1 Pediatrics Gastroenterology

8/11/2019 1 Pediatrics Gastroenterology

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PEDIATRICS

GASTROENTEROLOGY

Atan Baas SinuhajiSub Division of Pediatrics Gastroentero-Hepatology

Department of ChildHealthSchool of Medicine

University of North Sumatera


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PEDIATRICSGASTROENTEROLOGY

SYSTEMATIC PROBLEM

BASED

FUNCTION

DIGESTIVESYSTEM

MAJOR SIGNS

&SYMPTOMS


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DIGESTIVE SYSTEM

PERITONEUM

- ORAL CAVITY- GI TRACT (ESOPHAGUS ANAL)

DIGESTIVE GLANDS SAL IVA RY GLA NDS LIVER & B ILE DUCT PANCREAS

DIGESTIVE TRACT


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MAJOR SIGNS SYMPTOMS

1. DIARRHOEA2. VOMITING

3. FAILURE TOTHRIVE4. JAUNDICE5. ENCEPHALOPATHY6. DISORDERS OF

INGESTION

7. ABDOMINAL PAIN8. ABDOMINAL

DISTENSION9. CONSTIPATION10. GASTROINTESTINAL

HEMORRHAGE


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FUNCTION

1. EATING & DRINKING2. TRANSPORT3. DIGESTION &

ABSORPTION4. DEFENSE5. ENDOCRINE


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HOST EFENSE

IMMUNOLOGIC

NON IMMUNOLOGIC

GALT

-MUCOSE-GASTRIC ACID-MUCUS

-MOTILITY-MICROFLORA


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GALT(GUT ASSOCIATED LYMPHOID TISSUE)

SCATTERED AGGREGATES

PEYERS PATCHES


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MOTILITY

CONTRACTION MOVEMENT

RESTING NON RESTING MIXING PROPULSION


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MOTILITY

DISORDERS

ESOPH.DYSMOTILITY

CHESTPAIN

DD :1.GER *2.ANGINA3.MUSKULOSCLETAL

GASTROPARESIS

- DELAYED GASTRIC EMPTYING- DYSPEPTIC- ABSENCE OF PERISTALSIS

CHRONIC INT. PSEUDOOBSTRUCTION-NAUSEA & VOMITING-DISTENTION-ABDOMINAL PAIN-CONSTIPATION

* GER = Gastro Esophageal Reflux


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FEEDING

EATING DRINKING -TO CARRY

-TO BRING-TO SUCK-TO TASTE-TO MASTICATE-TO SWALLOW

LIQUID

SOLID


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FEEDING

ENTERAL PARENTERAL( I . V )

ORAL TUBE

OSTOMY NON OSTOMY

- GASTROSTOMY

- ILEOSTOMY

NASOGASTRIC TUBE


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PARENTERAL FEEDING

ENTERAL STARVATION

CHOLESTASISINTESTINAL ATROPHY

COLON

70 %INTRALUMINAL

30 %INTRAVASAL


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FLORA

SMALL INTESTINE COLON

AEROB > ANAEROB

1. HOST DEFENSE2. MATURATION OF GUT IMMUNE3. NUTRITION


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1. DIET2. ANTIMICROBIAL3. IMPAIRED OF GASTRIC

ACIDITY4. MOTILITY DISORDER5. ILEOCAECAL SPHINCTER

6. PCM7. ANATOMICAL

CHANGING OFINTESTINAL FLORA


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BIOTIC

ANTI PRO PRE SYN (EU)

