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"Studi kasus serial ini bertujuan untuk memberikan tatalaksana nutrisi pada pasien kanker kepala dan leher yang menjalani terapi kemoradiasi. Status nutrisi seorang pasien kanker merupakan salah satu prediktor dalam menentukan QOL dan survival, tetapi status nutrisi pada kasus serial ini dipengaruhi oleh banyak faktor antara lain metabolisme sel kanker, perubahan metabolisme dalam tubuh, efek samping radiasi, efek samping kemoterapi, serta faktor-faktor lain seperti psikis dan ekonomi. Serial kasus ini merupakan empat pasien kanker kepala dan leher berusia 30-57 tahun yang sedang menjalani kemoradioterapi dan telah mengalami penurunan berat badan bahkan sebelum dilakukan kemoradioterapi. Dalam perjalanan penyakitnya pasien mengalami efek samping terapi yang mempengaruhi status nutrisi pasien. Kebutuhan nutrisi pasien pada kasus serial ini dihitung menggunakan rumus Harris Benedict dengan faktor stres 1,5 dan diberikan protein sebanyak 1,5-2,0 g/kgBB/hari serta lemak 25-30%. Pemberian mikronutrien disesuaikan dengan RDA. Hasil dari kasus serial ini menunjukkan bahwa pasien yang status nutrisinya dapat dipertahankan menghasilkan outcome yang lebih baik daripada pasien yang status nutrisinya menurun. Untuk itu pada kasus keganasan kepala dan leher yang menjalani kemoradiasi sebaiknya diberikan konseling dan terapi nutrisi sejak awal sebelum timbul efek samping kemoradioterapi.

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This case studies aims to provide nutritional management of head and neck cancer patients undergoing chemoradiation therapy. Nutritional status of a patient's cancer is one of the predictors in determining QOL and survival. Nnutritional status is influenced by many factors, such as cancer cell metabolism, metabolic changes, the side effects of radiation and chemotherapy, as well as other factors such as psychological and economic. This is a case series of four head and neck cancer patients aged 30-57 years who were undergoing chemoradiotherapy and has lost weight even before chemoradiotherapy. In the course of illness of patients experience side effects of therapy affects the nutritional status of patients. Nutritional needs of patients in the case series were calculated using the Harris Benedict formula and stress factor 1.5. Protein was given 1.5 to 2.0 g protein/kgBW/day and 25-30% of fat. Micronutrient was provide as RDA. Results of this case series suggests that the nutritional status of patients who can be maintained produced better outcomes than patients whose nutritional status declined. For it is in the case of head and neck malignancies who underwent chemoradiation should be given counseling and nutrition therapy early before any side effects of chemoradiotherapy."

"Kolestasis merupakan salah satu manifestasi gangguan bilier yang terjadi akibat gangguan aliran empedu dari hati ke duodenum. Kolestasis diklasifikasikan berdasarkan perjalanan penyakitnya menjadi kolestasis akut dan kronis. Tatalaksana nutrisi pada kolestasis bertujuan untuk mengatasi defisiensi nutrien yang umumnya terjadi tetapi terdapat perbedaan dalam tatalaksana tersebut, tergantung penyebab kolestasis dan kondisi klinis pasien. Selain itu nutrisi perioperatif pada kolestasis yang menjalani pembedahan diperlukan untuk mencegah risiko komplikasi pasca bedah dan gangguan saluran cerna akibat tindakan pembedahan. Dilaporkan 4 kasus kolestasis, dua kasus kolestasis akut dan dua kasus lainnya kolestasis kronis. Kasus 1 dan 2, berturut-turut adalah kolestasis akut e.c. kolelitiasis multipel dan kolestasis akut e.c. kolesistolitiasis multipel. Kasus 3 adalah kolestasis kronis e.c. kista duktus koledokus dan kasus 4 kolestasis kronis e.c. adenokarsinoma ampula Vateri. Pasien kasus 3 berusia 2 tahun 3 bulan, sementara kasus 1, 2 dan 4 berusia antara 22 tahun sampai 45 tahun. Pada semua kasus terdapat riwayat nyeri perut bagian atas, sklera ikterik dan peningkatan kadar bilirubin, fosfatase alkali dan -GT. Keempat kasus menjalani pembedahan untuk mengatasi keadaan kolestasis tersebut. Tatalaksana nutrisi perioperatif yang adekuat pada kasus 1, 2 dan 4 dapat mencegah risiko komplikasi pasca bedah dan pada kasus 3 dapat memperbaiki komplikasi pasca bedah berupa wound dehiscence. Pasca bedah, kondisi klinis keempat pasien membaik, terlihat dari berkurangnya keluhan nyeri perut bagian atas, berkurangnya ikterik pada sklera dan perbaikan kapasitas fungsional. Toleransi asupan seluruh pasien membaik, ditunjukkan oleh kemampuan pasien untuk mengonsumsi makanan sesuai kebutuhan energi dan nutriennya. Berdasarkan kepustakaan dan pengalaman tatalaksana nutrisi keempat pasien tersebut, pada kolestasis diperlukan tatalaksana nutrisi yang adekuat yaitu pada perioperatif dan pasca rawat. Edukasi pasien tentang pemilihan jenis makanan dan cara pemberiannya berguna untuk mencegah kekambuhan.

