diare interna

7/26/2019 diare interna

http://slidepdf.com/reader/full/diare-interna 1/84

ORIAL2, B-11, BLOK GASTROINTESTINAL SYS

DIAREAcute bloody diarrhoea

FAKULTAS KEDOKTERAN

UNIVERSITAS SUMATERA UTARA

MEDAN 200



!EMI"U

D# $eora%& a%a' (ere)(ua% u)ur * tahu%#diba+a ibu%ya 'e !u$'e$)a$ de%&a% 'eluha%)e%cret $ela)a , hari- Fre'ue%$i lebih dari .'ali/hari- Ko%$i$te%$i cair# le%dir 1# darah 1-

De)a) 1 3 hari- Me%urut ibu%ya# D# $elalu)eri%&i$ $etia( 'ali a'a% 4A4- Dari(e)eri'$aa% 5$i'# D# terlihat hau$# le)ah#)ata terlihat ce'u%&# 6re'ue%$i %adi

078/)e%it# re&uler# te'a%a%/9olu)e 'ura%&#te)(teratur ,7#3:"- 4erat bada% $e'ara%& 7'&-

Apakah yang terja! paa "#



MORE INFO

!e)eri'$aa% 5$i' dite)u'a% tur&or $eda%&#(e)eri'$aa% abdo)e% $oe(el# (eri$talti' u$u$)e%i%&'at- 4erat bada%& $ebelu) $a'it ; '&-!e)eri'$aa% a%o&e%ital<terlihat )erah da%

lecet di $e'itar a%u$- !e)eri'$aa% darah ruti%di=u)(ai leu'o$it 2000/)),- !e)eri'$aa% uri%dala) bata$ %or)al- !e)eri'$aa% 6aece$>darah 1# le%dir1# caci%& ?# 'i$ta

Entamoeba histolytica ?- O$ $udah diberi'a%'otri)o'$a@ol $ela)a , hari# %a)u% tida')e)bai'-

Baga!$ana penanganan paa " anpe$er!k%aan apa &ag! yang !per&'kan#



MORE INFO 2

Kultur 6aece$ di=u)(ai Shi&ella $(-U=i $e%$iti9ita$>Kotri)o'$a@ol R

A$- Nalidi'$at S

A)(icilli% R



I!OTESA

•A%a' D )e%&ala)i diare a'ut• A%a' D )e%&ala)i dehidra$i

• A%a' D )e%derita di$e%tri



ANALISIS MASALAFre'ue%$i!eri$talti'Me%cret

Te%e$)u$Leu'o$ito$i$De)a)Fe$e$

De)a)Fre'ue%$iLeu'o$ito$i$

Te%e$)u$!eri$talti'Fe$e$Me%cret



LEARNINB ISSUE

- A%ato)i da% hi$tolo&i u$u$ halu$ da% u$u$ be$ar

2- Fi$iolo&i u$u$ halu$ da% u$u$ be$arbe$erta hor)o%?hor)o% da% e%@i) ya%& terlibat

,- De5%i$i# e(ide)iolo&i da% 6a'tor re$i'o diare

C- Kla$i5'a$i da% etiolo&i diare

3- !ato&e%e$i$ diare ya%& di$ebab'a% Entamoebahistolytica da% Shigella spp.

*- !ato5$iolo&i diare

.- Dia&%o$i$ da% (e)eri'$aa% (e%u%=a%& diare

7- Dia&%o$i$ ba%di%& di$e%tri;- Dehidra$i da% (e%atala'$a%aa%%ya

0-!e%atala'$a%aa% diare $ecara u)u)

-Ko)(li'a$i diare

2-!e%ce&aha% da% (ro&%o$i$ diare



ANATOMI USUS ALUS

•Duode%u)• e=u%u)

• Ileu)



