Immunologic

Aspect of Chronic
Diarrhea
Yasmar Alfa
Sub Bagian Gastrohepatologi Bagian
Ilmu Kesehatan Anak
FKUP/RSHasan SadikinBandung

Pendahuluan
Definisi
Diare kronik :
diare yang berlangsung lebih dari 14 hari
(W.H.O 1974).
Diare :
Buang air besar abnormal dengan perubahan
konsistensi tinja disertai/tanpa darah dengan
frekuensi > 3 kali dalam waktu 24 jam
(W.H.O 1984).

Pendahulua
n

Diare kronik disebut juga intractable diarrhea

3-20% diare pada anak < 5 tahun adalah diare
kronik
36-54% kematian disebabkan diare.
Angka kematian diare kronik : 5-7%
Angka kematian karena diare akut < 1%
Diare kronik penting karena mempunyai potensi
terjadinya
gangguan pertumbuhan

kurang energi protein

Pendahulua
n

DIARE
KRONIK

KE
P

Patofisiologi diare kronik

Faktor kunci terjadinya diare kronik adalah terjadinya

prolonged small intestinal mucosal injury

Akibat dari prolonged small intestinal mucosal

injury terjadi:
- malabsorbsi makanan
- infeksi bakteri tumbuh lampau
(bacterial overgrowth and infection)
- penurunan hormon enterik
- meningkatnya absorpsi protein asing
- tidak efektifnya penyembuhan fili usus
- KEP

PATHOGENIC MECHANISMS IN
INTRACTABLE DIARRHEA OF INFANCY
Malabsorptio
n
of nutriens
Protein
Energy

Bacterial
overgrowth
and infection
Prolonged Small
Intestinal
Mucosal Injury
Ineffective

Malnutrition

Decreased
enteric
hormones

villous repair
Increased absorption
of
native foreign protein

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

Bacterial overgrowth
And infection

Protein Energy
Malnutrition
Malabsorption of nutrients
Osmotic
Diarrhea

Lipid
malabsorption

Protein
malabsorption

decreased
pancreatic lipase
decreased
decreased
pancreatic
bile salt
protease
Decreased enteric hormones

Carbohydrate
malabsorption

decreased
acid/pepsin
pancreatic
amylase deficiency

disaccharidase
deficiency

Prolonged Small Intestinal

Mucosal Injury

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

decreased
cholecystokinin

Decreased
enteric hormones
decreased secretin

decreased gastrin

decreased
pepsin

decreased
intrinsic factor

decreased HCl
altered motility

and pancreozymin

decreased
bile salts

pancreatic insufficiency
Malabsorption of nutrients
Protein Energy Malnutrition

Increased absorption of
native foreign protein

Bacterial overgrowth
and infection

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

Bile salt
deconjugation

Bacterial overgrowth
and infection

Toxins

invasion

formation of
secondary bile salt
hepatic injury

Adhesion
Fluid and
Electrolyte loss

prolonged Small
Intestinal Mucosal Injury
Decreased
Brush border enzyme

Osmotic
diarrhea

formation of
organic acids

fermentation of carbohydrate

malabsorption
of nutriens

Protein Energy Malnutrition

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

Increased absorption of
native foreign protein

decreased enteric hormones

Ineffective villous repair

Decreased brush border

enzymes and active transport
Increased protein energy
requirement for replacement
Malabsorption of nutriens
Protein Energy Malnutrition

Bacterial overgrowth
and infection

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

Protein Energy malnutrition

Decreased specific
antibody production
Decreased exocrine
Pancreatic function
Reduced lymphocyte
responsiveness to mitogens

decreased serum
complement
decreased T-lymphocyte
number
Impairment of
delayed hypersensitivity

decreased hepatic synthetic and secretory function

PATHOGENIC MECHANISMS IN INTRACTABLE DIARRHEA OF

INFANCY

Increased Absorption of
Native Foreign Protein
Sensitization to
foreign protein

decreased
enteric hormones
Injury to
brush border

Protein sensitive enteropathy

Ineffective villous
repair
Decreased brush border enzyme

protein, fluid, and

electrolyte loss

Protein Energy Malnutrition

and active transport

Malabsorption of nutriens

Bacterial overgrowth and infection

Imunitas Saluran Cerna

Imunitas Saluran Cerna

Imunitas Saluran Cerna

Aspek Imunologis pada

Diare Kronik

Aspek imunologis pada diare kronik sangat

berhubungan dengan status imunologis pada KEP
Pada KEP akan terjadi defect imunologis, karena:
- Jumlah lymphoid aggregates sangat sedikit
- Jumlah sel plasma yang memproduksi sekretori Ig A
sangat sedikit
- Jumlah sel limfosit yang terdapat pada epitel mukosa
usus halus sangat sedikit
- Jumlah komplemen serum pada KEP menurun
- Atropi dari jaringan lymphoid

Penatalakssanaan Diare
Kronis

Atasi dehidrasi dengan pemberian cairan pada

anak dengan KEP: pakai RESOMAL
Terapi dietetic merupakan hal yang sangat
penting untuk penyembuhan KEP
Bila ada infeksi misalnya shigela, amuba, giardia,
diberikan obat antibiotika untuk menghilangkan
faktor infeksi ini.
Pemberian probiotik bermanfaat untuk
keseimbangan flora usus
Pemberian mikronutrien Zinc sangat bermanfaat
pada anak diare kronik dan KEP

TERIMA KASIH