FRUCTO-OLIGOSACCHARIDE

LACTOBACILLUS BIFIDOBACTERIUM

DYS

IMBALANCE


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DYSBIOTIC

IMBALANCE

M.O PATHOGEN M.O NON PATHOGEN

DISEASES


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PROBIOTIC

LIVE MICROORGANISMS

SUPPLEMENTAL FOOD

BENEFICIALLY AFFECT THE HOST

MICROBIAL BALANCE


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DIGESTION

BREAK DOWN

DIETARY FOOD

- PHYSIS- CHEMICAL - MECHANICAL

SMALLER PARTICLES&

CAN BE ABSORBED


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DIGESTION

INTRALUMINAL-PANCREAS

-LIVER-STOMACH

INTRACELLULAR- PEPTIDASE

- LIPASE

MEMBRANE- SUCRASE- MALTASE- LACTASE- GLUCOAMYLASE


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ABSORPTION

TRANSPORT OF WATEROR

DIGESTIVE PRODUCTS

LUMEN

MUCOSA

VESSELS BLOOD

LYMPH


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MUCOSA

TRANSCELLULAR PARACELLULAR

LUMINALMEMBRANE

TIGHT JUNCTION


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DIGESTION - ABSORPTION

INTRALUMINAL DIGESTION

PARACELLULAR

INTERCELLULAR

SPACE

TRANSCELLULAR

MEMBR. DIGESTION

CELLULAR UPTAKE

INTRACELL. DIGESTION

BASOLAT. MEMBRANE


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INTERCELLULAR SPACE

BASEMENT MEMBRANE

INTERSTITIAL SPACE

(LAMINA PROPIA)

VESSELS - BLOOD

- LYMPH


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TRANSCELLULAR PARACELLULAR

1

2

4 3 5

6 7

1. LUMINAL MEMBRANE2. TIGHT JUNCTION3. BASOLATERAL

MEMBRANE

4. INTERCELLULAR SPACE5. BASEMENT MEMBRANE6. LAMINA PROPRIA7. VESSELS (BLOOD /

LYMPH)


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DIARE AKUTPADA BAYI DAN ANAK

ATAN BAAS SINUHAJI

BAGIAN ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARARS H ADAM MALIK MEDAN


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DIARE

VOLUME AIR TINJA

LEMBEK CAIR

(WATERY) (LOOSE)


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AIR

HIPERSEKRESI

MALABSORBSIMALDIGESTI

HIPEROSMOLARPERISTALSISAREA OBSORBSI


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DIARE

- FREK. 3X /HARI - PERUB. KONSISTENSI- DGN / TANPA MUNTAH- DGN/TANPA DARAH

DIARE CAIRAKUT

(ACUTEWATERY

DIARRHOEA)

DISENTERI(DYSENTERY

FORM)PERSISTEN

< 14 HARI MENCRETBERDARAH > 14 HARI

MALNUTRISIBERAT


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BAYI YANG HANYA MINUM ASI SERINGKALI FREKUENSI B.A.B. 5-6x/HARI

TETAPI KONSISTENSI TINJANYA BAIK

BUKAN DIARE


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DIARE

RADANG

NON RADANG

INFEKSI - VIRUS- JAMUR

- BAKTERI- PARASIT

NON INFEKSI - ALLERGI- DLL

- HORMONAL- ANATOMI- DLL


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VIRUS PENYEBAB DIARE

1. ROTAVIRUS 6 BLN s/d 2.5 TAHUN2. NORWALK VIRUS3. ENTERIC ADENOVIRUS4. ASTROVIRUS5. CALICI VIRUS6. CORONA VIRUS7. SMALL ROUND VIRUS

- PARVOVIRUS LIKE AGENT- MINI ROTAVIRUS- MINI REOVIRUS


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DALAM PRAKTEK SEHARI-HARI

- SETIAP MENCRET CAIR 3x/HR,

DGN/TANPA MUNTAH,

DGN/TANPA LENDIR/DARAH


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KLASIFIKASI

1. USIA2. LAMA DIARE3. PENYEBAB4. BERAT - RINGAN5. PATOGENESIS6. DAYA TAHAN TUBUH7. PEROLEHAN8. KEJADIAN9. LOKALISASI KELAINAN10. WHO (2005)

1 USIA


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1.USIA

-NEONATAL DIARRHOEA : DIARE PD NEONATUS

-INFANTILE DIARRHOEA : DIARE PD INFANT

-CHILDHOOD DIARRHOEA : DIARE PD ANAK

2. LAMA DIARE

-DIARE AKUT : < 7 HR (90-95%)

