Kel 2

Defining Dyspepsia
• Chronic or recurrent pain or discomfort
centered in the upper abdomen
 etiologi
• Increased gastric acid
• H. pylori infection
• GI dysmotility (antral hypocontractility)
• Decreased perception threshold
• Autonomic dysfunction
• Decreased gastric accommodation
• Gastric myoelectric activity
• Psychological factors
 Epidemiologi
• Population-based studies on true functional
dyspepsia (FD) are few, due to the logistic
difficulties of excluding structural disease in
large numbers of people. Globally, the
prevalence of uninvestigated dyspepsia (UD)
varies between 7% - 45%, depending on
definition used and geographical location,
whilst the prevalence of FD has been noted to
vary between 11% - 29.2%.
 Klasifikasi dyspepsia

• Classification of dyspepsia Practical clinical classification, based on

complaints or dominant differences, is divided into 3 types of
dyspepsia:
• 1) Dyspepsia and complaints such as ulcers (dyspepsia such as
ulcers), with symptoms: a) Localized epigastric pain. b) Pain is lost
after eating or given antacids. c) Pain when hungry. d) Episodic pain.
• 2) Dyspepsia with GFI such as dysmotility (dysmotility-like
dyspepsia), with symptoms: a) Easy to full b) Stomach quickly feels
full when eating c) Nausea d) Vomiting e) Bloated upper abdomen
f) Increased discomfort when eating.
• 3) Nonspecific dyspepsia (no statement like the two types above)
 patofisiology
• Increased gastric acid
• H. pylori infection
• GI dysmotility (antral hypocontractility)
• Decreased perception threshold
• Autonomic dysfunction
• Decreased gastric accommodation
• Gastric myoelectric activity
• Psychological factors
 Work Diagnostics (5th edition in
disease, aru W. Sudoyo)
Dyspepsia is functional like a ulcer
• Anamneses: heartburn - wake up at night
• Symptom alarm: - over 10% weight loss -melena -
disfagia -anorrhea - history of gastric ulcer - more than 45
years old -anemia
• Physical examination epigastric pressure
• Supporting investigation -endoscopy promotes
hyperemia -pH metri assesses acid electrography shows
bradygastri or tachygastri
 DD Dyspepsia
• Functional Dyspepsia (60%) • Carbohydrate
• PUD (25%) Malabsorption
• GERD • Meds (NSAIDS, Narcotics,
• Biliary Pain etc.)
• Chronic Abdominal Wall • Infiltrative Diseases
Pain • Metabolic Disturbances
• Gastric CA • Hepatoma
• Esophageal CA • Ischemic Bowel Disease
• Other Abdominal • Systemic Disorders
Malignancy • Parasites
• Gastroparesis
• Pancreatitis
 Management dyspepsia
• Management of our dyspepsia for 2:
• 1. Non-medical 2. Medical
• 1. Non-medical • Dietetics There is no
standard dietetic that results in the healing of
complaints in a meaningful way, the basic
principle is to avoid the trigger food, such as
acid, spicy, high fat, and coffee.
• 2. Medical For dyspepsia it is an organic, functional like
ulcer
• • Antacids: aluminum hydroxide, magnesium hydroxide
• • PPI: omeprazole 2 x 20 mg / day
• • Mukoprotektor: Sukralfat ’’ 4x1 gr / day of aluminum
sucrose
• • AH2 inhibit: ranitidine For dyspepsia type of
dismotility
• • Antacids: aluminum hydroxide, magnesium hydroxide
• • Prokinetic: domperidone 3 x 10 mg / day before meals
• • Serotonin antagonist 5-HT3: ondasetron @narfoz For
NSAID-induced dyspepsia
• • PGE analogue: @sitotec 2 x 400mg / day misoprostol For
dyspepsia due to H. Pylori infection
• Line1: -Amoxicillin + Claritomycin + PPI -Metronidazole +
Claritomycin + PPI -Metronidazole + Tetracycline + PPI -
Metronidazole + amoxicillin + PPI
• Line 2: Bismuth / cbs + amoxicillin + claritomycin Bismuth +
metronidazole + claritomycin Bismuth + mentronidazole +
tetracycline Dose: PPI = 2 x 20 mg Amoxicillin: 2x 1000 mg
Clarithomycin: 2 x 500 mg Metronidazole: 3 x 500 mg
Tetracycline: 4 x 250 mg CBS / bismuth: 4 x 120 mg
 Complications
• • Esophageal narrowing. Esophageal stricture or stricture
can occur when a person often experiences heartburn
caused by gastric acid reflux. Gastric acid that rises into the
esophagus can cause scarring in the esophagus and narrow
the duct. Symptoms that may appear include difficulty
swallowing (dysphagia) and chest pain.
• • Barrett's esophagus. This condition occurs when exposure
to stomach acid occurs continuously in the esophagus. But
in this case, the cells in the lower esophagus turn into
cancer cells. These changes are at risk of causing
esophageal cancer.
•
• • Pyloric stenosis. This condition is caused by exposure
to stomach acid in the area of ​the pylorus (the part
between the stomach and small intestine) in the long
term. Exposure causes scarring and narrows the
pylorus, so food is not digested properly. This condition
can cause sufferers to feel nauseous and vomiting.
• • Peritonitis. Peritonitis is caused by exposure to
stomach acid in the area of ​the peritoneum (a thin
layer of the abdominal cavity). This exposure results
from tearing of the stomach wall, so that stomach acid
leaks into the peritoneal area and causes inflammation
in the area.
 Prognosis
• • Functional dyspepsia that is enforced after
accurate clinical and supporting examinations,
has a good prognosis Education
 advise
• a) Inform patients and their families about the trigger factors for
dyspepsia to be avoided and reduce the risk of developing
complaints.
• b) Inform patients and their families about how to take medication
at home, how each drug works, and how many times you take a
day.
• c) Inform the patient and the patient's family to drink the medicine
regularly according to the doctor's instructions.
• d) Advise patients and families to lose weight, regulate eating
patterns on time, reduce fatty foods, eat small portions), and
exercise regularly.
• e) Inform patients and families to stop smoking.
• f) Inform patients and families not to consume food or that can
irritate the stomach such as aspirin, alcohol, coffee, tea, spicy foods,
and cabbage