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Cholestasis is one manifestation of biliary disorders caused by interruption flow of bile from the liver to the duodenum. Cholestasis classified becomes acute and chronic cholestasis. Management of nutrition on cholestasis aims to improve nutrient deficiency that commonly occur but there is a difference in the treatment of these, depending on the cause of cholestasis and the clinical condition of the patient. Additionally perioperative nutrition on cholestasis who underwent surgery is needed to prevent the risk of post-surgical complications and gastrointestinal disorders caused by surgery.

Reported 4 cases of cholestasis, cholestatic two cases of acute and chronic cholestasis two other cases. Cases 1 and 2, respectively acute cholestasis ec kolelitiasis multiple and acute cholestasis e.c. kolesistolitiasis multiple. Case 3 is a chronic cholestatic e.c. koledokus duct cysts and 4 cases of chronic cholestasis ec adenocarcinoma of the ampulla of Vater. 3 case patients aged 2 years and 3 months, while cases 1, 2 and 4 are aged between 22 years to 45 years.. In all cases there is a history of upper abdominal pain, sclera jaundice and elevated levels of bilirubin, alkaline phosphatase, and -GT.

The four cases underwent surgery to resolve the situation cholestasis. Management of perioperative nutrition adequate in cases 1, 2 and 4 can prevent the risk of postoperative complications and in case 3 may improve post-surgical complications such as wound dehiscence. Post-surgery, four patients improved clinical condition, as seen from the reduced upper abdominal pain, jaundice in the sclera reduction and improved functional capacity. Tolerance intake of all patients improved, indicated by the patient?s ability to eat food and energy needs nutrient.

Based on the literature and experience of nutritional management of the four patients, the treatment of cholestasis is necessary that adequate nutrition in perioperative and post-hospitalization. Educating patients about the choice of food and the way of administration is useful to prevent a recurrence."

"Malnutrisi merupakan hal yang umum terjadi pada pasien sirosis hati Tata laksana nutrisi yang optimal bertujuan mempertahankan dan meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien Tatalaksana nutrisi pasien sirosis hati mencakup pemberian makronutrien mikronutrien dan nutrien spesifik serta cairan Pasien pada serial kasus ini terdiri atas tiga orang laki laki dan satu orang perempuan dengan rentang usia antara 30 sampai 57 tahun Tiga orang pasien menderita malnutrisi dan satu orang pasien berisiko malnutrisi Berdasarkan skrining seluruh pasien membutuhkan dukungan nutrisi Kebutuhan energi total KET pasien dihitung dengan menjumlahkan kebutuhan energi basal KEB yang didapat dengan menggunakan persamaan Harris Benedict dan faktor stres yang sesuai kondisi klinis pasien Pemberian nutrisi dimulai dengan 80 dari KEB sampai KEB kemudian ditingkatkan secara bertahap hingga mencapai KET Kebutuhan protein dan lemak disesuaikan dengan kondisi pasien Protein yang diberikan mempunyai kandungan asam amino rantai cabang AARC yang tinggi dan lemak jenis medium chain triglyceride MCT trigliserida rantai sedang Makanan diberikan dalam porsi kecil dengan jadwal pemberian sering dan malam hari diberikan late evening snack sebanyak 10 dari asupan harian total mengandung karbohidrat dan AARC Pada pasien dengan hiponatremia dilusional asupan cairan direstriksi Selama pemantauan dengan bertambah baiknya keadaan klinis maka asupan makan pasien dapat mencapai KET Serial kasus ini menunjukkan bahwa pada pasien sirosis hati dengan berbagai komplikasi tata laksana nutrisi yang baik dapat meningkatkan status gizi memperbaiki keadaan klinis dan meningkatkan kualitas hidup pasien