-DIARE BERKEPANJANGAN (PROLONGED) : 7-14 HR

-DIARE KRONIK : > 14 HR

3. PENYEBAB-RADANG : INFEKSI / NON INFEKSI

-NON RADANG

4 BERAT RINGAN ( WHO 1984)


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4. BERAT RINGAN ( WHO, 1984)

-DIARE RINGAN : < 1x / 2 JAM atau < 5cc / KgBB / JAM

-DIARE BERAT : > 1x / 2 JAM atau > 5 cc/KgBB/JAM

5.DAYA TAHAN TUBUH

-IMMUNOCOMPETENT : DAYA TAHAN TUBUH BAIK

-IMMUNOCOMPROMISED : DAYA TAHAN TUBUH

TERGANGGU ( MIS. AIDS )

6. PEROLEHAN

-NOSOCOMIAL : INFEKSI DI DAPAT DI RUMAH SAKIT

-COMMUNITY : INFEKSI DI DAPAT DI MASYARAKAT


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8. KEJADIAN

-ENDEMIC : SEPANJANG THN DIJUMPAI

-EPIDEMIC : ADA LETUSAN-LETUSAN

-CAMPURAN : SEPANJANG THN DIJUMPAIDISERTAI LETUSAN-LETUSAN

9. LOKALISASI KELAINAN

-USUS HALUS : CHOLERA, ETEC, ROTAVIRUS &G. LAMBLIA DIARRHOEA

-USUS BESAR : SHIGELLOSIS, AMOEBIASIS-KEDUANYA : CAMPYLOBACTERIOSIS,

SALMONELLOSIS


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10. WHO (2005)

-DIARE CAIR AKUT-DIARE PERSISTEN

-DIARE DISENTERI

-DIARE DENGAN MALNUTRISI BERAT


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MIKRO ORGANISME

GASTRIC BARRIER

MULTIPLIKASI

KOLONISASIADHEREN

- INVASI- DAMAGE

ENTEROTOXIN

MALABSORPSIHIPERSEKRESI

HIPERPERISTALIS

DIARE

PATOGENESIS DIARE INFEKSI AKUT

COLONIC SALVAGE


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DIARE

Membersihkan Bahan Patogen

Pertahanan

Self Limited

Kehilangan Air dan Elektrolit Makanan

Air dan Elektrolit Makanan

Dehidrasi HipoglikemiaStarvationMalnutrisi


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DI

ARE

AIR DEHIDRASI

BASA ASIDOSIS METAB

MAKANAN - HIPOGLIKEMIA- STARVATION- PCM

RUSAKMUKOSA

- MALABSORPSI- ENTEROPATI

HILANG PROT.- SENSITISASI

- NEC

ELEKTROLIT Na+ ==> atau

K+ ==> Ca2+ ==> Mg2+ ==> Zn ==> ACRODERMATITIS ENTEROPATHICA

ELEKTROLIT Na+ atau

K+ Ca2+ ==> TETANIMg2+ ==> TETANIZn ==>ACRODERMATITIS ENTEROPATHICA


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TETANY

HYPOCALCEMIC

HYPOMAGNESEMIC

ALKALOTIC


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KEHILANGAN AIR VIA TINJA

DEHIDRASI

AIR PLASMA

DEMAM HEMOKONSENTRASI HIPOVOLEMIA

RENJATAN RBF SYMPATH. DISCHARGE

- HEART RATE- VASOKONSTRIKSI

KOMA ARF


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TANDA DEHIDRASI

1. GELISAH S/DKOMA

2. UUB CEKUNG

3. MATA CEKUNG4. AIR MATA KERING5. BIBIR KERING6. HR

7. HIPOTENSI8. POLS HALUS9. OLIGURIA/ANURIA

10. TURGOR11. UJUNG JARI

DINGIN12. BB

DEHIDRASI


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DEHIDRASI

VOLUME NATRIUM PLASMA

DEHIDRASI RINGAN- SEDANG

= 5 - 10 % BB DEHIDRASI BERAT

> 10% BB

ISONATREMIA= 135 - 150 mEq/L

HIPO/HIPER NATREMIA


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TUJUAN PENGOBATAN PENDERITA DIARE

