan Anak RSUD Kab. Kediri

Fakultas Kedokteran Uni ersitas !i"a#a Kusuma Suraba#a$%&'


2/30

(A( I

PENDAHU)UAN

&. )atar belakan*

Mun%$h ($d$ $n$) serin* &eni&+ul)$n )e,e&$s$n ($d$ "r$n* %u$' +$h)$n &en#$di

&en$)u%)$n +il$ &un%$h diser%$i d$r$h -he&$%e&esis . Or$n* %u$ $)$n se*er$ &en,$ri

(er%"l"n*$n d")%er +il$ &en*$l$&i h$l ini. 1' Mun%$h d$($% se+$*$i $ $l (en $)i% s$lur$n

,ern$ $%$u dilu$r s$lur$n ,ern$ +$i) +eru($ in2e)si' in2l$&$si $%$u )el$in$n $n$%"&i.

Penin*)$%$n %e)$n$n in%r$,r$ni$l d$($% +er&$ni2es%$si $ $l +eru($ &un%$h' +e*i%u #u*$

$d$n $ in2e)si si%e&i) d$($% &eni&+ul)$n &un%$h.'3

id$) se&u$ "+$% $n%i &un%$h d$($%di+eri)$n )e($d$ se%i$( $n$) )$ren$ (en$n*$n$nn $ di%u#u)$n )e($d$ (en e+$+ &un%$h

sendiri. 1'3

P$d$ +$ i $n* )e,il d$n s$n*$% &ud$ $%$u )e%erl$&+$%$n &en%$l &un%$h d$($%

&e&+$h$ $)$n %er#$din $ $s(ir$si h$l ini &ud$h %er#$di )$ren$ $d$n $ )""rdin$si

neur"&us)uler $n* +elu& se&(urn$. n%u) &en,e*$h h$l %erse+u% ("sisi +$ i d$($%

di&irin*)$n $%$u %en*)ur$( d$n +u)$nn $ %erlen%$n*. &ur (enderi%$ $d$l$h h$l $n*

(en%in* d$l$& )$i%$nn $ den*$n &un%$h. P$d$ (eri"de ne"n$%$l %er#$din $ s(i%%in* $%$ure*ur*i%$si se#u&l$h )e,il isi l$&+un* &$sih d$l$& +$%$s )e $#$r$n d$n +u)$n

&eru($)$n )e$d$$n $n* ($%"l"*is di&$n$ &$sih %er#$di )en$i)$n +er$% $n* n"r&$l.

$l l$in $n* (erlu di,er&$%i $d$l$h &un%$h #u*$ &eru($)$n &$ni2es%$si d$ri )el$in$n

+$ $$n "+s%ru)si *$s%r"in%es%in$l $n* +il$ %id$) di%er$(i se,$r$ &e&$d$i d$($% 2$%$l4'5 .

Mun%$h $)u% &eru($)$n *e#$l$ $n* serin* %er#$di ($d$ )$sus $+d"&en $)u% d$n

in2e)si in%r$ &$u(un e)s%r$ *$s%r"in%es%in$l. Berl$in$n den*$n &un%$h $)u%' &un%$h

)r"nis/+erul$n* serin* &eru($)$n 2$)%"r $n* (en%in* d$ri *$&+$r$n )lini) su$%u (en $)i%.$ren$ (en $)i% $n* &end$s$ri &un%$h )r"ni)/+erul$n* serin* %id$) #el$s &$)$ serin*

dise+u% unexplained chronic vomiting . Belu& %erd$($% +$%$s$n $n* #el$s un%u) &un%$h

)r"ni)' %e%$(i +$%$s$n &un%$h )r"ni) serin* dis$&$)$n den*$n +$%$s$n di$re )r"ni)' $i%u

&un%$h $n* +erl$n*sun* le+ih d$ri du$ &in**u 3.


3/30

$. Tu"uan

a. Tu"uan Umum

n%u) &e&enuhi s $r$% d$l$& &en*i)u%i (r"*r$& )e($ni%er$$n )lini) Il&u

eseh$%$n An$) u&$h !$)i% e("lisi$n Pus$% $den !$id !u)$n%".

b. Tu"uan Khusus

n%u) &en*e%$hui d$n &e&$h$&i &un%$h ($d$ $n$) d$ri se*i de2inisi' e%i"l"*i'

($%"2isi"l"*i' di$*n"sis' d$n %er$(i sehin**$ d$($% di$(li)$si)$n den*$n se+$i)

+$i)n $ d$l$& (r$)%e) d")%er.


4/30

(A( II

TIN+AUAN PUSTAKA

&. De,inisi

Mun%$h $d$l$h di)elu$r)$nn $ isi l$&+un* &el$lui &ulu% se,$r$ e)s(ulsi2. s$h$

&en*elu$r)$n isi l$&+un* $)$n %erlih$% se+$*$i )"n%r$)si "%"% dindin* (eru%. !e,$r$ )linis'

)$d$n* )$d$n* suli% di+ed$)$n den*$n re2lu)s *$s%r"es"2$*us d$n re*ur*i%$si. e2lu)s

*$s%r"es"2$*us - 8E dide2inisi)$n se+$*$i )e&+$lin $ isi l$&+un* )ed$l$& es"2$*us %$n($

$d$n $ us$h$ d$ri +$ i $%$u $n$). A($+il$ isi l$&+un* %erse+u% di)elu$r)$n &el$lui &ulu%'

&$)$ )e$d$$n ini dise+u% se+$*$i re*ur*i%$si. Oleh )$ren$ i%u' &un%$h ($d$ +$ i $%$u $n$)

h$rus di(i)ir)$n (ul$ )e&un*)in$n su$%u 8E.

Mun%$h &eru($)$n re2le) (r"%e)%i2 %u+uh )$ren$ d$($% +er2un*si &el$ $n %")sin $n*

%id$) sen*$#$ %er%el$n. Mun%$h &eru($)$n us$h$ &en*elu$r)$n r$,un d$ri %u+uh d$n +is$

&en*ur$n*i %e)$n$n $)i+$% $d$n $ su&+$%$n $%$u (e&+es$r$n "r*$n $n* &en e+$+)$n

(ene)$n$n ($d$ s$lur$n (en,ern$$n 3'4' .

$. E-idemiolo*i

!indr"& Mun%$h !i)li) %er#$di se+$n $) 1'9 ($d$ $n$) $n$) se)"l$h. in*)$%

(re;$lensi re2lu)s *$s%r"es"2$*us s$n*$% +er;$ri$si d$ri +e+er$($ s%udi $n* %el$h dil$)u)$n

%e%$(i re2lu)s *$s%r"es"2$*us &eru($)$n h$l $n* s$n*$% u&u& %er#$di ($d$ %$hun (er%$&$

)ehidu($n. An*)$ )e#$di$n re2lu)s es"(h$*us &en,$($i 1:300 +$ i ($d$ %$hun (er%$&$

)ehidu($n. D$%$ &en e+u%)$n se)i%$r 50 ($d$ +$ i +eru&ur +ul$n &en*$l$&i re*ur*i%$si

)$li seh$ri $%$u le+ih. Pre;$lensi %er%in**i $i%u 67 %er#$di se)i%$r +$ i +eru&ur 4 +ul$n

d$n )e&udi$n (re;$lensi &enurun &en#$di 1 ($d$ s$$% +$ i +eru&ur 1 %$hun 6.

. Etiolo*i

E%i"l"*i &un%$h s$n*$% lu$s' seluruh )el$in$n $n* &en $n*)u% rese(%"r &un%$h +$i) d$ri

%r$)%us *$s%r"in%es%in$l' +er+$*$i ;iser$ -h$%i' *in#$l' ($n)re$s' #$n%un*' ($ru ' ,$n$lis

;es%i+ul$ris' 8he&"re,e(%i;e ri**er


5/30

4 #$&. e%$(i *e#$l$ &un%$h #u*$ &en*hil$n* le+ih ,e($% 1 4 #$& se%el$h di$re &un,ul.

Mun%$h #u*$ +is$ %er#$di $)i+$% *$n**u$n &e%$+"li) se+$*$i $)i+$% di$re/dehidr$si. Mis$ln $

$)i+$% $sid"sis4.

Pen e+$+ &un%$h ($d$ $n$) s$n*$% +er;$ri$si. Be+er$($ (en e+$+ &un%$h $n* serin*

di%e&u)$n ($d$ $n$)' $i%u:

1. !$lur$n ,ern$:$. O+s%ru)si: $%resi$ es"2$*us' s%en"sis (il"rus' $n%r$l e+' &"r+us

hirs,hs(run*' &$lr"%$si usus' ;"l;ulus' hi$%$l herni$' $)$l$si$' ileus

&e)"niu&' in%ususe(si. +. N"n "+s%ru)si: GE' *$s%r"en%eri%is' en%er")"li%is ne2ri%i)$ns' )$l$si$

. =u$r s$lur$n ,ern$ : %e)$n$n in%r$)r$ni$l &enin**i' in2e)si -!!P' s$lur$n n$($s'

s$lur$n )e&ih' ' hidr"se2$lus' )el$in$n &e%$+"li) 3. N"n "r*$ni) : %e)ni) (e&+eri$n &inu& $n* %id$) +en$r' iri%$si ,$ir$n $&ni"n' "+$%'

(si)"*eni)' &"%i"n si,)nes.

