GROUP 07 CASE 1B.ppt

7/25/2019 GROUP 07 CASE 1B.ppt

1/59

PEMICU 1

ROSA

KELOMPOK 7

BLOK GI.TRACT


2/59

scenario

Get that cow mi! awa" #rom me$ %ease&'''

"o( recei)e a ca #rom mrs.meati$ mother o# rosa$ a %re)io(s"heath" *+month+o, -ir. or the %ast / ,a"$ rosa ,e)eo%e, an occ(t0ee,inan, m(co(s in the stoo accom%anie, 0" a mo,erate

,e-ree o# emesis. owe)er$ her tem%erat(re hasn2t increase,$ noa0,omina cram%in- or coic$ 0(t to,a" she seems a 0it %ae an,more irrita0e.

Un#ort(nate" Mrs.Meati ,i,n2t 0reast#ee, Rosa a0o(t a wee! a-o$ an,-i)e her re-(ar cow mi! #orm(a. 3hie "o( are ,isc(ssin- her#ami" histor"$ Mrs.Meati re%orts that Rosa2s 0rother an, sister areha)in- #oo, aer-"$ her 4+"ear+o, 0rother is asthmatic as we as his#ather. The mother ass(me, that he has the same ,air" %ro,(ctaer-" !e his / "ear o, sister.

5o( te her to 0rin- him #or #(rther ,ia-nostic in)esti-ation an, ca theactation cinic #or a co(nsein- a%%ointment in or,er to ret(rn toe6c(si)e 0reast#ee,in-.


3/59

ame IM

STEPAIE 3IBISOO 89:979991 AGGOTA

LISA 3IBO3O 89:979998 AGGOTA

A;I SUR5A


4/59

LO

? Mm anatomi sa(ran %encernaan

? Mm #isioo-i sa(ran %encernaan

? Mm %ato#isioo-i emesis

? Mm %ato#isioo-i %en,arahan

? Mm h(0(n-an antara aer-i ma!anan ,an

%en,arahan

? Mm %emeri!saan %en(n@an-? Mm #a!tor resi!o

? Mm !om%i!asi


5/59

Istiah Asin-

Emesis? M(ntah ,oran,? E!s%(si# secara %a!sa isi am0(n- !e(ar mea(i m((t secara

(m(m ,ian--a% ata( ,ise0a0!an oeh motiitas am0(n- "an-a0norma sherwoo,

Occ(t 0ee,in-? Ke(arn"a ,arah ,aam @(mah !eci "an- han"a 0isa ,i,ete!si

,en-an (@i !imiawi ata( ,en-an mi!ros!o% ,oran,

Coic? "eri a0,omen a!(t ,itan,ai ,en-an n"eri )iscera intermiten

,en-an #(!t(asi ses(ai ,en-an %eristasis otot %oos.


6/59


7/59


8/59

isioo-i sa(ran cerna

? menerima ma!anan M((t

? memecah ma!anan men@a,i at+at -ii M((t$Ten--oro!an$ Keron-!on-an D Lam0(n-

? men"era% at+at -ii !e ,aam airan ,arah Us(s

? mem0(an- 0a-ian ma!anan "anti,a! ,a%at ,icerna,ari t(0(h

Sa(ran %encernaan ter,iri ,ari m((t$ ten--oro!an$!eron-!on-an$ am0(n-$ (s(s ha(s$ (s(s 0esar$re!t(m ,an an(s. Sistem %encernaan @(-a mei%(tior-an+or-an "an- tereta! ,i(ar sa(ran %encernaan$"ait( %an!reas$ hati ,an !an,(n- em%e,(.


9/59

M((t$ten--oro!an$!eron-!on-a

n? @aan mas(! (nt(! sistem %encernaan.

Ba-ian ,aam ,ari m((t ,ia%isi oeh

sea%(t en,ir. Pen-eca%an ,irasa!an oeh

or-an %erasa "an- ter,a%at ,i %erm(!aan

i,ah. Pen-eca%an reati# se,erhana$

ter,iri ,ari manis$ asam$ asin ,an %ahit.

Penci(man ,irasa!an oeh sara#o#a!tori(s ,i hi,(n- ,an e0ih r(mit$ ter,iri

,ari 0er0a-ai macam 0a(.