DEHIDRASI KURANG KALORIPROTEIN

AIR & ELEKTROLIT PEMBERIANMAKANAN

PENCEGAHAN PENGOBATAN

LAMA, BERAT,EPISODE

ZINK


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TATA LAKSANA

PEMERIKSAAN PENGOBATAN

1. Derajat Dehidrasi2. Problem Lain :

Malnutrisi Pneumonia dll

1. Air & elektrolit2. Makanan3. Obat-obatan

- Zink- anti mikroba- Simptomatis-

DERAJAT DEHIDRASI (WHO 2005)


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TANPADEHIDRASI

DEHIDRASIRINGAN -SEDANG

DEHIDRASIBERAT

KEADAANUMUM

BAIK GELISAH /REWEL

LESU, LUNGLAI,KOMA

MATA NORMAL CEKUNG CEKUNG

HAUS NORMAL HAUS TIDAK BISAMINUM

TURGOR NORMAL KURANG JELEK

NB : 1. PEMBACAAN DARI KANAN KE KIRI2. DISEBUT DEH. BERAT ATAU RINGAN SEDANG BILA DIJUMPAI

MINIMAL 2 TANDA.

DERAJAT DEHIDRASI (WHO, 2005)


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TERAPI CAIRAN

REHIDRASI PEMELIHARAAN

INISIAL REPLETION NORMAL

HOLLIDAY SEGAR

TAMPUNG

ABNORMAL+


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REHIDRASI

ORAL

ORALIT

I.V.

RINGER LAKTAT

RINGER ASETAT


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KH


53/103

Na +

2K +

LAMINAPROPRIA

BASEMENTMEMBRANE

3Na +

ENTEROSIT

LUMEN KH Peptida A.Amino

Na + air

PEMBULUH DARAH

MEKANISME KERJA ORALIT


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ORALIT (WHO)

LAMA(mmol/L)

BARU(mmol/L)

Na 90 75K 20 20Cl 80 65Sitrat 10 10

Glukosa 111 75311 245


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KEUNTUNGAN ORALIT (WHO, BARU)

STOOL OUTPUT = 20%

MUNTAH = 30%KEBUTUHAN CAIRAN IV = 33%

L U P D


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LUMEN USUS P. D ARAH

DIARE

LARUTAN GULA

LARUTAN GARAM

LARUTAN GARAM-GULA

INDIKASI I V


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INDIKASI I.V1. DEHIDRASI BERAT DGN/TANPA

RENJATAN2. MENCRET HEBAT

3. MASUKAN PER ORAL4. MALABSORPSI GLUKOSA5. DISTENSI ABDOMEN / OBSTR.

PARALITIK6. OLIGURIA / ANURIA YANG

BERLARUT-LARUT


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DEHIDRASI

TANPA RINGAN - SEDANG BERAT

< 5% 5 - 10% > 10%

A B C

A TANPA DEHIDRASI


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A. TANPA DEHIDRASI

1. ORALIT

1 Thn = 50 - 100 CC / X Mencret > 1 Th = 100 - 200 CC/ X Mencret

2. MINUM/MAKAN LBH BANYAK DARI BIASA

MENCEGAH JANGAN

TIMBUL DEHIDRASI

3. ZINK 10 20 mg/hari10 - 14 hari

B DEHIDRASI RINGAN SDG


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B. DEHIDRASI RINGAN -SDG

ORALIT 75 CC/kg BB /3 a 4 jam

INDIKASI

Ringer Laktat Ringer Asetat

C DEHIDRASI BERAT


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C. DEHIDRASI BERAT

100 CC/ kgBB/3-6 jam

< 1 Thn * initial = 30 CC/kgBB/ 1 jam* repletion= 70 cc/kgBB/5 jam

> 1 Thn * initial = 30 cc/kgBB/ jam* repletion = 70 cc/kgBB/2

jam


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ORALIT

PREVENTION

TREATMENT MAINTENANCE

DEHIDRASI DIARE

DIARE


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REHIDRASI

ANURIA/OLIGURIA URINCUKUP *

RENALFAILURE

PHYSIOLOGICOLIGURIA

TIDAKPERSOALAN

CAIRAN CAIRAN

NB : 1. * 1 cc / kg BB / jam2. Oliguria : < 400 cc / m 2 / hari

R l Ph i l i


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Fractionalexcretion

of Na+

%100

plasmaurin/Cr..Cr

plasmaurin/Na Na

RenalFailure

PhysiologicOliguria

Lasix diuresis (-) diuresis (+)