DUODENUM The 5r$t (ortio% o6 the $)all i%te$ti%e +hich i$

directly a%d 5r)ly attached to the (o$terior

abdo)i%al +all "o%$i$t > ? (ar$ $u(erior $horte$t (ortio%

? (ar$ de$ce%de%$

? (ar$ i%6erior 4e%d$ arou%d )ar'edly to the ri&ht a%d 6or+ard to

&o o9er i%to the i%te$ti%u) =e=e%u)e8uraduode%o=e=u%ali$

I% the )uco$a (re$e%t a lo%&itudi%al 6old (lica

lo%&itudi%ali$ duode%i a%d $)all (ro=ectio% u(o%+hich o(e% the ductu$ choledocu$ a%d ductu$(a%creaticu$ (a(illa Vateri





EENUM AND ILEUM

I%6ro%t a%d lateral+ard =e=e%u) a%d ileu) i$ co9eredby the &reat o)e%tu) o)e%tu) )a=u$

The )ucou$ )e)bra%e (re$e%t$ the $(ecial $tructur > !lica circulari$Kerc'ri%& >

? the co%$ta%t 6old

? I% =e=e%u) # they are lo%&er a%d hi&her tha% i%ileu)

Ly)(h %ode

? i% =e=e%u)# they are u$ually $i%&le %odulily)(hatici $olitary

? i% ileu)# they are %u)erou$ a%d hi&her a%d i% (artare cro+ded to&ether # Peyer Patcher %odulily)(hatici a&re&ati





ISTOLOBI USUS ALUS

LAYER "ES(RI)TION

MU"OSA E!ITELIUM SURFA"E A4SOR!TIVE "ELLS#BO4LET "ELLS# DNES "ELLS# M MI"ROFOLD"ELLSLAMINA !RO!RIA "ORE OF VILI# TU4ULAR

BLANDS# STEM "ELLS# !ANET "ELLSMUS"ULARIS MU"OSAE INNERENTER VILI#EGTEND ITS "ORE H OUTER

SU4MU"OSA DENSE# IRREBULAR FI4ROELASTI" "ONNE"TIVE TISSUE IT 4LOOD H LJM! VESSELS

MUS"ULARISEGTERNA SMOOT MUS"LE FI4ERS "IR"ULAR#LONBITUDINAL

SEROSA/ADVENTITIA

TIN SEROSA



Ba)bar hi$tolo&i u$u$ halu$

• duode%u)• ileu)• =e=u%u)



