DIARRHEA

BY_2ndGROUP

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SCENARIO
You are a health worker who was on duty at the IRD get An.B patient, female,
age 9 months, came with complaints of diarrhea.
Disease History Now:
Patients complain of watery diarrhea without blood since three days ago, as
many as 6-8 times per day. Diarrhea accompanied by vomiting, body sumer,
and cough. Currently the patient looks limp and awareness decreased slightly.
Physical examination:
The general state of weakness, GCS 345, 120x pulse / min, 64x RR / min, t 36C,
weight 7 kg. Head / neck: concave on the crown, + cowong eyes, dry mouth +.
Abdome: The liver / Lien intangible, turgor down, bowel sounds normal, red
looks around ans. Extremities: akral cold wet pale + / +.
Laboratory examination:
Hb 14 g / dl (10.5 to 12.9 g / dL)
8200 WBC / MM3 (6000-17500 / mm3)
Na 118 mEq / l (129-143 mEq / L)
K 4.8 mEq / l (3.1 to 5.1 mEq / L)
GDA 107 mg / dL (50-80 mg / dL)
Faeces: Consistency dilute, leko 0-1, erythema, pH 5, Clinitest +

DIFFICULT WORD
1. Diarrhea: BAB with state
and liquid stool frequency
exceeds normal limits
2. turgor: skin elasticity
3. Clinitest: an examination
using a tablet Clinitest used
to detect the presence of
substances in the feces which
reduces the copper contained
in the Clinitest tablet.
4. Akral: superior extremity
end

KEYWORDS
1. Diarrhea
2. Dehydration
3. Vomiting
4. pale Agency
5. Akral cool
pale

Learning Objective
1. Knowing the definition and classification of
diarrhea
2. Knowing the definition and classification of
dehydration
3. Knowing the link between diarrhea and
dehydration
4. Knowing the etiology of these cases
5. Knowing the pathogenesis of diarrhea of the case
6. Knowing the pathophysiology of diarrhea cases
7. Know the complications of diarrhea cases
8. Knowing the management of diarrhea cases

Pa t i e n t
problem

diarrhea

Lactose
intolerantion

dehydration

management

prevention

therapy

Definition of diarrhea
Diarrhea
is
an
increase
in
expenditure
softer
stool
consistency or more liquid than
usual, and there was at least 3
times in 24 hours. As for babies
a n d c h i l d r e n , d i a r r h e a i s d e fi n e d a s
spending stool >10 g/kg/24 hours,
while
the
average
expenditure
normal stools infants of 5-10 g /
k g / 2 4 h o u r s ( J u ff r i e , 2 0 1 0 ) .

Classification of diarrhea:

There is some division of diarrhea:

1. Based on the duration of diarrhea
(Suraatmaja, 2007):
a. Acute diarrhea
b. Chronic diarrhea
2. Based on the mechanism patofisiologik
(Simadibrata, 2006):
a. Diarrhea secretion (secretory diarrhea)
b. Osmotic diarrhea (osmotic diarrhea)

DEHYDRATION

A state of negative
fluid
balance.
Definition
Dehydration occurs
due to water loss
(output) more than
the water intake
(input). The
discharge is
usually
accompanied by an
electrolyte.

Based on the clinical

symptoms and physical
examination
:
Classification
mild dehydration (3-5%)
moderate dehydration (69%)
severe dehydration (10% or
more)
According to figures serum
electrolytes :
Dehydration Hiponatremik
or Hypotonic
Isonatremi or isotonic
dehydration
Dehydration Hipernatremik

RELATIONS OF DIARRHEA WITH DEHIDRATION

During the children diarrhea,
increased loss of fluids and
electrolytes contained in liquid
stools children. Dehydration occurs
when fluid loss is not replaced
adequately, so there arose a lack of
fluids and electrolytes. Therefore,
when diarrhea and vomiting, should
be specified as well the degree of

a. Infection factor
1. Enteral infection
2. Parenteral infection
b. Malabsorbtion factor
3. Carbohydrate malabsorbtion: disaccharides (lactose intolerance,
maltose dan sucrosa), monosaccharides, (glucose, fructose, dan
galactose intolerance). In infants and children the most
important and the most common is lactose intolerance.
4. Fat malabsorbtion
5. Protein malabsorbtion
c. Intake Factor
d. Psychology Factor
e. Education Factor
f. Job Factor

