Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antaraileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnyadibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasmastadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna.Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkangangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saatini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomihigh output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasimalnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditasdan mortalitas pasien ileostomi high output. Empat pasien ileostomi high outputdengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selamaperawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan,sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasiakibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomihigh output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatanstoma. Berdasarkan kriteria malnutrisi American Society for Parenteral andEnteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapimedik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecilnamun sering, restriksi cairan hipotonik, pemberian minuman berupa larutanelektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan danelektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi danprotein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan,keempat pasien mengalami penurunan output ileostomi, serta perbaikankeseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinisdan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengankondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saatperawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karenakomplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnyameninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaikikadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasienileostomi high output.
Ileostomy is a surgical procedure to divert the ileum onto an artificial opening inthe abdominal wall, aimed for fecal diversion. Ileostomy is commonly created inpatients undergoing treatment for colorectal cancer, advanced neoplasms withintestinal infiltration, or gastrointestinal inflammation. High output ileostomy(stoma output >1500 mL per day) can cause imbalance of fluid and electrolytes,and malnutrition in patients. At present, there is no comprehensive nutritionmanagement guideline for high output ileostomy patients. This case series aimedto support therapy, prevent malnutrition, improve clinical condition, as well as toreduce the morbidity and mortality of high output ileostomy patients. Four highoutput ileostomy patients, with a range of age 42 to 50 years old received medicalnutrition therapy during their hospital stay. Three cases were chronic cases inmalignancy, while the other case was an acute case of adhesion and perforation dueto strangulated femoral hernia. All four cases were early onset high outputileostomy, occurring in three weeks after stoma creation. Based on the AmericanSociety for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, thesefour patients were classified as severe malnutrition. Medical nutrition therapy wasadministered according to a set of principles: small frequent feeding and drinking,hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotilitymedication administration, as well as fluid and serum electrolytecorrection, according to patients' needs and clinical conditions. The target of energyand protein intake in all patients were achieved during hospital stay. During hospitalmonitoring, decreased ileostomy output as well as improvement in fluid andelectrolyte balance were observed in all patients. One patient clinically worsenedand died due to sepsis on the 18th day of hospital stay. Three patients showedimprovement in clinical condition and were discharged. One patient experienced anincrease in ileostomy output at home, and then readmitted ten days after hospitaldischarge due to severe anemia and electrolyte imbalance and subsequently died.Medical nutrition therapy may decrease output as well as improve fluid andelectrolyte balance in patients with high output ileostomy. |
SP-Eleonora Mitaning Christy.pdf :: Unduh