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Dyspepsia

catherine
definisi
ALGO DYSPEPSIA
H.pylori
Tx H.pylori
Lini 1: triple tx = 7-10 days
• PPI
- Omeprazole 20mg bid Or ranitidine bismuth
- Rabeprazole 20mg bid citrate 150mg bid
- Lanzoprazole 30mg bid
- Pantoprazole 40mg bid
- Esomeprazole 40mg bid
• Amoxicillin 1g bid
Or if alergi amox= Metronidazole 500 mg bid
• Clarithomycin 500 mg bid
Lini 2: Quadruple tx= 14 days
• PPI
- Omeprazole 20mg bid
- Rabeprazole 20mg bid
- Lanzoprazole 30mg bid
- Pantoprazole 40mg bid
- Esomeprazole 40mg bid
• Bismuth subsalicylate 4x525mg=4x2 tablet/day
• Metronidazole 4x250 mg
• Tetracycline 4x500mg
Lini 3: 10days
• PPI
- Omeprazole 20mg bid
- Rabeprazole 20mg bid
- Lanzoprazole 30mg bid
- Pantoprazole 40mg bid
- Esomeprazole 40mg bid
• Levofloxacin 500mg bid
• Amoxicillin 1g bid
• After eradikasi, lanjutkan PPI/H2RA min. 4 wks
Dd
1. Peptic ulcer
• CM khas PU:
- Gastric ulcer= pain immediately post-prandial
- Duodenal ulcer= pain 1,5-3 jam post-prandial, relieved by
eat&antacid
• History PU
• NSAID
• Smoker,alcoholic

2. GERD
• Heartburn, regurgitation
• Worse when supine
• Chronic cough, hoarse, sore throat
3. Biliary tract dz
• Classic biliary pain= episodic, acute&severe upper abdo pain mostly
@epigastric&RUQ
Occur post-prandial, esp.fatty food
Durasi at least 1 jam
Mostly @evening&night
Pain severity >5
• triad khas cholelithiasis, cholangitis, choledocholithiasis,
cholecystitis
• Risk factor F4

4. Pankreatitis
• Pain severe nembus ke back
• Berjam2
• Riw.heavy alcohol
• Riw.family
5. Cancer
• Red flag
• Smoker
• Early=vague, progressively severe&constant

6. Metabolic dz/delayed gastric emptying


• riw. DM, thyroid, prathyroid, CKD

7. Medication
• NSAID, biphosphonate, antibiotik
8. Hepatitis
• Mual muntah hebat, jaundice
• SGOT SGPT bilirubin ↑
• Risk factor

9. ACS inferior, atypical angina


• Cold sweat, dyspnea, palpitasi, syncope
• EKG (+) @ II,III,aVF
• Cardiac enzyme
• Risk factor
10. IBS
The Rome IV criteria :
recurrent abdominal pain on average at least 3 day per
month during the previous 3 months that is associated
with 2 or more of the following [2] :
• Related to defecation (may be increased or unchanged
by defecation)
• Associated with a change in stool frequency
• Associated with a change in stool form or appearance
Supporting symptoms include the following:
• Altered stool frequency
• Altered stool form
• Altered stool passage (straining and/or urgency)
• Mucorrhea
• Abdominal bloating or subjective distention
TX DYSPEP
Tx dyspep functional
PPI
antacids
• Al OH, Ca Carbonate
(-) konstipasi
• MgOH (-) diare
w/excessive dose
ranitidine
gerd
1. Heartburn
2. Regurgitasi
3. Dysphagia
4. Bloating bgt
tx

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