INFEKSI DAN HIPOTERMIA

PADA ILEUS


dr. Santi Rini, SpBA
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:
-vomiting<
- significant
whole distention
Malformations
Disruptions
Deformations
Syndrome

HAEC
(toxic Megacolon)
Anal Bleeding
(melena,hematozesia, fresh)
Mechanical Ileus
Functional Ileus
Septic shock
Hypo volumic shock
Ileus simple
Colicky pain
(intermittent)
Contiuous pain
/Ischemic pain
(anoksia)
Hollow viscus obstruction:
-mild : anorexia
-Moderate : nausea
-Severe : vomiting

G I Tract
Ureter
Billiary Tract
Pancreatic Tract
Tuba Fallopii
Gold standart: 6 hours
ILEUS
ABDOMEN DISTENTIONS
ILEUS
ILLUSTRATIONS
Normal
Ileus
Complications:
I.Third space syndrome
(Venous Obstruction)
Dehydrations mild (5%deficit)
- moderate (10%)
- severe (15%)
II.Abdomen compartment syndrome
(distended abdomen- venous return disrturb)
III.Sepsis
(fecal retentions-bactreial overgrowth-mucous
barrier damage)

Tx/ Fluid resucitations

Tx/Naso Gastirc Tube(NGT), rectal tube
Decompressions operative
Tx/ Antibiotic Drugs
Vasa:
lymph,venous,artery
TERMINOLOGY
Septicaemia
Sepsis
Septic shock
Systemic Inflammatory Response Syndrome
(SIRS)
HIPOTERMIA
Hipothalamus : pusat pengatur suhu
Suhu < 35
0
C
Dibawah 32,2
0
C : kegagalan renal akut dll
Iatrogenic hipotermia : insidens sering pada anestesi
Klinis : somnolent, stuporous, or comatose, cold and pale
sianosis
Prognosis : Dibawah 32,2
0
C survival 50%
PROBLEM ILEUS





Abdominal distention
compartement mnemonic F6:
- Feses (Fecaloma,fecalith)
- Fetus in feto
- Fibroids (Solid tumor)
- Flatus (Ileus)
- Fluid (Ascites)
- Fat
Obstipation
Abdominal distention Triad Ileus-Surgical Problem
Vomiting
Tabel : Sign and symptoms of dehydration

Assessment Mild (5%) Moderate (10%) Severe( 15%)
Vital sign
Heart rate
Respiratory rate
Blood pressure
Capillary refill
Mental Status
Skin
Color
Turgor
Temperature
Texture
Fontanelle
Mucous membrane

Eyes

Thirst
Urine Output

Normal
Normal
Normal
Normal
Alert

Pale
Normal
Warm
Normal
Flat
Dry
tears
Normal
sunken
Increased
Normal
concentrated

Increased
Increased
Normal
2 3 second
Irritable

Ashen
Poor
Cool
Dry
Depressed
Very dry
no tears
Darkened
Soft
Intense
Decreased
very concentrated

Tachycardia>130/min
tachypnea
Hypotensive systolic <80
>3 seconds
Lethargic

Mottled
Tenting
Cool,clammy
Doughy
Sunken
Parched

Sunken

Intense if conscious
Minimal






Definition ileus
Classification ileus:
1. Manifestations Clinic
- Upper
- Lower : - Mechanic
- Functional
2. Radiologic (Post Barium meal,enema)
- Upper (forgut)
- Intermediate (midgut)
- Lower (hindgut)





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

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

FUNCTIONAL LOWER GIT
OBSTRUCTION
SEPSIS
NEC (NECROTICANS ENTERO COLITIS)
INTRACRANIAL HEMORRHAGE
HYPOTHYROIDISM
MATERNAL DRUG INGESTION OR
ADDICTION
HYPERMAGNESEMIA
HYPOKALEMIA
MORBUS HIRSCHSPRUNG
GIT HAEMORHAGE
UPPER : MELENA
LOWER : HEMATOCHEZIA
RECTAL BLEEDING
LIGAMENTUM TREITZ LIMITED
COMMON CAUSES OF
GASTROINTESTINAL HEMORRHAGE
Patient < 1 Year Patient > 1 Year
Upper
Gastritis
Swallowed maternal blood
Peptic ulcer(duodenal and
gastric)
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
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
TERAPI NUTRISI PARENTERAL
EBB PHASE :-HIPOVOLEMIA
- CAIRAN RESUSITASI RL/ ASERING
FLOW PHASE : NORMOVOLEMIA
CAIRAN NUTRISI:
KH : D5, D10
PROTEIN : ASAM AMINO 2,5%, 5%,10%
LEMAK : LIPID 20%
ELEKTROLIT: KAEN I B, 3A, 3B
MINERAL
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





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 )
TOTAL BODY WATER ( ASHCRAFT )
UMUR %

Gestasional 12 minggu 94
12 minggu 32 minggu 80
Aterm
3-5 hari 78
-3 5
Neonatus 75 - 80
Children 65 - 75
Young Man 60
Young Woman 50
Over 60 years man 50
Over 60 years women 45
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
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 )
Increase
Full activity + oral feeds X 1.5
Fever + 12 % per C
Room temperature > 31 C + 30 % per C
Hyperventilation X 1.2
Neonate - 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
KASUS :
PASIEN BAYI USIA 1 tahun(BB 10 KG) DENGAN ILEUS DISERTAI
DEHIDRASI BERAT DAN FEBRIS SUHU 40
0
C, ASIDOSIS
METABOLIK DAN ANEMIA. HASIL LAB.HB 8G%, ALBUMIN 2
G/DL, K
+
2 MEQ/L, NA
+
160 MEQ/L, TROMBOSIT 50000
MM
2
/DL.( TBW 70%, t normal 36,5C)

TERANGKAN PENATALAKSANAAN LENGKAP dalam 6 jam?