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Background

A hydrocele is a collection of fluid within the processus vaginalis (PV) that produces swelling in theinguinal region or scrotum. An inguinal hernia occurs when abdominal organs protrude into theinguinal canal or scrotum. Inguinal hernia and hydrocele share a similar etiology and pathophysiologyand may coexist.

In the healthy male neonate, the testicle is surrounded by a closed cavitythe tunica vaginalis (!V) ofthe scrotum. In postnatal life, this is a potential space that should not communicate with the peritonealcavity of the abdomen.

Pathophysiology

"uring fetal development, the testicle is located below the #idney, within the peritoneal cavity. As thetesticle descends through the inguinal canal and into the scrotum, it is accompanied by a sacli#eextension of peritoneum, otherwise #nown as the PV. After the testicle descends, the PV obliterates inthe healthy infant and becomes a fibrous cord with no lumen. !he distal tip of the PV remains as amembrane around the testiclethe tunica vaginalis. $ormally, the inguinal region and scrotum shouldnot connect with the abdomen. $either abdominal organs nor peritoneal fluid should be able to passinto the scrotum or inguinal canal. If the PV does not close, it is referred to as a patent processus

vaginalis (PPV).

If the PPV is small in caliber and only large enough to allow fluid to pass, the condition is referred toas a communicating hydrocele. If the PPV is larger, allowing ovary, intestine, omentum, or otherabdominal contents to protrude, the condition is referred to as a hernia. %ultiple theories existregarding the failure of PV closure. &mooth muscle has been identified in PPV tissue but not innormal peritoneum. !he amount of smooth muscle present may correlate with the degree of patency.'or example, higher amounts of smooth muscle have been found in hernia sacs than in the PPV ofhydroceles. Investigation continues to determine the role of smooth muscle in the pathogenesis of thiscondition.

Epidemiology

Frequency

United States!he incidence of hernias is *+ per live births and is much more common following prematurebirth. hile hernia location is more common on the right side, as many as - are bilateral.

Mortality/Morbidity

!he greatest ris# associated with a hernia involves an intra*abdominal organ becoming trapped withinthe hernia sac. !his condition is referred to as incarceration of the organ. If bowel becomesincarcerated, it may become edematous. !he increased pressure may impair venous drainage,leading to more edema, which may impair arterial inflow of the bowel. !his can ultimately cause bowelischemia and possible rupture.

In a male, pressure on the spermatic cord by an incarcerated hernia may affect blood flow to the

testis. hen perfusion of the bowel is affected, a strangulated hernia exists. A strangulated hernia canlead to perforation of the entrapped bowel, peritonitis, sepsis, and even death. As such, anincarcerated or strangulated hernia is a surgical emergency. If a strangulated bowel is reducedsurgically at an early stage, viability may be preserved, and bowel resection may be avoided. Inchildren with a painful nonreducible hernia, incarceration should be suspected, necessitatingemergency evaluation.

!he omentum may become entrapped in a hernia, causing chronic abdominal pain with a persistentinguinal mass.

In females, the ovary or fallopian tube can enter hernia sacs and become incarcerated orstrangulated. An incarcerated ovary is an urgent problem that may result in inguinal pain andinfarction of the ovary. An incarcerated ovary does not carry the same ris# of sepsis as is seen with

bowel incarceration and perforation.

Sex


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ernias are / times more common in boys than in girls.

0owel incarceration is more common in females than in males.

In females, an ovary or fallopian tube incarcerates more fre1uently than bowel. !herefore, the overallincidence of bowel strangulation is lower in females than in males.

Age

!he incidence of PPV decreases with age. In newborns, 2-*34- have a PPV. ernias are + timesmore common in premature infants who weigh less than 5 g than in babies born at term. As manyas 6- of adults are discovered to have a PPV at autopsy. hy all PPVs do not develop into a herniaor hydrocele is not understood.

istory

A bulge in the groin or scrotal enlargement is the classic presentation of hernia or communicatinghydrocele. Pain is generally not a prominent feature but may occur if a hydrocele expands 1uic#ly7tension in the wall may cause milder pain. &evere pain raises concern about a strangulated hernia.Very rarely, a hydrocele may become infected and cause pain.

're1uently, parents report an intermittent bulge. !he bulge may reduce at night in the supine position.A history of vomiting, colic#y abdominal pain, or obstipation suggests bowel obstruction, which mayoccur with an incarcerated or strangulated hernia.