MO"I*I(ATIONS

• !LI"AE "IR"ULARESVALVES OF KER"KINB – TRANSVERSE FOLD OF

MU"OSA H SU4MU"OSA TAT FORM SEMI"IR"ULAR

TO ELI"AL ELEVATIONS• VILI

– E!ITELIALLJ "OVERED#FINBER?LIKE OR OAK LEAF?LIKE !ROTRUSIONS OFLAMINA !RO!RIA

• MI"ROVILI – A!I"AL INTESTINAL

E!ITELIUM "ELLMEM4RANE

S)E(I*I( *EATURES

• DUODENUM – 4RUNNERS

DUODENAL BLANDSIN SU4MU"OSA

• EUNUM – !LI"AE "IR"ULARES

• ILEUM – !EJERS !AT"ES



"ELLS FUN"TION

SUR*A(E ABSOR)TI+E (ELLSENTERO(YTES

• TALL "OLUMNAR "ELLS#OVAL NU"LEUS ALF4ASALLJ LO"ATED

• A!EG> OMOBENOUSLAJER4RUS 4ORDER

• FOR TERMINAL DIBESTIONH A4SOR!TIONS OF O H

NUTRIENT• SE"RETEDISA""ARIDASES H!E!TIDASES

GOBLET (ELLS

• INTERS!ERSED 4ETEENA4SOR!TIVE "ELLSUN"ELLULAR BLANDS

• IN DUODENUM# ILEUM

• !RODU"E BLJ"O!ROTEINMU"IN MU"US

• MU"US> !ROTE"T HLU4RI"ATE LININB OFINTESTINE



M MI(RO*OL"(ELLS

• SUAMOUS LIKE

"ELLS S!E"IALIPEDA4OVE TE LJM!OIDNODULE

• IM!ORTANT FOR

DEFENSE ME"ANISM• 4ASEMENT UNDER

TESE "ELLS ARE!OROUS FA"ILITATE

TRANSIT OF "ELLS

)ANET. (ELLS

• LO"ATED AT 4ASAL

!ORTION OFINTESTINAL "RJ!TS#!JRAMID?SA!E

• EGO"RINEQ LARBE#

EOSINO!ILI"SE"RETORJBRANULESA!I"AL"JTO!LASM

LJSOPOME#!OS!OLI!ASE A#DEFENSINS

• INNATE IMMUNITJ



ANATOMI USUS 4ESAR



LARBE INTESTINE

- Follo+i%& u(o% the $)all i%te$ti%e# it$ be&i%$ a$ thei%te$ti%u) caecu) i% the 6o$$a iliaca de8tra

2- !art o6 lar&e i%te$ti%e>•. "aecu)

•. "olo% a$ce%de%$

•. "olo% tra%$9er$u)

•. "olo% de$ce%de%$

•. "olo% $i&)oideu)

,- The (ortio% 6ro) the caecu) to the rectu) i$ called thecolon

C- The lar&e i%te$ti%e i$ caracteri@ed# it$ $ur6ace i$ %ot $)oothly

cyli%drical# but (re$e%t$ a %odular a((eara%ce due to thethree ro+$ o6 irre&ular# a$' li'e (ro=ectio%Q haustra

3- The$e ro+$ o6 hau$tra are $e(arated 6ro) o%e a%other bythree ba%d$? li'e $tri($ o6 the lo%&itudi%al )u$cleQ taenia coli



"AE"UM

The bli%d?$ac?li'e (ortio% o6 the lar&e i%te$ti%e$ituated belo+ the o(e%i%& o6 the ileu) i%to the

lar&e i%te$ti%eI% the 6or)atio% o6 thi$ the ter)i%al (ortio% o6 the$)all i%te$ti%e i$ i%9a&i%ated i%to the lar&e i%te$ti%eca9ity



A!!ENDIG VERMIFORMIS

A%arro+ # &e%erally cyli%drical# hollo+# bli%d e%di%&o6 the caecu)-

Le%&th a9era&e 7#3 c)

"OLON AS"ENDENS

• 4e&i%$ at the 6re%ula 9al9ulae coli a$ the directco%ti%uatio% o6 caecu)

"OLON TRANSVERSUM

Ru%$ out to the le6t a%d $o)e+hat u(+ard 6ro) thee8ura coli de8tra o9er the )eedia% (la%e i% acur9e co%9e8 6or+ard a%d at the $a)e ti)edo+%+ard a%d &oe$ o9er i%to the colo% d$ce%de%$



"OLON DES"ENDENS

A de$ce%di%& li)b o6 colo%

"OLON SIBMOIDEUM

Ter)i%al (ortio% o6 colo% # ha%&$ a$ a loo( &e%erallydo+% i%to the ca9ity o6 $)all (el9i$ a%d &oe$ o9er i%6ro%t o6 the $acru) i%to the rectu)

RE"TUM

Ter)i%al (ortio% o6 the di&e$ti9e tube +hich e8te%d$6ro) the colo% $i&)oideu) throu&h the i%6erior +all

o6 the $)all (el9i$ to the i%6erior o(ei%& a%u$





ISTOLOBI USUS 4ESARA))EN"I/ (AE(UM0(OL

ONANAL (ANAL

MU"OSA E!I > SIM!LE"OLUMNARLAMINA !RO!RIA

E!I > SIM!LE"OLUMNARLAMINA > ENDOED"RJ!TS OFLIE4ERKUN# NO

!ANET"ELLS#A4SOR!

