Rabu, 20 Februari 2008

koLitis ULseratif....

Gangguan saluran cerna adalah salah satu masalah yang sering kita dijumpai dimasyarakat. Diantaranya banyaknya penyakit tersebut gejala keluarnya feses berdarah, berlendir dan bernanah juga sering didapat

jika hal tersebut terjadi mungkin yang dialami adalah kolitis ulseratif.

mungkin info dibawah ini dapat sedikit menjelaskannya..

apa sih kolitis ulseratif itu ?

Kolitis Ulserativa merupakan suatu penyakit menahun, dimana usus besar mengalami peradangan dan luka, yang menyebabkan diare berdarah, berlendir, bernanah, kram perut dan demam. Colitis ulseratif biasa menyerang pada usia 15-35 tahun, tetapi dapat juga menyerang usia diatas 50 tahun


Penyebab nya apa aja ya?

Penyebab penyakit ini tidak diketahui, namun faktor keturunan dan respon sistem kekebalan tubuh yang terlalu aktif di usus, diduga berperan dalam terjadinya kolitis ulserativa. Selain itu ada juga beberapa fakor yang dicurigai menjadi penyebab terjadinya colitis ulseratif diantaranya adalah : hipersensitifitas terhadap factor lingkungan dan makanan, interaksi imun tubuh dan bakteri yang tidak berhasil (awal dari terbentuknya ulkus), pernah mengalami perbaikan pembuluh darah, dan stress.


Patofisiologis

Pada kondisi yang fisiologis system imun pada kolon melindungi mukosa kolon dari gesekan dengan feses saat akan defekasi, tetapi karena aktifitas imun yang berlebihan pada colitis maka system imunnya malah menyerang sel-sel dikolon sehingga menyebabkan terjadi ulkus

Ulkus terjadi di sepanjang permukaan dalam (mukosa) kolon atau rectum yang menyebabkan darah keluar bersama feses. Darah yang keluar biasanya bewarna merah, karena darah ini tidak masuk dalam proses pencernaan tetapi darah yang berasal dari pembuluh darah didaerah kolon yang rusak akibat ulkus. Selain itu ulkus yang lama ini kemudian akan menyebabkan peradangan menahun sehingga terbentuk pula nanah (pus).

Ulkus dapat terjadi pada semua bagian kolon baik, pada sekum, kolon ascenden, kolon transversum maupun kolon sigmoid.

A ulkus pada cekum C uklus pada kolon transversum

B ulkus pada kolon ascenden D ulkus pada kolon sigoid


Berdasarkan daerah yang terinfeksi kolitis ulseratif dapat dibagi menjadi beberapa tipe, yaitu :

Area yang terinfeksi

Name

Rectum

Ulcerative proctitis

Left side of the colon

Limited, or distal, colitis

Entire colon

Universal, or Pancolitis

Akibat ulkus yang menahun maka terjadilah perubahan bentuk pada kolon baik secara mikroskopik ataupun makroskopik,

Gejala yang sering timbul pada penyakit colitis ulseratif ini adalah :

  1. Nyeri perut

  2. Diare berdarah,berlendir dan bernanah

  1. Anemia

  2. Turunnya berat badan

Gejala yang timbul ini hampir sama dengan penyakit Chron karena itu sering sekali orang mengira penyakit ini adalah penyakit chron, tetapi jika kita lebih teliti maka banyak perbedaan yang terlihat, seperti yang tercantum pada tabel



Symptoms of Inflammatory Bowel Disease

Gejala

Ulcerative Colitis (UC)

Crohn's Disease (CD)

Diarrhea

Diare yang rekuren sangat sering dan selalu disertai mukus

Diare rekuren jarang dijumpai

Rectal bleeding

Darah juga selalu ada dalam feses

Kadang-kadag ada darah dalam feses.

Constipation

Jarang terjadi

Selalu terjadi konstipasi.

Fever

Bias terjadi apabila sudah parah.

Selalu tejadi walapun kenaikan suhu tidak terlalu tinggi, tetapi jika sudah mengalammi komlikasi maka akan lebih meninggi

Loss of appetite, weight loss,

Terjadi jika pnyakit sudah memasui tahap yang parah

Umum dijumpi penurunan sekitar 10-20% dari berat normal.

Abnormal defecation: Increased frequency, a feeling of incomplete evacuation, and tenesmus .

Gejala pada tahap mild or severe.

Terjadi disetiap tahap

Anal ulcers and fistulas: (channels that can burrow between organs, loops of the intestine, or between the intestines and skin).

Hamper tidak pernah ditemukan

Merupakan gejala awal


Diagnosanya ...

Untuk mengetahui pasti diagnose penyakit ini adalah dengan cara melakukan beberapa test.

  • Tes pertama yang dilakukan adalah anamnesis dan pemeriksaaan fisik tentunya, pada pemeriksaan fisik , periksalah kekauan dari otot-otot abdominal kemudian perhatikan

Apakah pasien demam dan dehirasi jika ya, kemungkinan pasien mengalami gejala awal ulkus

  • Pemeriksaan feses (berdarah, lender dan nanah)

  • Pada pemeriksaan laboratorium terlihat anemic dan malnutrisi

  • Sigmoidoskopi, cara yang paling baik yaitu dengan cara memasukan kamera kedalam saluran cerna, dan tampaklah bagian mana yang telah menganai ulkus

Pengobatan yang bisa dilakukan

Pengobatan ditujukan untuk mengendalikan peradangan, mengurangi gejala dan mengganti cairan dan zat gizi yang hilang.Penderita sebaiknya menghindari buah dan sayuran mentah untuk mengurangi cedera fisik pada lapisan usus besar yang meradang. Diet bebas susu bisa mengurangi gejala. Penambahan zat besi bisa menyembuhkan anemia yang disebabkan oleh hilangnya darah dalam tinja.