Physical

8xamine the child in the supine and standing positions. If a bulge is apparent in the standing position,lay the child in the supine position. 9esolution of the bulge in the supine position suggests a hernia ora hydrocele with a patent processus vaginalis (PPV).

If the bulge is not readily apparent, perform a maneuver to increase intraabdominal pressure.

'or example, have the child simulate blowing up a balloon, cough, or press firmly on the abdomen.9estraining a baby:s hands above his or her head causes the baby to struggle, potentially revealing

an occult bulge that is not visible otherwise. !ransillumination of the scrotum displays fluid in the tunica vaginalis, suggesting a hydrocele.

owever, this test does not fully exclude a hernia, as the bowel may also transilluminate.

0owel sounds in the scrotum are strongly suggestive of a hernia.

A bulge below the inguinal ligament is suggestive of lymphadenopathy.

8xaminers may try to elicit the ;sil# glove; sign.

o ?ryptorchid testis

o ypospadias

o Ambiguous genitalia

o 8pispadias and exstrophy of the bladder

o Ventriculoperitoneal shunt

o @iver disease with ascites

o Abdominal wall defects

o ?ontinuous ambulatory peritoneal dialysis

o Prematurity

o

@ow birth weighto 'amily history of hernia or hydrocele

o ydrops
http://emedicine.medscape.com/article/980360-overviewhttp://emedicine.medscape.com/article/956340-overviewhttp://emedicine.medscape.com/article/1017420-overviewhttp://emedicine.medscape.com/article/1015227-overviewhttp://emedicine.medscape.com/article/1015520-overviewhttp://emedicine.medscape.com/article/1014971-overviewhttp://emedicine.medscape.com/article/933942-overviewhttp://emedicine.medscape.com/article/975909-overviewhttp://emedicine.medscape.com/article/956340-overviewhttp://emedicine.medscape.com/article/1017420-overviewhttp://emedicine.medscape.com/article/1015227-overviewhttp://emedicine.medscape.com/article/1015520-overviewhttp://emedicine.medscape.com/article/1014971-overviewhttp://emedicine.medscape.com/article/933942-overviewhttp://emedicine.medscape.com/article/975909-overviewhttp://emedicine.medscape.com/article/980360-overview


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o %econium peritonitis

o ?hylous ascites

o ?ystic fibrosis

o ?onnective tissue disease

o %ucopolysaccharidosis

9eactive hydroceles result from inflammation and fluid accumulation in the tunica vaginalis

around the testicle, even though the PV is closed. A reactive hydrocele can result from the followingfactors>

o !rauma

o !orsion

o Infection (eg, epididymo*orchitis)

o Abdominal or retroperitoneal operations that impair lymphatic drainage

ernia classification

o Indirect hernias protrude through the internal inguinal ring, lateral to the inferior

epigastric vessels. !hey are caused by failure of the PV to obliterate. %ost inguinal hernias inchildren are the indirect type. !he hernia may extend down the inguinal canal toward the labia orscrotum.

o ?omplete inguinal hernias are indirect hernias that extend into the scrotum. !he

anatomic defect is similar to the defect of a communicating hydrocele, although the PPV is morewidely patent in hernias.

o "irect hernias protrude directly through the floor of the inguinal canal and are medial

to the inferior epigastric vessels. In children, these hernias are rare and are usually observed onlyafter prior inguinal surgery.

ydrocele classification

o ?ommunicating hydroceles involve a PPV that extends all the way into the scrotum.

In this case, the PPV is continuous with the tunica vaginalis, which surrounds the testicle. !heanatomic defect is identical to the defect with an indirect hernia7 however, the communication issmaller, so only fluid can pass into the PPV.

o $oncommunicating hydroceles contain fluid confined to the scrotum within the tunica

vaginalis. !he PV is obliterated so the fluid does not communicate with the abdominal cavity. &uch

hydroceles are common in infants, and the hydrocele fluid is usually reabsorbed before the infantis aged year.o 9eactive hydroceles are noncommunicating hydroceles that develop from some

inflammatory condition in the scrotum, such as trauma or infection.o ydrocele of the cord occurs when the PV obliterates above the testicle. A small

communication with the peritoneum persists, and the PV may be open as far down as the top ofthe scrotum. A sacli#e area within the inguinal canal fills with fluid. !he fluid does not extend intothe scrotum.

o ydrocele of the canal of $uc# occurs in girls when fluid accumulates within the PV in

the inguinal canal.o Abdominoscrotal hydrocele results from a miniscule opening in the PV. 'luid enters

the hydrocele and becomes trapped. !he hydrocele continues to enlarge and eventually bulgesupward into the abdomen, causing a fluid*filled mass in the abdomen.