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Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support ;Malnutrition is common in patients with liver cirrhosis Optimal nutrition support in patients with liver cirrhosis is required to maintain and improve clinical condition nutrition status and quality of life by providing macronutrient micronutrient specific nutrient and fluid according to the recommendation Patients in this case series were three males and one female with age ranged from 30 to 57 years old Three patients were malnourished while one was on risk of being malnourished Based on the screening conducted to these patients while their admission all four patients needed nutrition support therapy Total energy requirements were determined using Harris Benedict equation to calculate basal energy requirements and multiplied by stress factor Nutrition provision initiated from 80 basal energy requirement and increased gradually according to patient rsquo s tolerance until total energy requirements were achieved Protein and lipid were given in accordance with the patients clinical condition with protein contain high branched chain amino acid BCAA and fat which high in medium chain triglyceride MCT The diets delivered in small portion six times per day with late evening snack as much as 10 of total energy intake contained carbohydrate and BCAA Fluid restrictions were applied to patients with dilutional hyponatremia During hospitalization nutrition intake increased as general conditions improved Nutrition status clinical condition and quality of life of liver cirrhotic patients with various complications in this case series were improved by appopriate nutrition support "

"[Latar Belakang: Lama puasa prabedah mempengaruhi outcome pascabedah. Saat ini, pasien bedah anak masih dipuasakan lebih lama dari yang direkomendasikan. Sementara itu, belum ada rekomendasi dimulainya pemberian nutrisi enteral pascabedah.Metode: Dilakukan penilaian pada pasien anak yang menjalani pembedahan intraabdomen. Hal yang dinilai meliputi skrining gizi dengan berbagai metode, status gizi prabedah, lama puasa prabedah, jenis pembedahan, dimulainya nutrisi enteral pascabedah, pencapaian kalori total dan asupan protein, serta perbaikan kapasitas fungsional.Hasil: Pembedahan terdiri atas nonreseksi dan reseksi usus, masing-masing 2 kasus. Status gizi prabedah pasien pertama dan kedua malnutrisi ringan, sementara pasien ketiga dan keempat malnutrisi sedang. Rerata lama puasa prabedah berturut-turut 16 dan 7,5 jam untuk nonreseksi usus serta 17 dan 7 jam untuk reseksi usus. Semua pasien berada memiliki ASA 2. Pemberian nutrisi enteral dimulai berturut-turut 6 dan 4 jam pascabedah pada nonreseksi, serta hari ke-3 pascabedah pada kasus reseksi usus. Asupan kalori total tercapai berturut-turut pada hari ke-5 dan ke-9 pascabedah pada kasus nonreseksi, serta hari ke-5 dan ke-7 pada reseksi usus. Kebutuhan protein para pasien tercapai berturut-turut pada hari ke-3, 5, 7, dan 9 pascabedah untuk pasien terakhir. Perbaikan kapasitas fungsional pasien terjadi berturut-turut pada hari ke-6, 3, 6, dan ke-8 pascabedah pada pasien pertama, kedua, ketiga, dan keempat.Kesimpulan: Dengan tatalaksana komprehensif terapi medik gizi klinik perioperatif pasien bedah anak, dapat mencegah komplikasi bedah dan mempercepat pemulihan kapasitas fungsional.Background: Presurgery fasting time affects the surgery outcome. Nowadays, fasting in pediatric surgery patients are longer than recommended. However, there is no recommendation of the enteral feeding initiation after surgery.Method: The serial case assessed pediatric intarabdominal surgery patients. They were reviewed for nutritional scorings, presurgery nutritional status, presurgery fasting time, type of surgery, the time the enteral feedings intiatiation, the time to meet the requirement of total calories and protein intake, and the improvement of functional capacity.Results: Four cases were divided to non- and intestinal resection, 2 cases each. The nutritional status of the first and second patient were mild malnutrition, while the third and the fourth were moderate malnutrition. Mean fasting time were 16 and 7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2 ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery in nonresection, and at day 3 and 4 after surgery in resection case. The total calories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and 7 in the other case. The protein intake met total requirement in patients at day 3, 5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively.Conclusion: Comprehensive perioperative medical clinical nutrition management results in improving wound healing process and the functional capacity.;Background:Presurgery fasting time affects the surgery outcome. Nowadays, fasting inpediatric surgery patients are longer than recommended. However, there is norecommendation of the enteral feeding initiation after surgery.Method:The serial case assessed pediatric intarabdominal surgery patients. They werereviewed for nutritional scorings, presurgery nutritional status, presurgery fastingtime, type of surgery, the time the enteral feedings intiatiation, the time to meetthe requirement of total calories and protein intake, and the improvement offunctional capacity.Results:Four cases were divided to non- and intestinal resection, 2 cases each. Thenutritional status of the first and second patient were mild malnutrition, while thethird and the fourth were moderate malnutrition. Mean fasting time were 16 and7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery innonresection, and at day 3 and 4 after surgery in resection case. The totalcalories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and7 in the other case. The protein intake met total requirement in patients at day 3,5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively., Background:Presurgery fasting time affects the surgery outcome. Nowadays, fasting inpediatric surgery patients are longer than recommended. However, there is norecommendation of the enteral feeding initiation after surgery.Method:The serial case assessed pediatric intarabdominal surgery patients. They werereviewed for nutritional scorings, presurgery nutritional status, presurgery fastingtime, type of surgery, the time the enteral feedings intiatiation, the time to meetthe requirement of total calories and protein intake, and the improvement offunctional capacity.Results:Four cases were divided to non- and intestinal resection, 2 cases each. Thenutritional status of the first and second patient were mild malnutrition, while thethird and the fourth were moderate malnutrition. Mean fasting time were 16 and7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery innonresection, and at day 3 and 4 after surgery in resection case. The totalcalories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and7 in the other case. The protein intake met total requirement in patients at day 3,5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively.]"