10/59

am0(n-

? Or-an otot 0eron--a "an- 0esar ,an

0er0ent(! se%erti !an,an- !ee,ai$ ter,iri

,ari / 0a-ian "ait( !ar,ia$ #(n,(s ,an

antr(m. Ma!anan mas(! !e ,aam am0(n-,ari !eron-!onan mea(i otot 0er0ent(!

cincin s#inter$ "an- 0isa mem0(!a ,an

men(t(%. ;aam !ea,aan norma$ s#intermen-haan-i mas(!n"a !em0ai isi am0(n-

!e ,aam !eron-!on-an.


11/59

? 0er#(n-si se0a-ai -(,anma!anan$ "an-0er!ontra!si secara ritmi! (nt(! mencam%(rma!anan ,en-an enim+enim. Se+se "an-mea%isi am0(n- men-hasi!an / at %entin-

? en,ir? asam !ori,a C? %re!(rsor %e%sin enim "an- memecah!an

%rotein

Len,ir mein,(n-i se+se am0(n- ,ari !er(sa!anoeh asam am0(n-. Setia% !eainan %a,a a%isanen,ir ini$ 0isa men"e0a0!an !er(sa!an "an-men-arah !e%a,a ter0ent(!n"a t(!a! am0(n-


12/59

? Asam !ori,a menci%ta!an s(asana "an-

san-at asam$ "an- ,i%er(!an oeh %e%sin

-(na memecah %rotein. Keasaman

am0(n- "an- tin--i @(-a 0er%eran

se0a-ai %en-haan- terha,a% in#e!si

,en-an cara mem0(n(h 0er0a-ai 0a!teri.


13/59

Us(s ha(s

? Lam0(n- mee%as!an ma!anan !e ,aam

(s(s ,(a 0eas @ari ,(o,en(m$ "an-

mer(%a!an 0a-ian %ertama ,ari (s(s

ha(s. Ma!anan mas(! !e ,aam

,(o,en(m mea(i s#in-ter %ior(s ,aam

@(mah "an- 0isa ,i cerna oeh (s(s ha(s.


14/59

? ;in,in- (s(s !a"a a!an %em0((h ,arah

"an- men-an-!(t at+at "an- ,isera% !e

hati mea(i )ena %orta. ;in,in- (s(s

mee%as!an en,ir "an- me(masi isi

(s(s ,an air "an- mem0ant( mear(t!an

%ecahan+%ecahan ma!anan "an-

,icerna. ;in,in- (s(s @(-a mee%as!anse@(mah !eci enim "an- mencerna

%rotein$ -(a ,an ema!.


15/59

%an!reas

FAsini$ men-hasi!an enim+enim %encernaanF P(a( %an!reas$ men-hasi!an hormon

? Pan!reas mee%as!an enim %encernaan !e,aam ,(o,en(m ,an mee%as!an hormon !e

,aam ,arah. Enim "an- ,ie%as!an oeh%an!reas a!an mencerna %rotein$ !ar0ohi,rat ,anema!. Enim %roteoiti! memecah %rotein !e,aam 0ent(! "an- ,a%at ,i-(na!an oeh t(0(h,an ,ie%as!an ,aam 0ent(! ina!ti#. Enim inihan"a a!an a!ti# @i!a teah menca%ai sa(ran

%encernaan. Pan!reas @(-a mee%as!an se@(mah0esar so,i(m 0i!ar0onat$ "an- 0er#(n-simein,(n-i ,(o,en(m ,en-an cara menetra!anasam am0(n-.


16/59

hati

? se0(ah or-an "an- 0esar ,an memii!i 0er0a-ai#(n-si$ 0e0era%a ,iantaran"a 0erh(0(n-an ,en-an%encernaan.

? =at+at -ii ,ari ma!anan ,isera% !e ,aam ,in,in-

(s(s "an- !a"a a!an %em0((h ,arah "an- !eci+!eci!a%ier. Ka%ier ini men-air!an ,arah !e ,aam )ena"an- 0er-a0(n- ,en-an )ena "an- e0ih 0esar ,an%a,a a!hirn"a mas(! !e ,aam hati se0a-ai )ena%orta. ena %orta ter0a-i men@a,i %em0((h+%em0((h

!eci ,i ,aam hati$ ,imana ,arah "an- mas(! ,ioah.? ati mea!(!an %roses terse0(t ,en-an !ece%atantin--i$ seteah ,arah ,i%er!a"a ,en-an at+at -ii$,arah ,iair!an !e ,aam sir!(asi (m(m.


