LBM 5 SGD 1 MODUL ENTEROHEPATIK

STEP 1
Kadar amylase darah :
En!m "en#ernaan $ar%&h!dra'( )!$a am!lase "an#reas %er*+n,s! +'$
h!dr&l!s!s &l!,&sa$ar!da men)ad! d!sa$ar!da se"en+hnya d!d+&den+m( %!la
ada d!darah ada ')d ,,+an d! "an#reas y, s%a%$an am!lase %sa
%er"ndah $e darah ( sama $as+snya d, 'ransam!nase y, men!n,$a' "d
he"a'!'!s-
Kadar l!"ase : !dem
STEP .
1- Ba,a!mana *!s!&l&,! "en,el+aran en!m dan h&rm&n "ada "an#reas /
.- Ba,a!mana me'a%&l!sme dar! amylase ser'a l!"ase y, d!has!l$an &leh
"an#reas /
0- A"a h+%+n,an al$&h&l den,an $el+han "as!en /
1- Men,a"a 'er)ad! nyer! d! daerah +l+ ha'! selama . har! ( nyer! mendada$
dan he%a' /
5- A"a h+%+n,an r!2aya' &%es den,an $el+han /
3- Men,a"a d!'em+$an $adar am!lase men!n,$a' dan $adar l!"ase /
4- H+%+n,an $el+han den,an "en+r+nan na*s+ ma$an /
5- DD /
STEP 0
1- Ba,a!mana *!s!&l&,! "en,el+aran en!m dan h&rm&n "ada "an#reas /
6 Pen,el+aran en!m d!a'+r &leh sel as!n+s "da "an#reas dan h&rm&n
d!a'+r &leh "+la+7"+la+ lan,erhans-
Pan#reas : *+n,s! e$s&$r!n sel as!nar d+#'+r "an#rea'!#+s
en!m dan lar+'an %!$ar%&na' s"!n,'er &dd! d+&den+m
H&rm&n 8*+n,s! end&$r!n9 "r&d+$s! dan le"as$an !ns+l!n( ,l+$a,&n
mas+$ $e "+la+ lan,erhans -
En!m y, d!has!l$an "an#reas 8e$s&$r!n9 :
L!"ase "an#reas
Am!lase "an#reas
Pr&'e&l!'!$ 8Tr!"s!n ( Kem&'r!"s!n( $ar%&s!"e"'!dase(
am!n&"e"'!dase( elas'ase( d!"e"'!dase-9
:+n,s! : han#+r$an "r&'e!n-
Dmn '+%+h d!s+s+n &leh "r&'e!n sh!n,,a "an#reas "nya me$an!sme
+'$ $el+ar$an en!m7en!m---dalam %en'+$ !m&,en 8en!m y, %lm
a$'!*9
#normal : "an#reas 'da$ han#+r &elh en!mnya send!r!- Dan a$an a$'!*
%!la %er'em+ 'r!"s!n a'a+ $&nd!s! asam %asa se"er'! d!d+&den+m-
#Mekanisme masuknya :
Ma$anan d+&den+m ran,san, sel en'er&end&$r!n $el+ar$an
h&rm&n ##$ 8"en,ar+h! sel as!n+s "an#reas dan le"as$an !m&,en9
dan se$re'!n 8"en,ar+h! sel sen'r&as!nar has!l$an lar+'an
%!$ar%&na'9 d+$'+s "an#rea'!$+s -
.- Ba,a!mana me'a%&l!sme dar! am!l+m dan l!"ase 'erhada" "en#ernaan
ser'a $adar n&rmal amylase ; l!"ase y, d!has!l$an &leh "an#reas /
6Am!lase 'rhda" $ar%&h!dra' : Kar%& dalam %en'+$ "&l!sa$ar!da d!,as'er
)d d!sa$ar!da se%a,!an dan &l!,&sa$ar!da &leh en!m am!lase "an#reas
a$an d!+%ah men)ad! d!sa$ar!da se"en+hnya-
Lema$ : "&l!"e"'!da adanya h&rm&n <<K %+a' s"!n'er &dd! 'er%+$a
8ada ,aram em"ed+ em+ls! lema$ lema$ %sa d!#erna &leh en!m
l!"ase9
6:!s!&l&,! "em%en'+$an en!m amylase dan l!"ase
0- A"a h+%+n,an al$&h&l den,an $el+han "as!en /
Al$&h&l e*e$ '&$s!$ mer+sa$ s'r+$'+r "an#reas a$!%a' "a)anan lama
ran,san, s"!n,'er &dd! "en!n,$a'an 'e$anan %!l!er dan sal+ran
"an#reas "en,l+aran en!m r+sa$ "an#reas "an#rea'!'!s
6sel as!nar "r&d+$s! 'er+s !n*lamas!
# alkohol $+ran,!n !nh!%!'&r 'r!"s!n 'r!"s!n le%!h "e$a' "la$=
&%s'r+$s!