"ABSTRAKLatar Belakang: Prevalensi penyakit ginjal kronik (PGK) meningkat pada usia lanjut. Berdasarkan Riskesdas 2013, prevalensi PGK lebih tinggi pada usia 55-75 tahun dibandingkan usia kurang dari 55 tahun. Pada usia lanjut terjadi perubahan struktur dan fungsi ginjal, serta adanya riwayat penyakit komorbid seperti diabetesmelitus (DM), hipertensi, penyakit jantung dan pembesaran prostat, menjadi faktor risiko yang meningkatkan terjadinya PGK. Komplikasi yang dapat timbul pada penderita PGK antara lain frailty dan protein energy wasting, yang menyebabkan penurunan kapasitas fungsional dan kualitas hidup, serta peningkatan morbiditas dan mortalitas. Terapi nutrisi yang adekuat berperan penting untuk mencegah protein energy wasting dan komplikasi lain yang dapat timbul pada PGK.Metode: Laporan serial kasus ini memaparkan empat kasus PGK pada pasien usia di atas 60 tahun. Dua pasien memiliki penyakit komorbid DM dan hipertensi, dandua lainnya hanya hipertensi. Keempat pasien dalam serial kasus ini termasuk PGK derajat IV dan V. Pada dua kasus dilakukan hemodialisis, sementara pada dua lainnya belum dilakukan. Masalah yang timbul pada keempat kasus adalahterdapat gejala-gejala sindroma uremia yaitu mual, muntah, anoreksia, lemas, sesak, dan anemia sehingga asupan makanan tidak adekuat dan terjadi penurunankapasitas fungsional. Kebutuhan energi pasien dihitung dengan menggunakan persamaan Harris-Benedict ditambah faktor stres dan pemberian protein disesuaikan dengan sudah atau belum dilakukan hemodialisis. Komposisikarbohidrat dan lemak disesuaikan dengan rekomendasi theurapeutic lifestyle changes (TLC) dan American Diabetes Association (ADA). Suplementasi mikronutrien diberikan sesuai dengan kondisi pasien. Pemantauan pasiendilakukan setiap hari dengan memperhatikan perubahan gejala klinis, tanda vital, imbang cairan, kapasitas fungsional, analisis dan toleransi terhadap makanan,serta hasil pemeriksaan laboratorium.Hasil: Pemantauan yang dilakukan pada empat pasien selama perawatan di rumah sakit menunjukkan terjadi perbaikan gejala klinis serta peningkatan asupan makanan dan kapasitas fungsional.Kesimpulan: Terapi nutrisi dapat mendukung terapi utama pada penderita PGK usia lanjut dalam memperbaiki keadaan klinis dan kapasitas fungsional, serta mencegah komplikasi lebih lanjut

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ABSTRACT

Background: The prevalence of chronic kidney disease (CKD) increases in the elderly. Based on Riskesdas 2013, the prevalence of CKD is higher in the age of 55-75 years old compared to below 55 years of age. In the elderly, there are alterations in kidney structure and function, as well as history of comorbidities include diabetes mellitus, hypertension, heart disease and prostate hypertrophy that increase the factor CKD. Complication that may occur in patients with CKD including frailty and protein energy wasting, which can cause decreased

functional capacity and quality of life, and increased morbidity and mortality. Adequate nutrition therapy plays an important role in preventing protein energy wasting and other complications that may arise in CKD.

