OESOPHAGUS, OESOPHAGUS, MA MAAG, DUODENUM (OMD)
YOHANNA YOHANNA TANIA TANIA 42150020 DOSEN PEMBIMBING : Dr. Sudhara!", S#.$ad
DE%INISI T&'"' T&'"' #&&r"'aa rad"*+*" a+ura #&-&raa &rd"r" dar" *ra *&*#hau, aa, da du*d&u &ua'a &d"a '*ra /ar"u u+a '&ud"a d"aa" d&a u*r*'*#". • Tu!ua Tu!ua : Uu' &+"ha '&+a"a '&+a"a #ada *ra *&*#hau, aa, da du*d&u •
DE%INISI T&'"' T&'"' #&&r"'aa rad"*+*" a+ura #&-&raa &rd"r" dar" *ra *&*#hau, aa, da du*d&u &ua'a &d"a '*ra /ar"u u+a '&ud"a d"aa" d&a u*r*'*#". • Tu!ua Tu!ua : Uu' &+"ha '&+a"a '&+a"a #ada *ra *&*#hau, aa, da du*d&u •
MEDIA MEDIA 3ONT$ ONT$AS A. 3*ra *ra &d"a &d"a #*" #*"" " •. 3*ra &d"a a &"+"'" **r a* "". •. **h : Bar"u u+a (BaS*4) B. 3*ra &d"a &a" •. 3*ra &d"a a &"+"'" **r a* r&dah. •. **h : udara . D*u/+& '*ra •. Bar"u u+a 6 udara
37ASI%I3ASI PEME$I3SAAN OMD A. Bar"u 8a++*8 •. P&&r"'aa rad"*+*" *&*au d&a -ara &&+a &d"a '*ra B. Bar"u &a+ •. P&&r"'aa rad"*+*" +a/u da du*d&u d&a -ara &"u &d"a '*ra . Bar"u *++*8 hr*uh •. P&&r"'aa rad"*+*" uu ha+u d&a &"u &d"a '*ra a &ru#a'a '&+a!ua dar" #&&r"'aa /ar"u &a+ a &&r+u'a 8a'u /&/&ra#a !a uu' da#a a#a" '& #r*& #&-&raa a'aa
A$A PEMBE$IAN 3ONT$AS •
•
Uu' #&&r"'aa *&*au, #a"& d"/&r" u#&" /ar"u 'ura +&/"h 29 &d*' a'a. 3*ra /ar"u d"/"ar'a d" da+a u+u &&+ah "u #a"& d""ru'"'a uu' &&+a. P&/uaa rad"*ra d"+a'u'a &&+ah 'ura +&/"h 15 d&"' &&+ah /ar"u d""u. S&da'a uu' +a/u da du*d&u &&+ah #a"& d"/&r" u#&" /ar"u 'ura +&/"h 200 +, aau 'ura +&/"h au &+a '&ud"a #a"& d"uruh /&r/ar" d" aa &!a #&&r"'aa da d""a uu' &uar /ada '& '"r" da '& 'aa &/aa' 29 'a+" (/&ru+"u+") d&a a'ud aar u#&" /ar"u u+a da#a &+a#"" d"d" +a/u da du*d&u &-ara &raa, &&+ah "u &&ra d"+a'u'a #&a/"+a rad"*ra. $ad"*ra d"a/"+ &&+ah 'ura +&/"h 95 &" #* &d"a '*ra
P$OYE3SI PEMOT$ETAN • • • •
PA */+"u& $"h +a&ra+ PA AP */+"u&
INDI3ASI 1. D"a"a 2. Su#&' r&u' ar*&*#hau 9. P* *#&ra" &*#hau 4. D"#&#"a 5. Su#&' &*#+aa &*#hau, a&r da du*d&u ;. H&r"a h"aa+ <. S&*" #+*ru =. Tu'a' +a/u
3ONT$AINDI3ASI •
•
Su#&' #&r*ra" "da' /*+&h &ua'a BaSO4 &a#" &ua'a 8a&r *+u/+& '*ra (ur*ra>, "*#a"r* ) O/ru'" uu /&ar
