Nyeri Epigastrium

1. Nyeri
Epigastrium
dr. Nihayatul Amaliyah, Sp.PD
Pendekatan Diagnosis
FAKULTAS KEDOKTERAN
UNIVERSITAS SWADAYA GUNUNGJATI
RSUD WALED
2022

2. A picture is worth
a thousand words

3. Nyeri perut menjadi
keluhan utama paling
sering di IGD.*
> 1.5 juta pasien di 11 IGD
datang dengan keluhan
nyeri perut . *
*CDC, 2015

4. Regio Abdomen
*Bates Physical Examination 12th ed, 2017

5. *Bates Physical Examination 12th ed, 2017

6. Dyspepsia
Sindroma atau kumpulan gejala/keluhan yang terdiri dari :
- Nyeri atau rasa tidak nyaman di ulu hati
- Kembung
- Mual
- Muntah
- Sendawa
- Rasa cepat kenyang
- Perut terasa penuh/ begah
*Buku Ajar IPD FK UI, 2014

7. Prevalensi
15–25% populasi umum pernah mengalami
keluhan dispepsi dalam 12 bulan
Dispepsia merupakan keluhan yang lebih banyak
ditemui di pelayanan kesehatan primer dibandingkan
ulkus peptik , sekitar 5% lebih .
Hampir tidak ditemukan kelainan pada pemeriksaan
radiologi gastrointestinal bagian atas dan juga endoskopi
Temuan endoskopi dan berat/ringannya keluhan pada
pasien tidak berhubungan Talley, J Clin Gastroenterol 2001; 32: 286–93.
Locke, Ballieres Clin Gastroenterol 1998; 12: 435–42.
Paré, Can J Gastroenterol 1999; 13: 647–54.
van Bommel et al., Postgrad Med J 2001; 77: 514–18.
Talley et al., BMJ 2001; 323: 1294–7.

8. DM, Penyakit
Tiroid, PJK
Tidak terbukti adanya kelainan/gang.
Organik/struktural dan biokimia
NSAID, Aspirin,
antibiotik, digitalis,
teofilin, dll
Tukak gaster/duodenum, gastritis,
tumor, infeksi H.Pylori
Hepatitis, Pankreatitis,
Kolesistitis kronik
Penyakit dalam lumen
saluran cerna :
Etiologi Dispepsia
Obat-obatan :
Penyakit Hati, Pankreas,
Sistem bilier :
01 02 03
Penyakit Sistemik : Bersifat Fungsional :
04 05

9. ROME IV
Functional dyspepsia is a medical condition that significantly
impacts on the usual activities of a patient and is
characterized by one or more of the following symptoms:
postprandial fullness, early satiation, epigastric pain, and
epigastric burning that are unexplained after a routine clinical
evaluation
DISPEPSIA FUNGSIONAL
Criteria fulfilled for the last 3 months with symptom
onset at least 6 months prior to diagnosis

10. Dispepsia fungsional merupakan keluhan
yang umum, sekalipun di negara barat .
Angka kejadian :10-40 %
Angka remisi : 10-20%
Angka kekambuhan : 20-25%
Prevalensi

11. Karakteristik

12. Postprandial Distress Syndrome (PDS)
Must include one or both of the following at least 3 days a week:
• Bothersome postprandial fullness (i.e., severe enough to impact on usual activities)
• Bothersome early satiation (i.e., severe enough to prevent finishing a regular size meal)
• No evidence of organic, systemic, or metabolic disease that is likely to explain the symptom
on routine investigations (including at upper endoscopy)
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Supportive criteria
• Postprandial epigastric pain or burning, epigastric bloating, excessive belching, and nausea can
also be present
• Vomiting warrants consideration of another disorder
• Heartburn is not a dyspeptic symptom but may often co-exist
• Symptoms that are relieved by evacuation of feces or gas should generally not be considered as
part of dyspepsia
• Other individual digestive symptoms or groups of symptoms (e.g., from GERD and IBS) may co-
exist with PDS

13. Epigastric Pain Syndrome (EPS)
Must include one or both of the following symptoms at least 1 day a week:
• Bothersome epigastric pain (i.e., severe enough to impact on usual activities)
• Bothersome epigastric burning (i.e., severe enough to impact on usual activities)
• No evidence of organic, systemic, or metabolic disease that is likely to explain the
symptom on routine investigations (including at upper endoscopy).
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Supportive criteria
• Pain may be induced by ingestion of a meal, relieved by ingestion of a meal, or may occur
while fasting
• Postprandial epigastric bloating, belching, and nausea can also be present
• Persistent vomiting likely suggests another disorder
• Heartburn is not a dyspeptic symptom but may often co-exist
• The pain does not fulfill biliary pain criteria
• Symptoms that are relieved by evacuation of feces or gas generally should not be considered
as part of dyspepsia
• Other digestive symptoms (such as from GERD and IBS) may co-exist with EPS

14. It’s composed of
hydrogen and helium
Saturn
Mars is actually a very
cold place
Jupiter is the biggest
planet of them all
Jupiter
Symptoms
Patofisiologi

16. Diagnostik
Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

17. Diagnostik H. Pylori
Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

18. Management of Dyspepsia. ACG. 2017
Tatalaksana

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20. Eradikasi
H. Pylori

21. Alarm Symptoms
Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

22. Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

23. Apabila ditemukan lesi mukosa (mucosal damage) sesuai hasil
endoskopi, terapi dilakukan berdasarkan kelainan yang
ditemukan.
Kelainan yang termasuk ke dalam kelompok dispepsia organik
antara lain gastritis, gastritis hemoragik, duodenitis, ulkus
gaster, ulkus duodenum, atau proses keganasan.
DISPEPSIA ORGANIK
Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

24. Terapi Dyspepsia Organik
.Pada ulkus peptikum (ulkus gaster dan/ atau ulkus duodenum),
obat yang diberikan antara lain kombinasi PPI, misal rabeprazole
2x20 mg/ lanzoprazole 2x30 mg dengan mukoprotektor, misalnya
rebamipide 3x100 mg.
Konsensus Nasional Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori

25. TERIMA KASIH
dr. Alin