Methods: This case series report describes four cases of CKD in patients aged above 60 years old. Two patients have comorbid disease diabetes mellitus and hypertension and the others have only hypertension. The four patients in this case series are in CKD stage IV and V. Two cases with hemodialysis, while in the others has not done yet. Problems arising in all cases are uremic syndrome

symptoms such as nausea, vomiting, anorexia,fatigue, dypsnea, and anemia causing inadequate food intake and decreased functional capacity. Energy requirements of the patients calculated using the Harris-Benedict equation added by stress factor and the amount of protein depends on whether the hemodialysis has or has not been applied. Carbohydrate and fat composition appropriated to the

theurapeutic lifestyle changes (TLC) and the American Diabetes Association (ADA) recommendations. Micronutrients supplementation was given in

accordance to patient's condition. Patient monitoring is carried out every day by observing changes in clinical symptoms, vital signs, fluid balance, functional

capacity, dietary analysis and food tolerance, and laboratory resultsResults: Monitoring conducted in the four patients during treatment at the hospital showed the improvements in clinical symptoms, and increased in food

intake and functional capacity."

"ABSTRAKLatar belakang: Luka bakar merupakan suatu trauma yang menyebabkan kerusakan dan kehilangan jaringan karena kontak dengan objek bersuhu tinggi. Kondisi tersebut memicu respons inflamasi lokal dan sistemik yang memicu komplikasi. Hipermetabolisme dan hiperkatabolisme yang terjadi memerlukan tatalaksana nutrisi adekuat untuk menurunkan respons inflamasi, mencegah wasting otot, meningkatkan imunitas, dan mempercepat penyembuhan luka.Metode: Empat pasien dalam serial kasus ini mengalami luka bakar berat karena api dengan berbagai pencetus. Dua pasien dalam serial kasus ini masuk perawatan lebih dari 24 jam pasca kejadian. Status nutrisi pasien obes derajat II 1 pasien dan obes derajat I 3 pasien . Target energi menggunakan metode Xie dan Harris ndash;Benedict dengan berat badan sebelum sakit. Pemberian nutrisi diberikan sesuai dengan rekomendasi untuk sakit kritis fase akut 20 ndash;25 kkal/kg BB. Nutrisi dini dilakukan pada dua pasien yang datang kurang dari 24 jam pasca kejadian. Nutrisi diberikan melalui jalur enteral dengan metode drip intermittent. Tatalaksana nutrisi selanjutnya disesuaikan dengan toleransi dan kondisi klinis yang dialami pasien.Hasil: Tiga pasien meninggal selama perawatan karena komplikasi sepsis Tatalaksana nutrisi dinaikkan bertahap sesuai kondisi klinis pasien. Pasien kasus keempat mengalami perbaikan dengan luas luka bakar 48,5 menjadi 11,5 dan peningkatan kapasitas fungsional, walaupun terjadi penurunan berat badan hingga 12 kg selama perawatan.Kesimpulan: Tatalaksana nutrisi yang adekuat dengan memperhatikan kondisi klinis serta parameter penunjang lainnya dapat menunjang proses penyembuhan luka serta menurunkan laju morbiditas dan mortalitas pada pasien luka bakar. Kata kunci: luka bakar berat, tatalaksana nutrisi.

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ABSTRACT

Background Burn injury is a trauma that caused damage and tissue loss due to contact with high temperature objects. That conditions will initiated local and systemic inflammatory reaction, which trigger complications after burn injury. Adequate nutrition management is needed in hypermetabolic and hypercatabolic condition to decrease the inflammatory response, prevents muscle wasting, improve immunity and wound healing.

Methods Four patients in this case series suffered from burn injury by fire with various origins. Two patients in this case series were treated more than 24 hours after trauma. Patients nutritional status were obese grade II 1 patient and grade I 3 patients. Energy requirement was measured by using Xie and Harris Benedict equations, with usual body weight. Nutrition was given base on recommendation for critically ill in acute phase, 20 ndash 25 kcal kg BW. Enteral nutrition was initiated for two patients who came less than 24 hours post burn, using intermittent drip method. The nutrition was adjusted daily depend on their clinical condition.

