Kasus 2_PSCBA CA ENDOMETRIUM - Copy.pptx

1. Stase Gastro

2. Pembahasan Kasus
BAB Hitam
GI Bleeding
Ca Endometrium
Riwayat penggunaan
NSAID untuk mengurangi
nyeri perut bawah sejak
Januari 2022
Pelacakan ec susp
nonvariceal (gastritis erosiva)
PSCBA ec susp nonvariceal
(gastritis erosiva) dengan
problem- anemia life
threatening
Perut panas
Mual
Tidak mau
makan
BB turun

3. Perdarahan Saluran Cerna
• Kondisi Akut (Overt)
Munculnya salah satu dari 3:
• Muntah darah warna merah segar sampai kecoklatan
(hematemesis)
• Feses berwarna hitam (melena)
• Feses dengan darah berwarna segar (hematokezia)
• Kondisi Kronik (Occult)
Perdarahan saluran cerna samar (positive FOBT, with/without Iron
deficiency anemia)
• Obscure bleeding
Perdarahan saluran cerna atas berulang (sumber tidak teridentifikasi
setelah endoskopi/kolonoskopi)  overt/occult
• Berdasarkan lokasi: ligamentum Treitz
Proksimal  PSC Atas , Distal PSC Bawah
1. Djojoningrat D. Pendekatan Klinis Penyakit Gastrointestinal. 5th ed.
2. Bestari MB. Endoscopic Therapy in the Management of Non Variceal Bleeding. Makalah Simposium Indonesian Digestive Disease Week. 2013
3. Laine L. Gastrointestinal Bleeding. Harrisons Princ Intern Med. 18th ed.

4. KU: CM, sedang
TD: 116/66 mmHg
N: 135x/menit, reg
RR: 28x/menit
T: 38.5
Spo2: 95 on RA/ 99 on
NK 3 lpm
BB: 47 kg
TB: 158 cm
BMI: 18.83 kg/m2

5. ALGORITMA TATALAKSANA

8. Glasgow-Blatchford Bleeding Score
Total 14
High Risk for GI Bleeding
Rockall Score
Total 3
Intermediate Risk

9. Glasgow-Blatchford Bleeding Score
Total 14
High Risk for GI Bleeding
Rockall Score
Total 3
Intermediate Risk

12. Pada pasien untuk
membedakan GI bleeding
ec drug induced dd
malignancy dengan
endoskopi + biopsi

13. Cause Bleeding
Manifestation
Associated sign and
symptoms
Associated condition
or risk factor
Endoscopic finding
Duodenal and/or
gastric ulcer
Hematemesis,
melena, hematokezia,
occult blood loss
Upper abdominal pain
Pain associated with
eating
Dyspepsia
Infection
NSAIDs
Stress ulcer
Excess gastric acid
production (ZES)
Idiopatic
Ulcer with smooth, reguar,
rounded edges, ulcer base
often filled with exudate
Esophagitis Hematemesis,
melena, occult blood
loss
Dyspgahia/odynophagia,
retrosternal pain, food
impaction
GERD
Medication (pill
esophagitis)
Infection
Erythema, mucosal
breaks/erosions, exudative
lesions, superficial/deep
ulcer, stenosis, scarring
Gastritis/
gastropathy
Occult blood loss
Hematemesis
Melena
Dyspepsia Risk:
- H. pylori
- NSAIDs
- Excessive alcohol
consumption
- Radiation injury
- Physiologic stress
- Weight loss surgery
- Bile reflux
Risk factor for bleeding:
- Anticoagulat use
Erythematous mucosa
Superficial erosion
Nodularity
Diffuse oozing

14. Cause Bleeding
Manifestation
Associated sign and
symptoms
Associated condition or
risk factor
Endoscopic finding
Upper GI tumor Hematemesis,
melena,
hematokezia
Occult blood loss
Weight loss,
anorexia,
nausea/vomiting,
early satiety,
epigastric pain,
dysphagia, gastric
outlet obstruction,
palpable mass,
paraneoplastic
manifestation
Virtually any tumor type may
bleed
Benign Tumor: leiomyoma,
lipoma, polyp
Malognant: adenoca, GI
stromal tumor, lyphoma,
Kaposi sarcoma, carcinoid,
melanoma, metastatic tumor
Ulcerated mass in the
esophagus, stomach, or
duodenum
Hemobilia Hematemesis,
melena,
hematokezia
Biliary colic
Jaundice
(obstructive)
Sepsis (biliary)
Past history of liver or biliary
tract instrumentation and/or
injury
Blood or clot emanating from the
ampula
ERCP may reveal a filling defect
in the bile duct
Hemosuccus
pancreaticus
Occult blood loss,
Hematemesis,
melena,
hematokezia
Abdominal pain, past
evidence of
symptoms/sign of
pancreatitis, imaging
evidence of
pancreatitis, elevated
amylase and lipase
Chronic pancreatitis,
pancreatic pseudocysts,
pancreatic tumor, pancreatic
pseudoaneurysm, therapeutic
endoscopy of pancreas or
pancreatic duct
Blood or clot emanating from the
ampula
Cross sectional imaging or
angiography

15. Prevalensi metastasis dari
ca endometrium
Prevalensi besar Riwayat
penggunaan NSAID untuk
mengurangi nyeri perut
bawah sejak Januari 2022

19. SINTESA STASE
ASESMEN
1. PSCBA ec susp nonvariceal
(gastritis erosiva) dengan
problem
- anemia life threatening
2. Ca cervix st IIIB P4A0
3. CKD st III-IV riwayat HD ec
hidronefrosis on nefrostomi
(membaik) dengan
- hiponatremia hipoosmolar
berat
4. Suspek ISK komplikata
5. Hipoalbuminemia
Anamnesis
BAB cair berwarna hitam seperti petis sejak 1 minggu SMRS, 8 kali sehari
disertai mual, penurunan nafsu makan, berat badan tidak kunjung naik dan
demam disertai menggigil.
Riwayat penggunaan NSAID untuk mengurangi nyeri perut bawah sejak Januari 2022
Pemeriksaan Fisik
KU: CM, sedang
Kepala : konjuntiva pucat (+/+)
RT : feses (+) berwarna kehitaman.
Pemeriksaan Penunjang
Hb 5.1
AT 502
Na 134
AE 1.96
Hmt 15.1
BUN 38
Creat 1.96
Na 120
Cl 93
Osm 259
K 5.3
Cl 97
Hispatologi: cavum uteri (kerokan) : non keratinizing squamous cell carcino
Plan
Endoskopi