Infeksi & Hipotermi Final 1

8/11/2019 Infeksi & Hipotermi Final 1

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INFEKSI DAN HIPOTERMIA

PADA ILEUS

dr. Santi Rini, SpBA


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SYNOPSIS

Morbus

HIrschsprung Ileus

Congenital

anomaly

Ileus Strangulation(Vascular compromise)

Peritonitis Acute Abdomen(Emergencies)

Obstipation

Distention

Vomiting

Upper ileus:-vomiting>-mild distention(epigastric)

Pylorus (Gastric outlet)

Duodenum Obstructions

Lower Ileus:-vomiting130/min

tachypnea

Hypotensive systolic 3 seconds

Lethargic

Mottled

Tenting

Cool,clammy

Doughy

Sunken

Parched

Sunken

Intense if conscious

Minimal


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HIGH GIT OBSTRUCTION

GASTRIC OUTLET OBSTRUCTION

- HPS ( HYPERTROPHIC PYLORIC STENOSIS )

- ANTHRAL WEB- PYLORIC MUCOSA PROLAPS

DUODENAL OBSTRUCTION

- ATRESIA/STENOSIS DUODENUM- PANCREAS ANNULARE

- LADD`S MEMBRANE


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MECHANICAL LOWER GIT

OBSTRUCTION

MECONIUM ILEUS MECONIUM PLUG SYNDROME

NEONATAL SMALL LEFT COLON SYNDROME MALROTATION WITH VOLVULUS INCARCERATED HERNIA JEJUNOILEAL ATRESIA COLONIC ATRESIA INTESTINAL DUPLICATION INTUSSUSCEPTION HERNIA INGUINALIS


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FUNCTIONAL LOWER GIT

OBSTRUCTION

SEPSIS

NEC (NECROTICANS ENTERO COLITIS)

INTRACRANIAL HEMORRHAGEHYPOTHYROIDISM

MATERNAL DRUG INGESTION ORADDICTION

HYPERMAGNESEMIAHYPOKALEMIA

MORBUS HIRSCHSPRUNG


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GIT HAEMORHAGE

UPPER : MELENA

LOWER : HEMATOCHEZIA

RECTAL BLEEDING

LIGAMENTUM TREITZ LIMITED


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COMMON CAUSES OF

GASTROINTESTINAL HEMORRHAGE

Patient < 1 Year Patient > 1 Year

Upper

Gastritis

Swallowed maternal blood

Peptic ulcer(duodenal andgastric)

Malrotation and volvulus

Lower

Anal fissure

Intussusception

Necrotizing enterocolitis

Meckels diverticulum

Malrotation and volvulus

Upper

Peptic ulcer

Varices

Lower

Colonic polyps

Intussusception

Meckels diverticulum

Infections diarrhea

Inflammatory bowel disease


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FLUIDS RESUSCITATION

PROGRAMS

The fluids compartement :

-First : Intracellular

-Seconds : Extracellular :-Plasma intravascular

-Interstitial cell

-Non Functional

Thirds space : 1. Cavum intra peritoneal (abdomen)

2. Cavum inra pleural (thorax)

The Fluids: Resusitations:-Kristaloid: ringer Lactate, asering,saline

-Koloid: plasbumin

Nutrisions: Dextrose 5%,Aminofusin 5%, Intralipid 20%

Physiologist

circulatory


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TERAPI NUTRISI PARENTERAL

EBB PHASE :-HIPOVOLEMIA

- CAIRAN RESUSITASI RL/ ASERING

FLOW PHASE : NORMOVOLEMIACAIRAN NUTRISI:

KH : D5, D10

PROTEIN : ASAM AMINO 2,5%, 5%,10%

LEMAK : LIPID 20%

ELEKTROLIT: KAEN I B, 3A, 3B

MINERAL


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REASONING

FLUIDS PROGRAM 6 HOURS

Gold standart periodic ileus

Intra vascular Ringers lactate are to resist

in oncotyic pressure poor conditions

(hypo albuminemia)

Shock 1 hour program

Fourth step management:

1. The kind fluids

2. The fluids quantity

3. The giving methode of fluid : intravenous perifir

or central

4. Monitoring evaluations every 1 hours


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Jumlah cairan :

1. Defisit cairan / dehidrasi

a. Dehidrasi Ringan : 5% ( 50ml/kgbb x TBW )

b . Dehidrasi Sedang : 10% (100ml/kgbb x TBW )

c. Dehidrasi Berat : 15% (150ml/kbbb x TBW )* Tonisitas darah:Hipotonis,isotonis,hipertonis

2. Maintenance

Neonatus: 24 jam post operatif dikurangi 30%

3. Perkiraan cairan hilang dalam 24 jam( on going loss )

2&3 modification to Fluid intake ( see table )


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TOTAL BODY WATER ( ASHCRAFT)

UMUR %

Gestasional12 minggu 94

12 minggu 32 minggu 80

Aterm

3-5 hari 78

-3 5

Neonatus 75 - 80

Children 65 - 75

Young Man 60Young Woman 50

Over 60 years man 50

Over 60 years women 45


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MAINTENANCE ( ASHCRAFT )

* Daily Fluid Requirements

Weight Volume

Premature (< 2kg ) 150 ml / kg

Neonatus & infant (2-10 kg ) 100ml/kg for first 10kg

Infant & children (10-20kg ) 1000ml+50ml/kg over 10 kg

Children ( > 20 kg ) 1500ml+20ml/kg over 20 kg


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TABLE : MODIFICATION TO FLUID INTAKE

Decrease Adjustment

Humidified Inspired air X 0.75

Basal state (eg pa ralysed ) X 0.7

High ADH (IPPV,brain injury ) X 0.7

Hypothermia - 12 % per C

High room humidity x 0.7

Renal failure x 0.3 (+urine output )


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Increase

Full activity + oral feeds X 1.5

Fever + 12 % per C

Room temperature > 31 C + 30 % per C

Hyperventilation X 1.2Neonate - preterm (1-1.5 kg ) X 1.2

- radiant heater X 1.5

- photo terapy X 1.5

Burn - first day + 4% per 1%

area burn- Subsequently + 2% per 1%

area burn


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KASUS

PASIEN BAYI USIA 1 tahun(BB 10 KG) DENGAN ILEUS DISERTAI

DEHIDRASI BERAT DAN FEBRIS SUHU 400C, ASIDOSIS

METABOLIK DAN ANEMIA. HASIL LAB.HB 8G%, ALBUMIN 2G/DL, K+2 MEQ/L, NA+160 MEQ/L, TROMBOSIT 50000

MM2/DL.( TBW 70%, t normal 36,5C)

TERANGKAN PENATALAKSANAAN LENGKAP dalam 6 jam?


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Infeksi & Hipotermi Final 1

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