"i##erential "iagnoses Abdominal !rauma

?ryptorchidism

!esticular !orsion

Varicocele in Adolescents

$o medical therapy is effective for a hernia or a communicating hydrocele. Aspiration and

inection of sclerosing agents have been recommended for noncommunicating hydroceles inadults, but this therapy is relatively contraindicated in children. 0ecause most hernias andhydroceles in children are associated with a patent processus vaginalis (PPV), sclerosingagents may damage intraabdominal contents and are not li#ely to correct the underlyingpathology. Anti*inflammatory agents may be used in the setting of a reactive hydrocele.

Antibiotic therapy is often prescribed for infectious epididymo*orchitis with a reactivehydrocele.
http://emedicine.medscape.com/article/185777-overviewhttp://emedicine.medscape.com/article/1001602-overviewhttp://emedicine.medscape.com/article/940726-overviewhttp://emedicine.medscape.com/article/438378-overviewhttp://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/1016840-overviewhttp://emedicine.medscape.com/article/185777-overviewhttp://emedicine.medscape.com/article/1001602-overviewhttp://emedicine.medscape.com/article/940726-overviewhttp://emedicine.medscape.com/article/438378-overviewhttp://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/1016840-overview


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BackgroundA hydrocele is a fluid collection within the tunica vaginalis of the scrotum or along the

spermatic cord. These fluid collections may represent persistent developmental connections

along the spermatic cord or an imbalance of fluid production versus absorption. In rare cases,

similar fluid collections can develop along the canal of Nuck in females. See the image

below.

Young girl with groin bulge, which, at surgery, was a hydrocele of along the canal ofNuck.

y themselves, hydroceles pose little risk of clinical conse!uence. "owever, the potential for

more than fluid to appear within developmental connections between the abdominal cavity

and the scrotum or the association with underlying scrotal pathology re!uires that hydroceles

be evaluated with due prudence. See the image below.

"ydrocele that e#tended retrograde into the abdominal compartment.

$or additional information on hydroceles, see the articles "ydrocele and "erniain

e%edicine&s 'ediatrics( Surgery volume and "ydrocele, $ilarialin the )rology volume.

istory o# the ProcedureThe description of the abdominal cavity parietes to the tunica vaginales is attributed to *alen

in +- A. "owever, the clear description of the inguinal anatomy and its relationship to

groin hernias and hydroceles was not recorded until the +/th century.

ProblemThe presence of fluid within the hemiscrotum imparts little clinical impact on the testis.

"owever, determining the cause for the increased fluid, specifically any associated clinically

significant pathology, remains the primary concern with regard to hydroceles. 0nce

pathology that is more ominous has been e#cluded, persistence of the hydrocele or the

association of discomfort may indicate the need for surgical intervention.

'atients who have undergone varicocelectomy may be an important e#ception in which a

hydrocele may be of clinical importance. This procedure, usually performed when dilated

vessels around the testes are believed to increase intratesticular temperatures, thereby leading

or contributing to male infertility, may damage nearby lymphatic vessels. This, in turn, maycause the formation of postvaricocelectomy hydroceles in appro#imately 1 of patients,
http://emedicine.medscape.com/article/1015147-overviewhttp://emedicine.medscape.com/article/438525-overviewhttp://emedicine.medscape.com/article/436829-overviewhttp://refimgshow%281%29/http://refimgshow%283%29/http://emedicine.medscape.com/article/1015147-overviewhttp://emedicine.medscape.com/article/438525-overviewhttp://emedicine.medscape.com/article/436829-overview


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potentiating the insulation of the testicle and leading to persistent problems with sperm

production. The use of microscopes during this procedure has significantly decreased the

incidence of lymphatic obliteration and, therefore, hydrocele formation.

Epidemiology

Frequency

'atent processus vaginalis are found in 234/31 of term male infants at birth. This fre!uency

rate steadily decreases until age 5 years, when it appears to plateau at appro#imately 564731.

