Beruflich Dokumente
Kultur Dokumente
GROUP 8
FACULTY OF MEDICINE
MUHAMMADIYAH PALEMBANG UNIVERSITY
2018
CHAPTER II
DISCUSSION
2.2 Scenario A
“When Feces in Trouble”
Specific condition :
Abdomen : flat, increased bowel sounds, liver and lien are not palpable, decrease
turgor pressure
Laboratory Examination :
Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-), yellowish
color
3. Physical Examination :
Specific condition :
Head : close forehead, sunken eyes, no tears, wet mouth mucous
Abdomen : flat, increased bowel sounds, liver and lien are not palpable,
decrease turgor pressure
4. Laboratory Examination :
Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-),
yellowish color
Figure 2 Segmentation
The small intestine is remarkably well adapted for its primary role
in absorption.
All products of carbohydrate, protein, and fat digestion, and most of the
ingested electrolytes, vitamins, and water, are normally absorbed by the
small intestine indiscriminately. Usually, only the absorption of calcium
and iron is adjusted to the body’s needs. Thus, the more food consumed,
the more that will be digested and absorbed, as people who are trying to
control their weight are all too painfully aware. Most absorption occurs
in the duodenum and jejunum; very little occurs in the ileum, not
because the ileum does not have absorptive capacity but because most
absorption has already been accomplished before the intestinal contents
reach the ileum. The small intestine has an abundant reserve absorptive
capacity. About 50% of the small intestine can be removed with little
interference to absorption—with one exception. If the terminal ileum is
removed, vitamin B12 and bile salts are not properly absorbed because
the specialized transport mechanisms for these two substances are
located only in this region. All other substances can be absorbed
throughout the small intestine’s length. The mucous lining of the small
intestine is remarkably well adapted for its special absorptive function
for two reasons: (1) it has a large surface area, and (2) the epithelial cells
in this lining have a variety of specialized transport mechanisms.
3.Large Intestine
The large intestine consists of the colon, cecum, appendix, and
rectum. The cecum forms a blind-ended pouch below the junction of the
small and large intestines at the ileocecal valve. The small, fingerlike
projection at the bottom of the cecum is the appendix, a lymphoid tissue
that houses lymphocytes .The colon, which makes up most of the large
intestine, is not coiled like the small intestine but consists of three
relatively straight parts—the ascending colon, the transverse colon, and
the descending colon. The end part of the descending colon becomes
shaped, forming the sigmoid colon (sigmoid means “S shaped”), and
then straightens out to form the rectum (meaning “straight”).
HISTOLOGY
1.Stomach
The stomach is an expanded hollow organ situated between the
esophagus and small intestine.At the esophageal-stomach junction, there
is an abrupt transition from the stratified squamous epithelium of the
esophagus to the simple columnar epithelium of the stomach. the
stomach is divided into the narrow cardia, where the esophagus
terminates, an upper dome-shaped fundus, a lower body or corpus, and a
funnel-shaped, terminal region called the pylorus.
2. Small Intestine
The small intestine is a long, convoluted tube about 5 to 7 m
long; it is the longest section of the digestive tract. The small intestine
extends from the junction with the stomach to join with the large
intestine or colon. For descriptive purposes, the small intestine is divided
into three parts: the duodenum, jejunum, and ileum. Although the
microscopic differences among these three segments are minor, they
allow for identification of the segments. The main function of the small
intestine is the digestion of gastric contents and absorption of nutrients
into blood capillaries and lymphatic lacteals.
Regional Differences in the Small Intestine
The duodenum is the shortest segment of the small intestine. The villi in
this region are broad,tall, and numerous, with fewer goblet cells in the
epithelium. Branched duodenal (Brunner’s) glands with mucus-secreting
cells in the submucosa characterize this region.
The jejunum exhibits shorter, narrower, and fewer villi than the
duodenum. There are alsomore goblet cells in the epithelium.
The ileum contains few villi that are narrow and short. In addition, the
epithelium contains more goblet cells than in the duodenum or jejunum.
The lymphatic nodules are particularly large and numerous in the ileum,
where they aggregate in the lamina propria and submucosa to form the
prominent Peyer’s patches.
3.Large Intestine
The wall of the colon has the same basic layers as the small
intestine. The mucosa consists of simple columnar epithelium, intestinal
glands , lamina propria , and muscularis mucosae . The underlying
submucosa contains connective tissue cells and fibers, various blood
vessels, and nerves. Two smooth muscle layers make up the muscularis
externa . The serosa (visceral peritoneum and mesentery) covers the
transverse colon and sigmoid colon. There are several modifications in
the colon wall that distinguish it from other regions of the digestive tract
(tube). (Eroschenko,victor,p.2016)
c. What is the meaning from nausea and vomiting with frequency 1-2
times a day, as much as 1/4 cup, contain what his consumed, and
not expulsion?