Results Three patients died during treatments for septic complications. Nutrients management gradually increase in accordance to clinical conditions. Patient in 4th cases experienced improvement with burn area decreased from 48,5 to 11,5 , also increasing on functional capacity, despite of weight loss up to 12 kg during treatment.

Conclusion Adequate nutritional management based on clinical conditions not only to reduce morbidity and mortality in burn patients, but also lead to improve healing process.. Keywords severe burn, nutrition management."

"ABSTRAKLatar belakang: Sistektomi radikal dengan ileal conduit yang merupakan tata laksana utama karsinoma buli adalah prosedur pembedahan kompleks yang seringkali membutuhkan rawat inap yang lama dan menyebabkan berbagai komplikasi. Malnutrisi praoperatif merupakan kontributor penting terhadap tingginya morbiditas dan mortalitas pada sistektomi radikal. Dukungan nutrisi perioperatif yang adekuat bertujuan untuk menurunkan stres akibat pembedahan sehingga dapat mencegah komplikasi, menunjang outcome yang baik, dan memperpendek masa rawat inap pascaoperasi.Metode: Laporan serial kasus ini menyajikan empat kasus karsinoma buli, dengandua kasus termasuk kaheksia kanker dan dua kasus termasuk pra-kaheksia. Keempat pasien dilakukan sistektomi radikal dengan ileal conduit dan diberikan dukungan nutrisi perioperatif yang mencakup carbohydrate loading dan nutrisi enteral dini pascaoperasi serta pemberian nutrisi secara bertahap. Dilakukan pemantauan yang meliputi keluhan klinis, pemeriksaan fisik, antropometri, hasil laboratorium, dan analisis asupan.Hasil: Tiga pasien mengalami hiperglikemia yang berlangsung singkat tanpa membutuhkan terapi insulin. Dua pasien mengalami ileus paralitik pascaoperasi, namun dapat teratasi secara konservatif dalam waktu cepat. Dua pasien mencapai 70-80 target kalori dalam 5 hari pascaoperasi, sedangkan pasien yang mengalami ileus paralitik mencapai target kalori 60-70 dalam waktu 9 hari pascaoperasi. Masa rawat inap pascaoperasi bervariasi mulai dari 7 hingga 10 hari.Kesimpulan: Dukungan nutrisi perioperatif pada keempat pasien menunjang dalam mengontrol stres pembedahan yang terlihat dari hiperglikemia yang hanya berlangsung singkat, mencegah komplikasi, serta memperpendek masa rawat inap.

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ABSTRACT

Background Radical cystectomy and ileal conduit, a mainstay treatment of bladder carcinoma, is a complex surgery which not rarely requires a long hospital stay and has many complications. Preoperative malnutrition is on of important contributor to high morbidity and mortality in radical cystectomy. Adequate perioperative nutritional support aims to alleviate surgical stress, thus prevent complications, support good outcome, and shorten length of hospital stay after surgery.

Method This case series presenting 4 cases of bladder carcinoma, consists of 2 cases of cancer cachexia and 2 cases of pre cachexia. All of the patients had undergone radical cystectomy and ileal conduit, and was supported by perioperative nutrition including carbohydrate loading and postoperative early enteral nutrition. The monitoring included clinical complaints, physical examination, anthropometry, laboratory results, and intake analysis.

Result Three patients had hyperglycemia lasted only in short period and no insulin treatment needed. Two patients experienced postoperative paralytic ileus and was resolved only with conservative treatment. Two patients achieved 70 ndash 80 calorie target on 5 days after surgery, while the others who experienced paralytic ileus achieved 60 ndash 70 calorie target in 9 days postoperative. Length of stay in the hospital after surgery was varied between 7 to 10 days.

Conclusion Perioperative nutritional support on the above patients had contribution in controlling surgical stress, seen on the short period hyperglycemia, preventing complications, and shortening the hospital stays."