17/59

Kan,(n- em%e,eDsa(ran

em%e,(? mem0ant( %encernaan ,an %en"era%an

ema!

? 0er%eran ,aam %em0(an-an im0ah

tertent( ,ari t(0(h$ ter(tama haemo-o0in

0 "an- 0erasa ,ari %en-hanc(ran se

,arah merah ,an !ee0ihan !oestero


18/59

Us(s 0esar

? !oon asen,ens !anan

? Koon trans)ers(m

? Koon ,esen,ens !iri

? Koon si-moi, 0erh(0(n-an ,en-an re!t(m

Ban"a!n"a 0a!teri "an- ter,a%at ,i ,aam

(s(s 0esar 0er#(n-si mencerna 0e0era%a

0ahan ,an mem0ant( %en"era%an at+at

-ii.


19/59

? Ba!teri ,i ,aam (s(s 0esar @(-a 0er#(n-si

mem0(at at+at %entin-$ se%erti )itamin

K. Ba!teri ini %entin- (nt(! #(n-si norma

,ari (s(s. Be0era%a %en"a!it sertaanti0ioti! 0isa men"e0a0!an -an--(an

%a,a 0a!teri+0a!teri ,i,aam (s(s 0esar.

A!i0atn"a ter@a,i iritasi "an- 0isamen"e0a0!an ,i!e(ar!ann"a en,ir ,an

air$ ,an ter@a,iah ,iare.


20/59

Re!t(mDan(s

? 0(ah r(an-an "an- 0erawa ,ari (@(n- (s(s0esar seteah !oon si-moi, ,an 0era!hir ,ian(s. Biasan"a re!t(m ini !oson- !arena tin@a,isim%an ,i tem%at "an- e0ih tin--i$ "ait(%a,a !oon ,esen,ens.


21/59

? An(s mer(%a!an (0an- ,i (@(n- sa(ran

%encernaan$ ,imana 0ahan im0ah !e(ar

,ari t(0(h. Se0a-ian an(s ter0ent(! ,ari

%erm(!aan t(0(h !(it ,an se0a-ianann"a ,ari (s(s. S(at( cincin 0erotot

s#in-ter ani men@a-a a-ar an(s teta%

tert(t(%.


22/59

MUTA

;e#inisi

E!s%(si# secara %a!sa isi am0(n- !e(ar mea(i m((t

secara (m(m ,ian--a% ata( ,ise0a0!an oeh motiitas

am0(n- "an- a0norma sherwoo,.

M(ntah ,i!oor,inasi!an ,i %(sat m(ntah ,ime,(a$,im(ai ,ari mas(!an a#eren !e

sara# %(sat m(ntah ,an se@(mah rese%tor

,i se.t(0(h


23/59

MUTA

? Etioo-i (m(m F Obat2an OAIS$ ,i-o!sin$ eritromisin$

F Gangguan susunan saraf pusat t(mor$

%en,arahan intra !rania$ in#e!si$ motionsic!ness$ -an--(an %si!iatri!$ -an--(an a0irin

F Gangguan GI & peritoneal -astric o(teto0str(ction$ o0str(!si (s(s ha(s$ -astro%aresis$

%an!reatitis$ !oesistitis$ he%atitis a!(tF Gangguan metabolik endokrin (remia$!etoasi,osis ,ia0eti!$ %en"a!it tiroi,


24/59

Etioo-i m(ntah

? Stim(asi ta!ti ,i 0a-$0!- ten--oro!? IritasiH%ere-an-an am0(n-D,(o,en(m? Pe te!anan intra!rania

? RotasiHa!seerasi !e%aa "an- se0a0in,i"

? "eri he0at ,ari 0er0a-ai or-an

? Bahan !imia termas(! o0atH0ahan0erac(n "an- mem(ai m(ntah? M(ntah %si!isemosi


25/59

Taha%an M(ntah

? Taha% na(sea

,ise0a0!an oeh )aso!onstri!si %eri#er. Ber!erin-at ,in-in$ %(cat$sai)asi$ ta!i!ar,i$ 0erna#as ,aam ,an %"or(s -astrica mem0(!a$serta !onstra!si ,(o,en(m ata( @e@(n(m.

? Taha% retchin-

am0(n- 0er!onstra!si$ s#in-ter oeso#a-(s 0awah ter0(!a$ins%irasi ,aam ,en-an !ontra!si ,ia#ra-ma ,ii!(ti ,en-anrea!sasi otot ,in,in- %er(t ,an am0(n-.