Obat-obatan seperti :

  • dosis kecil loperamide atau difenoksilat, diberikan pada diare yang relatif ringan.

  • Untuk diare yang lebih berat, mungkin dibutuhkan dosis yang lebih besar dari difenoksilat atau opium yang dilarutkan dalam alkohol, loperamide atau codein.

  • Pada kasus-kasus yang berat, pemberian obat-obat anti-diare ini harus diawasi secara ketat, untuk menghindari terjadinya megakolon toksik.

  • Sulfasalazine, olsalazine atau mesalamine sering digunakan untuk mengurangi peradangan pada kolitis ulserativa dan untuk mencegah timbulnya gejala.

Obat-obatan ini biasanya diminum namun bisa juga diberikan sebagai enema (cairan yang disuntikkan ke dalam usus) atau supositoria (obat yang dimasukkan melalui dubur).

Penderita dengan kolitis berat menengah yang tidak menjalani perawatan rumah sakit, biasanya mendapatkan kortikosteroid per-oral (melalui mulut), seperti prednisone.
Prednisone dosis tinggi sering memicu proses penyembuhan. Setelah prednisone mengendalikan peradangannya, sering diberikan sulfasalazine, olsalazine atau mesalamine.
Secara bertahap dosis prednisone diturunkan dan akhirnya dihentikan. Pemberian kortikosteroid jangka panjang menimbulkan efek samping, meskipun kebanyakan akan menghilang jika pengobatan dihentikan.

Bila kolitis ulserativa yang ringan atau sedang terbatas pada sisi kiri usus besar (kolon desendens) dan di rektum, bisa diberikan enema dengan kortikosteroid atau mesalamine.
Bila penyakitnya menjadi berat, penderita harus dirawat di rumah sakit dan diberikan kortikosteroid intravena (melalui pembuluh darah).

Penderita dengan perdarahan rektum yang berat mungkin memerlukan transfusi darah dan cairan intravena.Untuk mempertahankan fase penyembuhan, diberikan azathioprine dan merkaptopurin.Siklosporin diberikan kepada penderita yang mendapat serangan berat dan tidak memberikan respon terhadap kortikosteroid. Tetapi sekitar 50% dari penderita ini, akhirnya memerlukan terapi pembedahan.


Pembedahan

Kolitis toksik merupakan suatu keadaan gawat darurat. Segera setelah terditeksi atau bila terjadi ancaman megakolon toksik, semua obat anti-diare dihentikan, penderita dipuasakan, selang dimasukan ke dalam lambung atau usus kecil dan semua cairan, makanan dan obat-obatan diberikan melalui pembuluh darah.

Pasien diawasi dengan ketat untuk menghindari adanya peritonitis atau perforasi.
Bila tindakan ini tidak berhasil memperbaiki kondisi pasien dalam 24-48 jam, segera dilakukan pembedahan, dimana semua atau hampir sebagian besar usus besar diangkat.

Jika didiagnosis kanker atau adanya perubahan pre-kanker pada usus besar, maka pembedahan dilakukan bukan berdasarkan kedaruratan.Pembedahan non-darurat juga dilakukan karena adanya penyempitan dari usus besar atau adanya gangguan pertumbuhan pada anak-anak.

Alasan paling umum dari pembedahan adalah penyakit menahun yang tidak sembuh-sembuh, sehingga membuat penderita tergantung kepada kortikosteroid dosis tinggi.
Pengangkatan seluruh usus besar dan rektum, secara permanen akan menyembuhkan kolitis ulserativa.

Penderita hidup dengan ileostomi (hubungan antara bagian terendah usus kecil dengan lubang di dinding perut) dan kantong ileostomi. Prosedur pilihan lainnya adalah anastomosa ileo-anal, dimana usus besar dan sebagian besar rektum diangkat, dan sebuah reservoir dibuat dari usus kecil dan ditempatkan pada rektum yang tersisa, tepat diatas anus.


sumber info diatas fika ambil dari :

Sylvia A.price Lorraine M. Wilson . Patofisilogi Konsep Klinis Proses-Proses Penyakit Vol.1. Edisi 6 .EGC; Jakarta. 2006

http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/

www.manukahoneyusa.com/ulcerative-colitis.htm

www.pentasausa.com/what.asp

http://www.indonesiaindonesia.com/f/10717-kolitis-ulserativa/

mungkin info ini kurang lengkap ya?! jadi kalo ada yang mau nambah ato komen fika seneng banget...










55 komentar:

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Evan mengatakan...

halo Fika,

Saya dulu juga menderita UC.

tapi skr alhamdulillah sudah sembuh.

Pengalaman saya ada disini:

http://evangeminika.blogdetik.com/2008/12/16/obati-sakit-perut-anda-dengan-tepung-sagu-atau-kanji/

mudah2an bermanfaat,

Evan
www.posvideo.net

Dr. Davon Jacobson, MD mengatakan...

This is really a well laid out website. I like how you have presented your information in excellent detail. You seem to really love your site. Keep up the great work here and please visit by my blog sometime. The url is http://healthy-nutrition-facts.blogspot.com

Evan Geminika mengatakan...

halo Fika,

seperti yang saya sudah jelaskan sebelumnya.

Ulcerative Colitis sudah ada obat nya dan tidak perlu pembedahan.

Pembedahan hanya akan membahayakan pasien.

terapi untuk Ulcerative Colitis dapat di lihat di blog saya:

Terapi Ulcerative Colitis

atau bisa kirim email ke saya, evan.geminika@gmail.com

Sekali lagi saya ingatkan, sebaiknya jangan melakukan tindakan pembedahan, coba dulu terapi yg ada di blog saya di atas.

salam,
Evan
www.posvideo.net

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