"ABSTRAKLatar Belakang: Penyakit autoimun terjadi karena tubuh tidak mampu untuk mengenali sel atau jaringan tubuh sendiri, sehingga tubuh memberikan respons seperti proses eliminasi antigen terhadap sel atau jaringan tubuh sendiri. Berbagai faktor risiko, antara lain genetik, lingkungan dan nutrisi berperan pada perkembangan penyakit autoimun. Saat penyakit autoimun telah menimbulkan gejala, pasien memiliki risiko mendapat nutrisi yang tidak adekuat. Selain itu, kondisi autoimun akan menimbulkan respons inflamasi terus-menerus di dalam tubuh. Bila kondisi ini terus berlanjut akan menyebabkan peningkatan status metabolisme, status nutrisi, status imun dan menimbulkan gangguan kapasitas fungsional pada pasien. Pasien dengan penyakit autoimun harus didukung dengan edukasi dan mendapat terapi nutrisi yang tepat dan adekuat, terutama saat menjalani proses terapi sehingga kebutuhan nutrisi dapat terpenuhi sesuai dengan kondisi pasien. Metode: Laporan serial kasus ini menguraikan empat kasus penyakit autoimun. Dua kasus merupakan kasus neurologi, sementara dua kasus lain adalah kasus penyakit kulit. Dua pasien memiliki status nutrisi malnutrisi berat, satu pasien berat badan normal berisiko malnutrisi dan satu pasien obes I berisiko malnutrisi. Terapi nutrisi sesuai mengacu pada diet seimbang. Semua pasien mendapat terapi nutrisi sejak dikonsulkan ke Departemen Medik Ilmu Gizi hingga hari terakhir perawatan di RS. Asupan energi dan protein diberikan meningkat bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien diberikan kepada pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, imbang cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, asupan pasien dapat mencapai kebutuhan energi total dan mikronutrien diterima oleh pasien. Perbaikan klinis dan perbaikan kapasitas fungsional terjadi pada 3 pasien. Satu pasien mengalami perburukan dan meninggal akibat sepsis pada hari perawatan ke-33. Kesimpulan: Terapi nutrisi pada pasien autoimun dapat mendukung proses pengobatan berupa perbaikan kapasitas fungsional dan lama rawat 3 pasien.

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ABSTRACTObjective Autoimmune disease is a condition of body inability to recognize the cells or tissues itself. It will response as antigen elimination process against the cells or tissue itself. Autoimmune risk factors, such as genetic, enviromental and nutrients play a role in the development of autoimmune diseases. When the symptoms occur, the patient have a risk of inadequate nutrition. In addition, autoimmune condition will cause continuous inflammatory response. This situation will increase patients rsquo s metabolic, nutritional, and immune status. Thus, reduce the patient rsquo s functional capacity. Patient with autoimmune disease should be supported by appropriate and adequate nutrition education and therapy, especially during the therapeutic process so that the nutrition requirements can be fulfilled according to the patient 39 s condition. Methods These case report outlines four cases of autoimmune disease. Two cases are cases of neurology, while the other two cases are cases of skin disease. Two patients had severe malnutrition, one normoweight patient at risk for malnutrition and one obese patient at risk of malnutrition. Management of appropriate nutrition refers to a balanced diet. All patients received nutritional therapy from the Clinical Nutrition Department until the last day of hospitalization. The energy and protein intake increase gradually in accordance with improved clinical conditions and patient rsquo s tolerance. Supplementation of micronutrients is given to the patient. Patient monitoring includes subjective, hemodynamics, analysis and tolerance of intake, laboratory examination, anthropometry, fluid balance, and functional capacity Results During hospital monitoring, the patient 39 s nutrition intake can achieve the total energy and protein requirement as well as the micronutrients. Clinical condition and functional capacity improvements occurred in 3 patients. One patient had worsening condition and died due to sepsis in the 33rd day of treatment. Conclusion Nutritional therapy for patients with autoimmune disease can support the treatment process in improvement of functional capacity and length of stay."

"ABSTRAKLatar Belakang: Malnutrisi terjadi pada 80 karsinoma gaster. Pasien kanker yang menjalani pembedahan memerlukan dukungan nutrisi perioperatif dengan tujuan meningkatkan status gizi, mengurangi sensitivitas insulin dan menurunkan proses katabolisme. Metode: Pasien serial kasus adalah perempuan dengan rentang usia 28-74 tahun dengan diagnosis karsinoma gaster stadium lanjut. Terapi medik gizi prabedah diberikan dalam bentuk nutrisi oral dan enteral untuk mendukung kecukupan status gizi. Enam jam menjelang pembedahan, tiga pasien mendapatkan nutrisi parenteral formula glukosa asam amino dengan kandungan 15 g protein dan 37,5 g asam amino, sedangkan satu pasien dengan penyakit penyerta diabetes melitus tipe 2 mendapatkan nutrisi berupa cairan glukosa 50 g. Hasil: Pasien diberikan nutrisi enteral dini 2-30 jam pascabedah gastrektomi disertai dengan dukungan nutrisi parenteral. Hanya satu pasien mengalami kenaikan glukosa darah pascabedah hari pertama, namun glukosa darah terkontrol dengan pemberian insulin. Klinis dan penyembuhan luka pascabedah baik, pasien mendapatkan nutrisi oral pada 3 ndash; 7 hari pascabedah. Kesimpulan: Terapi medik gizi perioperatif pada karsinoma gaster memberikan hasil yang baik pada outcome bedah.

