CHRONIC DIARRHEA

I.HARTANTYO

Department of Child Health, Medical

Faculty Diponegoro University/
Dr. Kariadi Hospital Semarang
 Introduction
Diarrhea is one of the main cause of
morbidity & mortality
In Indonesia, 1-9% of acute diarrhea
becomes chronic diarrhea
Chronic diarrhea is potential in
disturbing growth and development
 Definition
There are many definitions for chronic
diarrhea
Indonesia : diarrhea lasting 2 weeks or longer

Predisposing Factor
Exact data unknown
Malnutrition
Prolonged duration of diarrhea
Decreasing intrstinal enzymactivity
Loss of intestinal wall integrity
 Classification
Based on character of stool: (Arasu, 1984)
Watery stool
Fatty stool
Bloody stool

A. Watery Stool
1. Allergic gasteroenteropathy
2. Disacharidase deficiency
3. Primary immune defect
4. Intestinal infection
A. 5. Contaminated small bowel syndrome
6. Persistent post enteritis diarrhea
7. Diarrhea related to endocrine disturbance
8. Diarrhea related to neoplasm
9. Acid bile malabsorbtion

B. Fatty stool
1. Pancreas insufficiency, PEM, LBWB
2. Intestinal lymphangiectasis
3. Cholestasis
4. Drug induced steatorrhea
B.5. Contaminated small bowel syndrome
6. Primary immune defect

C. Bloody stool
1. Campylobacter, salmonella, shigella
2. Entamoeba histolitica
3. Inflammatory bowel disease
4. Pseudomembranous enterocolitis
5. Diarrhea related to anal lesion
 Pathogenesis &
Pathofisiology
Pathogenesis is very complex
Several etiologic factors interrelated
Vicious circle
Lebenthal (1984):
Intestinal mukosal injury abnormal
epitel
abnormal morfology & function
maldigestion and malabsorption
 Arasu (1979)
Mechanism of chronic diarrhea depends on
the main cause
Often in combination

A. Osmotic diarrhea
Accumulation of on absorbable
products hypertonic environment
Example : Lactose intolerance
B. Secretoric diarrhea
- enterotoxin stimulation secretoric
diarrhea
- Example : V. colora
C. Bacterial overgrowth
- leads to unconjugation of bile salt
fat malabsortion
D. Absence of normal active ion
absorption mechanism
E. Mucosal injury disturbance of water
and electrolite permeability
F. Abnormal intestinal motility may cause
- stasis
- bacterial overgrowth
G. Intractable diarrhea syndrome
- vilial atrofi
- prolonged loss of nutrient
- inadequate kalori
protein depletion & malnutrition
H. Other mechanism Zn deficiency
 Diagnosis
1. History
Duration of diarrhea
Extra intestinal symptoms
Growth disturbance
Malabsorption
Faecal appearance, frequency,
consistency, blood and mucus
Dietary history
2. Phisical examination
Anthropometric standart
Signs of dehydration
Abdominal examination

3. Laboratory examination
Faeces
Blood
Hydrogen breath test
Sigmoidoscopy with/without rectal biopsy
Radiologic examination
Intestinal biopsy 96% mucosal atrofi
 Management
Rehydration
Diaetary management
Underlying cause
Propper feeding
Promotion of breastfeeding
Avoid lactose intolerance (polymer glucose)
Avoid fat malabsorbtion (MCT)
Hypoallergenic (hydrolisated protein)
Adequate lectrolite and vitamins
Enteral and parenteral feeding
Semarang :
Children 6-24 month: tempe porridge
Tempe traditional nutritional source
PER is identic to cow milk casein
rice lack of lysin
tempe in metionin and cystein
combination is recommended
 Fermentation process easy digestion
changes in protein, fat, carbohydrat &
vitamins
Tempe lipase
antibacterial properties
antioxydant
 Summary
Chronic diarrhea has been described
Proper diagnosis and therapy are
important
Combination of rice and tempe
alternatife dietary management