TIVE# BO4LET HDNES "ELLS

E!I>SIM!LE"U4OIDAL# STRS NONKERATINIPED#STR SKERATINIPED

LAMINA> ANALBLANDS#"IR"UMANALBLANDS

SU4MU"OSA FI4ROELASTI" TISSUE# VENOUS!LEGUS

MUS"ULARIS OUTER LAJERBATERED 4J

TAENIA "OLI

TI"KENEDINNER LAJER

SEROSA/

ADVENTITIA

A!!ENDI"ES

E!I!LOI"AEQ FATFILLED !OU"ES



Ba)bar hi$tolo&i u$u$ be$ar da% a(e%di'$



DEFENISI DAN E!IDEMIOLOBI DIARE

• Me%urut O# diare adalah bua%& air be$ar, 8/2C =a)# de%&a% 'o%$i$te%$i cair- Ja%&(ali%& (e%ti%&> 'o%$i$te%$i ti%=a cair# 1/?le%dir atau darah-

• E(ide)iolo&i diare>? * =uta a%a' )e%i%&&al/tahu%

? . 'e)atia% a%a' di du%ia a'ibat diare

? Di I%do%e$ia> Diare adalah (e%yebab'e)atia% a%a' terba%ya' C2



FAKTOR RESIKO DIARE

- U)uri%$ide%$ terti%&&i u$ia *? bula%

2- I%6e'$i a$i)(to)ati'

,- Mu$i)

C- y&ie%e

3- I%tolera%$i la'to$a

*- Va'$i% rota9iru$



ETIOLOBI DIARE

• Tida' 'ura%& dari 23 =e%i$ )i'roor&a%i$)eda(at )e%yebab'a% diare (ada bayi da%a%a'-

• !e%yebab uta)a> 9iru$# ba'teri# da% (ara$it



DIARROEA

INFLAMMATION

NONINFLAMMATION

INFE"TION ? VIRAL? FUNBAL

? 4AKTERIA? !ARASITE

NON INFE"TION ? ALLERBJ? etc

? ORMONAL? ANATOMI"AL? etc



Bolo%&a% ba'teri

• Aero)o%a$

• 4acillu$ $ereu$

• "a)(ylobacter =e=u%i

• "lo$tridiu) (er6ri%&e%$

• "lo$tridiu) decile

• E$cherichia coli

• !le$io)o%a$ $hi&eloide$

• Sal)o%ella

• Shi&ella• St(hylococcu$ aureu$

• Vibrio cholera

• Vibrio (arahae)olyticu$

• Jer$i%ia e%terocolitica



Bolo%&a% 9iru$

• A$tro9iru$

• "alci9iru$%oro9iru$#$a(o9iru$

• E%teric ade%o9iru$

• "oro%a9iru$

• Rota9iru$

• Nor+al' 9iru$

• er(e$ $i)(le8 9iru$

• "yto)e&alo9iru$u)u)%ya ter=adi ha%ya (ada (e%derita

i)u%oco)(ro)i$ed



Bolo%&a% (ara$it

• 4ala%tidiu) coli

• 4la$tocy$ti$ ho)o%i$

• "ry(to$(oridiu) (ar9u)

• E%ta)oeba hi$tolytica

• Biardia la)blia

• I$o$(ora belli

• Stro%&yloide$ $tercorali$

• Trichuri$ trichiura



• Diare 'ar%a 9iru$ > 9iru$ )e%&i%6e'$i da%)e%&ha%cur'a% $el?$el u=u%&?u=u%& 9illu$

