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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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