/. Pato,isiolo*i

e&$&(u$n un%u) &e&un%$h)$n &eru($)$n su$%u )eun%un*$n )$ren$

&e&un*)in)$n (en*elu$r$n %")sin d$ri l$&+un*. Mun%$h %er#$di +il$ %erd$($%

r$n*s$n*$n ($d$ (us$% &un%$h ->"&i%in* 8en%re ' su$%u (us$% )end$li di &edull$ +erde)$%$n den*$n (us$% (ern$($s$n $%$u 8he&"re,e(%"r ri**er


6/30

G$&+$r 1. An$%"&i Pus$% Mun%$h

Mun%$h se+en$rn $ &eru($)$n (eril$)u $n* )"&(le)' di&$n$ ($d$

&$nusi$ &un%$h %erdiri d$ri 3 $)%i;i%$s $n* %er)$i%' n$use$ -&u$l ' re%,hin*'

(en*elu$r$n isi l$&+un*. Ad$ re*i" $n$%"&i di &edull$ $n* &en*"n%r"l &un%$h'

,he&"re,e(%"r %ri**er ?"ne -8 < d$n ,en%r$l ;"&i%in* ,en%re -8>8 . 8 < $n*

%erle%$) di $re$ ("s%re&$ ($d$ d$s$r u#un* ,$ud$l ;en%ri)el I> dilu$r +l""d +r$in

+$rrier -s$ $r "%$) . ese(%"r did$er$h ini di$)%i;$si "leh +$h$n +$h$n (r"e&e%i) did$l$& sir)ul$si d$r$h $%$u di ,$ir$n ,ere+r"s(in$l -8!@ . E2eren d$ri 8 <

di)iri& )e 8>8 sel$n#u%n $ %er#$di ser$n*)$i$n )e#$di$n $n* di&ul$i &el$lui

;$*$l e2eren s(l$n,hni,. 8>8 %erle%$) dinu)leus %r$,%us s"li%$rius d$n dise)i%$r

2"r&$%i" re%i)ul$ris &edull$ %e($% di+$ $h 8


7/30

G$&+$r . e2le)s E&esis 6

E&esis se+$*$i res("ns %erh$d$( *$s%r"in%es%in$l iri%$n &is$ln $ ,"((er'

r$di$si $+d"&en' dil$%$si *$s%r"in%es%in$l $d$l$h se+$*$i $)i+$% d$ri si*n$l $2eren ;$*$l)e ,en%r$l ($%%ern *ener$%"r $n* di(i,u "leh (ele($s$n l")$l &edi$%"r in2l$&$si' d$ri

&u)"s$ $n* rus$)' den*$n (ele($s$n se)under neur"%r$ns&i%%ers e)si%$si $n* ($lin*

(en%in* $d$l$h ser"%"nin d$ri sel en%r",hr"&$22in &u)"s$. P$d$ &$+u) -&"%i"n

si,)ness ' si*n$l $2eren )e ,en%r$l ($%%ern *ener$%"r +er$s$l d$ri "r*$n ;es%i+ul$r'

;isu$l ,"r%e ' d$n ,"r%i,$l ,en%re $n* le+ih %in**i se+$*$i sens"r in(u% $n*

%erin%e*r$si le+ih (en%in* d$ri ($d$ $2eren d$ri *$s%r"in%es%in$l4'5' .

$n*s$n*$n &un%$h +er$s$l d$ri' *$s%r"in%es%in$l' ;es%i+ul" ",ul$r' $2eren ,"r%i,$l

$n* le+ih %in**i' $n* &enu#u 8>8 d$n )e&udi$n di&ul$i n$use$' re%,hin*' e)(ulsi

isi l$&+un*. Ge#$l$ *$s%r"in%es%in$l &eli(u%i (eris%$l%i)' s$li;$si' %$)hi(ne$'

%$,hi)$rdi$4'5' .


8/30

G$&+$r 3. e2le)s Mun%$h

es("ns s%ere"%i(i) ;"&i%in* di&edi$si "leh e2eren neur$l ($d$ ;$*us'

(hreni,' d$n s $r$2 s(in$l. In(u% un%u) s $r$2 ini +er$s$l d$ri +r$in s%e&

C;"&i%in* ,en%re . 8en%re ini %$&($)n $ +u)$n &eru($)$n s%ru)%ur $n$%"&i %un**$l'

%e%$(i &eru($)$n #$lur $)hir +ers$&$ d$ri re2le $n* di(r"*r$& se,$r$ sen%r$l &el$lui

in%erneur"n &edul$r di nu)leus s"li%$rius d$n +er+$*$i &$,$& %e&($% dise)i%$r

2"r&$%i" re%i)ul$ris. In%erneur"n %erse+u% &eneri&$ in(u% d$ri ,"r%i,$l' ;$*$l'

;es%i+ul$r' d$n in(u% l$in %eru%$&$ d$ri $re$ ("s%re&$. Are$ ("s%re&$ $d$l$h

,he&"re,e(%"r %ri**er ?"ne $n* %erle%$) did$s$r ;en%ri)el I> dilu$r s$ $r "%$) d$n

diiden%i2i)$si se+$*$i su&+er $n* ,ru,i$l un%u) in(u% $n* &en e+$+)$n ;"&i%in*'

%eru%$&$ res("ns %erh$d$( "+$% $%$u %")sin4'5' .

0. Pato*enesis

Mun%$h +er$d$ di+$ $h )end$li sis%e& s$r$2 (us$% d$n d$er$h di &edul$ "+l"n*$%$'

$i%u nu)leus s"li%er d$n 2"r&$si re%i)uler l$%er$l $n* di)en$l se+$*$i (us$% &un%$h. Pus$%

&un%$h di$)%i;$si "leh i&(uls $n* +er$s$l d$ri ,he&"rese(%"r %ri**er ?"ne -8 < '

$i%u%e&($% +er)u&(uln $ +er+$*$i i&(uls $2eren $n* dih$n%$r)$n &el$lui ner;us ;$*us.

P$d$ 8 < #u*$ di%e&u)$n +er+$*$i neur"%r$ns&i%%er d$n rese(%"r -s$l$h s$%un $ $d$l$h

rese(%"r d"($&in . Pr"ses &un%$h &e&(un $i 3 %$h$(' $i%u n$use$' re%,hin*' d$n e&esis. N$use$ &eru($)$n sens$si (si)is $n* dise+$+)$n "leh +er+$*$i s%i&ulus -"r*$n ;iser$'


9/30

l$+irin' $%$u e&"si . @$se ini di%$nd$i $d$n $ r$s$ &u$l $n* diser%$i *e#$l$ "%"n"& se(er%i

(r"du)si $ir liur +er%$&+$h' +er)erin*$%' (u,$%' %$)i)$rdi' $%$u $n"re)si$. Ger$)$n (eris%$l%i)

$)%i2 +erhen%i' %e)$n$n di 2undus d$n )"r(us &enurun sed$n*)$n %e)$n$n di $n%ru& s$&($i

($rs desendens du"denu& &enin*)$%. P$d$ 2$se re%,hin* %er#$di ins(ir$si d$l$& den*$n "%"%

(eru% d$n di$2r$*&$ ser%$ rel$)s$si s2in*%er es"2$*us. B$ $h. @$se e&esis di%$nd$i den*$n

(eru+$h$n den*$n %e)$n$n in%r$%"r$)s -d$ri ne*$%i2 &en#$di ("si%i2 . D$n rel$)s$si s2in*%er

es"2$*us sehin**$ isi l$&+un* di)elur)$n di)elu$r)$n d$ri &ulu%.

'. Fase Muntah

Fase Nausea Nausea $%$u &u$l &eru($)$n sens$si (si)is $n* %id$) n $&$n %$(i +u)$n

&eru($)$n sens$si $n* &en $)i%)$n $n* &end$hului r$s$ $%$u )ein*in$n un%u)

&un%$h $n* dise+$+)$n "leh +er+$*$i s%i&ulus se(er%i r$n*s$n*$n "r*$n ;iser$'

l$+irin' &$u(un e&"si. @$se ini di%$nd$i $d$n $ r$s$ &u$l $n* diser%$i *e#$l$ "%"n"&

se(er%i (r"du)si $ir liur +er%$&+$h' +er)erin*$%' (u,$%' %$)i)$rdi$' $%$u $n"re)si$.

!el$&$ (eri"de n$use$' %er#$di (enurun$n %"nus )ur;$%ur$ &$ "r' )"r(us d$n 2undus.

An%ru& d$n du"denu& +er)"n%r$)si +erul$n* ul$n*' sed$n*)$n +ul+us du"denirel$)s$si sehin**$ %er#$di re2lu)s ,$ir$n duedenu& )ed$l$& l$&+un*. P$d$ 2$se n$use$

ini +elu& %er#$di (eris%$l%i) $)%i2. Mun%$h $n* dise+$+)$n "leh (enin*)$%$n %e)$n$n

in%r$)r$ni$l d$n "+s%ru)si s$lur$n *$s%r"in%es%in$l %id$) did$hului "leh 2$se n$use$3.