? Taha% e!s%(si

ins%irasi ,aam ,en-an !ontra!si ,ia#ra-ma$ otot ,in,in- %er(t0er!onstra!si$ serta !onstra!si otot arin- men(t(% -otis ,an

nares %osterior.


26/59


27/59

Per,arahan sa cerna 0a- atas

? Per,arahan sa(ran ma!anan %ro!sima

,ari i-.Treit

? Pen"e0a0 %er,arahan %ain-

serin-%ecahn"a )arises eso#a-(s$-astritis

erosi#$t(!a! %e%ti!$-astro%ati

!on-esti#$sin,roma Maor"

weiss$!e-anasan


28/59

? Pen-eoaan %er,arahan SCBA

F Pemeri!saan awa$%ene!anan %a,a e)a(asi

stat(s hemo,inami!

F Res(sitasiFAnamnesisD%em.#isi!D%em.ain

F Memasti!an %er,arahan SCBA ata( SCBB

F Mene-a!!an ,ia-nosis %astiF Tera%i (Hmen-henti!an %er,arahan$%en"em0(han

,an mence-ah %er,arahan (an-


29/59

Pemeri!saan awa SCBA

? Te! ,arahDna,i %osisi 0er0arin-

? Per(0 ortostati! te! ,arahDna,i

? A,a ti,a!n"a )aso!ontri!si %eri#er? Kea"a!an na%s

? Tin-!at !esa,arn

? Pro,(!si (rin


30/59

Tan,a* %er,arahan SCBA

? i%otensiJ9H49mmh-

? Te!.,iastoi! ortostati! t(r(n19mmh-

ata( sistoi! *9mmh-

? re! na,i ortostati! menin-!atmenin-!at

1:menit

? A!ra ,in-in? Kesa,aran men(r(n

? An(riaHoi-(ria%ro,.(rin J/9mH@am


31/59

Kec(ri-aan %er,arahan a!(t

? ;itan,ai !on,isi hemo,inami! ti,a! sta0i

0ia ,item(!an

F ematemesis

F emato!eia

F ;arah se-ar %a,a as%irasi %i%a nasi-astri!

F i%otensi %ersisten

F ;aam *8@am ha0is!an trans#(si ,arah >99+

1999m


32/59

Pemeri!saan an@(tan

? ;aam anamnesis %er( ,ite!an!anF S@a! !%an t@,n"a %er,arahanD%er!iraan ,arah "-

!e(arF Riwa"at %er,arahan se0e(mn"aF Riwa"at %er,arahan ,aam !e(ar-aFA, ti,a!n"a %er,arahan ,i 0a-ian t(0(h ainF Pen--(naan o0at*anAISDanti!oa-(anF Ke0iasaan min(m a!ohoF Kem(n-!inan %en"a!it hati !roni!$;B;$,emam

ti#oi,$GGK$;M$T$aer-i o0atF Riwa"at aer-i se0e(mn"a


33/59

Per,arahan sa cerna 0a-

0awah? Per,arahan "an- 0erasa ,ari (s(s ,i

se0eah 0awah i-.Treit

? Pasien ,atan- ,en-an !e(han ,arah

se-ar wa!t( BAB

? >9 A!(t 0erhenti sen,irin"a

?1: 0er,am%a! %a,a T;


34/59

KARAKTERISITIK KLIIK

? EMATOKESIA

F ;arah se-ar "an- !e(ar me an(s.men(n@(!an

%er,arahan !oon se0eah !iri.@(-a ,a%at 0erasa

,ari %er,arahan sa cerna 0a- atas$(s( ha(s ,antransit ,arah "an- ce%at

? MELEA

F Tin@a 0erwarna hitam ,en-an 0a( "an-

!has.meena tim0( 0ia 0 ,i!on)ersi !e hematin

ata( hema!rom oeh 0a!teri seteah 18@am


35/59

? ;ARA SAMAR

F Tim0( 0ia ,a %er,arahan rin-an nam(n ti,a!

sam%ai mer(0ah warna #eses

F Tes G(aiac


36/59

;;

? ;i)erti!(osis

? An-io,is%asia,aerah se!(mD!oon

se0eah !a

? Koitis is!emia

? Pen"a!it %erianahemori,D#is(ra ani

? eo%asia !oon


37/59

Etioo-i ain SCBB

? KOLITIS%er,arahan rin-an+se,an-? ;i)erti!(ar MECKELKe.!on-enita ,i

ie(m ,a%at 0er,arah ,aam @(mah

0an"a! a!i0at ,ari m(!osa "an-men-hasi!an asam? ITUSUSEPSI!otoran 0erwarna mar(n

,isertai rasa n"eri ,i ,aerah %oi%Ht(mor

-anas? i%ertensi PORTALarises ,i

ie(!oonDanore!ta


38/59

%enataa!sanaan

? Tera%i en,os!o%i

? An-io-ra#i tera%(ti!

