Upaya Pencegahan Perdarahan Saluran Cerna Bagian Atas Berulang Pada Pasien Varises Gastroesofagus Derajat 3-4

Priska Dewi Forceviana Savitri, dr. Wahyu Damayanti, Sp.A(K).; dr. Desy Rusmawatiningtyas, M.Sc, Sp.A(K)

2023 | Tesis-Spesialis | S2 Ilmu Kesehatan anak

Background: Gastroesophageal varices are venous vascular dilatations within the lumen of the gaster and esophagus caused by both intrahepatic and extrahepatic abnormalities. It occurs as a result of increased portal blood pressure of more than 5 mmHg that is settled or called portal hypertension. Gastroesophageal varicose hemorrhage is a leading cause of morbidity and mortality in children with portal hypertension, with a mortality rate of 19%. Due to its high mortality, early intervention is crucial to preventing the occurrence of gastrointestinal bleeding. It is carried out to prevent recurrent bleeding through the administration of primary prophylaxis to prevent the occurrence of gastroesophageal varices with non-specific beta-blockers (NSBBs) as well as endoscopic examination with varicose ligation or periodic sclerotherapy to evaluate and prevent complications. Case: Long-term monitoring and multidisciplinary intervention were carried out on girls aged 12 years 1 month, with diagnosis of gastroesophageal varices grade 3-4, vitamin D insufficiency, severely stunted, and severely underweight. The study observed eight variables, consisting of four external variables and four prognosis variables. The outer variables achieved are the implementation of the diagnosis of gastroesophageal varices based on Shearwave Elastography, nutritional status and quality of life, coagulopathy, respiratory tract infections, and constipation. The variable that has not reached the target is the occurrence of upper intestinal hemorrhage and vitamin D insufficiency. As for the problems faced because of the non-routine drug consumption caused by the lack of drug monitoring as well as the price of vitamin D is expensive and not borne by the BPJS. Conclusion: Regular monitoring of patients with gastroesophageal varicose veins is needed to reduce the incidence of recurrent bleeding, improve quality of life, and reduce morbidity and mortality.

Background: Gastroesophageal varices are venous vascular dilatations within the lumen of the gaster and esophagus caused by both intrahepatic and extrahepatic abnormalities. It occurs as a result of increased portal blood pressure of more than 5 mmHg that is settled or called portal hypertension. Gastroesophageal varicose hemorrhage is a leading cause of morbidity and mortality in children with portal hypertension, with a mortality rate of 19%. Due to its high mortality, early intervention is crucial to preventing the occurrence of gastrointestinal bleeding. It is carried out to prevent recurrent bleeding through the administration of primary prophylaxis to prevent the occurrence of gastroesophageal varices with non-specific beta-blockers (NSBBs) as well as endoscopic examination with varicose ligation or periodic sclerotherapy to evaluate and prevent complications. Case: Long-term monitoring and multidisciplinary intervention were carried out on girls aged 12 years 1 month, with diagnosis of gastroesophageal varices grade 3-4, vitamin D insufficiency, severely stunted, and severely underweight. The study observed eight variables, consisting of four external variables and four prognosis variables. The outer variables achieved are the implementation of the diagnosis of gastroesophageal varices based on Shearwave Elastography, nutritional status and quality of life, coagulopathy, respiratory tract infections, and constipation. The variable that has not reached the target is the occurrence of upper intestinal hemorrhage and vitamin D insufficiency. As for the problems faced because of the non-routine drug consumption caused by the lack of drug monitoring as well as the price of vitamin D is expensive and not borne by the BPJS. Conclusion: Regular monitoring of patients with gastroesophageal varicose veins is needed to reduce the incidence of recurrent bleeding, improve quality of life, and reduce morbidity and mortality.

Kata Kunci : Varises gastroesofagus, insufisiensi vitamin D, malnutrisi, Gastroesophageal varices, vitamin D insufficiency, malnutrition