HIPEREMESIS HIPEREMESIS GRAVIDARUMGRAVIDARUMGRAVIDARUMGRAVIDARUM

Makmur SMakmur SMakmur SMakmur S

Hiperemesis GravidarumHiperemesis GravidarumHiperemesis GravidarumHiperemesis Gravidarum

DefenisiDefenisi:: MualMual dandan muntahmuntah yangyang hebathebatDefenisiDefenisi:: MualMual dandan muntahmuntah yangyang hebathebatpdpd kehamilankehamilan mudamuda mengakibatkanmengakibatkanpekerjaanpekerjaan seharisehari--harihari tergangguterganggu dandanpekerjaanpekerjaan seharisehari--harihari tergangguterganggu dandankeadaankeadaan umumumum memburukmemburuk..

EtiologiEtiologi:: belumbelum diketahuidiketahui secarasecara pastipasti

Etiologi: belum diketahui secara pastiEtiologi: belum diketahui secara pasti

FAKTOR PREDISPOSISI FAKTOR PREDISPOSISI

Steps of VomitingSteps of Vomiting

Patologi.Patologi.Patologi.Patologi.

Pada bedah mayat:Pada bedah mayat:Pada bedah mayat:Pada bedah mayat:

H tiH ti d i l k k id i l k k i1.1. Hati:Hati: degenerasi lemak, nekrosis.degenerasi lemak, nekrosis.2.2. Jantung:Jantung: Atrofi, perdarahan subendokardial.Atrofi, perdarahan subendokardial.3.3. Otak:Otak: bercak perdarahan pd corpora bercak perdarahan pd corpora

mamiliria, ventrikel III dan IV, encefalopati mamiliria, ventrikel III dan IV, encefalopati wernickelwernickelwernickel.wernickel.

4.4. Ginjal:Ginjal: Pucat dan deg.Lemak pd tubuli Pucat dan deg.Lemak pd tubuli kontortikontortikontorti.kontorti.

PatofisiologiPatofisiologiPatofisiologiPatofisiologi

Pembakaran fat yg terus menerusPembakaran fat yg terus menerusPembakaran fat yg terus menerusPembakaran fat yg terus menerus——» oksidasi tak sempurna » oksidasi tak sempurna ——» ketosis.» ketosis.M l d t hM l d t hMual dan muntahMual dan muntah——» dehidrasi » dehidrasi ——» hemokonsentrasi » hemokonsentrasi ——» » zat toksik memenuhi jaringan.zat toksik memenuhi jaringan.MuntahMuntah——» hipokalemia» hipokalemia——»perut »perut pp ppgembung dan kerusakan hati.gembung dan kerusakan hati.

TandaTanda--tanda dan gejala:tanda dan gejala:

Tahap I.Tahap I.KU lemah, BB KU lemah, BB ↓↓, nyeri ulu hati, , nyeri ulu hati, Nadi = 100x/m, turgor , lidah Nadi = 100x/m, turgor , lidah , g ,, g ,kering, mata cekung.kering, mata cekung.

Tahap IITahap IITahap II.Tahap II.Lemah, apatis, lidah kering dan Lemah, apatis, lidah kering dan kotor, nadi: filiformis, temp naik, kotor, nadi: filiformis, temp naik, ikterusikterus ±±, oliguria, obstipasi., oliguria, obstipasi.ikterus ikterus ±±, oliguria, obstipasi., oliguria, obstipasi.

Tahap III.Tahap III.Tahap III.Tahap III.

Muntah berhentiMuntah berhenti ——»kesadaran»kesadaranMuntah berhenti Muntah berhenti ——»kesadaran »kesadaran menurun ( somnolent menurun ( somnolent -- coma ), nadi coma ), nadi

ikt t ik TDikt t ik TDmenurun, ikterus, temp naik, TD menurun, ikterus, temp naik, TD menurun, menurun, Komplikasi yang fatal Komplikasi yang fatal ——» ggn SSP, » ggn SSP, encepalofati Wernickle ( nistagmusencepalofati Wernickle ( nistagmusencepalofati Wernickle ( nistagmus encepalofati Wernickle ( nistagmus dan diplopia ), ggn mental.dan diplopia ), ggn mental.

Pengobatan.Pengobatan.11 IsolasiIsolasi1.1. Isolasi.Isolasi.2.2. Terapi Psikologik.Terapi Psikologik.3.3. Cairan Parenteral.Cairan Parenteral.4.4. Lab: hb, Urea darah, kgd, elektrolit dan Lab: hb, Urea darah, kgd, elektrolit dan , , g ,, , g ,

liver function test.liver function test.55 Insulin, asam amino essensial danInsulin, asam amino essensial dan5.5. Insulin, asam amino essensial dan Insulin, asam amino essensial dan

vitamin.vitamin.66 Makanan peroral dgn sedikit cairanMakanan peroral dgn sedikit cairan6.6. Makanan peroral dgn sedikit cairan.Makanan peroral dgn sedikit cairan.