Laboratorium

Urine osmolality(mOsm/kgH 2O)500

Na + urin (mEq/l) > 40 1%


65/103

PEMBERIAN MAKANAN

SETELAH REHIDRASI

TIDAK MEMPERBERAT /

MENIMBULKAN DIARE

UJI TOLERANSI

ASI SUB BAGIAN GE BIKA FKUSU: SUSU FORMULA DISTOP USIA 4 -6 BLN : MAKANAN PENDAMPING ASI PROBLEM: USIA < 4 BLN & ASI ( -)

MTBS : SUSU FORMULA ( -)


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BUKU MANAJEMEN TERPADU BALITA SAKIT (MTBS) WHO


67/103

ANTIMIKROBA

1. Kolera

2. Disenteri Sigella3. Amubiasis4. Giardiasis

Diare Akut(WHO)


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ANTIMIKROBA (WHO)

1. KOLERA TETRASIKLIN 12,5 mg/Kg BB - 4 x sehari

3 hari

2. DISENTERI BASILLER 5 mg TMP + 25 mg SMX/Kg BB - 2 x sehari

5 hari

3. AMUBIASIS METRONIDAZOLE 10mg/Kg BB - 3 x sehari

5 hari

4. GIARDIASIS METRONIDAZOLE 5 mg / Kg BB - 3 x sehari5 hari

EFEK SAMPING ANTIMIKROBA


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EFEK SAMPING ANTIMIKROBA

1. PERUBAHAN FLORA USUS2. OVERGROWTH:

- MONILIA- ENTEROCOCCUS

- ANAEROB- PSEUDOMONAS

3. KERUSAKAN MUKOSA USUS4. IRITASI5. PSEUDOMEMBRANOUS ENTEROCOLITIS6. BLOOD DYSCRASIA7. MUNTAH


70/103

ANTIDIARRHOEAL (United States F.D.A)

1. Bowel Movement2. Stool Consistency3. Cramps

A drug that can be shown by objective

measurement to treat or control the symptomsof diarrhea


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1.ANTI MIKROBA YG SEDIKIT /TIDAK DISERAP :

-Streptomisin-Neomisin-Hidroksikuinolin-Sulfa yang tidak diserap

2. ANTI MOTILITAS :-- Loperamid-- Difenoksilat

3. ADSORBEN :-Kaolin/pektin-Carkoal-Atapulgit / smektit

4. ANTI SEKRESI :-Asam salisilat-Klorpromazin

5. PENELITIAN :-Laktobasillus-Fruktooligosakarida

Obat Antidiare

NB : Gol 1 s/d 4 TIDAK DIANJURKAN

KAOLIN


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KAOLIN

1. Mempermudah penetrasi jar. oleh virus

2. Tidak terbukti bermanfaat dlm mengurangi/merubah komposisi tinja

3. Mengganggu kerja antibiotik4. Efek kosmetik5. Malabsorpsi

IODOHIDROXY QUINOLINE

1. Tidak berguna2. Di Jepang ==> Subacute Myelo Optic Neuropathy

( SMON)

OPIAT & SPASMOLITIKA


73/103

OPIAT & SPASMOLITIKA

1. MEMPERPANJANG MASA DEMAM2. MEMPERPANJANG MASA EKSKRESI

BAHAN PATOGEN

3. MENGGANGGU PERISTALTIK USUS4. MENAMBAH MASA UNTUK PROLIFERASI,

PEMBENTUKAN TOKSIN & INVASI

MIKROORGANISME

5. PARALISIS USUS


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75/103

ELEKTROLIT - ASAM BASA

INISIAL

DIAGNOSA

REHIDRASI

TREATMENT

ELEKTROLIT ASAM BASA


76/103

ELEKTROLIT ASAM BASA

INITIAL

DEHIDRASIISONATREMIA

REHIDRASI

HIPONATREMIA

DILUTIONAL

DIARRHOEA


77/103

METABOLIC ACIDOSIS

ANION GAP

NORMAL

LOSS OF HCO 3-

INCREASED

STARVATION

RENALHYPOPERFUSION

TISSUE HYPOXIA SALICYLATE

INTOXICATION INBORN ERROR


78/103

ANION GAP = Na+

- (Cl + HCO 3-

)