(ada u$u$ halu$• Diare 'r% ba'teri yer=adi )elalui $alah $atu

)e'a%i$)e ya%& berhubu%&a% de%&a%

(e%&atura% tra%$(or io% dala) $el $elu$u$ cAM!#cBM!#da% "a de(e%de%



!e%yebab diare %o% i%6e'$i• Ke$ulita% )a'a%

• De6e' a%ato)i$

?)alrota$i? (e%ya'it hirch$(ru%&

? $hort bo+el $y%dro)e

? atro5 )i'ro9illi

? $tricture

• Malab$or($i

? de5$ie%$i di$a'arida$e? )alab$orb$i &lu'o$a?&ala'to$a

? cy$tic 5bro$i$

? chole$to$i$

? (e%ya'it celiac

• E%do'ri%o(ati

? thyroto'$i'o$i$

? (e%ya'it addi$o%

? $i%dro)a adre%o&e%ital



• Keracu%a% )a'a%a%

? lo&a) berat

? )u$hroo)$

• Neo(la$)a

? %eurobla$to)a

? (haeochro)ocyto)a

? $i%dro)a @olli%&er elli$o%

• Lai%2? i%6e'$i %o%&a$troi%te$ti%al

? aler&i $u$u $a(i

? (e%ya'it croh%

? de5$ie%$i i)u%? coliti$ ul$ero$a

? &a%&&ua% )otilita$ u$u$

? (ella&ra



Diare 'ro%i$

Di %e&ara )a=u lebih 'are%a i%tolera%$i (rotei%$u$u $a(i/'eledaiQceliac di$ea$e&lute%?$e%$iti9e e%tero(athyda% cy$tic 5bro$i$

T( da(at ber)ula dari diare a'ut a'ibat i%6e'$i

$alura% cer%a-



KLASIFIKASI DIARE

• U)ur

• O%$et

• Etiolo&i

• Ke(araha%

• o$t de6e%$e

• !ato&e%e$i$

• Su)ber i%6e'$i

• Te)(at (atolo&i• O 2003



Me%urut u)ur

• Neo%atal diare > diare (ada %eo%atu$ 27hari

• I%6a%tile diare > diare (ada bayi

• "hildhood diare > diare (ada a%a'2 tahu%



Me%urut o%$et

• Diare a'ut > .hari ;0?;3

• Diare (rolo%&ed )e%eta(> .?C hari

• Diare 'ro%i$ > C hari

)e%urut etiolo&i• I%a)a$i > i%6e'$i da% %o% i%6e'$i

• No% i%a)a$i



Me%urut 'e(araha%%ya

• Diare ri%&a% > 8/2 =a) atau 3)l/'&bb/=a)

• Diare berat > =a) atau 3 )l/'&bb/=a)

Me%urut ho$t de6e%$e• I)u%oco)(ote%t

• I)u%oco)(ro)i$ed> AIDS# Leu'e)ia



Me%urut(ato&e%e$i$%ya

A4SOR!TIVE/OSMOTI"SE"RETORJ- FASTINB STO!S

"ONTINUES

2- STOOLS OSM- C00270

,- Na 1 ,000

C- K 1 ,0C0

3- Na1K8 2 20270

*- SOLUTE BA! 270



Me%urut $u)ber i%6e'$i%ya

• No$o'o)ial> i%6e'$i%ya 'e%a di RS

• "o))u%ity> dari li%&'u%&a%/)a$yara'at

Me%urut e(ide)iolo&i

• E%de)i'> $elalu ada tia( $aat• E(ide)i'> 'e=adia% )elebihi 'e=adia% bia$a

• ca)(ura%



Me%urut te)(at (atolo&i%ya

• U$u$ halu$> cholera#rota9iru$

• U$u$ be$ar > $hi&olo$i$#a)oeba$i$

• Kedua dua%ya >ca)(hylobacterio$i$#$al)o%ello$i$

Me%urut O tahu% 2003• Diare a'ut

• Diare (er$i$te%t

• 4e%tu' di$e%tri• Diare de%&a% 'e(araha%

• )al%utri$i



Ti(e Ti(e

!ATOBENESIS DIARE AKI4AT Shigella spp.



Shigella spp.