Indeed, autopsy series of men have identified a fre!uency rate of 531 of the processus

vaginalis remaining patent until late in life. "owever, clinically apparent scrotal hydroceles

are evident in only -1 of term males beyond the newborn period. 8ertain conditions, such

asbreech presentation, gestational progestin use, and low birth weight, have been associated

with an increased risk of hydroceles. The incidence of hydroceles in men is less well known.

See the image below.

"ydrocele. Small patent processus vaginalis 9indicated by the bubbles: as viewed

laparoscopically.

EtiologyThe causes of hydroceles are legion. In children, most hydroceles are of the communicating

type, in which patency of the processus vaginalis allows peritoneal fluid to flow into thescrotum, particularly during ;alsalva.

In the adult population, filariasis,a parasitic infection caused by Wuchereria

bancrofti,accounts for most causes of hydroceles worldwide, affecting more than +53 million

people in more than < countries 9see "ydrocele, $ilarial:. "owever, this condition is

virtually none#istent in the )nited States, where iatrogenic causes of hydroceles predominate.

$ollowing laparoscopic or transplant surgery in males, inade!uate irrigation fluid aspiration

may cause hydroceles in patients with a patent processus vaginalis or a small hernia. 8areful

aspiration of fluid at the end of laparoscopic procedures helps prevent this complication. In

noncommunicating hydroceles, for both children and adults, the balance between fluid

production within the tunica and the fluid absorption is altered.

A few studies have attempted to show a link between certain molecular derangements and an

increased incidence of patent processus vaginales 9and therefore hydroceles and indirect

hernias:. Two such e#amples include increases in maternal estrogen concentrations during

pregnancy and abnormalities in the calcitonin gene4related peptide 98*=': released by the

genitofemoral nerve.>+?

PathophysiologyThe pathophysiology of hydroceles re!uires an imbalance of scrotal fluid production and

absorption. This imbalance can be divided further into e#ogenous fluid sources or intrinsic

fluid production.
http://emedicine.medscape.com/article/262159-overviewhttp://emedicine.medscape.com/article/217776-overviewhttp://emedicine.medscape.com/article/217776-overviewhttp://emedicine.medscape.com/article/438525-overviewhttp://refimgshow%282%29/http://emedicine.medscape.com/article/262159-overviewhttp://emedicine.medscape.com/article/217776-overviewhttp://emedicine.medscape.com/article/438525-overview


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Alternatively, hydroceles can be divided into those that represent a persistent communication

with the abdominal cavity and those that do not. $luid e#cesses are from e#ogenous sources

9the abdomen: in communicating hydroceles, whereas noncommunicating hydroceles

develop increased scrotal fluid from abnormal intrinsic scrotal fluid shifts.

!ommunicating hydroceles@ith communicating hydroceles, simple ;alsalva probably accounts for the classic variation

in sie during day4sleep cycles. Nonetheless, with the incidence of patent processus so great,

why children with clinically apparent hydroceles are relatively few remains somewhat

ine#plicable. 8hronically increased intra4abdominal pressure 9eg, as in chronic lung disease:

or increased abdominal fluid production 9eg, children with ventriculoperitoneal shunts:

probably warrants early surgical intervention.

$oncommunicating hydroceles

In noncommunicating hydroceles, the pathophysiology may occur as a result of increased

fluid production or as a conse!uence of impaired absorption. A sudden onset of scrotalhydrocele in older children has been noted after viral illnesses. In such cases, viral4mediated

serositis may account for the net increased fluid production. 'osttraumatic hydroceles likely

occur secondary to increased serosal fluid production due to underlying inflammation.

Although rare in the )nited States, filarial infestations are a classic cause of the decreased

lymphatic fluid absorption resulting in hydroceles.

Presentation"ydroceles typically manifest as a soft nontender fullness within the hemiscrotum. The testis

is generally palpable along the posterior aspect of the fluid collection. @hen the scrotum is

investigated with a focused beam of light, the scrotum transilluminates, revealing a

homogenous glow, without internal shadows.

The inability to clearly delineate or palpate the testicular structuresB the presence of

tenderness, fever, or any gastrointestinal symptoms 9eg, vomiting, constipation, diarrhea:B or

the appearance of internal shadows on transillumination should raise the suggestion of a

different diagnosis or some additional underlying pathology. Scrotal ultrasonography is the

ne#t logical step.