? Tera%i 0e,ah? !om%i!asi


39/59

Pemeri!saan %en(n@an-

? Tes ,arah samar

? Pemeri!saan ,e#.0esi

? En,os!o%iDra,io-ra#i


40/59

Ta0e %er0e,aan %er,arahan

SCBADSCBB

scba scbb

MAIESTASIKLIIK

ematemesisDmeena emato!esiaD @ernih

ASPIRASIASOGASTRIK

0er,arah J/:

RATIOBUH!reatinin

Menin-!at /: norma

AUSKULTASIUSUS

hi%era!ti#


41/59

Aer-i ma!anan

? Kom%onen ,iet ,a%at men"e0a0!an r6

"an- mer(-i!anma!anan

ter!ontaminasi mi!ro0aHto!sin

? %(n"a a!ti#itas #arma!oo-is

? mem0e0ani %roses a0sro0si ,an ,i-esti

"an- s(,ah ter-an--(


42/59

? ALer-i ma!anans(at( res%on "an-,i%erantarai r6.im(noo-is terha,a% aniti-enma!anan

? Protein s(s( sa%i%en"e0a0 aer-i (tama%a,a sa.%encernaan

? R6 im(noo-is "an- teri0athi%ersensiti)itasana#ia!ti! "an- ce%at "an- mei0at!an

I-E$hi%ersensiti)itas sitoto!si! 0er-ant(n-I-MDI-G$hi%ersensiti)itas !om%e!sim(n$,an hi%ersensiti)itas se(er


43/59

? Mani#estasi !inisF M((t(serasi m(!osa ,an-!a

0er(an-D,ermatitis %eriora

F Lam0(n-

%er,arahanDra,an- e,ematosa ,im(!osa am0(n-$m(ntah a!(t$,iare encer @(-a,a%at men-an,(n- ,arah


44/59

F Us(s ha(s,iare encer a!(tres%on ce%at

terha,a% mas(!n"a anti-en ,en-an ata(

tan%a m(ntah ,an !e@an- %er(t$,iare

!ronisD-a-a t(m0(h$na#s( ma!ant(r(n$retar,asi

%ert(m0(han$hi%o%roteinemia$,e#.0esi$eosino

#iia

F Koon,iare 0ercam%(r ,arah seteah min(ms(s( sa%i$tin@a ,iare men-an,(n- eosino#i


45/59

? ;ia-nosis-e@aa a!(tmere,a8>@am$!ronis1min--( seteah%en-hentian sem(a anti-en "an- men-an--(

? ;im(ai ,ri ,osis !eci1+:mD,inai!!an ter(ssam%ai 00ra%a hari asa!an ti,a! ter@a,ires%on

? Kea,aan ain "an- men"e0a0!an -e@aa "an-

smain#e!si enteri!$intoerasi a!tosa$%en"a!itra,an- (s(s "anti,a! s%esi#i!


46/59

? Pen-o0atanF Pem0erian ASI "an- ama men-(ran-i

intoeransi th, s(s( sa%i

F Mem0(anma!anan %en--an--( ,ari ,ietF I0( mean@(t!an ,iet tan%a s(s( sa%i @i!a 0a"in"a aer-i %rotein s(s(

F Pem0erian %rotein s(s( "an- s(,ah ,ihi,roisis

F Men--anti s(s( se-ar ,en-an s(s( "an-teah ,i%roses,i(a%!an$0(0(!

F Pem0erian natri(m !romo-i!at secara ora


47/59

? Pro-nosis

? Ke0an"a!an !as(s han"a 0ersi#at

sementara

? :9 0a"i sme0(h ,am 1 tah(n ,an

!e0an"a!an ainn"a ,aam * tah(n


48/59

Gastroenteritis eosino#ii!