• Shigella spp. )eru(a'a% )odi5'a$i dari E.coli- E.coli )e%&ala)i e9olu$i (ada &e%oti(e da% 6e%oti(e 9irule%$i%yada% )e%=adi Shi&ella- Shi&ella adalah ba'teri bata%& &ra)%e&ati6 %o% )otil $ehi%&&a ha%ya )e)ili'i a%ti&e% O# tida')e)ili'i a%ti&e% Fa&el-

• Fe$e$ ora%& ya%& teri%6e'$i Shi&ella bi$a )e%&a%du%& 0*?07 Shi&ella (er &ra)- Shi&ella a'a% taha% (adali%&'u%&a% luar $ela)a , hari? )i%&&u-

• !ort de%tre Shi&ella>

? La%&$u%&> dari ora%& 'e ora%&

? Tida' la%&$u%&> 6e'al?oral )elalui )a'a%a% ya%&



SaatMa'ro6a&e



SaatMa'ro6a&e

Rea'$i i%a)a$i da% to'$i% Shi&ella ber$a)a?$a)a )e%yebab'a% 'eru$a'a% =ari%&a% ya%& lebih

(arah la&i





Vi l i



Virule%$i

!ATOBENESIS DIARE AKI4AT



!ATOBENESIS DIARE AKI4ATEntamoeba histolytica

• 4e%tu' i%6e'ti6> 'i$ta )ata%& ya%& terda(at(ada ora%& $ehat- Ki$ta da(at hidu( la)adala) air0?C hari# li%&'u%&a% le)bab2hari da% )ati (ada $uhu 30:" da% dala)

'eadaa% 'eri%&-• 4e%tu' (ato&e%> hi$toliti'a-

• 4e%tu' dia&%o$ti'> 'i$ta beri$i e%ta)oebadala) 6e$e$-

Ki$ta

4e%tu'



4e%tu'

!ATOFISIOLOBI DIARE



!ATOFISIOLOBI DIARE

• Diare o$)oti'

• Diare $e'retori'

• Diare e'$udati6

• Diare 'are%a &a%&&ua% )otilita$

Di ti'



Diare o$)oti'

• 4aha% ya%& tida' da(at di$era(

)e%i%&'at'a% o$)olarita$ dala) ro%&&a u$u$hi%&&a a'a% )e%ari' air da% ele'trolit dari(la$)a 'e ro%&&a u$u$- Ma'a #=adilah diare

• "o%toh > I%tolera%$i )a'a%a%# +a'tu(e%&o$o%&a%la)bu%& ya%& ce(at# de5$ie%$i e%@i)la'ta$e#

la'$a% o$)oti'

Di ' t i'



Diare $e'retori'

• To'$i% ya%& di'eluar'a% ba'teri to'$i% 'olera#

(e%&aruh &ara) e)(edu# hor)o% i%te$ti%al$e(erti &a$tri% 9a$oacti9e i%te$ti%al (oli(e(tide VI!)e%yebab'a% &a%&&ua% tra%$(ort caira% ele'trolit # di)a%a ab$or($i 'ura%& dari $e're$i-

• To'$i% )e%$ti)ula$i cAM! da% cBM! hi%&&a)e%$ti)ula$i $e're$i caira% da% ele'trolit-

• A'ti6> &a%&&ua% alira%ab$or($i dari lu)e% u$u$ 'edala) (la$)a atau (erce(ata% caira% air dari (la$)a'e lu)e%-

• !a$i6> te'a%a% hidro$tati' dala) =ari%&a% 'are%a ter=adie'$(a%$i air dari =ari%&a% 'e lu)e% u$u$- "o%toh >(e%i%&&ia% te'a%a% 9e%a )e$e%terial# ob$tru'$i $i$te)li)6ati'# i$'e)ia u$u$# (ro$e$ (erada%&a%-

Di ' d ti6



Diare e'$udati6

• Keru$a'a% )u'o$a u$u$ halu$ atau u$u$

be$ar a'ibat (ro$e$ i%a)a$i-

• I%a)a$i H e'$uda$i da(at ter=adi a'ibati%6e'$i ba'teri# %o% i%6e'$i &lute% $e%$iti9e

e%tero(athy# I4D# atau a'ibat radia$i-• "o%toh > 'oliti6 ul$ero$a# (e%ya'it "roh%#

a)ebia$i$# $hi&ello$i$# i%6e'$i ca)(ylobacter#i%6e'$i yer$i%ia-

Di ' tilit



Diare 'are%a &a%&&ua% )otilita$

• Ba%&&ua% (ada 'o%trol oto%o)i'