Fase Retching

@$se ini d$($% %er#$di %$n($ dii)u%i &un%$h. P$d$ 2$se ini %er#$di )e)e#$n*$n d$n

%erhen%in $ (ern$2$s$n $n* +erul$n* ul$n*' se&en%$r$ *l"%is %er%u%u(. O%"% (ern$2$s$n

d$n di$2r$*&$ +er)"n%r$)si &en e+$+)$n %e)$n$n in%r$%"r$)$l &en#$di ne*$%i2. P$d$

$)%u $n* +ers$&$$n %er#$di )"n%r$)si "%"% $+d"&en d$n l$&+un*' 2undus dil$%$si

sed$n*)$n $n%ru& d$n (il"rus +er)"n%r$)si. !2in*%er es"2$*us +$ $h &e&+u)$' %e%$(i

s2in*%er es"2$*us $%$s &$sih &enu%u( &en e+$+)$n chyme &$su) )e d$l$& es"2$*us.

P$d$ $)hir 2$se ini %er#$di rel$)s$si "%"% dindin* (eru% d$n l$&+un* sehin**$ chyme

$n* %$din $ sud$h &$su) )ed$l$& es"2$*us )e&+$li )e l$&+un*. @$se ini d$($%

+erl$n*sun* +e+er$($ si)lus 3.


10/30

Fase Emesis1 Eks-ulsi,1 Muntah

A($+il$ 2$se retching &en,$($i (un,$)n $ d$n didu)un* "leh )"n%r$)si "%"%

$+d"&en d$n di$2r$*&$' $)$n +erl$n#u% &en#$di &un%$h #i)$ %e)$n$n %erse+u% d$($%

&en*$%$si &e)$nis&e $n%i re2lu)s d$ri s2in*%er es"2$*us +$*i$n +$ $h. P$d$ 2$se ini

(il"rus d$n $n%ru& +er)"n%r$)si sed$n*)$n 2undus d$n es"2$*us rel$)s$si ser%$ &ulu%

%er+u)$. P$d$ 2$se ini #u*$ %er#$di (eru+$h$n %e)$n$n in%r$%"r$)$l d$n in%r$$+d"&in$l

ser%$ )"n%r$)si d$ri di$2r$*&$. P$d$ e(is"de e)s(ulsi %un**$l %er#$di %e)$n$n ne*$%i2

in%r$%"r$)$l d$n %e)$n$n ("si%i2 in%r$$+d"&in$l' d$n d$l$& $)%u +ers$&$$n %er#$di

)"n%r$)si $n* ,e($% d$ri di$2r$*&$ $n* &ene)$n 2undus sehin**$ %er#$di re2lu)s isi

l$&+un* )e d$l$& es"2$*us. Bil$ e)s(ulsi sud$h %er#$di' %e)$n$n in%r$%"r$)$l )e&+$li

("si%i2 d$n di$2r$*&$ )e&+$li )e ("sisi n"r&$l 3.

2. Sindroma Muntah

Muntah siklik 34#5li5 omitin*6

Meru($)$n )el$in$n 2un*si"n$l *$s%r"in%es%in$l $n* d$($% di iden%i2i)$si

den*$n $d$n $ 3 $%$u le+ih e(is"de &u$l d$n &un%$h $n* +erl$n*sun* sel$&$

hi%un*$n #$& hin**$ h$ri $n* diselin*i den*$n &$s$ +e+$s *e#$l$ hin**$ +e+er$($

&in**u $%$u +ul$n. P$d$ sindr"& ini %id$) did$($%)$n )el$in$n &e%$+"li,' neur"l"*i,'

$%$u *$s%r"in%es%in$l. @re)uensi d$ri ser$n*$n r$%$ r$%$ +er)is$r 1 )$li e(is"de (er

%$hun den*$n +$%$s$n 1 70 )$li (er%$hun. Ge#$l$ l$in $n* &en er%$i $i%u le%$r*i'

(u,$%' de&$& rin*$n' s$)i% )e($l$' #er$ $% $%$u +isul ($d$ )uli%' s$)i% )e($l$' n eri

$+d"&en #u*$ d$($% %er#$di' d$n serin*)$li e(is"de e(is"de ini %i&+ul )$ren$ s%res

2isi)$l $%$u e&"si"n$l. Pen e+$+ d$ri sindr"& ini &$sih +elu& di)e%$hui. Be+er$($

(en#el$s$n $n* &e&un*)in$n (en e+$+ ini se(er%i &i*r$n' dis2un*si

h ("%h$l$&us/$dren$l' dis2un*si $u%"n"&' )e*$*$l$n neur"i&un/$ler*i &$)$n$n'

)el$in$n ")sid$si $s$& le&$)' (en $)i% &i%")"ndri$' ion channelopathy ' )el$in$n

&"%ili%$s *$s%r"in%es%in$l. Ad$n $ s%res &en e+$+)$n &enin*)$%n $ se)resi d$ri

A8 rele$sin* h"r&"ne d$n ;$s"(resin d$ri hi("%$l$&us d$n (i%ui%$ri $n*

&e&edi$si $)%i;$si d$ri re2le)s e&e%i) $n* &e&+u$% %er#$din $ &u$l d$n &un%$h.6

Muntah -siko*enik

Pen e+$+ )el$in$n "r*$ni) %$) di%e&u)$n' sindr"&$ ini &ene)$n)$n (en*$ruh $n* )u$% d$ri )"r%e)' 2$)%"r (si)"l"*i $n* &er$n*s$n* &u$l -n$use$ d$n


11/30

&un%$h. 8iri ,iri &un%$h (si)"*eni) $d$l$h +er#$l$n )r"nis' %er)$i% den*$n s%res

$%$u &$)$n' %id$) $d$ n$use$ d$n $n"re)si$' &un%$h d$($% di(i,u "leh dirin $ sendiri

den*$n &e&$)s$)$n &un%$h $%$u &e&$su)$n %$n*$nn $ )ed$l$& &ulu%. Mun%$h

se&+uh se%el$h dir$ $% di ru&$h s$)i%5.

Ruminasi

e#$di$n $n* se,$r$ s$d$r d$n &en en$n*)$n &e&un%$h)$n &$)$n$n d$ri

l$&+un*' di)un $h )un $h d$n di%el$n )e&+$li '3'4 . An$) +es$r $%$u de $s$

&ere*ur*i%$si)$n &$)$n$n den*$n ,$r$ )"n%r$)si "%"% $+d"&en' sed$n* ($d$ +$ i

&el"*") )ed$l$& &ulu%n $ den*$n #$ri d$l$& u($ $ un%u) &eni&+ul)$n

re*ur*i%$si. @$)%"r (si)"l"*is &e&$in)$n (er$n$n (en%in* ($d$ )e#$di$n %erse+u%'

%e%$(i (eril$)u %erse+u% +erhen%i den*$n &en*"+$%i es"2$*i%isn $. $l %erse+u%

didu*$ un%u) &eni&+ul)$n *$* re2le) $d$l$h se+$*$i res("ns %erh$d$( n eri

%en**"r")$nn $. Di)$%$)$n +$h $ ru&in$si se+$*$i &$ni2es%$si d$ri GE '

sehin**$ di$*n"sis d$n (en*"+$%$nn $ (erlu &e&(er%i&+$n*)$n 2$)%"r (si)"l"*is

d$n es"2$*i%isn $. erd$($% +en%u) ru&in$si (si)"*eni) d$n sel2 s%i&ul$%in*.

Psi)"*eni) +i$s$n $ %er#$di ($d$ $n$) n"r&$l den*$n *$n*u$n hu+un*$n "r$n* %u$

$n$)' sed$n*)$n sel2 s%i&ul$%in* serin* %er#$di ($d$ $n$) den*$n )e%erl$&+$%$n

&en%$l5' .

Abdominal mi*raine

!u$%u sindr"& den*$n *e#$l$ $+d"&in$l (eri"di). N eri e(i*$s%ri) $%$u

(eriu&+ili,$l diser%$i n$use' &un%$h' di$re' ($n$s d$n &en**i*il' ;er%i*"' iri%$+el

ser%$ ("liuri$. Bil$&$n$ *e#$l$ $+d"&in$l diser%$i s$)i% )e($l$ $n* %er#$di ($d$ 30

40 ($%ien den*$n &i*r$ine )e($l$ di$*n"sis $)$n &ud$h di+u$%' %e%$(i +il$

)e#$di$n %erse+u% %ersendiri is"l$%ed $+d"&in$l &i*r$ine $n* +i$s$n $ ($d$ 3 (enderi%$' di$*n"sis #$di le+ih su)$r +el$)$n*$n &e&$n* d$($% %i&+ul &i*r$ine.

Is"l$%ed $+d"&in$l ($in ser$n*$n +i$s$n $ &end$d$) +er$)hir d$l$& #$& s$&($i

h$ri' d$n ,iri ,irin $ sel$lu s$&$ ($d$ se%i$( ser$n*$n %$&($) n"r&$l dilu$r

ser$n*$n. Bi$s$n $ %erd$($% 2$&ili den*$n ri $ $% &i*r$ine5.


