DIARRHEA

EVA HERENCIA PURBA / 13.005

DEFINITION

Passage of abnormally liquid or unformed

stools at increased frequency

Acute : < 2 weeks

Persistence : 2-4 weeks
Chronic : > 4 weeks

ACUTE

EPIDEMIOLOGY
90% of diarrhea cases
Attacks children and adolescent
2-3 times attacks develop country

ETIOLOGIES
Infections
E. Coli, S. aureus -> watery
Giardiasis -> watery and mushy
E. Histolytica -> bloody

Medication : side effects and antibiotics

Ischemia
Toxin

HIGH RISK
Traveller to develop country (tropic)
Eat new food esp sea food, uncooked food,
fast food
Acquired immune deficiency syndrome
(HIV)
Using antimicroba drugs

DIAGNOSE
Anamnesis
Mild dehydration (water loss 2-5% weight)
Decrease turgor, hoarseness, no shock

Moderate (water loss 5-8% weight)

bad turgor, hoarseness, shock, high RR and
pulse

Severe dehydration (water loss 8-10%)

Symptom same like moderate, low
consciousness, stiff muscles

Physical Examination
Increased bowel
Tenderness

Laboratory
Px darah rutin
Leukositosis : inflamasi
Eosinofil : alergi makanan atau infeksi parasit di usus
Kadar b12 rendah : pertumbuhan bakteri berlebih
Albumin rendah : kehilangan protein dari peradangan
ileum dan jejenum

Stool test (N: 7.0 7.07)

<5.5 kelainan di usus halus, intoleren laktosa. >5.5
kelainan di colon
Telur parasit
Gelembung lemak
Darah
Bau busuk dan banyak -> infeksi

TREATMENT
Loperamide :
Slows intestinal motility through opioid receptor
Direct effects on circular and longitudinal muscular
Reduces fecal volume
Increases viscosity

Metronidazole
Inhibits nucleic acid synthesis by disrupting DNA -> strand
breakage

Cipro
Inhibits relaxation of DNA
Inhibits DNA gyrase in susceptible organisms
Promotes breakage of double stranded DNA

LIQUID COUNT
Adult : 20cc / kg,weight
Children
<10 kg
daily fluid : 100ml/kg
Hourly fluid : 4ml/kg

10-20kg
daily fluid : 1000ml+50ml/kg
Hourly fluid : 40ml + 2ml/kg

>20kg
daily fluid : 1500 ml + 25ml/kg
Hourly fluid : 60 ml + 1ml/kg

CHRONIC

EPIDEMIOLOGY
10% of cases

CLASSIFICATION
Secretory : derangement of fluid and electrolyte
transport
Medication : ethanol -> epithelial injury
Resection : inadequate surface for reabsorption
Congenital ion absorption defect

Osmotic : a substance that osmotically active

draws water
Laxative : Mg in antacids
Carbo Malabsorbtion : lactase deficiency

Steatorrhea : fatty feces

Intraluminal maldigestion pancreatic exocrine
insuficiency

Inflammatory
Pain, fever, bleeding
Exudation
Fat malabsorption

TREATMENT
Causative
Loperamide 2 mg q.i.d prn