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7/25/2019 diarrhea 18-11-14.ppt
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Approach to the patient with diarrheaApproach to the patient with diarrhea
dr Putra Hendradr Putra Hendra
UNIBAUNIBA
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DiarrheaDiarrhea
Defnition:Defnition:
abnormal increase in stoolabnormal increase in stool liquidityliquidity, stool, stool
requencyrequency, and stool, and stool weightweight(more than 200(more than 200
grams per day).grams per day).
Diarrhea :Diarrhea :
2 wee!s: acute "inection 2 wee!s: acute "inection
# 2 wee!s: chronic$# 2 wee!s: chronic$
%smotic, secretory, e&udati'e,%smotic, secretory, e&udati'e,
motilitymotility
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Intake
2 literStool
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%echani#m o! Diarrhea%echani#m o! Diarrhea
1. motic diarrhea1. motic diarrhea
2. 'ecretor( diarrhea2. 'ecretor( diarrhea
3. In!lammator( diarrhea3. In!lammator( diarrhea
). A"normal $a#trointe#tinal motilit(). A"normal $a#trointe#tinal motilit(
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Rai#ed CI 'ecretion
K
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Acute DiarrheaAcute Diarrhea
In!ectiou#In!ectiou# *on in!ectiou#*on in!ectiou#
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+tiolo$( o! in!ectiou# diarrhea+tiolo$( o! in!ectiou# diarrhea
,acterial
Shigella Sp.
Aeromonas Shigelloides
Salmonella Sp.
Vibrio Sp.
Compylobactor Sp. Clostridium difficile
E.coli-++C ++C +I+C +A+C and +0+C
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iral Norwalk
Rotairus
Enteric adenoirus
Cytomegaloirus
!erpes simple irus
un$al Candida Sp.
!istoplasma Sp.
ara#ite Entamoeba histolytica
"iardia lamblia
Strongyloides
Cryptosporidium
Cyclospora Cayetanensis
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Clinical 'ettin$Clinical 'ettin$ood poi#onin$ 4ater Diarrheaood poi#onin$ 4ater Diarrhea D(#enter(D(#enter(
-entero/neuro-entero/neuro -nonIn6a#i6e-nonIn6a#i6e -In6a#i6e or$ani#m -In6a#i6e or$ani#m
to7in producin$ &r$ani#mto7in producin$ &r$ani#m
e6ere6er RareRare *on or Low 8rade *on or Low 8rade CommonCommon
Incu"ationIncu"ation 9 : hour#9 : hour# : hour#3 da(#: hour#3 da(# 13 da(#13 da(#
eroideroid
%ucou#"lood( #tool%ucou#"lood( #tool *on *on *on *on CommonCommon
*au#ea 6omitin$*au#ea 6omitin$ ;;;; ; ; ; ;
ene#mu#ene#mu# ; ;
oluminou# #toololuminou# #tool ; ; ;; ;; ; ;
+tiolo$(+tiolo$( Staphylococcus E#EC$ E%EC$ EAECStaphylococcus E#EC$ E%EC$ EAEC ShigellaShigella
aureus$ C.perfringens Aeromonas$aureus$ C.perfringens Aeromonas$ #.shigelloides#.shigelloides
&$ ceceus&$ ceceus Vibrio Cholerae Vibrio Cholerae E'EC E!ECE'EC E!EC
SalmonellaSalmonella "iardia$"iardia$ SalmonellaSalmonella
Cryptospodium CampylobactorCryptospodium Campylobactor
SalmonellaSalmonella C.difficile$C.difficile$ irusirus E.!istolyticaE.!istolytica
V.#arahemolyticusV.#arahemolyticus
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Vibrio CholeraVibrio Cholera
ram*negati'eram*negati'e +ur'ed rod+ur'ed rod .*.-.*.- m widthm width
/.*2.1/.*2.1 m lengthm length acultati'e anaerobeacultati'e anaerobe 3ingle polar 4agellum3ingle polar 4agellum +hemoorganotroph+hemoorganotroph %ptimal growth 20*50%ptimal growth 20*50
degreesdegrees
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3hort incubation period (2 hours to 3hort incubation period (2 hours to days)days)
67 o those inected do not de'elop67 o those inected do not de'elopsymptomssymptoms
/00*/000 organisms may cause/00*/000 organisms may causedisease, although a million are neededdisease, although a million are needed
to consistently inectto consistently inect
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8ransmission8ransmission
Direct ecal*oral contamination orDirect ecal*oral contamination or
ingestion o contaminated water and oodingestion o contaminated water and ood
9in!ed to inadequate en'ironmental9in!ed to inadequate en'ironmental
management (lac! o sae water andmanagement (lac! o sae water andsucient sanitation)sucient sanitation)
;uman*;uman contact does not spread;uman*;uman contact does not spread
the bacteriumthe bacterium
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reatmentreatment
1. 'upporti6e1. 'upporti6e
2. '(mptomatic2. '(mptomatic
3. 'peci!ic3. 'peci!ic
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Drug of choiceDrug of choice Alternative Alternative
Shigella sp.Shigella sp. *or!lo7acin o!lo7acin Cipro!lo7acin ce!tria7one*or!lo7acin o!lo7acin Cipro!lo7acin ce!tria7one
Areomonas sp.Areomonas sp. Amlno$l(co#ide %/'%
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Chronic organic diarrhea (Non !'V)Chronic organic diarrhea (Non !'V)
In!lammator(In!lammator( 'ecretor('ecretor(
%ala"#orption%ala"#orption
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Chronic In!lammator( Diarrhea
In!ection In!lammator( "owel
Radiation
I#chemic
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PEMERIKSAAN PENUNJANGPEMERIKSAAN PENUNJANG
a!ros!opis dan mi!ros!opis
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KOMPLIKASI
Kehilangan air dan elektrolit Dehidrasi, Hipokalemia, Asidosis metabolik,
Kejang, Alkalosis metabolik
Gangguan sirkulasi darah Syok hipoolemik
Gangguan gi!i Hipoglikemia, "alnutrisi energi protein, Intolerasi laktosa
sekunder
PENENUAN DERAJA DEHIDRASIPENENUAN DERAJA DEHIDRASI
#erdasarkan ##
$ingan pe ## < % &FSedang pe ## % ' (0 &F#erat pe ## ) (0 &F
"enurut Haroen *oerasid +modikasi-
$ingan $asa haus . /liguria ringan
Sedang anda diatas 1 turgor kulit ,F ubun2 . mata ekung
#erat anda diatas 1 somnolen,
sopor, koma, syok, na3as kussmaul
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score
>untah/
Go&s cholerica 2?esadaran apatis/
?esadaran somnolen, soporous sHd coma2
3is toli! H sama dengan I0 mmhg
2adi # H sama dengan /20Hm /
apas ?ussmaul (#50Hm)/
8urgor !ulit !urang /
acies cholerica2
E&tremitas dingin/
Jasher hand /3ianosis
2 # *
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Degree o DehydrationDegree o Dehydration
>ild dehydration (5*7)>ild dehydration (5*7)
>oderate dehydration (6*/07)>oderate dehydration (6*/07)
3e'er dehydration (/0*/7)3e'er dehydration (/0*/7)
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Degree o DehydrationDegree o Dehydration
3e'ere dehydration (/0*/7)3e'ere dehydration (/0*/7)
**Lapid wea! pulse.Lapid wea! pulse. *9ow B
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Signs of Hypervolemia:Signs of Hypervolemia:
;ypertension;ypertension
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Management ofManagement of
Hypervolemia:Hypervolemia:
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