12/30

. +enis7+enis (ahan Muntahan

Berd$s$r)$n *$&+$r$n d$ri isi l$&+un* - $n* d$($% +eru+$h sesu$i $)%u d$n

(er#$l$n$n (en $)i% ' &$)$ %i(e &un%$h$n d$($% diiden%i2i)$si &en#$di:

Alimentary Vomiting

Meru($)$n &un%$h$n $n* +erisi &$)$n$n $n* +elu& di,ern$ $%$u +$ru

se+$*i$n di,ern$' %er)$d$n* d$l$& #u&l$h $n* +erle+ih. i(e ini $n* ($lin* serin*

did$($%)$n d$n d$($% %er#$di se*er$ $%$u +e+er$($ #$& se%el$h &$)$n. Mun%$h$n ini

($lin* serin* dise+$+)$n )$ren$ re2lu)s es"2$*us' &$l2"r&$si $n$%"&i d$ri s$lur$n

,ern$ +$*i$n $%$s' $%$u )$ren$ in%"ler$nsi &$)$n$n. "&(li)$si u%$&$ $)i+$% %i(e

&un%$h$n ini $d$l$h &$lnu%risi6.

Acid Vomiting

Bi$s$n $ %$&($) se+$*$i se#u&l$h )e,il ,$ir$n &u)us +er $rn$ )e(u%ih$n d$n

&en*$ndun* &$%eri$l +us$ den*$n ( 5' $n* &un*)in %er#$di sel$&$ $%$u seles$i

&$)$n d$n %er)$d$n* %er#$di ($d$ $)%u &$l$& h$ri. Bi$s$n $ diser%$i den*$n $d$n $

*$n**u$n +eru($ iri%$+ili%$s' )ur$n* is%ir$h$%' +$ i &en$n*is' d$n n eri e(i*$s%riu&

$%$u r$s$ ($n$s d$l$& (eru% ($d$ $n$) $n$). i(e ini le+ih &eru($)$n (en $)i% re2lu)

es"2$*us den*$n )"&(li)$si +eru($ es"2$*i%is d$n s%ri)%ur (e(%i) -#$r$n* %er#$di 6.

Bilious vomiting

$r$)%eris%i) d$ri %i(e &un%$h$n ini $d$l$h e)s(ulsi d$ri ,$ir$n +er $rn$ hi#$u

)e)unin*$n $n* %e+$l. P$d$ +$ i d$n ne"n$%us' &un%$h$n %i(e ini sel$lu &eru($)$n

%$nd$ $n* (en%in* un%u) &e&i)ir)$n $d$n $ %"%$l -$%resi$ $%$u se+$*i$n -s%en"sis"+s%ru)si s$lur$n ,ern$ $n* +er$d$ di dis%$l d$ri $&(ull$ >$%er $n* &e&+u%uh)$n

di$*n"s$ ($s%i d$n in%ensi2/su+in%ensi2 %er$(i6.

Bloody vomiting

Mun%$h +er $rn$ &er$h %er$n* $%$u se(er%i )"(i $n* d$($% di$)i+$%)$n "leh

$d$n $ (erd$r$h$n $n* +$ru %er#$di &$u(un sed$n* %er#$di ($d$ s$lur$n ,ern$ +$*i$n

$%$s -es"2$*us' l$&+un*' $%$u du"denu& . Mun%$h ini le+ih +$n $) &eru($)$n)"&(li)$si d$ri ($d$ &$ni2es%$si )linis $ $l. In%$)e nonsteroidal anti-inflamatory


13/30

drugs -N!AIDs d$($% #u*$ &en e+$+)$n %er#$din $ &un%$h ini. e&$%e&esis

&eru($)$n )e*$ $%d$rur$%$n $n* ("%ensi$l d$n sel$lu h$rus die;$lu$si di ru&$h s$)i%.

A($+il$ (erd$r$h$n rin*$n d$n %id$) &eni&+ul)$n $ne&i$ $%$u (eru+$h$n

he&"din$&i) d$($% di+eri)$n "+$% $n%i se)re%"ri. Perd$r$h$n d$ri ;$rises es"2$*us

d$($% %er#$di s$n*$% &$si2 $n* #u*$ &eru($)$n )e*$ $%d$rur$%$n d$n h$rus se*er$

&end$($%)$n %er$(i. e&$%e&esis %id$) sel$lu +er$s$l d$ri %r$)%us *$s%r"in%es%in$l'

%e%$(i d$($% #u*$ +er$s$l d$ri (erd$r$h$n %"nsil' l$rin*' $%$u %r$)e$ den*$n *e#$l$

+i$s$n $ d$r$hn $ $n* )elu$r sedi)i% d$n diser%$i *e#$l$ s$)i% %en**"r") d$n +$%u).

Bil$ &un%$h$n +eru($ +e)u$n d$r$h d$n +er $rn$ hi%$& serin*)$li +er$s$l d$ri

(erd$r$h$n hidun* +$*i$n ("s%eri"r +i$s$n $ di indi)$si d$ri l$(is$n %i(is d$ri d$r$h di

d$l$& "r"2$rin* 6.

8. Dia*nosis

Men*in*$% +$h $ &un%$h $d$l$h *e#$l$ d$ri +er+$*$i &$,$& (en $)i%'

&$)$ e;$lu$si di$*n"sis &un%$h %er*$n%un* ($d$ di2erensi$l di$*n"sis $n* di+u$%

+erd$s$r)$n 2$)%"r l")$si s%i&ulus' u&ur d$n *e#$l$ *$s%r"in%es%in$l $n* l$in. !e%el$h

dil$)u)$n $n$&nesis len*)$( &en*en$i &un%$hn $' )e&udi$n dil$n#u%)$n den*$n

(e&eri)s$$n 2isi) (enderi%$' &$)$ un%u) &e&+$n%u (ene*$)$n di$*n"sis dil$)u)$n

(e&eri)s$$n (enun#$n*. Fenis (e&eri)s$$n (enun#$n* di(ilih sesu$i den*$n du*$$n

di$*n"sis +erd$s$r)$n d$%$ $n$&nesis d$n &$ni2es%$si )linis 1'4'5'7 .

Anamnesis 1'3'4'5

$n*)$i$n (er%$n $$n $n* d$($% &e&+i&+in* )i%$ ($d$ di$*n"sis $n* %e($%' se+$*$i

+eri)u%:

si$ d$n #enis )el$&in

en%u)$n le+ih dulu' $($)$h $n* dih$d$(i: s(i%%in*' re*ur*i%$si $%$u &un%$h$($n &ul$i &un%$hDer$#$%/+er$%n $ &un%$h' )e)u$%$nn $ -(r"#e)%ilB$*$i&$n$ )e$d$$n )eseh$%$n $n$): $($)$h i$ &en#$di )urus $%$u (en$&+$h$n

+er$% +$d$n n"r&$lAd$)$h 2$)%"r (redis("sisi - $n* le+ih di)en$l "r$n* %u$ $n* &en e+$+)$n

%i&+uln $ &un%$h iniA($)$h $d$ (en $)i% l$in $n* &en er$n* $n$)' se(er%i hidr"se2$lus' in%"ler$nsi

susu' ri $ $% "(er$si $+d"&en dll.


14/30

B$*$i&$n$ +en%u)/isi &un%$h$n' $($)$h se(er%i susu/&$)$n$n $s$l -isi d$ri

es"2$*us ' %el$h &eru($)$n susu $n* %el$h &en**u&($l -isi l$&+un* $%$u

&en*$ndun* e&(edu -isi du"denu& d$n $d$)$h d$r$h!$$% &un%$h +erhu+un*$n den*$n s$$% &$)$n/&inu&

A($)$h (eru+$h$n ("sisi %u+uh &e&(en*$ruhi )e#$di$n &un%$hDi(erlu)$n in2"r&$si %en%$n* die%: )u$li%$s' )u$n%i%$s' dd$n 2re)uensi &$)$n'

(en%in* %eru%$&$ ($d$ $n$) )e,ilB$*$i&$n$ %e)ni) (e&+eri$n &inu&B$*$i&$n$ (ul$ )"ndisi (si)"s"si$l di ru&$h: +$*$i&$n$ si2$% i+u' $ $h' $($)$h

(en,e&$s' $($)$h $d$ nene) $n* serin* n*"&el.