%ndicationsIndications for intervention in hydroceles include the following(

Inability to distinguish from an inguinal hernia $ailure of the hydrocele to resolve spontaneously after an appropriate interval of

observation

Inability to clearly e#amine testis

Association of hydroceles with suggestive pathology 9eg, torsion,tumor:

'ain or discomfort

%ale infertility

'atient desire

&ele'ant AnatomyThe developmental anatomy of the inguinal canal is responsible for the genesis of pediatric

communicating hydroceles. As the testis descends from the posterolateral genitourinary ridgeat the beginning of the third trimester of fetal gestation, a saclike e#tension of peritoneum
http://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/438817-overviewhttp://emedicine.medscape.com/article/438817-overview


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descends in concert with the testis. As descent progresses, the sac envelops the testis and

epididymis. The result is a serosal4lined tubular communication between the abdomen and

the tunica vaginalis of the scrotum.

The peritoneum4derived serosal communication is the processus vaginalis, and the serosa of

the hemiscrotum becomes the tunica vaginalis. At term, or within the first +45 years of life,the processus vaginalis of the spermatic cord fuses, obliterating the communication between

the abdomen and the scrotum. The processus fuses distally as far as the lower epididymal

pole and anteriorly to the upper epididymal pole. $ailure of complete fusion may result in

communicating hydroceles, indirect inguinal hernias, and the bell4clapper deformity of

abnormal testicular fi#ation in the scrotum. >5?

!ontraindications&eemingly, no true absolute contraindications exist for repair of hydroceles. owever, given theminimal clinical conse1uence of the hydrocele itself, patients deemed as poor surgical or anestheticris# may preclude safe surgical repair. Additionally, while a slight maority of pediatric surgeons across$orth America would repair any communicating hydrocele (somewhat irrespective of age) if it wereclearly communicating, waiting until the child is aged *+ years is certainly reasonable. Additionally,small atrophic testes, or solitary testes, should be approached with great caution to minimiDe the ris#of anorchia.

http://emedicine.medscape.com/article/438724-overviewshowall

!he tunica vaginalis is a structure within the testicles. It consists of two layers of serous

membranes which cover the tunica vaginalis albuginea, a layer of fibrous material which wraps

around thetestes. &everal layers of tissue are involved in the structure of the scrotum to support

and protect the contents, and the tunica vaginalis is one of them. $umerous detailed drawings of

scrotal anatomyare available for people who are interested in learning more about the

development and structure of the testes.

!his layer of tissue arises from the vaginal process during fetal development. It starts as a pouch

in the peritoneum which gradually moves downward and shifts to accommodate the development

of the testes. !his occurs in response to hormone levels during development which also

predicate the formation of the genitalia. In women, sometimes the vaginal process fails to

develop normally during fetal development, and as a result they may develop a structure #nown

as the ?anal of $uc#, and they can be prone to cysts and other problems.

http://www.wise!ee".com/what-is-the-tunica-va!inalis.htm

http://www.em#r$olo!$.ch/an!lais/u!enital/diffmorpho04.html

VOMCERAN

Komposisi:Tiap tablet selaput film mengandung:Ondansetron HCl setara dengan Ondansetron..............................4 mgOndansetron HCl setara dengan Ondansetron..............................8 mg

Tiap mL injeksi mengandung:Ondansetron HCl dihidrat setara dengan ondansetron..................2 mg

Farmakologi:Ondansetron adalah antagonis reseptor 5HT3 yang poten dan selektif yang dapat menghambat

keadian mual dan!atau muntah yang disebabkan karena pemberian obat atau tindakan yangbersifat emetogenik serta mual dan!atau muntah pas"a operasi. #fek anti$muntahnya dapatteradi akibat penghambatan reseptor serotonin baik pada perifer maupun sentral.
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Indikasi:%enanganan mual dan!atau muntah yang disebabkan oleh kemoterapi dan radioterapi yangemetogenik dan dapat uga digunakan untuk pen"egahan mual dan!atau muntah pas"a operasi.

Kontraindikasi:Hipersensitif terhadap ondansetron

Peringatan dan Peratian:&ehamilan' ondansetron sebaiknya tidak digunakan pada kehamilan' terutama pada trimesterpertama' ke"uali bila manfaat yang didapat melebihi dari risiko yang mungkin teradi.(anita menyusui' %er"obaan pada he)an "oba menunukkan adanya ekskresi ondansetron padaair susu tikus. Oleh sebab itu selama pemberian ondansetron dianurkan untuk tidak menyusui.

