DIARHEA IN CHILDREN

CREATED: Rifka Nur Anisa (41181396100013)

SUPERVISED BY DR. PULUNG M. SILALAHI, SP.A

Definition
When someone defecates with a
soft or liquid consistency, it can
even be water only and the
frequency is more frequent than
usual (3x or more) in one day.
Epidemiology

In infant death (age 29 days-11 months) 

diarrhea (31.4%) and pneumonia (23.8%).
In children under five (aged 12-59 months) 
diarrhea (25.2%) and pneumonia (15.5%).

Diarrhea is one of the causes of high morbidity & mortality

rates in children <5 years old worldwide (1 billion in pain & 3
million deaths per year).
Transmission
 Risk Factors
Do not do Lack of
exclusive Water cleaning
breastfeed contaminati facilities
ing on (MCK)

Poor Poor food

environmental hygiene Malnutriti
and personal preparation on
hygiene and storage

Decreased Decreased Immunodeficien

intestinal stomach cy
motility acid
 Risk Factors
Ag Most episodes of diarrhea occur in the first 2 years
of life.
e (6-11 month  complemented food with breastmilk
is given)
Asymptoma Most intestinal infections are asymptomatic
tic infection and the proportion of these asymptomatic
increases after the age of 2 years due to the
formation of active immunity

Seasonal Rotavirus : throughout the year with an

factors increase during the dry season.

Bacteria : the rainy season.

 Etiology
BACTERIA VIRUS PARASITE
Aeromonas Astrovirus Balantidium coli
Bacillus cereus Calcivirus (Norovirus, Sapovirus) Blastocystis homonis
Canpilobacter jejuni Enteric adenovirus Crytosporidium parvum
Clostridium perfringens Coronavirus Entamoeba histolytica
Clostridium defficile Rotavirus Giardia lamblia
Escherichia coli Norwalk virus Isospora belli
Plesiomonas shigeloides Herpes simpleks virus Strongyloides stercoralis
Salmonella Cytomegalovirus Trichuris trichiura
Shigella    
Staphylococcus aureus    
Vibrio cholera    
Vibrio parahaemolyticus    
Yersinia enterocolitica    

- Infection
- Non-
infection
Classification

Duration
- Acute diarrhea : < 14 days
- Persistent diarrhea : > 14 days
- Prolonged diarrhea : 7-14 days
 Pathophysiology
Osmotic/ absorption
disorders

Shifting of
There is food Osmotic water and
or substance pressure in electrolytes
that can not the intestinal (Na) into the
be absorbed cavity rises intestinal
cavity

Excessive
contents of the
intestinal cavity
Diarrhea will stimulate the
intestines to
expel them
Pathophysiology
Secretion disorders
There will be an
increase in
secretion,
Due to certain water and
causes (eg electrolytes
toxins) in the into the cavity
intestinal wall in the intestinal
wall

Increased
intestinal
cavity
contents

Diarrhea
Pathophysiology
(Rotavirus)
Clinical Manifestation
(Based on etiology)
• Vomiting followed by diarrhea and
Vira
fever
l
• No fecal leukocytes
• Recovery occurs within 7 days

• Fever is found > 40 0C

Bacteri • Bloody stool, Abdominal pain
al • No vomiting before diarrhea
• > 10 times / day

• > 7 days
Protozo
a
• Expulsive diarrhea accompanied by
vomiting, abdominal cramps, and
flatulence.
Clinical Manifestation
(Dehydration)
Clinical Manifestation
(Dehydration)
Clinical Manifestation
(Dehydration)
 Diagnosis
ANAMNESIS
Diarrhea symptoms and risk factors

PHYSICAL EXAMINATION
Vital signs, weight, dehydration signs,
perianal rash.

LABORATORIUM
Serum electrolytes, arterial blood gas,
stool analysis, stool culture
Pemeriksaan Fisik
Managements
Managements (Rehydration)
Managements (Rehydration)
Managements (Rehydration)
Managements (Rehydration)
Managements
Correction of acid base and imbalance
electrolyte
Managements
Correction of acid base and imbalance
electrolyte
Zink

<6 months: >6 months:

½ tablet (10 mg) 1 tablet (20 mg)
per day for 10 days per day for 10 days
Antibiotics should not be used routinely
Diarrhea with blood (mostly due to shigellosis), suspected cholera.
Complications
Electroly Edema/
te Over-
Imbalan hydratio
ce n

Colitis
pseudo Paralytic
membra Ileus
nosa

Metaboli
c Seizure
acidosis
Preventions
 References
1. Meivy. 2014. Faktor Yang Berhubungan Dengan Kejadian Dehidrasi Diare Pada Balita Di Wilayah Kerja Puskesmas Kalijudan. Jurnal
Berkala Epidemiologi, Vol. 2, No.3 September 2014: 297-308. Departemen Epidemiologi Fakultas Kesehatan Masyarakat Universitas
Airlangga. Surabaya.

2. Buletin Jendela dan Data Informasi Kesehatan. 2011. Situasi Diare di Indonesia. Triwulan II. ISSN 2088 - 270X. Kementerian Kesehatan RI

3. Kliegmman RM, Stanton BF, Joseph W, Schor N, Behrman R. Nelson textbook of Pediatrics. 20th ed. 2015. Philadelphia: Elsevier.

4. Direktorat Jendral Pengendalian Penyakit dan Penyehatan Lingkungan. 2011. Panduan Sosialisasi Tatalaksana Diare Balita. Jakarta:
Kementrian Kesehatan Republik Indonesia.

5. Ikatan Dokter Anak Indonesia. 2009. Buku Ajar Gastroenterologi-Hepatologi Jilid 1. UKK- Gastroenterologi-Hepatologi IDAI.

6. Pengurus Besar Ikatan Dokter Indonesia. 2017. Panduan Praktik Klinis Bagi Dokter di Fasilitas Pelayanan Kesehatan primer Ed. 1. Jakarta:
IDI.

7. Kementerian Kesehatan RI. 2018. Riset Kesehatan Dasar; RISKESDAS. Jakarta

8. Frye, Richard E. 2013. Diarrhea. Available at http://www.emedicine.com

9. Departemen Kesehatan Anak. 2014. Panduan Praktek Klinik (PPK) Divisi Gastrohepatologi. RSUP Dr.Mohammad Hoesin Palembang.

10. Alfa, Yasmar. 2010. Diare Akut Pada Anak. Bandung : SMF Ilmu Kesehatan Anak FK UNPAD/RSHS

11. Departemen/SMF Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjajaran. 2014. Pedoman Diagnosis dan Terapi Ilmu Kesehatan
Anak Ed. 5. Bandung: SMF Ilmu Kesehatan Anak FK UNPAD/RSHS

12. Simadibrata, M.K. 2006. Pendekatan Diagnostik Diare Kronik. Di dalam : Sudoyo Aru w et al, editor. Buku Ajar Ilmu Penyakit Dalam. Jilid I
Edisi IV. Jakarta: Pusat Penerbitan Depertemen Ilmu Penyakit Dalam FK UI

13. PPM. 2009. Pedoman Pelayanan Medis. Ikatan Dokter Anak Indonesia. Edisi I

14. WHO.2005. Buku saku Pelajanan Kesehatan Anak di Rumah Sakit. Jakarta: WHO Indonesia.