An$&nes$ %$&+$h$n d$($% +eru($ se+$*$i +eri)u%:

Mun%$h $n* %er#$di s$$% &$)$n$n $%$u &inu&$n +$ru s$&($i di d$l$& r"n**$

&ulu%' (i)ir)$n $d$n $ in2e)si r"n**$ &ulu%.Ad$n $ ri $ $% hidr$&ni"n sel$&$ )eh$&il$n' (i)ir)$n )e&un*)in$n $%resi$

es"2$*usB$ i den*$n &un%$h &en e&(r"% +e+er$($ s$$% se%el$h di+eri &inu& (i)ir)$n

$d$n $ *$n**u$n gastric outlet Mun%$h den*$n ri $ $% )e%erl$&+$%$n (en*elu$r$n &e)"niu& $%$u )"ns%i($si se#$)

l$hir (erlu di(i)ir)$n $d$n $ M"r+us irs,h(run*Mun%$h did$hului n eri (eru% d$n (eru% )e&+un* (erlu di(i)ir)$n $d$n $ "+s%ru)si

s$lur$n ,ern$Mun%$h ($d$ +$ i $n* %er#$di +e+er$($ s$$% se%el$h &inu& sed$n*)$n 2$)%"r l$in

$n* dise+u% di $%$s %id$) $d$' (erlu di(i)ir)$n )e&un*)in$n GE $%$u 2$)%"r n"n

"r*$ni) se+$*$i (en e+$+ &un%$hMun%$h ($d$ $n$) $n* sel$lu %er#$di ($d$ )e$d$$n %er%en%u $n* s$&$' (erlu

di(i)ir)$n 2$)%"r (si)"*eni) se+$*$i d$s$r )eluh$n %erse+u%

Pemeriksaan Fisik 1'3'4'5'7

e$d$$n u&u&: )"&("s &en%is' le%h$r*i' )e#$n*' *e#$l$ neur"l"*i $n* l$inI)%erus' rhini%is' &"nili$sis!%$%us hidr$si/sir)ul$si: n$di' %ensi' +er$% +$d$n' lin*)$r$n len*$n' lin*)$r$n )e($l$'

M!Bil$ $d$ %$nd$ in2e)si' (i)ir)$n &un%$h se+$*$i s$l$h s$%u *e#$l$ in2e)si %erse+u%Ber,$) (u%ih den*$n d$s$r &er$h ($d$ r"n**$ &ulu% (erlu di(i)ir)$n su$%u

)$ndidi$sis "r$li(ers$li;$si ($d$ +$ i +$ru l$hir' (i)ir)$n $d$n $ $resi$ es"2$*us

Mun%$h $n* did$hului *$&+$r$n *er$)$n (eris%$l%i) l$&+un* se%el$h di+eri &inu&'

(i)ir)$n s%en"sis (il"rus hi(er%r"2i).


15/30

Dis%ensi (eru% d$n ($d$ (e&eri)s$$n ,"l") du+ur di%e&u)$n $&(ul$ )"l$(s' (erlu

di(i)ir)$n )e&un*)in$n $d$n $ &"r+us hirs,hs(run*.O+s%ru)si s$lur$n ,ern$ (erlu di(i)ir)$n +il$ di%e&u)$n (eru% dis%ensi d$n +isin*

usus &enin*)$% ($d$ d$er$h (r")si&$l d$n &enurun ($d$ d$er$h dis%$l.

Mun%$h ($d$ +$ i $n* diser%$i *e#$l$ )linis l$inn $ se(er%i di$re' )e&+un*' eri%e&$ (eri$n$l' d$n serin* 2l$%us' (erlu di(i)ir)$n $d$n $ in%"ler$nsi l$)%"s$.

Mun%$h $n* %er#$di ($d$ +$ i seh$% d$n %id$) di%e&u)$n *e#$l$ se(er%i $n*

dise+u% di$%$s' (erlu di(i)ir)$n $d$n $ 2$)%"r "r*$ni)' se(er%i %e)ni) (e&+eri$n

&inu& $%$u iri%$si ,$ir$n $&ni"n-+$ i +$ru l$hir .

Pemeriksaan Penun"an* 1'3'4'5

Pe&eri)s$$n l$+"r$%"riu&

Pe&eri)s$$n urin: urin len*)$(' redu)si' )ul%ur Pe&eri)s$$n d$r$h: d$r$h len*)$(' B N' seru& )re$%inin' seru& ele)%r"li%' $n$lisis

*$s d$r$h' $n$lisis $s$& $&in"' =@ ' *lu)"s$ d$r$h' $&"ni$

Pe&eri)s$$n r$di"l"*is d$n (enun#$n* l$inn $:

)e,uri*$$n %erh$d$( $%resi$ es"2$*us d$($% dil$)u)$n (e&$s$n*$n (i($ n$s"*$s%ri)

d$n (e&eri)s$$n 2"%" "en%*en %"r$)s$d$n $ *$n**u$n gastric outlet d$($% di+u)%i)$n den*$n (e&eri)s$$n &inu&

+$riu&' sed$n*)$n s%en"sis (il"rus hi(er%r"2i sel$in den*$n &inu& +$riu& d$($%

di+u)%i)$n den*$n (e&eri)s$$n ul%r$s"n"*r$2i)e,uri*$$n %erh$d$( M"r+us irs,h(run* d$($% dil$)u)$n (e&eri)s$$n +$riu&

ene&$ d$n +i"(si his$( re)%u&$d$n $ ileus -($r$li%i) $%$u "+s%ru)si d$($% di+u)%i)$n den*$n (e&eri)s$$n 2"%"

("l"s $+d"&en $%$u 3 ("sisi un%u) &elih$% dis%ri+usi ud$r$$d$n $ in2e)si d$($% di+u)%i)$n den*$n (e&eri)s$$n d$r$h (eri2er len*)$( d$n urin

len*)$()e,uri*$$n $d$n $ re2lu)s es"2$*us d$($% di+u)%i)$n den*$n &el$)u)$n

(e&eri)s$$n (e&$n%$u$n ( es"2$*us 4 #$&)"nsul%$si )e (si)"l"* +il$ di,uri*$i $d$n $ 2$)%"r (si)"*eni) )e,uri*$$n )el$in$n "r*$n di lu$r s$lur$n ,ern$ d$($% dil$)u)$n (e&eri)s$$n sesu$i

!PM )el$in$n %erse+u%.

Pendekatan Dia*nosis

Men*$d$)$n di$*n"sis +$ndin* den*$n &e&i)ir)$n se&u$ (en e+$+ &un%$h

d$l$& (r$)%e)n $ suli% dil$)s$n$)$n )$ren$ (en e+$+ &un%$h s$n*$% lu$s d$n

serin*)$li %id$) &ud$h di%e&u)$n. Pende)$%$n di$*n"sis +erd$s$r)$n usi$ $n$)


16/30

serin*)$li d$($% &e&(er&ud$h d$n +er&$n2$$% d$l$& u($ $ &en,$ri (en e+$+

&un%$h3.

Be+er$($ *e#$l$ (en%in* $n* (erlu di(erh$%i)$n d$l$& (ende)$%$n di$*n"sis

&un%$h ($d$ +$ i d$n $n$) $d$l$h se+$*$i +eri)u%:

&. Si,at Muntahan

Ben%u): +en%u) &$)$n$n $n* &$sih d$($% di)en$li ($d$ &un%$h $n* %er#$di

l$&$ se%el$h &$)$n' &enun#u))$n $d$n $ s%$%is ($d$ l$&+un*B$u: +$u $s$& serin*)$li &en$nd$)$n s%$%is ($d$ l$&+un*' +$u +usu)/%in#$

&enun#u))$n $d$n $ "+s%ru)si rend$h$rn$: #i)$ di%e&u)$n &un%$h$n $n* +er $rn$ e&(edu h$rus di(i)ir)$n $d$n $

*$n**u$n di se+el$h dis%$l $&(ul$ >$%eri. !uh$r "n" &en*$n#ur)$n un%u)

&el$)u)$n (en$%$l$)s$n$$n "+s%ru)si usus ($d$ se%i$( )e#$di$n &un%$h den*$n

&un%$h$n $n* +er $rn$ hi#$u s$&($i %er+u)%i %id$) %erd$($% "+s%ru)si ususD$r$h: ($d$ &un%$h$n ne"n$%us )e&un*)in$n %er#$di $)i+$% ne"n$%us &enel$n

d$r$h i+u s$$% dil$hir)$n $%$u +$ i &en*is$( d$r$h d$ri (u%in* $n* (e,$h (e,$h

-2isur$ . n%u) &e&+ed$)$n (erd$r$h$n $n* +er$s$l d$ri +$ i' &is$ln $ ($d$

er"si es"2$*us $%$u de2e) )"$*ul$si' d$($% dil$)u)$n u#i AP 3'5 .

$. Frekuensi Muntah

Mun%$h $n* s$n*$% serin* d$n &ene%$( &enun#u))$n 2$)%"r $%$u )el$in$n $n*

(er&$nen 3.

. Kekuatan Muntah

Mun%$h $n* $&$% )u$% -(r" e)%il ($d$ +$ i d$n $n$) serin* %erd$($% ($d$ s%en"sis

(il"rus d$n (enin**i$n %e)$n$n in%r$)r$ni$l. P$d$ (enin**i$n %e)$n$n in%r$)r$ni$l'

&un%$h %id$) diser%$i n$use$3.

/. Hubun*an den*an Makanan


17/30

P$d$ +$ i &un%$h $n* %er#$di sel$&$ $%$u sesud$h &$)$n' h$&(ir sel$lu

dise+$+)$n "leh dis%ensi l$&+un* $n* +erle+ih$n $)i+$% ,$r$ (e&+eri$n &$)$n

$n* s$l$h -$er"2r$*i 3.