77 Makanan biasaMakanan biasa7. 7. Makanan biasa.Makanan biasa.

8 Boleh pulang dan bila ada serangan8 Boleh pulang dan bila ada serangan8.Boleh pulang dan bila ada serangan 8.Boleh pulang dan bila ada serangan kembali ke RS.kembali ke RS.

9 Kadang2 kehamilan harus diakhiri bila9 Kadang2 kehamilan harus diakhiri bila9.Kadang2 kehamilan harus diakhiri bila 9.Kadang2 kehamilan harus diakhiri bila keadaan memburuk atau adanya keadaan memburuk atau adanya polineuritis atau psikosapolineuritis atau psikosapolineuritis atau psikosa.polineuritis atau psikosa.

Diff. Diagnosa:Diff. Diagnosa:Diff. Diagnosa:Diff. Diagnosa:

11 Ulkus peptikumUlkus peptikum1.1. Ulkus peptikum.Ulkus peptikum.2.2. Appendisitis.Appendisitis.

T t kT t k3.3. Tumor otak.Tumor otak.4.4. Radang otak.Radang otak.5.5. Hepatitis.Hepatitis.

Diet Modifications:Diet Modifications:Diet Modifications:Diet Modifications:Eat smaller, more frequent meals.Eat smaller, more frequent meals.Avoid fatty, creamy foods which slow down gastric emptying.Avoid fatty, creamy foods which slow down gastric emptying.Eat mainly carbohydrates which are bland such as potatoes, pasta, rice, or Eat mainly carbohydrates which are bland such as potatoes, pasta, rice, or soups including these.soups including these.Drink sports drink or bouillon in small sips for a total of 1Drink sports drink or bouillon in small sips for a total of 1-- 1 5 L/ day to1 5 L/ day toDrink sports drink or bouillon in small sips for a total of 1Drink sports drink or bouillon in small sips for a total of 1-- 1.5 L/ day to 1.5 L/ day to prevent dehydration. They tend to be better tolerated than water.prevent dehydration. They tend to be better tolerated than water.Introduce crackers and peanut butter, or cheese in small amounts as Introduce crackers and peanut butter, or cheese in small amounts as tolerated for protein.tolerated for protein.Next, small amounts of baked chicken or fish can be introduced as there Next, small amounts of baked chicken or fish can be introduced as there are digested more easily.are digested more easily.

So you tell her to try these and come back in about a week if not So you tell her to try these and come back in about a week if not improving.improving.

INTRODUCTIONINTRODUCTIONHG, defined as persistent vomiting that HG, defined as persistent vomiting that leads to weight loss greater thanleads to weight loss greater than 5%5% ofofleads to weight loss greater than leads to weight loss greater than 5%5% of of prepre--pregnancy weight, with associated pregnancy weight, with associated

l t l t i b l d k t il t l t i b l d k t ielectrolyte imbalance and ketonuria, electrolyte imbalance and ketonuria, occurs in about occurs in about 1%1% of pregnancies.of pregnancies.Although NVP may be classified as Although NVP may be classified as mild, mild, moderate or severemoderate or severe the severity ofthe severity ofmoderate, or severemoderate, or severe, the severity of , the severity of nausea or vomiting may not adequately nausea or vomiting may not adequately reflect the distress it causesreflect the distress it causesreflect the distress it causes.reflect the distress it causes.

VOMITINGVOMITINGPATHWAYSPATHWAYS

Ipecac syrup

Beberapa faktor predisposisiBeberapa faktor predisposisi

1.1. Faktor hormonal: Faktor hormonal: HCG i k t d i i id lli dHCG i k t d i i id lli dHCG meningkat pd primigravida, gemelli dan HCG meningkat pd primigravida, gemelli dan mola hidatidosa.mola hidatidosa.

22 F kt P ik l ikF kt P ik l ik2. 2. Faktor Psikologik:Faktor Psikologik:Keretakan RT.Keretakan RT.T k t K hil k jT k t K hil k jTakut Kehilangan pekerjaan.Takut Kehilangan pekerjaan.Takut Hamil.Takut Hamil.Hamil yg tidak diinginkanHamil yg tidak diinginkan

3. Faktor Organik3. Faktor Organik

Masuknya villi chorialis dalam sirkulasi ibu Masuknya villi chorialis dalam sirkulasi ibu »resistensi ibu menurun»resistensi ibu menurun——»resistensi ibu menurun.»resistensi ibu menurun.