## alkohol '!n,$a'an asam lam%+n, dan se$re'!n d! lam%+n, s"!n'er
&dd! dan s"!n'er #h&led&#&d+&denal )+n#'!&n r+sa$ ma$anannya
re*l+$ "a#reas 8a$!%a' am"+la >a'er r+sa$9
### hipersekresi protein '!m%+nan "r&'e!n d! d+#'+s "an#rea'!#+s
&%'r+$s!-
Pen!n,$a'an $adar am!lase dan l!"ase : "en!n,$a'an se$res! en!m
"an#reas al$&h&l %ers!*a' '&$s!s- 8$adar n&rmal 0?71?? IU=l!'er9-
6al$&h&l y, mas+$ $edarah sama a'a+ '!da$ den,an al$&h&l y,
6"er)alanan al$&h&l mas+$ $e "a#nreas // 8"er)alanan al$&h&l mas+$ $e
"em%+ll+h darah/9
Alh&h&l lam%+n, '!n,$a'$an h&rm&n se$re'!n '!n,$a'$an ,e'ah
"an#reas dmn al$&h&l %ers!*a' mer+sa$ d+#'+s #h&led&#&d+&denall!s
d+&den+m r+sa$ sal+ran #h&led&#&d+&denall!s )!$a ada s+m%a'an
re$*l+$ $e "an#reas "a#nrea'!'!s
1- Men,a"a 'er)ad! nyer! d! daerah +l+ ha'! selama . har! ( nyer! mendada$
dan he%a' /
Le'a$ "an#reas e"!,as'r!+m h!"&$&n'r!a$a s!n!s'ra
Nyer! : dar! $er+sa$an= "eradan,an a$!%a' al$&h&l a'a+ 'ra+ma'!$ a'a+
&%s'r+$s! a$+' 8&nse' . har! 9 6 adanya $er+sa$an sel as!nar
$el+ar$an s!'&$!n. 8TN: al*a ds%9 ne$r&s!s "em%-darah !s$em!$
$er+sa$an "ada sel. d! "an#reas h!n,,a 'er)ad! ne$r&s!s-
Or,an y, $em+n,$!nan 'er$ena :
7 He"ar he"a'!'!s( H<<
# curiga di VF : (menjalar ke suprascapula)
7 Gas'er ,as'r!'!s( d!s"e"s!a( Gerd ( <a +l#er
# Nyeri ulu hati hingga ke punggung
7 Pan#reas "an#rea'!'!s( <a Pan#reas(
#(menjalar ke punggung)
7 es&*a,+s( 6"en)alaran : nyer! dada
7 d+&den+m(6"en)alaran : 7
7 nyer! "s!$&s&ma'!$( 6"en)alaran : 7
7 e$!m&s!s (
7 *ra$'+r #&s'a(
7 '+m&r es&*a,+s(
7 "er!'&n!'!s #penjalaran : seluruh lapang abdomen
7 d!a*ra,ma 8'ra+ma myal,!a9(
5- A"a h+%+n,an r!2aya' &%es den,an $el+han /
A$!%a' $&ns+ms! al$&h&l rese"'&r sel dalm '+%+h 'er'+m"+$ &leh
$&les'er&l dan lema$ "an#reas has!l$an h&rm&n !ns+l!n dan )$a 'er)ad!
"eradan,an 'er$ena $e "+la+ len,erhans //
Ke am"+la >a'er &%'r+$s!
6 e'!& +'ama : $&lel!'!as!s 80?73?@9 a$!%a' $&les'er&l y, men+m"+$( dar!
d+a *a$'&r : $&les'er&l( &%es-- 8$&les'er&l enda" d! rese"'&r !ns+l!n( !ns+l!n
dan ,l+$a,&n %er"en,ar+h "ada me'a%&l!sme lema$ dan "r&'e!n( $'!$a
'r)ad! "en!n,$a'an hr+s ada h&rm&n y, men,&n'r&l( 9
Al$&h&l
6 $&lel!'!as!s : $rna ada s+m%a'an d! sal+ran Aes!#a %!l!ar!s ma$a %a'+nya
lan,s+n, mas+$ $e "an#reas-
3- Men,a"a d!'em+$an $adar am!lase men!n,$a' dan $adar l!"ase /
Al$&h&l "en!n,$a'an "en,el+aran en!m
Am!lase : 'erda"a' $elen)ar "an#reas( a!r l!+r( am!l+m B mal'&sa(
6men!n,$a' %!la ada ,,+an "an#reas( d!"en,ar+h! &leh "nye%a% nyer! d!
+l+ ha'! /
L!"ase : men!n,$a' a"a%!la ada ,,+an a%sr&%s! lema$-
End&$r!n men,el+ar$an h&rm&n = en!m $e darah-
E$s&$r!n $el+ar$an-------------------le2a' d+#'+s
4- H+%+n,an $el+han den,an "en+r+nan na*s+ ma$an /
Adanya "en,ar+h "ada "en!n,$a'an asam lam%+n,(
6O%es!'as dmn sel lema$nya %anya$ "en,ar+h! h&rm&n le"'!n
h!"&'alam+s mene$an na*s+ ma$an
6 adanya "en,a$'!*an en!m "r&'e&l!'!$ d! "an#reas r+sa$ "an#reas
"en+r+nan na*s+ ma$an-
Sara* y, "ersara*! "an#reas : ner>+s >a,+s 8"en#e'+s re*le$ m+n'ah9
5- DD /
Presh&#$( nad! men!n,$a'( TD men+r+n-
7 Pan#rea'!'!s a$+'
7