0. 9e"ala )ain

Bil$ di#u&($i u+un u+un $n* &en"n#"l $%$u *e#$l$ neur"l"*is l$in' h$rus

di(i)ir)$n $d$n $ (r"ses in%r$)r$ni$l!e(sis d$n in2e)si l$in se(er%i *$s%r"en%eri%is' &enin*i%is d$n in2e)si s$lur$n $ir

)e&ih &eru($)$n (en e+$+ &un%$h $n* serin* di%e&u)$n ($d$ ne"n$%usi $ $% hidr$$&ni"n d$($% +erhu+un*$n den*$n $%resi$ s$lur$n (en,ern$$n

Me)"neu& $n* %id$) )elu$r d$l$& 4 #$& serin* di#u&($i ($d$ (en $)i%

irs,h(run* $%$u ileus &e)"neu&

Ad$ $n* &e&+ed$)$n &un%$h $%$s )el$in$n &edis d$n &un%$h +ed$h' %e%$(i

se+en$rn $ +$%$s$n ini %id$) sel$lu %e*$s. H$n* le+ih (en%in* $d$l$h +il$ &ene&u)$n

*e#$l$ &un%$h' h$rus di%e%$()$n $($)$h &un%$h dise+$+)$n )el$in$n $n* h$rus se*er$

di%"l"n* se,$r$ +ed$h $%$u %id$). &u&n $ )$sus se&$,$& ini &en,$)u( )el$in$n

$n* di*"l"*)$n $+d"&en $)u%. Ad$ +e+er$($ (e*$n*$n un%u) &endu*$ $+d"&en $)u%:

N eri (eru% &un,ul &end$hului &un%$h d$n/$%$u +erl$n*sun* le+ih d$ri 3

#$&Mun%$h +er,$&(ur e&(eduDis%ensi $+d"&en3.


18/30

B$*$n 4. Pende)$%$n Di$*n"sis Mun%$h ($d$ Ne"n$%us 1


19/30

B$*$n 5. Al*"ri%&$ (ende)$%$n un%u) &en*e;$lu$si ($sien den*$n Mun%$h 7


20/30

&%. Dia*nosis (andin*

P$d$ d$s$rn $ (en e+$+ &un%$h s$n*$% +$n $). Pende)$%$n &un%$h ($d$

$n$) &eru($)$n (r"+le& $n* suli%' di$*n"s$ +$ndin* +u)$n h$n $ &en $n*)u%

&$s$l$h *$s%r"in%es%in$l %e%$(i #u*$ &$s$l$h e&er*ensi ($d$ $n$). Pen e+$+ &un%$h

($d$ $n$) s$n*$% +er;$ri$si d$n %er*$n%un* usi$. Be+er$($ )e$d$$n d$($% se+$*$i

(en,e%us %er#$din $ &un%$h se(er%i in2e)si' iri%$si &$)$n$n' %r$u&$' $ler*i' *$n**u$n

($d$ (enden*$r$n se(er%i di??iness d$n &"%in si,)es' )el$in$n ($d$ s$r$2 se(er%i %r$u&$

d$n in2e)si. l$si2i)$si &un%$h +i$s$n $ did$s$r)$n ($d$ l")us $n$%"&i' u&ur (enderi%$' $d$n $ *e#$l$ d$n %$nd$ $s"si$si $n* l$in 4'5 . Mun%$h h$rus di+ed$)$n

den*$n:

Possettin*

Pen*elu$r$n sedi)i% isi l$&+un* seh$+is &$)$n' +i$s$n $ &eleleh )elu$r d$ri &ulu%.

!erin* did$hului "leh +ersend$ $. id$) +er+$h$ $. A)$n hil$n* den*$n sendirin $ 1'3 .

Ruminasi 3 merycism 6

!u$%u )e+i$s$$n $+n"r&$l' &en*elu$r)$n isi l$&+un*' &en*un $hn $' )e&udi$n

&enel$nn $ )e&+$li. $d$n* )$d$n* dir$n*s$n* se,$r$ s$d$r den*$n &en*"re) 2$rin*

den*$n #$ri. id$) +er+$h$ $. e+i$s$$n s$d$r $n* suli% un%u) dihil$n*)$n.

Me&+u%uh)$n +i&+in*$n (si)"l"*i)/(si)"%er$(i $n* in%ensi2 1'3 .

Re*ur*itasi 3*umoh: spitting 6

Dise+$+)$n in)"&(e%ensi s(in)%er )$rdi"es"2$*e$l d$n/$%$u &e&$n#$n*n $ $)%u

(en*"s"n*$n l$&+un*. D$($% &en**$n**u (er%u&+uh$n d$n &eni&+ul)$n in2e)si

%r$)%us res(ir$%"rius +erul$n* $)i+$% $s(ir$si. M$l$h$n di(er)ir$)$n +is$ &eru($)$n

s$l$h s$%u (en e+$+ sudden infant death syndrome . $(i se+$*i$n +es$r $)$n

&en*hil$n* sendiri den*$n +er%$&+$hn $ u&ur +$ i 1'3 .


21/30

Re,luks *astroeso,a*eal 3R9E6

GE $d$l$h )elu$rn $ isi l$&+un* )e d$l$& es"2$*us. e$d$$n ini &un*)in n"r&$l

$%$u d$($% (ul$ $+n"r&$l. !e%i$( re2lu)s %id$) sel$lu diser%$i re*ur*i%$si $%$u &un%$h'

%e%$(i se%i$( re*ur*i%$si ($s%i diser%$i re2lu)s3.

$+el 1. Di$*n"sis B$ndin* Mun%$h ($d$ B$ i 4

8"&&"n $re

An$%"&i, "+s%ru,%i"n Adren"*eni%$l s ndr"&e

G$s%r"en%eri%isBr$in %u&"r -in,re$sed in%r$,r$ni$l

(ressure

G$s%r"es"(h$*e$l re2lu @""d ("is"nin*

O;er2eedin* In+"rn err"r "2 &e%$+"lis&

! s%e&i, in2e,%i"n en$l %u+ul$r $,id"sis

u&in$%i"n

!u+dur$l he&"rrh$*e

$+el . Di$*n"sis B$ndin* Mun%$h ($d$ An$) d$n e&$#$ 4

8hild Ad"les,en%


22/30

8"&&"n

G$s%r"en%eri%is G$s%r"en%eri%is

! s%e&i, in2e,%i"n ! $%e&i, in2e,%i"n

" i, in*es%i"n " i, in*es%i"n

Per%ussis s ndr"&e In2l$&&$%"r +" el dise$se

Medi,$%i"n A((endi,i%id

Mi*r$ine

Pre*n$n,

Medi,$%i"n

I(e,$, $+use/+uli&i$

$re

e e s ndr"&e e e s ndr"&e

e($%i%is e($%i%is

Pe(%i, ul,er Pe(%i, ul,er

P$n,re$%i%is P$n,r$%i%is

In,re$sed in%r$,r$ni$l (ressure In,re$sed in%r$,r$ni$l (ressure


23/30

Middle e$r dise$se Middle e$r dise$se

8he&"%her$( 8he&"%her$(

A,h$l$si$ 8 ,li, ;"&i%in*

8 ,li, ;"&i%in* Bili$r ,"li,

Es"(h$*e$l s%ri,%ure en$l ,"li,

Du"den%$l he&$%"&$

In+ern err"r "2 &e%$+"lis&

&&. Kom-likasi

Kom-likasi Fisik

!$l$h s$%u )"nse)uensi $)i+$% &un%$h $n* +erl$n*sun* %erus &enerus $d$l$h

ru(%urn $ dindin* )$(iler d$n &en*$)i+$%)$n (erd$r$h$n ($d$ #$rin*$n su+)u%$n $n*

%$&($) ($d$ $#$h d$n leher +er+en%u) se(er%i )e($l$ (eni%i. D$($% #u*$ %er#$di

Mallory-Weiss Syndrome di$)i+$%)$n )$ren$ %er#$di herni$si 2undus ($d$ 2$se retching

d$n e)s(ulsi )$d$n* )$d$n* d$($% &eni&+ul)$n r"+e)$n r"+e)$n l"n*i%udin$l ($d$

&u)"s$. e$d$$n ini di%$nd$i den*$n +$h$n &un%$h$n $n* &en*$ndun* d$r$h se%el$h

+e+er$($ si)lus recthing d$n e)s(ulsi. Di$*n"sis d$($% di%e*$))$n den*$n (e&eri)s$$nend"s)"(i d$n )el$in$n ini +i$s$n $ se&+uh %$n($ )"&(li)$si. "&(li)$si +eri)u%n $

$n* &un*)in did$($%)$n $d$l$h $s(ir$si isi l$&+un*. As(ir$si +$h$n &un%$h$n d$($%

&en e+$+)$n $s2i)si$. E(is"de $s(ir$si rin*$n +erul$n* ul$n* d$($% &en e+$+)$n

in2e)si s$lur$n n$2$s +erul$n*. !el$in $n* dise+u%)$n di$%$s )"&(li)$si l$in $n*

d$($% %er#$di $d$l$h *$*$l %u&+uh )e&+$n*. Mun%$h $n* +erul$n* ul$n* d$n ,u)u(

he+$% $)$n &en e+$+)$n *$n**u$n *i?i "leh )$ren$ in%$)e &en#$di s$n*$% +er)ur$n*

d$n +il$ h$l ini %er#$di ,u)u( l$&$. r$u&$ i*$ d$n "%"% $+d"&en $n* d$($% s$n*$%

serius %e%$(i #$r$n* %er#$di.'5


24/30

Kom-likasi Metabolik

Dehidr$si/ *$n**u$n ele)%r"li% d$n $s$& +$s$ d$($% %er#$di. Mun%$h &un%$h $n*

he+$% d$n +erul$n* ul$n* $)$n &en e+$+)$n hil$n*n $ d$n 8I $n* &$ni2es%se+$*$i $l)$l"sis &e%$+"li)' $n* d$($% &en e+$+)$n %er#$din $ cardiac arrest . '5