OESOPHAGUS
1. A'a+a"a E*au •
•
Gaua **r"' #ada ** #*+* &*au, a &"+"'" 'ara'&r""' /&ru#a '&aa+a #"-h&r &*au /a8ah uu' /&r&+a'a" da "da' adaa &ra'a #&r"a+"' #ada &*au 3&+a"a "" d"&/a/'a aua &ur*u'u+ar a /&ra'"/a '&aa+a r&+a'a" /aa &*a*ar"' (/aa &*a*ar"' !ad" &#") #ada #r*& &&+a &h"a &&/a/'a d"+aa" (#&+&/ara) /a"a #r*'"a+ &*au. O+&h 'ar&a &#"a /aa &*au da +a/u, a'a ** /&r'*ra'" a#a
ETIO7OGI A. Pr"&r •. T"da' adaa &+uruh aau &/a"a &+ a+"* "h"/"*r #ada #+&'u M"&&r"'u (Au&r/a-h@) #ada &*au. Ha+ "" &a'"/a'a '&"da'&"/aa aara &ur* &'"a*r"' da &ur* "h"/"*r"' a &&/a/'a #"-h&r &*au /a8ah "da' da#a /&r&+a'a". •. S&r" d"ada" d"+aa" &*au da a" a'aa B. S&'ud&r •. P&a'" -haa, a+"a", a"+*"d*", ar'*"d*"
PATO%ISIO7OGI T&*r" uaa a da#a &!&+a'a #&a'" "", aara +a": • T&r!ad" a/*ra+"a &ur*&"' #r"&r a d"&ra" d&a "da' /&ru"a &ur* "h"/"*r"' da &r!ad" d&&&ra" #r*r&" dar" a+"* &+ • T&r!ad" d&>"&" dar" a+"* &+ #+&'u "&&r"', da#a !ua d"&/a/'a *+&h Gar*E*#ha&a+ $&u D"&a& (GE$D), #&a'" haa, da "&'" "ru.
PATO%ISIO7OGI •
A/*ra+"a **r"' #ada a-ha+a"a &*au &ru#a'a ha"+ dar" #&urua u" #ada **r &ur* a &r+&a' #ada #+&'u "&&r"'u "raura+. S&-ara u"*a+, '*ra'" #"-h&r &*au d"aur *+&h #&+&#aa &ur*ra"&r &'"a*r"' (a&"+'*+" da u/a" P) da r&+a'a" #"-h&r &*au d"aur *+&h #&+&#aa &ur*ra"&r "h"/"*r"' ("r" *'"da da a*a-"& "&"a+ #&#"d&). S&&*ra a &d&r"a a-ha+a"a &*au '&h"+aa a+"* &+ "h"/"*r" a &&/a/'a '&"da'&"/aa da+a ra"" &ur* &'"a*r" da "h"/"*r", &h"a &a'"/a'a "/u+a &'aa a "" #ada #"-h&r &*au da "da' da#a /&r&+a'a".
MANI%ESTASI D"a"a (a'aa #ada da -a"r) • $&ur"a" a'aa T&r!ad" 'ar&a &rda#a r&&" &!u+ah /&ar a'aa #ada &*au a /&rd"+aa". $&ur"a" "" &r" &r!ad" #ada a+a har" 'ar&a #*"" #a"& a &+&a '&"'a "dur, da ha+ "" /&r#*&" &&/a/'a uau #&u*"a a#"ra" • N&r" dada r&r*&ra+ T&r!ad" 'ar&a adaa &'aa a "" #ada &*au • H&ar/ur+"'& -h& #a" Adaa aa +a'a a &r/&u' dar" &r&a" "a"a a'aa #ada +u& &*au. •
%OTO THO$AC •
•
•
Adaa d"+aa" &*au P&+&/ara &d"a"u a'"/a d"+aa" &*au T"da' adaa &+&/u udara a *ra+ #ada +a/u, 'ar&a '*ra'" #"-h&r &*au /a8ah &-&ah udara uu' au' '& da+a +a/u.
