-Case ReportAcute Gastroenteritis

CONSULTANT:
Irman Permana, Dr., Sp.A.

PRESENTED BY :
REIZKY MUHAR (109170023)

PEDIATRIC DEPARTEMENT
WALED GENERAL HOSPITAL
2015

Definition Gastroenteritis
Diarrhea is the passage of unusually loose or
watery stools, usually at least three times in a 24
hour period. However, it is the consistency of the
stools rather than the number that is most
important. Frequent passing of formed stools is
not diarrhoea (WHO, 2005).

WHO. The Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health
Workers 2005.

Epidemiology

Farthing et al. Acute Diarrhea. World Gastroenterology Organisation, 2008;

Inverse association between coverage rates of oral rehydration solution (ORS) use and rates of mortality from diarrhoea in various
countries.

Farthing et al. Acute Diarrhea. World Gastroenterology Organisation, 2008;

Causes of diarrhoea with acute onset include the

Etiology

following:
Infections
Drug-induced
Food allergies or intolerances
Disorders of digestive/absorptive processes
Chemotherapy or radiation-induced enteritis
Vitamin deficiencies

Guandalini S. Diarrhea. Available from: http://emedicine.medscape.com/article/928598-followup

[Accesed 23 February 2011].

Infectious causes of acute diarrhoea in developed countries

Viruses

Guandalini S. Diarrhea. Available from: http://emedicine.medscape.com/article/928598-followup [Accesed 23 February 2011].

Classification
Acute

WHO. The Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health Workers.2005.

Feces from humans or animals containing pathogenic microbes

or their toxins

food

fingers

fluids

Ingestion of organism and/ or toxin

Organisms multiply and toxin

produced but infection remain in GI
tract

Organism invade or toxins absorbed

dissemination

DIARE
Symptoms of
systemic
infection ex.
Fever etc.

Pathogenesis of diarrhoea

Pathophysiology
dismotility
inflammatory
malabsorption
secretory
osmotic

9
Silbernagl S and Lang F. Color Atlas of Pathophysiology. New York: Thieme, 2009;

10

http://www.wrongdiagnosis.com/bookimages/16/5413.1.png

11

Diagnosis
History : ask presence of blood in
the stool; duration of diarrhea;
number of watery stools per day;
number of episodes of vomiting etc.
Physical examination: look and feel
Take temperature
WHO. The Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health Workers
2005.

12

Look and Feel

WHO. The Treatment of Diarrhoea: a Manual for Physicians and Other

Senior Health Workers 2005.

13

Laboratory
Complete blood count

Guandalini S. Diarrhea. Available from: http://emedicine.medscape.com/article/928598-followup [Accesed 23

February 2011].

14

Differential Diagnose
Appendicitis
Intussuception
Crohn disease
Irritable bowel syndrome

Guandalini S. Diarrhea. Available from: http://emedicine.medscape.com/article/928598-followup [Accesed 23 February 2011].

Treatment
ORS, iv infusion
Zn
Nutrition
Vitamin A
Antibiotic
Probiotic

WHO. The Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health
Workers.2005.

15

16

17
Ionic composition of intravenous infusion solutions

Prevention
Water, sanitation, and hygiene:
Safe food:

Cooking eliminates most pathogens from foods

Exclusive breastfeeding for infants
Weaning foods are vehicles of enteric infection.
Micronutrient supplementation: the effectiveness
of this depends on the childs overall immunologic
and nutritional state; further research is needed .
vaccines

Farthing et al. Acute Diarrhea. World Gastroenterology Organisation, 2008;

18

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Keluhan Utama : Buang air besar cair

Riwayat penyakit sekarang : pasien datang ke ke rumah sakit dengan
keluhan buang air besar cair sejak 1 hari sebelum masuk ke rumah
sakit, buang air besar dirasakan terus menerus sebanyak lebih dari
4 kali dalam sehari dengan volume kurang lebih 1 gelas tiap kali
buang air besar berwarna kekuningan, tidak berlendir, tidak
berdarah, tidak berbau busuk dan tidak berampas. Pasien juga
mengeluhkan adanya mual dan muntah sejak 1 minggu sebelum
masuk rumah sakit.
Saat masuk rumah sakit pasien mengeluhkan sesak nafas yang hilang
timbul sejak dua bulan yang lalu, sesak disertai dengan nyetri dada.
Pasien tidak mengeluhkan adanya demam, kejang dan menggigil.
Pasien mengatakan nafsu makannya yang menurun.