Kom-likasi Psikolo*is

"&(li)$si ini %er#$di $)i+$% (en*$l$&$n &$s$ l$lu $n* +erhu+un*$n den*$n

&u$l &un%$h d$n n eri (eru% $%$u r$s$ %er+$)$r ($d$ e(i*$s%riu& $n* he+$% $n*

,enderun* &eni&+ul)$n )"ndisi $;ersi di )e&udi$n h$ri' (ene&($%$n si%u$si seru($'

$%$u sensi%i$si +erle+ih$n %erh$d$( s%i&ulus $n* serin*)$li %id$) s$&$. Ini d$($%&en,e%us)$n %i&+uln $ (eril$)u $n"re)si$ ($d$ $n$) $n$)' &ere)$ &e&ilih un%u)

%id$) &$)$n )$ren$ %$)u% $)$n &en*$l$&i h$l $n* s$&$ se(er%i $n* (ern$h di$l$&i

se+elu&n $. e$)si %erse+u% di(er)ir$)$n %i&+ul $)i+$% s%i&ulus ($d$ )"r%e)s $)$n

(en*$l$&$n &un%$h se+elu&n $' %e%$(i #$rin*$n s$r$2 $n* %uru% +e)er#$ d$n

+$*$i&$n$ ("l$n $ &$sih +$n $) +elu& di)e%$hui se,$r$ ($s%i. '5

&$. Penatalaksanaan 1'3'4'5'7'

&. Umum

a. E,ek )okal

"+e)$n M$ll"r eiss +i$s$n $ h$n $ &eni&+ul)$n (erd$r$h$n )e,il

sehin**$ %id$) di(erlu)$n su$%u %ind$)$n. !e+$li)n $ r"+e)$n es"2$*us -sindr"&$

Burh$;e &e&erlu)$n %ind$)$n r$di)$l.

b. E,ek Metabolik

P$d$ (enderi%$ &un%$h +erul$n* d$n +er)e($n#$n*$n d$($% %er#$di

*$n**u$n )esei&+$n*$n ,$ir$n d$n ele)%r"li% $n* &e&erlu)$n ,$ir$n d$n

ele)%r"li% (en**$n%i - in*er l$)%$% ' )e&udi$n disusul den*$n (e&+eri$n ,$ir$n

d$n ele)%r"li% un%u) ru&$%$n

5. As-irasi


25/30

As(ir$si isi l$&+un* $n* &$si2 &e&erlu)$n (e&+eri$n $n%i+i"%i)$ d$n

)$d$n* )$d$n* )"r%i)"s%er"id. P$d$ inh$l$si isi l$&+un* +eru($ susu d$l$&

#u&l$h di)i% de&i sedi)i% d$($% &eni&+ul)$n sensi%is$si %erh$d$( (r"%ein susu

s$(i sehin**$ &eni&+ul)$n +r"n)hi%is $ler*i)

d. E,ek Nutrisi

Men#el$s)$n )e($d$ "r$n* %u$ &en*en$i ,$r$ ,$r$ (e&+u$%$n &inu&$n/

&$)$n$n' d$n %e)ni) (e&+eri$n &$)$n$n. D$n $n* %$) )$l$h (en%in*n $ $d$l$h

&ene)$n)$n hu+un*$n $n* h$r&"nis $n%$r$ +$ i den*$n i+u d$n $ $h. Bil$

&un%$h %erus &enerus d$n di(er)ir$)$n $)$n &eni&+ul)$n %er#$din $ *$n**u$n

*i?i $%$u (en e&+uh$n &un%$h $)$n +erl$n*sun* l$&$' )$d$n* )$d$n*

di(erlu)$n (e&+eri$n nu%risi ($ren%er$l

$. Sim-tomatik

;bat Antiemetik

$l$u(un %u#u$n u%$&$ (en$%$l$)s$n$$n &un%$h $d$l$h &en*hil$n*)$n )$us$

s(esi2i)n $' n$&un (en$%$l$)s$n$$n si&(%"&$%i) un%u) &en*ur$n*i $%$u

&en*hil$n*)$n *e#$l$ &un%$h $,$()$li (erlu dil$)u)$n %erle+ih d$hulu. Perlu diin*$% +$h $ ($d$ )e$d$$n $n* $)u% d$n &un%$h $n* he+$%' "+$% $n%i &un%$h h$n $

+er&$n2$$% #i)$ "+$% %erse+u% d$($% diser$( d$l$& #u&l$h $n* ,u)u(.

Men*hen%i)$n &$)$n/&inu& un%u) +e+er$($ #$& d$($% &e&+$n%u &en*ur$n*i

he+$%n $ &un%$h sehin**$ &e&un*)in)$n (e&+eri$n "+$% "+$% (er "r$l.

Titik tan*ka- ker"a obat anti muntah

i%i) %$n*)$( )er#$ "+$% $n%i &un%$h d$($% %erle%$) di +e+er$($ +$*i$n %u+uh'

&is$ln $ rese(%"r )i&i$ %eru%$&$ di(en*$ruhi "leh *"l"n*$n 2en"%i$sin' $n%i

his%$&in d$n $n%$*"nis d"($&in.

Pus$% &un%$h di(en*$ruhi se,$r$ l$n*sun* "leh *"l"n*$n $n%i )h"liner*i).

ese(%"r di ;es%i+ulu& "leh *"l"n*$n $n%ihis%$&in' sed$n*)$n rese(%"r (eri2er

di(en*$ruhi se,$r$ +er+ed$ +ed$ "leh *"l"n*$n 2en"%i$sin' $n%$*"nis d"($&in'

+e%$ne)h"l' (enin*)$%$n $se%il)h"lin "leh *"l"n*$n &e%")l"(r$&ide' d"&(erid"ne

d$n ,i,$(rid. !e,$r$ u&u& d$($% di)$%$)$n' $n%ihis%$&in %eru%$&$ +$i) di(er*un$)$n un%u) $n%i &$+u) - motion sickness ' $n%$*"nis d"($&in un%u)


26/30

&"%ili%$s *$s%r"in%es%in$l d$n *"l"n*$n 2en"%i$?in un%u) e2e) s$&(in* d$ri "+$%

si%"s%$%i)$' r$di$si d$n ure&i$.

$+el 3. G"l"n*$n "+$% $n%ie&e%i) 3

An%i)"liner*i) ",ine' Bus)"($n' "l"("n' A%r"(in

An%ihis%$&in Di&enh drin$%e -Dr$&$&in' An%i&" '

Me,l"?ine - $;e* l ' Pr"&e%h$?ine

-2ener*$n' A;r"(e*@en"%i$?in Pr")l"r(er$?ine -!%e&e%il ' Per;en$?in

-A;"&i% ' ie%il(er$?ine &$le$% - "re,$nAn%$*"nis d"($&in Me%")l"(r$&id ->"&i%r"l ' D"&(erid"ne

-M"%iliu&Menin*)$%)$n $se%il)"lin Me%")l"(r$&id=$n*sun* ($d$ rese(%"r &us)$rini) Be%$ne,h"l

Berd$s$r)$n (en*$ruhn $ %erh$d$( &"%ili%$s usus' "+$% $n* +i$s$ di+eri)$n

se+$*$i "+$% si&(%"&$%i) un%u) &un%$h d$($% di+$*i &en#$di *"l"n*$n:

9olon*an I.

G"l"n*$n s%i&ul$n &"%"r *$s%r"in%es%in$l

Meru($)$n +$h$n -serin*)$li neur"%r$ns&i%er $%$u se#enis $n* &enin*)$%)$n

$)%i2i%$s "%"% ("l"s. !el$in &er$n*s$n* &"%ili%$s #u*$ &er$n*s$n* se)resi $n*

%id$) %er+$%$s ($d$ usus s$#$.

8"n%"h: Be%$ne,h"l' $n* ($d$ $n$) h$n $ di*un$)$n ($d$ GE

9olon*an II.

G"l"n*$n "+$% (r")ine%i)

O+$% ini &en"r&$lisir *$n**u$n &"%ili%$s "%"% sehin**$ &e&(un $i si2$%

&e&(er+$i)i )""rdin$si $)%i2i%$s (eris%$l%i). Pr"%i(e d$ri *"l"n*$n ini $d$l$h

&e%")l"(r$&ide $n* &e&(un $i e2e) $n%$*"nis %erh$d$( rese(%"r d"($&in

-$n%$*"nis %erh$d$( inhi+isi &"%"ri) "leh d"($&in $n* %id$) s$#$ %er+$%$s ($d$

%in*)$% *$s%r"in%es%in$l' %e%$(i #u*$ &e&(un $i (en*$ruh ($d$ %in*)$% susun$ns $r$2 (us$% sehin**$ d$($% %er#$di e2e) s$&(in* neur"l"*i).


27/30

O+$% *"l"n*$n D"&(erid"ne -M"%iliu& di)$%$)$n &e&(un $i e2e) s$&$ %e%$(i

%$n($ &e&(en*$ruhi susun$n s $r$2 (us$%' $l$u(un %id$) s(esi2i).

edu$ "+$% $n%$*"nis d"&($&in ini d$ $ (r")ine%i) $ $d$l$h den*$n ,$r$

$n%$*"nis%i) %erh$d$( inhi+isi &"%"ri) "leh d"($&in.

