ESSENTIAL

GASTROINTESTINAL
PROBLEMS

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INTRODUCTION
DIARRHEA :

a. ACUTE DIARRHEA
b. CHRONIC DIARRHEA
OBSTIPATION
RECCURENT ABDOMINAL PAIN

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DIARRHEA
DEFINITION

:
* changes of the frequency and
consistency of the stool
* National Seminar on Rehydration III, 1983
semiliquid watery stool
frequncy 3 5 times per day
SIGNS AND SYMPTOMS
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SIGN AND SYMPTOMS

AETIOLOGICAL

DIARRHEA & VOMITING

COMPLICATION
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ETIOLOGICAL FACTOR
INFECTION:

a. parenteral
b. enteral
DIETETIC
PSYCHOLOGICAL
CONSTITUTION
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MECHANISM OF DYSBIOSIS

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COMPLICATION OF DIARRHEA
DEHYDRATION water & electrolyt

a. dehydration
d. hypocalcemia
b. dehyd & acidosis e. meteorism
c. hypokalemia
f. shock syndrome
NUTRITION malnutrition
MUCOSAL INJURY macromolecule
a. allergy
migration
b. septichemia
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MANAGEMENT OF
DIARRHEA
(John Biddulp)

Five

Ds :

DEHYDRATION
DIAGNOSE
DIETETICAL PROCEDURE
DRUGS
DISACCHARIDASE

DEFFICIENCY
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REHYDRATION
BODY FLUID

RESTORATION
ORALLY IS FIRST PRIORITY :
* oralyte : early, household fluid
* gentelly, small portion but frequently
INTRAVENOUSLY:
* direct into intravenous compartment
* heavy deplesite, severe dehydration
or high fever
* impossible by orally (vomiting)

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REHYDRATION
NO

DEHYDRATION :

* ORAL REHYDRATION
* ORAL PROBLEM & HYPERTHERMIA
SOME

DEHYDRATION :

* ORAL REHYDRATION
* ORAL PROBLEM & HYPERTHERMIA
SEVERE

DEHYDRATION :
ROSE SYSTEM
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PEDIATRIC REHYDRATION:
TOTAL VOLUME

OF PEDIATRIC
BODY FLUID IS RELATIVE HIGH
RATIO OF CIRCULATING AND
DEPOT OF BODY FLUID IS SMALL
RESPONS CAPACITY OF THE
ORGANS ARE STILL LOW

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TOTAL BODY WATER

INFANT

MALE

FEMALE

THIN

80

65

55

AVERAG.

75

60

50

FAT

65

55

45

( value in % )

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INTRVENOUS REHYDRATION
REPLACEMENT

OF :
* fluid deplesit circulation failure
* oxygen deplesit & glucose deplesit
FAST REPLACEMENT:
* initial dose : 10 15 ml/kg/hr
* maintenance dose 125 200 ml/day

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PHYSICAL EXAMINATION:
HYDRATION

STATUS
NUTRITION STATUS
ABDOMINAL EXAMINATION :
to different with surgical abdominal cases
ETIOLOGICAL ASPECT : - enteral
- parenteral
COMPLICATION ASPECT :
* Etiolgical dissorders
* Secretoric and electrolyte imbalance
* Nutrition dispersal

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NUTRITION TREATMENT
SUFFICIENT

ON CALORY AND

PROTEIN
AVOID MALABSORTION SYNDROM

MALABSORPTION
DIAGNOSTIC
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MALABSORPTION
DIAGNOSIS

:
* physical : meteoristic, excoriation
watery,voluminous,acid stool
* reduction test of stool
PROGRESS CONDITION:
* mucosal injury
* microbial overgrowth
* maldigestion
* allergy
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NUTRITION TREATMENT
ACCEPTABILITY :
a. taste and vlafour
b. performance
AVOID MALABASORTION
formula composition for
* intolerance
* maldigestion
* allergy

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CHRONIC DIARRHEA IN
CHILDREN
I.SUDIGBIA
Department of Child Health
Medical Faculty of Diponegoro University
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INTRODUCTION
MORE

THAN 2 WEEKS
LEBENTHAL (1983) :
* prolonged small intestine mucosal injury
M.BABA (2001) :
* Osmotic
* Secretory
* Intestinal transit
* Exudative
INCIDENCE & MORTALITY :
Problem for young infant with high risk :
* complication
* mortality rate

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MAJOR CAUSES OF CHRONIC DIARRHEA I

(Vanderhoof,1993)
INFANTS

:
* Intractable diarrhea of infancy
* Proctacted infectious enteritis
* Milk and soy intolerance
* Autoimmune enteropathy
* Hirschprungs disease
TOODLERS :
* Chronic nonspecific diarrhea
* Proctacted viral enteritis
* Giardiasis

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MAJOR CAUSES OF CHRONIC DIARRHEA II

(Vanderhoof,1993)

* Ulcerative colitis
* Tumor secretory diarrhea
* Celiac disease
SCHOOL AGE CHILDREN :
* Inflamatory bowel disease
* Apendiceal abces
* Primary acquaired lactase deficiency
* Constipation with encopresis

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RECURRENT
ABDOMINAL PAIN

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INTRODUCTION
DEFINITION

* AT LEAST 3 EPISODES IN 3 MONTHS

PERIOD
* INTERFERES WITH NORMAL
CONDITION
* SCHOOL AGE : 5 14 YEARS OF AGE
* LOCALIZED PERIUMBILLICAL PAIN
DUE TO BOWEL MUSCLE TENSION

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PATHOPHYSIOLOGY
ETIOLOGY AND

PATHOPHYSIOLOGY
POORLY UNDERSTOOD
IS NOT SYNONYM WITH IMMAGINARY OF
CHILD EXPIRIENCE OF ABDOMINAL PAIN
BOWEL MOTILITY DISTURBANCE
DISTENSION OR SPASM
INCREASED MUSCLE TENSION
PAIN ORIGIN IS NERVE ENDING IN
MUCUSA, MUSCLE AND SEROSA

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FACTORS INFLUENCE ON
RECURRENT ABDOMINAL PAIN
* LOWERED THRESHOLD OF PAIN
* ENVIROMENTAL INFLUENCES

respons of family members

* physically
* psychologically
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STUDIES ON FACTORS WHICH

INFLUENCED REC.ABD.PAIN
Hodge

et al (1984) : significantly difference in life

stress experiences
Greene et al (1985) : significantly higher stress in
adolescens
Mc.Grath et al (1987) : no significantly deffernce
in life stress
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Thank you

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