NILAI NORMAL = 8 16 mEq/L

CLINICAL MANIFESTATIONS


79/103

CLINICAL MANIFESTATIONS

AIR HUNGER : KUSSMAUL BREATHING ANOREXIA , NAUSEA & VOMITINGDEPRESSION OF CNS FUNCTIONS : COMA &CONVULSIONPERIPHERAL VASCULAR RESISTANCE :HYPOTENSIONCARDIAC CONTRACTILITY :

A LOWERED THRESHOLD FOR VENTRICULARFIBRILATIONPREDISPOSES TO PULMONARY EDEMAK + INTRACELLULAR

AFFINITY Hb TO O 2

DEHIDRASI + ASIDOSIS METABOLIK


80/103

REHIDRASI

pH , HCO 3- , pCO 2

pH < 7.2 ATAU HCO 3- < 10 mEq/L

HCO 3- = 1-2 mEq/Kg BB

- FUNGSI PARU BAIK- TIDAK ADA HIPOKALEMIA

pCO 2 (calculated) = (1.54 X HCO3-) + 8.36 + 1.11

SESUAI TIDAK SESUAI

ASIDOSIS METABOLIK


81/103

TIDAK SESUAI

pCO 2 (c) > pCO 2 (lab) pCO 2 (c) < pCO 2 (lab)

ASIDOSIS METABOLIK+

ALKALOSIS RESPIRATORIK

ASIDOSIS METABOLIK+

ASIDOSIS RESPIRATORIK

OVERSH OOT M ETABOLI C AL KAL OSI S ASIDOSIS PARADOKSAL

HCO 3-

DOSAGE OF HCO 3- ( m g)


82/103

HCO 3- = (HCO 3- desired - HCO 3- actual ) X 0,3 X BB(kg)

HCO 3- d ?

HCO 3- d H 2CO 3

20

HCO 3- d 20 x 0,03 pCO 2 = 0,6 pCO 2 ..(1)

pCO 2 ( 1,54 X HCO 3-a ) + 8,36 1,11 (2)

HCO 3-a pCO 2 - 8,36

1,54 (O.6 pCO 2 - 5) HCO 3- =

= 1,5 m g/kgBB=

1 - 2 m g/kgBB

=

=

=

=

0,6 pCO 2 - ( 0,6 pCO 2 - 5) X 0,3 BB(KG)

PEMBERIAN HCO 3-


83/103

1. TIDAK BOLEH TERLALU CEPAT OVERSHOOT MET.ALKALOSIS ASIDOSIS INTRASEL

2. HIPOKALEMIAPARALISIS OTOT PERNAFASAN

3. GGN FUNGSI PARU-PARU

4. INSUFF. SIRKULASI

3

NaHCO 3


84/103

I.V. ADMINISTRATION

SERUM : HCO 3- + H +

CORRECTION OF ACIDOSIS

DECREASINGRESPIRATORYDRIVE

H 2O + CO 2

BLOOD BRAIN BARRIER

BRAIN : HCO 3- + H +

SLOW

H 2O + CO 2 RAPID

CEREBRAL ACIDOSIS AND DEPRESSION

MECHANISM OF PARADOXAL ACIDOSIS


85/103

vasodilatasi ICP

anoxia

intracelluler acidosisHiperkarbia

DEHIDRASI + HIPERNATREMIA


86/103

REHIDRASI

HIPERNATREMIA( > 150 mEq/l)

-INFUS STOP- AIR PUTIH

DEHIDRASI + HIPONATREMIA


87/103

REHIDRASI

HIPONATREMIA( < 135 mEq/L)