A)hir $)hir ini di(r"du)si "+$% $n* &e&(un $i d$ $ (r")ine%i) %$n($ e2e)

$n%$*"nis%i)' &e&(un $i e2e) l$n*sun* &er$n*s$n* (en*elu$r$n $se%il)"lin se,$r$

2isi"l"*i) d$l$& (le)sus &ien%eri)us' d$n den*$n de&i)i$n &e&(un $i e2e)

s(esi2i) &"%"ri) ($d$ %in*)$% usus +$*i$n dis%$l.

$+el 4. O+$% "+$% $n* &e&(en*$ruhi &"%ili%$s usus3

Me)$nis&e $)si !%i&ul%$n &"%ili%$s O+$% (r")ine%i)

E2e) l$n*sun* ($d$

rese(%"r &us)$rini)

Be%$ne,h"l

An%$*"nis rese(%"r

D"($&in

Me%")l"(r$&id'

D"&(erid"ne

Menin*)$%)$n $se%il)"lin Me%")l"(r$&id' 8is$(rid

;bat #an* serin* di-akai men*obati muntah dan *an**uan motilitas lambun*<

&. Metoklo-ramid

8u)u( e2e)%i2' ,$r$ )er#$ $d$l$h +l")$de rese(%"r d"($&ine di 8 < - chemo

receptive trigger zone ' sehin**$ d$($% &en*"n%r"l +$i) n$use &$u(un &un%$h

se,$r$ sen%r$l. Perlu diin*$%' "+$% ini d$($% &en e+$+)$n re$)si dis%"ni$ d$n

dis)ine%i) ser%$ )risis ")ul"*iri)

$. Dom-eridone

D$($% di)$%$)$n le+ih $&$n. 8$r$ )er#$ +l")$de d"($&in rese(%"r +$i) di 8


28/30

n%u) &en,e*$h n$use$ d$n &un%$h ($d$ (en*"+$%$n si%"s%$%i)$' d"sis (er "r$l 1

&*/)* ++/h$ri -le+ih e2e)%i2 d$ri &e%")l"(r$&id 0'5 &*/)* ++/h$ri . D"sis ($d$

$n$) $n$) 0' 0'4 &*/)* ++/h$ri (er "r$l' in%er;$l 4 #$&.

. 4isa-ride

O+$% (r")ine%i) $n* +$ru' &enin*)$%)$n (en*elu$r$n $se%il)"h"lin se,$r$ 2isi"l"*is

$n* sele)%i2 ($d$ %in*)$% ("s% *$n*li"ni) d$ri s $r$2 ($d$ (le)sus &ien%eri)us.

id$) &e&(un $i si2$% +l")$de ($d$ rese(%"r d"($&in' %e%$(i &enin*)$%)$n

(eris%$l%i) *$s%r"du"den$l. P$d$ $n$) #u*$ e2e)%i2 un%u) &en,e*$h re2lu)s d$n

&e&(er+$i)i )lerens d$ri re2lu)s &$%eri$l di es"2$*us. D"sis 0' 0'4 &*/)* ++/h$ri.

/. (etanekhol!u$%u )h"lines%er den*$n ,$r$ )er#$ sele)%i2 ($d$ &us)$rini) rese(%"r' e2e) )er#$n $

,u)u( ($n#$n*. P$d$ $n$) $n$) di($)$i un%u) %er$(i GE' d"sis 0'6 &*/)* ++/h$ri'

di+$*i 3 d"sis' (er "r$l $%$u 0'15 0' &*/)* ++/h$ri su+ )u%$n.

Pen5e*ahan dan -endidikan

1. An$) diis%ir$h$%)$n -se+$i)n $ di %e&($% %idur s$&($i &er$s$ le+ih en$) . Minu&$n di+eri)$n den*$n &en**un$)$n send")' sedi)i% de&i sedi)i% $n*

din$i))$n se,$r$ +er%$h$( se%i$( 15 &eni%

3. D$($% di+eri)$n &inu&$n &$nis se(er%i #us -)e,u$li #eru) d$n $n**ur )$ren$ %erl$lu

$s$& ' siru(' $%$u &$du -u&ur di $%$s 1 %$hun

4. ind$r)$n &$)$n$n ($d$% sel$&$ 6 #$&

5. Beri)$n r$s$ n $&$n -%urun)$n suhu %u+uh

6. ind$r)$n $)%i;i%$s +erle+ih$n se%el$h &$)$n


29/30

(A( III

KESIMPU)AN

Mun%$h &eru($)$n (en*elu$r$n isi l$&+un*/es"2$*us den*$n ($)s$. s$h$

&en*elu$r)$n isi l$&+un* $)$n %erlih$% se+$*$i )"n%r$)si "%"% dindin* (eru%. Mun%$h h$rus

di+ed$)$n d$ri ("sse%in*'ru&in$si' re*ur*i%$si d$n re2lu)s *$s%r"es"2$*e$l.

Mun%$h d$($% di)$%$)$n s$l$h s$%u d$ri &e)$nis&e (er%$h$n$n %u+uh $n*

&en*inden%i2i)$si d$n +eru($ $ &en*elu$r)$n $*en $n* &eru*i)$n $n* %el$h %er%el$n.

Mes)i(un &un%$h %er)es$n h$l $n* sederh$n$ %e%$(i *e#$l$ ini d$($% &en*$r%i)$n +e*i%u +$n $) )e&un*)in$n (en e+$+ $n* &end$s$rin $ &ul$i d$ri )e$d$$n $n* rin*$n d$n

&$sih d$l$& +$%$s n"r&$l' %e%$(i #u*$ &un*)in &eru($)$n )e$d$$n $n* serius. Mun%$h

$n* +er)e($n#$n*$n d$n +erul$n* ($d$ $n$) $)$n &eni&+ul)$n )e$d$$n $n* le+ih +uru)

d$n $($+il$ %id$) di%$n*$ni den*$n $de)u$% $)$n &en e+$+)$n )"&(li)$si $n* +er$%.

Pen*en$l$n d$n (ende)$%$n di$*n"sis s$n*$% di(erlu)$n.

Dih$r$()$n &el$lui re2er$% ini' &un%$h se+$*$i su$%u *e#$l$ )linis d$($% le+ih di)en$li

den*$n (ende)$%$n di$*n"s%i) $n* +en$r den*$n %u#u$n &en,$ri e%i"l"*i $n* %e($% $*$r

d$($% se*er$ di%$n*$ni.


30/30

DAFTAR PUSTAKA

1. Is&$il d$n $h u . Mun%$h P$d$ An$). D$l$&: !uh$r "' ed. G$s%r"en%er"l"*iAn$) Pr$)%is. 19 . F$)$r%$: B$l$i Pener+i% @ I. $l. 109 115.

. M$r)u& A ' Is&$el !' Al$%$s . Mun%$h P$d$ B$ i. D$l$&: Bu)u A#$r Il&u

eseh$%$n An$). 19 5. F$)$r%$: In2"&edi)$. $l. 311.

3. !ur$$%&$#$' !ud$r $%. G$s%r"en%er"l"*i An$). 005. F$)$r%$: !$*un* !e%". $l. 155

169.

4. Putra, Deddy S Muntah Pada !nak Diunduh dari" .dr dedd .,"&/$r%i)el)eseh$%$n/4 &un%$h ($d$ $n$) .(d2 Diakses pada tanggal ## $kto%er &'#'

5. Sudarmo, Su%i(anto M Pen$%$l$)s$n$$n Mun%$h ($d$ B$ i d$n An$) Diunduh dari"

.(edi$%ri).,"&/+ule%in/ 0060 0 h 0*( +ule%in. (d2 Diakses pada tanggal ##

$kto%er &'#'

6. $;elli' Al+er%". e,urren% >"&i%in*. D$l$&: Gu$nd$lini' !%e2$n" ed. Essen%i$l

Pedi$%ri, G$s%r"en%er"l"* ' e($%"l"* ' $nd Nu%ri%i"n. 005. !A: M,Gr$ ill

Medi,$l Pu+lishin*. $l. 3 14.

7. =$ne ' $ ne. he G$s%r"in%es%in$l r$,% J =i;er. D$l$&: ud"l(h' A+r$h$& ed.

ud"l(h s @und$&en%$ls "2 Pedi$%ri,s. 00 . !A: M,Gr$ ill Medi,$l Pu+lishin*.

$l. 466 47 .

. !"ndhei&er' Fudi%h. >"&i%in*. D$l$&: $l)er' All$n ed. Pedi$%ri,s G$s%r"in%es%in$l

Dise$se. 004. !A: B8 De,)er. $l. 03 09.
http://www.dr-deddy.com/artikel-kesehatan/4-muntah-pada-anak.pdfhttp://www.dr-deddy.com/artikel-kesehatan/4-muntah-pada-anak.pdfhttp://www.pediatrik.com/buletin/20060220-hw0gpy-buletin.pdfhttp://www.pediatrik.com/buletin/20060220-hw0gpy-buletin.pdfhttp://www.pediatrik.com/buletin/20060220-hw0gpy-buletin.pdfhttp://www.dr-deddy.com/artikel-kesehatan/4-muntah-pada-anak.pdfhttp://www.dr-deddy.com/artikel-kesehatan/4-muntah-pada-anak.pdf

referat muntah pada anak adi

Documents