ESO%AGOG$APHY •
E*au /a"a d"a+ a &&ru#a" #aruh /uru (/"rd/&a' a##&ara-&) aau &'*r "'u (*u& a"+ a##&ara-&)
ENDOS3OPI
•
P&&#"a &*a*ar"'
2. DIE$TI3E7 ESO%AGUS •
•
D"&r"'&+ &*au ada+ah #&*!*+a d"d" &*au, /a"' &+uruh /a"a d"d"a au#u haa u'*aa, '& arah +uar +u& &/&u' ru'ur &#&r" 'a*, a &+"/a'a au aau +&/"h +a#"a d"d" &*au. Uua, 'a* &r&/u da#a &r!ad" #ada "a /a"a dar" &*au, a"u #&r/aaa #har*&*#hau (#har*&*#ha&a+ !u-"*), d" /a8ah /"ur-a"* ra'&a, da d" aa d"araa
37ASI%I3ASI A. D"&r"'&+ &'&r • D"&r"'&+ #u+" (d*r*a '&ra) "" &r+&a' d" ar" /a"a #*&r"*r, a"u d" da+a &""a 3"+++"a, a d"/aa" d" a#" '"r" da 'aa *+&h .'*r"'*r ar" "&r"*r (.r"*ar"&u) da d" &/&+ah 'auda+ *+&h .'r"'*ar"&u.
B. D"&r"'&+ #ara/r*'"a+ • D"&r"'&+ ar"' "" aa !ara &r!ad", /"aaa d"&u'a &-ara '&/&u+a. 7*'a"a /"aaa d" /a8ah #&r-a/aa ra'&a , d" d"d" d&#a &*au. . D"&r"'&+ &#"&r"' • D"&r"'&+ &#"#r&"' &ru#a'a aua &*au a !ara. Ha+ "" /&rhu/ua d&a aua *"+"a a &!ad" #&&/a/ d"&r"'&+ da /&/&ra#a &!a+a a +a".
ETIO7OGI •
•
•
•
P&&/a/ &r&r" a &daar" &r!ad"a d"&r"'&+ &*au ada+ah aua *"+"a dar" &*au. P&&/a/ +a" &#&r" aa+ah ru'ura+ &*au &#&r" #ada d"&r"'&+ &'&r. D"&r"'&+ &'&r &r!ad" 'ar&a '&'a'ua >&r aa &*au &h"aa &'aa d" da+a +u& #ada aa &&+a &"'a Pada d"&r"'&+ #ara/r*'"a+ #&&/a/a ada+ah ar"'a dar" +aur d"d" &*au da #a+" &r" d"&/a/'a *+&h #&&rua '&+&!ar #ara/r*'"a+ 'ar&a u/&r'u+*". 7*'a"a /"aa d" /a8ah #&r-a/aa ra'&a, d" d"d" d&#a &*au. S&da'a #ada d"&r"'&+ &#"&r"' #&&/a/ uaaa a"u a'"/a aua *"+"a. M&uru D&/a, 50 dar" ;5 'au d"&r"'&+ &#"&r"' &#ua" aua *"+"a d" 'auda+ d"&r"'&+, &r&r" /&ru#a #a& da a'a+a"a. S"aa &d&r"a h&r"a h"au da r"'ura
PATO%ISIO7OGI •
D"&r"'&+ &'&r d"&/a/'a *+&h adaa '&rua'a dar" >&r &*au /a"a aa, &h"a &r!ad" "'**rd"a" aara #&uu#a +*" da a*ar" &ra aa+a ** 'r"'*ar"&u /&r&+a'a" &+aa &&+a. Ha+ "" &&/a/'a #&"'aa &'aa "ra/*+u &+aa a& &&+a, &h"a &r!ad" h&r"a" #ada ar&a a /&r#*&" +&ah #ada d"d" ar" #*&r"*r, &ruaa #ada 3"++"a@ r"a+& #ada *r*ar" '&"'a &&+a &+a8a &ra'a &uu# >&r &*au /a"a aa.
•
•
D"&r"'&+ &#"r&"' "/u+ a'"/a #&"'aa &'aa &8a'u '*ra'" #*r#u+" &*au &+a8a #r*& #&uu#a >&r &*au /a"a /a8ah. D"&r"'&+ #ara/r*'"a+ &/aa" '*&'u&" dar" #&ar"'a &'aa dar" +uar &*au a'"/a #r*& "aa" ("a+a a'"/a "aa" '&+&!ar +"& &d"a"u #ada #a"& u/&r-u+*").
MANI%ESTASI A. D"&r"'&+ &'&r •. D"a"a •. A#"ra" a a r&'ur& aau /&ru+a da adaa "r"a" +ar" &&/a/'a /au' •. A#"ra" *-ura+ &ruaa &r!ad" #ada *ra ua da#a &&/a/'a #&u*"a /ah'a a/& #aru. •. Suara #arau da#a &r!ad" a'"/a #&&'aa dar" &ru +ar&a+ r&-ur&.
