Diagnosis Dan Penatalaksanaan Kasus Gastritis Erosif Kronik Pada Geriatri Dengan Riwayat Konsumsi NSAID
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Abstract
Pendahuluan: Gastritis merupakan inflamasi pada mukosa dan submukosa gaster dikarenakan oleh banyak etiologi. Gastritis pada geriatri berlansung secara kronik hingga dapat terjadi ulkus. Data epidemiologi menyatakan bahwa kasus gastritis erosiva hingga ulkus peptikum merupakan penyakit dominan pada geriatri riwayat konsumsi NSAID terutama aspirin mencapai 70% dan beresiko tinggi terinfeksi H.pylori akibat melemahnya faktor defensif. Manajemen khusus pada pasien geriatri sebagai diagnosis dini dan edukasi akan menurunkan angka insiden infeksi H.pylori yang berpotensi malignancy.
Ilustrasi kasus: seorang wanita lanjut usia 68 tahun dengan keluhan utama hematemesis 2 kali dan keluhan tambahan BAB melena 1 minggu, mual-muntah, lemas-lesu serta nafsu makan menurun dan dengan riwayat penggunaan NSAID terutama Asam Mefenamat 3 tahun dan Aspirin 2 tahun.
Pemeriksaan Fisik: Bagian wajah terdapat bercak hitam. Bagian abdomen nyeri tekan di area epigastrium tanpa organomegali dan perut tampak cembung. Bagian ekstremitas inferior didapatkan pasien edema pretibial.
Pemeriksaan Penunjang: Pemeriksaan hematologi rutin didapatkan hasil, Hemoglobin: 7,2 gr/dL, Leukosit: 18.000 μL/dL, Eritrosit : 2,8 juta/μL, Hematokrit: 30%, Trombosit: 210.000 μL/dL, Neutrofil Segmen: 82 %, Limfosit: 20%, LED: 45 mm/jam. Pemeriksaan Endoskopi tampak mukosa edema hiperemis berat dan tampak erosi di area antrum-fundus. Pemeriksaan histopatologi sel infiltrate limfosit dengan metaplasia ringan.
Penatalaksanaan: Tatalaksana non-farmakologi dan tataksana farmakologi.
Diskusi: Gastritis dapat ditegakkan diagnosis dengan gold standart pemeriksaan endoskopi dan pemeriksaan histopatologi. Hasil anamnesis terutama riwayat pasien dan pemeriksaan fisik memberikan gambaran awal. Mengenali tanda alarm sign sebagai awal tatalaksana. Gastritis di Indonesia mencapai 40,8% oleh karena itu diperlukan edukasi dan motivasi pada pasien. Kriteria diagnosis gastritis menggunakan kriteria sistem Sidney visual revisi dengan OLGA.
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References
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