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ABSTRACT<>br>Objective Almost 80 gastric carcinoma patients was malnourished. Perioperative nutrition aims to support nutrition status, reduce insulin resistance and lower hypercatabolic state. Methods Four patients in this case series were female, age ranged 28-74 years with end stage gastric carcinoma. Preoperative nutrition was given by oral and enteral to support nutrition status. Six hours prior to surgery, patients were given preoperative nutrition glucose amino acid formula in three patients and dextrose formula in one patient. Glucose amino acid formula contains 15 g protein and 37,5 g amino acid, while dextrose formula contains 50 g glucose. Results All of patients have early enteral nutrition within 2 ndash 30 hours postoperative. Only one patient have risen blood glucose level, but had been controlled by administer insulin. Postoperative wound healing were good, the patients have oral nutrition within 3 ndash 7 days postoperative. Conclusion Perioperative nutrition supports good clinical outcomes in gastric carcinoma patients."

"ABSTRAKAngka kejadian karsinoma kolorektal cukup tinggi mencapai 1,3 juta kasus dengan angka kematian sebesar 694.000 per tahun. Sekitar 30 hingga 87 pasien kanker mengalami malnutrisi sebelum menjalani terapi kanker. Terapi medik gizi bertujuan untuk mencegah atau memperbaiki keadaan malnutrisi, mencegah kehilangan massa otot, mengurangi efek samping terapi kanker, meningkatkan kualitas hidup, dan mempercepat penyembuhan luka. Pasien serial kasus ini berjumlah empat orang, berusia 33 hingga 60 tahun. Tiga orang pasien memiliki diagnosis adenokarsinoma rektum dan satu orang didiagnosis dengan adenokarsinoma kolon asendens dengan stoma double barrel setinggi ileum terminal dan kolon desenden. Keempat pasien memiliki status gizi kaheksia kanker. Pemantuan dilakukan setiap hari meliputi penilaian subjektif dan objektif meliputi tanda vital, kondisi klinis, antropometri, kapasitas fungsional, analisis asupan dan laboratorium. Pada saat dipulangkan, kondisi klinis keempat pasien mengalami perbaikan yang dilihat dari produksi stoma yang semakin padat dan toleransi asupan oral baik. Keempat pasien juga mengalami perbaikan kapasitas fungsional. Pemberian kebutuhan energi pada kasus ini rata-rata sebesar 30-39 kkal/kg/hari. Pemberian nutrisi memperhatikan jenis stoma, bagian usus yang vital, kondisi klinis, dan parameter biokimia. Pemberian terapi medik gizi yang adekuat dapat mendukung proses penyembuhan luka pasca tindakan pembedahan dan kapasitas fungsional.

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ABSTRACT<>br>The incidence of colorectal carcinoma is quite high, estimated at 1.3 million cases with 694,000 deaths per year. About 30 to 87 of cancer patients are malnourished before undergoing cancer therapy. Medical nutrition therapy aims to prevent or improve the state of malnutrition, prevent muscle mass loss, reduce the side effects of cancer therapy, improve quality of life, and accelerate wound healing. Patients in this case series involve four subject, aged 33 to 60 years. Three patients had a diagnosis of rectal adenocarcinoma and one person was diagnosed with ascending colon adenocarcinoma with double barrel stoma as high as the terminal ileum and descending colon. All patients had nutritional status of cancer cahexia. Daily monitoring includes subjective and objective assessments including vital signs, clinical conditions, anthropometry, functional capacity, intake analysis, and laboratory analysis. At the time of discharge, the clinical condition of all four patients got improvement from solid stoma production and tolerance of oral intake. The four patients also experienced improved functional capacity. In providing nutrition therapy, we should consider to the type of stoma, vital part of the intestine, clinical conditions, and biochemical parameters. Adequate medical nutrition therapy can support post surgical wound healing and functional capacity."