B. D"&r"'&+ #ara/r*'"a+ • Sa'" #ada u/&ra+ • D"a"a . D"&r"'&+ &#"&r"' • D"a"a • S&da8a • N&r" #ada da&rah u/&ra+ da &!a+ar '& dada /a"a /a8ah, &#"ar"u, aau #ada da&rah #uu d" aara '&dua u+a -a#u+a • T&r&da' da /au'
DIE$TI3E7 EN3E$
Pada a/ar d"aa, &r+"ha d"&r"'&+ &/aa" 'a* a "/u+ dar" ar" &ah #ada d"d" ar" d"a+ #*&r"*r a /&rd&'aa d&a pharyngoesophageal junction. Ini merupakan identikasi terbaik, saat proses &&+a, a#a' +a&ra+ a d"&r"'&+a &rda#a #ada
DIE$TI3E7 EPINE%$I3
•
D"&r"'&+ &#"r&"' a a#a' #ada #&&r"'aa /ar"u &*a*ra>
DIE$TI3E7 PA$AB$ON3IA7
•
D"&r"'&+ #ara/r*'"a+ a a#a' #ada #&&r"'aa &*a*ra> '*ra
T SAN •
D"&r"'&+ F&'&r da#a d""+a" +&a', u'ura da /&u' 'au d"&r"'&+
9. U73US PEPTI3UM •
•
Suau +u'a &r/u'a /&r/&u' /u+a aau *a+ #ada /a"a +a/u aau uu 12 !ar" U+'u #ada +a/u u+'u a&r U+'u #ada uu 12 !ar" u+'u du*d&u
•
ETIO7OGI • • •
Helicobacter pylori NSAID M"u a+'*h*+ da &r*'*'
ANATOMI
PATO%ISIO7OGI •
U+'u #&#"'u &r!ad" #ada u'*a a &ha"+'a a+'a+", /"aaa #ada aau d" d&'a -uraura "*r, 'ar&a !ar"a "" "da' da#a &aha '&r!a aa +a/u #&-&raa (H+ da #&#"). Er*" a &r!ad" /&r'a"a d&a #&"'aa '*&ra" da '&r!a aa #&#", aau /&r'&aa d&a #&urua #&rahaa *ra+ dar" u'*a. Mu'*a a rua' "da' da#a &&'r&" u'u a -u'u# /&r"da' &/aa" /ar"&r &rhada# aa '+*r"da
MANI%ESTASI N&r" S&a" u#u+, &ruu', aau &r/a'ar d" &#"ar"u &ah aau d" #uu • P"r*" (&r" u+u ha") S&a" +u'a /a'ar #ada &*au da +a/u, a a"' '& u+u, 'ada'ada d"&ra" &ru'a" aa. Eru'a" ? &da8a &r!ad" /"+a +a/u #a"& '** • Muah • 3*"#a" D"& da */a*/aa • P&rdaraha ar*"&"a+ T"da' &a+a" '&+uha &/&+ua (a& a'u) &a#" &u!u''a &!a+a &&+aha •
U73US GASTE$
•
Add""*a+ had*8
U73US GASTE$ •
•
Adaa a/ara +&&r -ur& u+-&r P&/&'a'a ? &d&a d" &'"ar u+'u da#a &#&r+"ha'a +"#aa+"#aa "&r" da adaa /aaa /aaa a d"&/u Ha#* 7"&.
U73US DUODENUM
•
Adaa a/ara #*h* #"u aau #"&r&& d&*r"
U73US DUODENUM
•
Ga/ara dau dada# ? -+*&r+&a d&*r"
U73US DUODENUM
•
+*&r+&a d&*r" * du*d&a+ /u+/ (arr*8)
4. 3A$SINOMA GASTE$ A. Ear+ Gar"- a-&r (EG) •. I"+ah EG "" &+"#u" &ua 'ar"*a a "da' "a" '&da+a +a#"a u'u+ar" da a"h &r/aa #ada u'*a da u/u'*a. EG da#a /&ru#a #&*!*+a dar" *'u '&-"+ da 'ada &-ara d"ad"a &+ua, &h"a &&a'a '&u'"a dar" a/ua /&/&ra#a *'u (u+"-&r").