E!ek samping#fek samping yang mungkin teradi adalah sakit kepala' demam' menggigil' konstipasi' sensasipanas pada daerah kepala' nyeri epigastrium' nyeri muskuloskeletal' nyeri dada' rasa lemas'ansietas' hipotensi' gatal' parestesia' sedasi dan diare. #fek samping yang arang dilaporkan danbiasanya hanya bersifat sementara adalah peningkatan aminotransferase yang bersifatasimptomatik.

"osis dan #ara pem$erian:%en"egahan mual dan muntah pas"a operasi:

*ntuk dosis a)al 8 mg tablet diberikan + am sebelum prosedur anastesi' dan 8 mg berikutnyadiberikan setiap 8 am untuk periode )aktu +, am.

%enanganan mual dan muntah pas"a operasi:*ntuk penanganan mual muntah pas"a operasi' -on"et neksi dapat diberikan se"ara intra/ena

atau intramuskular tanpa pengen"eran.0e)asa

-on"eran ineksi diberikan sebagai dosis tunggal 4 mg se"ara intramuskular atau melalui ineksiintra/ena lambat tidak kurang dari 31 detik sebaiknya antara 2$5 menit' segera sebelum induksi

anastesi atau diberikan segera pas"a operasi apabila pasien mengalami mual dan!atau muntah.nak

0osis rekomendasi untuk pasien pediatrik usia + bulan hingga +2 tahun dengan berat badankurang atau sama dengan 41 kg adalah dalam dosis tunggal 1'+ mg!kg sedangkan untuk berat

badan lebih dari 41 kg diberikan dosis tunggal 4 mg. &e"epatan pemberian -on"et neksi tidakboleh kurang dari 31 detik sebaiknya antara 2$5 menit' diberikan segera sebelum induksi

anastesi atau segera pas"a operasi apabila pasien mengalami mual dan!atau muntah.

Mual%munta &ang diinduksi kemoterapi:

*ntuk penanganan mual dan!atau muntah yang diinduksi kemoterapi' -on"et neksi ineksi harusditambahkan 51 m6 larutan dekstrosa 57 atau aCl 97.

0e)asa

*ntuk kemoterapi yang sangat emetogenik misalnya: "isplatin : ;eumlah 8 mg dosis tunggaldiberikan se"ara ineksi intra/ena lambat atau sebagai tetesan infus dalam )aktu +5 menit

sebelum kemoterapi diberikan. ;elanutnya diikuti dengan tetesan infus se"ara konstan dengan

ke"epatan + mg!am selama 24 am atau diberikan melalui ineksi intra/ena lambat sebanyak 2kali dengan dosis masing$masing 8 mg atau melalui tetesan infus selama +5 menit dengan selang)aktu 4 am. ;etelah itu pemberian dapat dilakukan se"ara oral dengan dosis 8 mg setiap +2 am

selama 5 hari.

*ntuk kemoterapi yang kurang emetogenik misalnya: "y"lophospamide: ;eumlah 8 mgdiberikan se"ara ineksi intra/ena lambat atau sebagai tetesan infus dalam )aktu +5 menit

sebelum kemoterapi diberikan' selanutnya se"ara oral dengan dosis 8 mg setiap +2 am selama 5hari.

nak < , bulan:-on"et neksi dengan dosis 1'+5 mg!kg diberikan se"ara intra/ena dalam )aktu 31 menit

sebelum kemoterapi diberikan. ;elanutnya dosis yang sama 1'+5 mg!kg dapat diberikan 4$8am setelah dosis pertama. %emberian obat dilakukan melalui tetesan infus tidak kurang dari +5

menit.


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=ual$muntah yang diinduksi radioterapi: 0iberikan 8 mg ondansetron tablet setiap 8 am sekali.%emberian dilakukan +$2 am sebelum dilakukan radioterapi. 6ama pengobatan tergantung padalamanya pemberian radioterapi.*sia lanut:Ondansetron dapat ditoleransi dengan baik pada penderita berusia di atas ,5 tahun tanpapenyesuaian dosis' frekuensi dan "ara pemberian.

%enderita dengan gangguan fungsi ginal: Tidak memerlukan penyesuaian dosis harian' frekuensimaupun "ara pemberian.%enderita dengan gangguan fungsi hati: 0osis total harian disarankan tidak melebihi 8 mg.

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