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 Which plays a role in the incidence of acute

diarrhea mainly due to an infection that is causal
(agent) and host (host). Host factors is the body's
ability to defend itself to the organisms that can
cause acute diarrhea, consisting of power factors
or internal environment gastrointestinal tract,
among others: the acidity of the stomach, intestinal
motility,
immunity
and
intestinal
microflora
environment. Causal factors that penetration can
damage the mucosal cells, the ability to produce a
toxin that affects the small intestine and secretion
of adhesion of germs. Pathogenesis of diarrhea
caused by bacterial infection / parasite consists of :

1. Diarrhea for non-invasive bacteria

(enterotoxigenic)
2. Diarrhea due to bacterial /
parasite invasive (enterovasif)
3. Diarhhea cause of Rotavirus

Pathophysiology of Intolerance lactose

Diarrhea
Lactose can not be absorbed as a sacaride, but it must be hydrolysis as
glucose and galactose with lactase enzyme helper in small intestine.
When the activity of lactase drops or does not exist, then the lactose is
not absorbed will reach the distal intestine or colon.
The presence of lactose in the intestinal lumen resulted in increased
osmotic pressure and draw water and electrolytes that will increase the
volume in the intestinal lumen. This situation will stimulate peristalsis of
the small intestine so that the layover time is accelerated and interferes
with the absorption.
In the colon, the lactose is fermented by colonic bacteria and produce
lactic acid and other short chain fatty acids such as acetic acid, butyric
acid and propionic acid. This will result into a liquid feces, acid, and
foaming and redness of the skin around the anus (erythema natum).

C O M P L I C AT I O N

Hypovolemic Syock
Hypovolaemic is a reduction in circulating blood volume in
the body. This situation is classified as an emergency in
which the amount of blood and fluid are loss and makes
heart unable to pump blood in sufficient quantities. Loss of
fluid in hypovolemic shock can be caused by diarrhea,
vomiting, and lack of food intake. To maintain perfusion of
the heart and brain, then an increase in sympathetic work,
hyperventilation, veins collapse, release of stress
hormones as well as a major expansion for the
replenishment of the interstitial and extracellular fluid, and
a decrease in urine volume

Melena/ Hematochezia
Feces with blood can be caused by Entamoeba
hystolytica. Although the exact mechanism is
not known, suspected trofoit invade the
intestinal wall to secrete proteolytic enzymes.
The release of toxic materials cause an
inflammatory reaction that damages the
mucosa. If continued will arise ulcer until the
submucosal layer or layers of the muscularis.

Febris
bacteria that enters the body is regarded as an antigen by the
body. The lipopolysaccharide of bacteria remove toxins from
the cell membrane. Cell job is to destroy these toxic or
infectious substances are neutrophils and macrophages by way
of phagocytosis or non-phagocytosis. Secretion of phagocytic
induces fever, mainly through the release of endogenous
pyrogens ((Interleukin-I). This response is the primary appears
when invasive bacteria circulating in the circulation and
fagosited by macrophages and neutrophils. Pyrogen
endogenous further stimulate spending prostaglandin
(prostaglandin E2) of the hypothalamus, causing rise in body
temperature.

management in the case of the

scenario

Ministry of Health. (2011).

According to the Indonesian Ministry of Health

(2011)
The procedural principle of diarrhea in children
are LINTAS DIARE (five steps to complete
diarrhea
1. Rehydration using low osmolarity
2. Zinc is given for 10 consecutive days
3. Continue breastfeeding and Food
4. Antibiotics Selective
5. Advice to parents / nanny
Ministry of Health. (2011).

Prevention
1. How to give fluids and medications at home
2. When should bring back the toddler to the
health worker if:
a. Diarrhea more often
b. repeated vomiting
c. Very thirsty
d. Eating / drinking less
e. fever
f. bloody stools
g. Does not improve in 3 days.

Ministry of Health. (2011).

conclusion
Based Clinitest can be seen that the relatively
acute diarrhea is caused by lactose intolerance.
Malabsorption and intestinal discharge from the
pathophysiology of diarrhea causing various
complications such as malnutrition, dehydration,
and hyponatremia. Management of diarrhea do
with promotive measures for prevention and for
the
treatment
of
diarrhea
rehydration,
administration of zinc, antibiotics, and nutrition.