37ASI%I3ASI EG 3+a">'a" 'ar"*a +a/u &uru a#a Gar*&&r*+*"-a+ Ed*-*# S*-"& : 1. T"#& I (#r*rud&d #&) : u*r aa a &"a" haa &r/aa #ada u'*a da u/u'*a a /&r/&u' #*+"#*"d. B&u'a "r&u+&r, #&ru'aa "da' raa, #&rdaraha d&a aau a#a u+&ra". •
2. T"#& II (u#&r>-"a+ #&) : Da#a d"/a" aa 9 u/"#& : a. Elevated type : Ta#a' &d"'" &+&a" u'*a +a/u, ha#"r &#&r" "#& I, &rda#a &d"'" &+&a" &ra da +&/"h &+ua da &+&/ar. /. Flat type: T"da' &r+"ha &+&a" aau d&#r&" #ada u'*a da haa &r+"ha #&ru/aha #ada 8ara u'*a. -. Depressed type: D"da#a'a #&ru'aa a "r&u+&r da #""r a "da' raa ("r&u+&r) h"#&r&"? #&daraha 9. T"#& III (&-aa&d #&) : &&ru#a" B*ra II (u*r aa +a!u) da &r" d"&ra" '*/"a" &#&r" II- 6 III aau III 6 II- da IIa 6 II-.
B. Ada-&d Gar"- a-&r (AGr) • Pada "#& +a!u, &+&+ 'a'&r udah &r!ad" #&r+uaa #ada +a#"a u'*a, u/u'*a, u'u+ar", 'ada'ada a#a" +a#"a #r*#r"a da &r*a. Bah'a &r" &r!ad" ">+ra" aau &aa& '& '&+&!ar +"& aau *ra +a"a.
37ASI%I3ASI M&uru '+a">'a" B*ra da#a d"/a" aa: 1. B*ra I: B&u'a /&ru#a #*+"#*"d 'ar"*a a &r" !ua d"&/u &/aa" ua" da u'*a d" &'"ar u*r ar*> da "r&u+&r 2. B*ra II: M&ru#a'a * ">+ra" -ar-"*a*u u+-&r d&a &#" u+'u &ra u'*a &'"ara &*!*+ da d"&ra" *du+ar. Daar u+'u &r+"ha &'r*" d&a 8ara '&-*'+aa, '&a/ua da &rah '&h"aa. Mu'*a &'"ar u+'u a#a' aa h"#&r&" 9. B*ra III: /&ru#a ">+ra" -ar-"*a*u u+-&r, u+'ua &#ua" d"d" da &r+"ha adaa ">+ra" #r*r&" da d"u 4. B*ra I: /&ru#a /&u' d"u& ">+ra" #&, "da' &r+"ha /aa &a #ada d"d" da ">+ra" d"u #ada &+uruh u'*a. •
PATO7OGI 3&/aa'a 'a'&r a&r ada+ah ad&*'ar"*a (0 J K), a +a" +"*a, +&"*"*ar'*a, ad&*ah*a da +a"+a". 3&/aa'a +*'a" u*r #ada da&rah ar*#"+*r"', 'uraura "*r +&/"h &r" dar"#ada 'uraura a*r. 3ar"*a a&r /&raa+ /&raa+ dar" #&ru/aha &#"&+ #ada &/ra& u'*a a&r, a /&r'&/a #ada /a"a /a8ah a&r, &da'a #ada ar*> a&r d"da#a'a /a"a aa a&r da &-ara u+"&&r. • 3ar"*a a&r &r+"ha /&/&ra#a /&u' : 1. S&#&r&#aa /&raa+ dar" #r*#"a a /&r/&u' ua" da u/uh '& +u& &/aa" aa. 2. S&#&r&#aa /&r/&u' u*r a /&ru+&ra" 9. Maa a u/uh &+a+u" d"d" &"a" +a#"a **. 4. P&&/araa &+a+u" d"d" a d"-&ar" #&&/ara #ada #&ru'aa (=K) 5. B&r/&u' +"""#+a"'a (10 J 15K) ;. S&#&r"aa 'ar"*a /&r/aa" /&u' d" aa. •
MANI%ESTASI • • • • • • • • • • • •