-Case ReportAcute Gastroenteritis

CONSULTANT:
Irman Permana, Dr., Sp.A.

PRESENTED BY :
REIZKY MUHAR (109170023)

PEDIATRIC DEPARTEMENT
WALED GENERAL HOSPITAL
2015

CASE REPORT
Personal Identity

Name
: Sandi Nugraha
Age : 14 years old
Gender : Male
Religion : Islam
Fathers name : Wasjan
Education : Junior High School
Occupation : Mercant
Age : 40 years old
Mothers name : Ani Triani
Education : Junior High School
Occupation : Housewife
Age : 32 years old

CASE REPORT
Chief complaints: Diarrhea
History of present illness:
Patient came to the hospital with complaints of diarrhea since 1
day before hospital admission, the diarrhea continuously
perceived as much more than 4 times a day with a volume of
approximately 1 cup each defecate. A yellowish liquid stool, no
slimy, no bleeding, no stink, no pulpy. Patient also complain of
nausea and vomiting since one week before entering the
hospital. Currently hospitalized patients complain of shortness of
breath intermittent since two months ago, accompanied by chest
pain. Patients did not complain of fever, convulsions and chills.
Patients say that declining appetite.

History of previous illness

History of growth and development

PHYSICAL EXAMINATION
Generalized Status:
General state : Moderately ill
Sensorium : fully aware

Vital Sign
Blood Pressure : 110/70 mmHg
Respiration Rate : 24 tpm
Body Temperature : 36,1 oC

Antropometric Status
Body weight : 24,5 kg
Body height
: 135 cm

Nutrition Status
BMI/Age (Z-score) : 13,6/14 = -1 (Thin/Wasted)

Local Examination
Head

Local Examination
Thorax

Local Examination
Extremit

Neurology Examination
Consciousnes

RESUME
Patient came to the hospital with complaints of diarrhea since one day
before hospital admission, the diarrhea continuously perceived as
much more than 4 times a day with a volume of approximately one
cup each defecate. A yellowish liquid stool, no slimy, no bleeding, no
stink, no pulpy.
Patient also complain of nausea and vomiting since one week before
entering the hospital. Currently hospitalized patients complain of
shortness of breath intermittent since two months ago, accompanied
by chest pain. Patients did not complain of fever, convulsions and
chills. Patients say that declining appetite, but the symptoms doesnt
improve with this treatment.
These are the findings from physical examination. The general
appearance was moderately ill, the level of consciousness was
composmentis. BP: 110/70 mmHg, RR: 24 tpm, T: 36,1 BMI/A: -1
(wasted). From the local examination, sunken eyes and dry lips was
found.

DIFFERENTIAL DIAGNOSE
Gastroenteritis bacterial infection with mildmoderate dehydration.
Gastroenteritis viral infection with mildmoderate dehydration.

LABORATORY TESTING

Darah rutin

Routine Blood Test

Haemoglobin

16,9

Basophil

Leucocyte

16,2

Eosinophil

Erythrocyte

6,4

Lymphocyte

26

Hematocrit

41

Monocyte

Segment

67

Stab

Platelet

529

MCH

26

MCHC

41

MCV

64

RDW CV

114

RDW SD

40,9

WORKING DIAGNOSE
Gastroenteritis bacterial infection with mildmoderate dehydration.

THERAPY

IVFD RL 125 ml/kg/h

Oralit 1800 ml/hr
Ampicilin 200mg 2x1 IV
Ondansentron 4mg 1x1 IV
Ranitidin 25mg 3x1 IV
L-bio Sach 2x1
Zinckid 10mg 2x1 selama 2 minggu

EDUCATION
Using a clean water
Cultivating the habit of washing hands with soap
after defecation and before eating.
Use a clean bathroom for the whole family
Improving the nutritional value of food in
sufficient quantity

PROGNOSIS
Prognosis :
- Quo ad Vitam
: Ad bonam
- Quo ad Functionam : Ad bonam
- Quo ad Sanationam : Ad bonam

Thank A Huge