Answer:
The meaning of nausea and vomiting with frequency 1-2 times a day,
as much as 1/4 cup is to Indicates there has been dehydration at Roni.
With the possibility of being viral infection of the stomach thus
damaging the gastric mucosal layer irritation and cause vomiting with
what content is eaten (Sherwood, 2014).
The meaning of contain what his consumed, and not expulsion is
To eliminate the alleged occurrence of intestinal obstruction and
nervous system disorders centers that cause increased intracranial
pressure (eg neoplasm, encephalitis, hydrocephalus) Also to exclude the
possibility of esophageal sphincter hypothony lower part, abnormal
position of esophageal joint with cardiac and gastric emptying of solid
contents. Because usually in this disease vomiting projectile (spray with
strong) (Sudoyo, 2009)
3. Physical Examination :
Vital signs : compos mentis; PR : 140 times per minute, regular ; RR : 32 times
per minute ; temp : 36, 4°c
Specific condition :
Abdomen : flat, increased bowel sounds, liver and lien are not palpable,
decrease turgor pressure
General Condition:
-Moderate Illness -No illness Abnormal
PR=140
x/minute(regular) -Neonatus 100-180
Normal
1 minggu – 3 bln 100-200
3 bln – 2 thn 80-150
2 thn – 10 thn 70-110
RR=32 x/minute
> 10 thn 55-90
-Hipotermia< 36oC
Normotermia
Normotermia 36,5-37,2oC
Subfebris 37,3-38oC
Febris> 38oC
Hiperpireksia≥ 41,2oC
Specific condition :
Answer :
4. Laboratory Examination :
Basophils: 0-1%
Eosinophils: 1-3%
Neutrophil segment
Differential count Neutrophil rods: 2-6%
↓
0/1/2/45/48/4 Neutrophil segments: 50-70%
Lymphocytes ↑
Lymphocytes: 20-40%
Monocytes: 2-8%
Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-), yellowish
color
6. How to diagnose?
Answer :
Zinc is given for 10 days in a row Zinc reduces the duration and
severity of diarrhea. Zinc can also restore the child's appetite. Based
on their effect on the immune function or on the structure and
function of the gastrointestinal tract and to the process of improving
the gastrointestinal epic during diarrhea. Administration of zinc in
diarrhea can increase the absorption of water and electrolytes by the
small intestine, increase the rate of bowel epithelial regeneration,
increase the number of brush bordering apical, and increase the
immune response that speeds up colon clearance from the gut.
Provision of zinc can reduce the frequency and volume of bowel
movements so as to reduce the risk of dehydration in children.
Children over 6 months of age: 20 mg (1 tablet) per day
Zinc is given for 10-14 consecutive days even though the child has
recovered from diarrhea. For older children, zinc can be chewed or
dissolved in boiled water or oralit.
Non-pharmacology:
1. Advice to mother or caregiver: return immediately if fever, bloody
stool, recurrent, eat or drink a little, very thirsty, diarrhea more often,
or have not improved within 3 days.
2. Provision of food should be continued during diarrhea and
improved after recovery. Continuing feeding will speed up the return
of normal bowel function including the ability to receive and absorb
various nutrients, thus deteriorating nutritional status can be
prevented or at least reduced. At least 50% of the diet should be from
food and administered in small or frequent (6 or more) meals and the
child is persuaded to eat. The combination of infant formula with
supplementary foods such as serelia is generally well tolerated in
weaned children. In older children, food can be provided consisting
of: local staple foods, such as rice, potatoes, wheat, bread or noodles.
To increase its energy content can be added 5-10 ml of vegetable oil
for every 100 ml of food.
3. Giving extra foods rich in nutrients a few weeks after recovery to
improve malnutrition and to achieve and maintain normal growth.
(Juffrie, M., et al., 2015)
An-Nahl : 114
Then eat of what Allah has provided for you [which is] lawful and good. And
be grateful for the favor of Allah, if it is [indeed] Him that you worship.
2.6 Conclusion
Diwan, A 2 years old suffering of acute diarrhea (acute gastroenteritis)
with mild-moderate dehydration due to viral infection
2.7 Conceptual Framework
Virus infection
in 24-48 hours
Diarrhea
dehydration
Daftar Pustaka
Aru W, Sudoyo. 2009. Buku Ajar Ilmu Penyakit Dalam, jilid II, edisi V. Jakarta:
Interna Publishing
Arvin, B.K. 2000. Nelson Health Sciences kid, Issue 15, vol. 3, books of
IDAI, 96-98
Price SA, Wilson LM. 2012. Patofisiologi konsep klinis proses-proses penyakit,