B&ra /ada &uru N&r" &#"ar"u Muah '&+uha #&-&raa A*r&'"a D"a"a Nau&a 3&+&aha S&da8a H&a&&" $&ur"a" 7&'a '&a
37ASI%I3ASI TNM 3A$SINOMA GASTE$ Tu*r Pr"&r • T" : ar-"*a ""u • T1 : Ia" '& +a"a #r*#r"a aau u/u'*a • T2 : Ia" '& u'u+ar" #r*#r"a • T9 : P&&ra" '& &r*a • T4 : Ia" '& *ra &'"ar M&aa" 3&+&!ar 7"& $&"*a+ • N0 : N*& • N1 : M&aa" '& '&+&!ar #&r"ar"' 9 - dar" u*r #r"&r • N2 : M&aa" '& '&+&!ar +"& #&r"ar"' +&/"h dar" 9 - dar" #""r u*r #r"&r (&#a!a +a/u '"r", -** h&#a"-, +"#a aau ar&r" -&+"a-) M&aa" auh • M0 : N*& • M1 : M&aa" !auh
STAGING 0
Tis
N0
M0
1
T1 T2
N01 N0
M0 M0
2
T1 T2 T9
N2 N1 N0
M0 M0 M0
9
T2 T9 T4
N2 N12 N01
M0 M0 M0
4
T4 T14
N2 N12
M0 M1
EG
•
Adaa a/ara >++" d&&-
AGr •
•
Adaa a/ara h"+aa d"&"/"+"a da '**ur a a/*ra+ dar" a&r d"'ar&a'a ad&*-ar-"*a ">+ra". Adaa a/ara L+&ah&r /*+& a#a' &#&r" #aruh #ada &*au d"a+
T SAN •
AGr d&a &aa& '& h&#ar da adaa a-"&
5. O7U7US GASTE$ •
3&+a"a '*&"a+ d&>"&" >'a" dar" a&r '& !ar"a &'"ara &h"a a&r da#a &r#u"r.
ETIO7OGI A. 3*&"a+ B. Id"*#a"' A/*ra+"a '&+&ura dar" +"a& ar*#+&"', ar*du*d&a+, ar*r&"', da ar*h&#a"'
37ASI%I3ASI A. Ora*a'"a+ • Ga&r /&r*a" &&+"+"" a'" a &hu/u'a ar*&*a&a+ !u-"* da /a"a aru #"+*ru /&r*a" '& arah a /&r/&da d&a r*a" /a"a udu. *+u+u a&r "#& *ra*a'"a+ /&rhu/ua d&a d&&' d"araa"'a. 3*#+"'a" /&ru#a "'ar&ra" da rau+a" +&/"h &r" d"!u#a" #ada "#& "". B. M&&&r"'*a'"a+ • Pada "#& &&&r"'*a'"a+, aru #"+*ru /&r*a" '& arah a&r"*r da u#&r"*r &h"a #&ru'aa #*&r"*r a&r /&rada d" a&r"*r. • *+u+u a&r "#& "" "da' /&rhu/ua d&a d&&' d"a raa"'a da !ara &"/u+'a '*#+"'a" rau+a",& h"a +&/"h &r" /&r"a 'r*". . 3*/"a" • 3*/"a" "#& '*/"a" aara *ra*a'"a+ da &&&r"
O$GANOA3SIA7 •
Ga&r /&r*a" &&+"+" " a'" a &huhu 'a ar*&*a&a+ !u-"* da /a"a aru #"+*ru /&r*a" '& arah a /&r/&da d&a r*a" /a"a udu.
MESENTE$OA3SIA7 •
Aru #"+*ru /&r *a" '& arah a&r"*r da u#&r"*r &h"a #&ru'aa #*&r"*r a&r /&rada d" a&r"*r.
DA%TA$ PUSTA3A •
•
•
Sud**, Aru . Bu'u A!ar I+u P&a'" Da+a "+"d I Ed"" I. a'ara: Pua P&&r/"a I+u P&a'" Da+a, %3 UI. 200<. "++"a A, P&&r H. A-ha+a"a * h& &*#hau: a ur"-a+ d"&a&. A&r"-a *++&& * Sur&* 200 20=: 151. " d& *. Bu'u A!ar I+u B&dah. Ed"" 2. a'ara: EG. 2005.
