DIARE AKUT PADA

DEWASA

Departemen Ilmu Penyakit Dalam

FK USU
Diarrhea is a common symptom in
adults. Most patients with diarrhea
never seek medical attention, but
patients who have had symptoms for
more than a few days or who have
coexisting fever, prostration, or rectal
bleeding are likely to present for
evaluation
 Diarrhea is a response of the bowel to
infection, drugs, foods, or disease.

Three factors can lead to the passage of

unformed stools :
• An increase in intestinal fluid and
electrolyte secretion (osmotic or secretory
diarrhea)
• Malabsorption of intraintestinal contents
(due to damaged intestinal lining of small
bowel)
* Altered intestinal motility (dysmotility
diarrhea).
 "Diarrhea(Gastroenteritis)
• ACUTE
• CHRONIC
• INFECTIOUS
• NON INFECTIOUS
• CHILDREN
• ADULT
 Infectious Diarrhea
• Communicable diseases
• Morbidity in Indonesia : 21.22 per 1000
peoples (1996)
• Highest Morbidity in Aceh (69.54/1000
peoples)
• CFR = 2.4% (1996)
 DiARRHEA EPiSODE
• Children under 5 years : 1.6 – 2.2
times/year

• For all age : 230 - 330 per 1000 peoples

 Definition of Diarrhea
• Increase of abnormal stools weight
(unformed stools)
* Man : > 235 g/day
* Woman : > 175 g/day
• Increase of abnormal defecation frequency
more than twice in a day
• But ;
 Defecation twice in a day is diarrhae
 Defecation thrice in a day but normal
consistency is not diarrhae
These quantitative criteria should not be
applied strictly, however. Some individuals
may have stool weights of 300 g/d because
of fiber ingestion but do not complain of
diarrhea because their stool consistency is
normal. Other patients have normal stool
weight but complain of diarrhea because their
stools are loose or watery.
 ETIOLOGY OF DIARRHEA

• The main cause of • Infection by virus

Acute GE is virus commonly in small
(Rota Virus) 38-60% intestine
 ETIOLOGY OF DIARRHEA

Crypta epithelial cells

In normal condition Infection process in migrate to villi
have an equilibrium the GI tract mucosa surface, this cells is
state between fluid cause disconnect immature, can cause
absorbtion & epithelial cells disturbance of the
secretion function of fluid
absorbtion, therefor
diarrhae is appear.
Photo Vili
 Symptoms and Signs
• Diarrhea
• Abdominal pain
• Headache
• Vomiting
• Fever
• Myalgia
• Arthralgia
• Dehydration
Following Symptoms in Adult
Acute GE
 Classification of Acute GE
• Choleriform GE
• Non Choleriform GE
 Table 1 :
Characteristics in 3
Types of Acute GE
 Table 2 :
Types of Diarrhea Caused
by Enteropathogen
 DIAGNOSIS
• Anamnese
• Faeces Rutine
• Faeces culture
Stool examinations for ova and
parasites may be indicated in patients
when the illness originated during
travel to high-risk areas or when illness
persists longer than 2 weeks.
Differential Diagnosis of Acute GE
• Infections
• Bacterial
• Parasitic
• Viral
• Food poisoning
• Medications
 Choleriform GE (CHOLERA)
• Definition :acute episode diarrhea disease that cause
severe dehydration and death in hours
• Etiology : Vibrio cholera grup O1 : classic & El Tor.
• Pathogenesis :
- Ingestion of V.cholera in large amount.
- Some of bacteria will be die in gastric acidity
- Some survive and will be develop in small intestine and
large intestine
- Produce toxin (Cholera Toxin / CT)
- CT can damage intestine mucosal
#Inhibition of Na Luminal NaCl accumulation
#Ekskretion of Cl Luminal fluid retention
Watery diarrhea
DEHYDRATION
 Symptoms & Signs :
Inkubation period : 24 - 48 haours.
- Watery Diarrhea ( > 250 ml / kgBW).
- Specific Stools color
- No pain and fever
- Vomiting.
- Weakness, thirsty
- Muscular cramp due to electrolyte loss.
- Decrease of counscious due to hyponatremia &
dehydration.
- Kussmaul breathing
- postural hypotension,weak pulse
- oliguria
- Woman washer hand/washer woman.
- Dehidration --- hypovolemic shock --- death.
 Laboratorium:
- Hematocrite 
- Lekositosis.
- Ureum & Creatinin 
- pH  due to bicarbonate 
Bacterial Detection :
- Darkfiels Microscope.
- Stool culture.
Management :
- Causal : # Tetracycline 4 x 500 mg for 2 - 3 days.
# Doxycycline 300 mg SD.
# Ampicilin, Quinolone.
 Treatment
• Self limited
• Following Symptoms :
 Dehidration
 Fever
 Abdominal pain
• Condition of the Patient :
 Elderly
 Immunocompromised
 Treatment (Cont’)
• Preventing dehydration is a major goal
of therapy, and either OTC preparations
or home remedies are often effective.
• In the case of large-volume diarrhea,
glucosecontaining oral fluid-electrolyte
solutions are more appropriate.
 Treatment (Cont’)
• An adequate history is essential to
understanding its cause and severity.
• For patients with mild to moderate
acute diarrhea, a diagnostic workup
may not be necessary; empiric,
supportive treatment is usually
sufficient.
 Treatment (Cont’)
• Rehidration and diet
• Specific : Antibiotic and
Antiparasite drugs :
* Empiric
* Specific
• Symptomatic : Anti diarrhae
 REHIDRATION :
• Depends on a dehidration states
• Goldberger :
Mild : volume loss 2% BW :
Moderate : volume loss 6% BW
Severe (Shock) : volume loss > 7%
BW
• Mild dehydration : thirsty, weakness
• Moderate : dry mouth dan tongue,
generalized weakness, decrease BP,
increase pulse rate and pyriformis, cold
of extremities
• Severe (Shock) : hypotension,
tachycardia, women washer hand,
decrease of conscious
 Rehydration :
• Mild and no vomiting : Oral Rehydration
Therapy (ORT = Oralit)
• Moderate : IVFD : Ringer Lactate, Ringer
Acetate, NaCl 0.9%, Ringer solution.
Initial dose : 20 cc/Kg BW in hour
Maintenance dose : 50 cc/KgBW in 24
hours + concomitant volume loss + IWL
• Severe : IVFD two lines
 Monitoring
• Vital signs : sensorium, BP, pulse rate,
pulse pressure
• Urine output / hour
• Haematocrite
• Ureum/Creatinine
• Blood gas analysis
• Blood Electrolyte
 Complications
• Acute Tubular Necrosis
• Acute Renal Failure
• Metabolic Acidosis
 Treatment (Cont’)
Antibiotic therapy is generally not
necessary for acute diarrheal
episodes except when treatable
parasites or some bacterial agents
are known to cause the infection.
ANTI DiARRHAE DRUGS
• Kaolin
• Pectin
• Attapulgite
• Diphenoxilat
• Loperamide
• Bismuth Subsalisilate
 Administration of LOPERAMIDE
• Loading dose : 2 tablets (4 mg)
• Followed by 1 tab.(2 mg) after each loose
stools
• Not to exceed 8 tablets in 24-hour period
• No recommanded to children
• NO RECOMMENDED by ‘FIXED DOSE’ ‘
• For Acute Diarrhae, if no improve after 24
hours stop treatment