? Be(m ,imen-erti$"an- men-aami in#itrasi

eosino#iia %eri#er.eso#a-(s ,an (s( 0esar

@(-a ,a%at teri0at

? In#itrasi eosino#i ,a%at ,item(!an %a,#a

m(!osa$m(s!(aris$serosa

? Keteri0atan m(!osa%er,arhan

? Keteri0atan m(s!(arisstri!t(rDo0str(!si

? Keteri0atan serosaasites eosino#ii!


49/59

? Mani#estasiF "eri %er(t$m(ntah*$,iare$maa0sro0si$entero%ati

!ehian-an+%rotein$!eteram0atan %ert(m0(han.BBti,a! nai!$-e@aa+-e@aa o0str(!si (s(s$asites

eosino#ii!F Ge@aa ato%i!rhinitis$asmaF Pen"a!it ini 0er@aan !ronisF Bent(! m(!osa ,a%at ,i,ia-nosis ,en-an a,an"a

se@(mah 0esar eosino#i %a,a sam%e 0io%si %er ora

antr(m am0(n-H(s(s ha(sF Pen,erita tertoon- ,en-an men-henti!an

,iet$!e0an"a!an 0(t(h %em0erian !orti!osteroi,sistemi!


50/59

Intoeransi a!tosa Lactose intolerance

? Intoeransi terha,a% a!tosa + ,ise0a0!an a!ti)itasa!tase

? La!tosa "anti,a! ,icerna a!tase F ,i#ermentasi oeh0a!teri (s(s F 0ersi#at osmoti! a!ti# F menari! air F

-e@aa m(as$ !em0(n-$ ,iare seteah min(m s(s(

? ;a%at 0ersi#at

+ %rimer primary lactose intolerance

0an"a! ,i@(m%ai %a,a ras non Ka(!asian

+ se!(n,er secondary lactose intolerance

a!i0at %en"a!it ra,an- (s(s$ Kwashior!or


51/59

E%i,emioo-i

? Kenai!an a!ti#itas a!tase am0at %a,a msa@anin ,an seteah t(r(n seteah (m(r /tah(n

? Serin- %a,a 0a"i %remat(r$,an 00ra%a ana!

"an- e0i t(a ,an ,ewasa

? 1: ,ewasa !(it %(tih

? 89,ewasa oran- Tim(r

? >: oran- !(it hitam ,i AS

? Kea,aan ini ,iwaris!an secara resesi# a(tosom


52/59

Mani#estasi !ini!

? Ge@aa ter@a,i a!i0at res%on ,ari !ons(msia!tosa -(a ,aam s(s(

? ;iare cair men"em0(rN%er(t !em0(n-

? Bor0or-ami? Kent(t? E!s!oriasi ,i ,aerah %o%o!? Sin,roma n"eri !e@an- %er(t 0er(an- ,an

samar*? Ana! %rase!oahDse!oahmen-aami n"eri

%er(t ten-ah secara e%iso,i!


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Tataa!sana

? Pen-o0atanmen-henti!an s(s( ,ari ,iet

? Pem0erian %re%arat a!tase s(,ah a,a

?Ka%s( ,en-an a!ti)itas a!tase ,i0eri0ersama ma!anan

? 5o-(rt "an- men-an,(n- 0a!teri "an-

%ro,(!si enim a!tase


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%ato#isioo-i

Gastroenteritis a!(t

!er(sa!an m(!osa (s(s ha(s,e#esiensia!tase

a0sro0si %rotein asin- intoeransi

a!tosa

sensitisasi terha,a% %rotein s(s( sa%i

CMPSE


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%ato#isioo-i

Gastroenteritis a!(t

!er(sa!an m(!osa (s(s ha(s,e#esiensia!tase

a0sro0si %rotein asin- intoeransi

a!tosa

sensitisasi terha,a% %rotein s(s( sa%i

CMPSE


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Kesim%(an ,an Saran

? Kem(n-!inan rosa men,erita aer-i

ma!anan ,en-an intoeransi a!tosa.

? La!(!an %emeri!saan terha,a% a!tosa.

? La!(!an tes aer-i

? Se0ai!n"a henti!an %em0erian s(s( sa%i

#orm(a ,an -anti ,en-an %em0erian ASI

e!s!(si#.


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;ATAR PUSTAKA

? Ar( 3. S(,o"o$ Bam0an- Seti"oha,i$ I,r(s Awi$

Marce(s S K$ Siti Setia,i$ e,itor. B(!( a@ar Im(

Pen"a!it ;aam. E,isi 8.


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Terima !asih

Documents

GROUP 07 CASE 1B.ppt