HipoNasimpt

SetelahRehidrasi

HipoNaasimpt

NaCl 3% Restriksi CairanRL

Na (mEq) = (135 - NaSerum) x 0,6 x BB (kg) DEHIDRASI HIPO/ HIPERKALEMIA


88/103

REHIDRASI

HIPOKALEMIA

Mencret (+) Mencret

HIPERKALEMIA

Fungsi Ginjal

ECGRL

N abN

K + oral K + drip(sampai 3 mEq / kgBB / hari)

Gagal Ginjal Akut

Restriksi Cairan

DEMAM


89/103

TURUNKAN TEMP

MENDINGINKANTUBUH

OBAT

- Buka Baju- Lap Keringat- Kipas

- Kompres

1. Paracetamol :30 mg/Kg/hari - 3 dosis

2. - Acetyl Salicylic Acid

- Mefenamic Acid

Tidak dianjurkan


90/103

V. CHOLERAE


91/103

O1 Non O 1(Non Agglutinable)

- Biotip - Eltor- Classic

- Serotip - Ogawa- Inaba- Hikojima

O2 - 138O140 - 142 O139

Bengal Strain

ENTERO TOXIN


92/103

Tidak MenggangguAbsorpsi Na + di Villus Cell

Surface Receptor

Sekresi Cl - di Crypt Cell

Adenyl Cyclase

C - AMP

Absorpsi


93/103

Villi

Crypt

Lumen Usus

Absorpsi

Sekresi

V. CHOLERAE


94/103

JEJUNUM

- COPIOUS DIARRHOEA

- FISHY RICE WATER STOOLS- DEMAM (-)- SAKIT PERUT (-)- RAPID DEHYDRATION & SHOCK

- BIOKIMIA (+)- HISTOLOGI (-)

DIAGNOSA


95/103

- KLINIS

ANAK BESAR

DEH. BERAT

ANAK-ANAK LAIN (+)

- LABDARK FIELD MICROSCOPEKULTUR

Th C i l kt lit Ri g L t t I V


96/103

Th Cairan elektrolit Ringer Lactate I.V.

MAKANAN

AB Tetrasiklin atauDoksisiklin

Rehidrasi & Pemeliharaan

Kadar Na + tinja( 88 101 mEq/ L)

SINDROMA DISENTRI


97/103

= DIARE + DARAH

1. DISENTRI- BASILLER- AMUBA

2. Enterocolitis- Cows milk allergy

3. Trichuriasis

4. Lain-lain - Entero invasive E coli

- C. jejuni

DISENTRI BASILLER


98/103

= SHIGELLOSIS

KOLON

S. DYSENTRIAE

S. FLEXNERIS. BOYDIIS. SONNEI

SHIGELA


99/103

SHIGELA

INVASI SHIGA TOXIN

INHIBISISINTESA PROTEIN

SITOTOKSIK

SHIGELA


100/103

- DIARE AIR- DIARE BERDARAH- TENESMUS- SAKIT PERUT- URGENSI

- DEMAM- KEJANG- SEPSIS- HEMOLYTIC UREMIC

SYNDROME- TOXIC MEGA COLON- PROLAPSUS RECTI

Th


101/103

Th

1. CAIRAN-ELEKTROLIT

2. FEEDING

3. - SELF LIMITED- BERAT TMP - SMX

Cefixime: 8 mg/kg/hr

2 dosis nalidixic acid ampisilin

SALMONELLOSIS


102/103

TYPHOIDAL ENTERIC FEVER :-S. TYPHOID TYPHOID FEVER

-S. PARATYPHOID PARATYPHOID FEVER

NON TYPHOIDAL : SALMONELLA

GASTROENTERITIS


103/103

INDIKASI PEMBERIAN AB PADASALMONELLA GASTROENTERITIS

1. 3 MONTH OF AGE

2. OLD DEBILITATED PATIENT

3. DYSENTERY FORM ESPECIALLYILLNESS > 5 DAYS

4. IMMUNOCOMPROMISED : STEROID,MALIGNANCY

5. BACTERIAEMIA

Documents

1 Pediatrics Gastroenterology