)e%yebab'a% +a'tu ta%$it u$u$ )e%=adilebih ce(at

• Mi$al%ya (ada diabeti' %euro(ati# (o$t

9a&oto)i# (o$t re$e'$i u$u$# hi(ertiroid#tiroto'$i'o$i$# $i%dro)a u$u$ iritabel-

! t 5 i l i Di



!ato5$iolo&i Diare

DIABNOSIS DAN !EMERIKSAAN !ENUNANB DIARE



DIABNOSIS DAN !EMERIKSAAN !ENUNANB DIARE

• A%a)%e$i$

• !e)eri'$aa% 5$i'

• !e)eri'$aa% darah ruti%

• !e)eri'$aa% uri%

• !e)eri'$aa% 6e$e$• !e)eri'$aa% radiolo&i

A%a)%e$i$/History Taking



A%a)%e$i$/History Taking

• Autoa%a)%e$i$ H aloa%a)%e$i$

• Keluha% uta)a

diare >4ua%& air be$ar e%cer/$e)i?$olid ,

'ali/hari atau 200&/hari

Le%dir#darah#)u%tah boleh ada/tida' ada

• Ditelu$uri 'eluha% uta)a ri+ayat (e%ya'itdiare >

La)a%ya $a'it diare

Fre'ue%$i

Volu)e

ar%a H bau

4atu'#(ile'#'e=a%& $ebelu)#$ela)a#$etelah

diare

• Keluha% ta)baha% a'ibat diare da%



Keluha% ta)baha% a'ibat diare da%dehidra$i >

au$

Le)ahMata terlihat ce'u%&

Meri%&i$ / ce%&e%& / &eli$ah

%a6$u )a'a% )e%uru%Ubu%?ubu% be$ar ce'u%&

To%u$ H tur&or 'ulit berubah

Sela(ut le%dir )ulut H bibir 'eri%&

• Ri+ayat 'e$ehata% )a$a lalu hi$torydiare (ada (a$ie% H (e%ya'it lai%

• Ri+ayat )a'a% / )i%u) (ola H aler&i

•



!e)eri'$aa% Fi$i'• Te'a%a% darah hi(ote%$i ortho$tati'

• De%yut %adi• Te)(eraturfever moderate to severe)

• 4erat bada%

• !e)eri'$aa% 5$i' abdo)e% (eri$talti'u$u$ )e%i%&'at

• !e)eri'$aa% a%o&e%ital )erah H lecet$e'itar a%u$



!e)eri'$aa% Laboratoriu)• Darah leu'o$it

• Leu'o$ito$i$ i%6e'$iW• Ele'trolit dala) darah

• Uri%



!e)eri'$aa% Lai%• "olo%o$co(y (e)eri'$aa%

)e%&&u%a'a% e%do$'o( (ada 'olo%)elalui re'tu)

• !a%=a%& 2)eter

• Me%&e9alua$i i%6e'$i / ab%or)alita$$tru'tur 'olo% =u&a da(at &u%a'a% Gray /"T Sca%

• Hydrogen breath test )alab$orb$i &ula

• Si&)oido$co(y i%$(e'$i colo%)e%&&u%a'a% tube ya%& ti(i$'a)era didala)

• u&a da(at )e%&u)(ul $el/=ari%&a%



!e)eri'$aa% Ti%=a• Volu)e ti%=a %or)al > 00?,00&/hari

• Ko)(o$i$i

.0 hari#,0 $i$a )a'a%a% H 'u)a%• Ma'ro$'o(i$ bau#'o%$i$te%$i#'eberadaa%

darah#(ara$it

• Mi'ro$'o(i$ $ele(itel#)a'ro6a&#le'o$it#eritro$it#'ri$tal#$i$a )a'a%a%#$el

ra&i#telur H =e%ti' caci%&#(roto@oa• Le%dir di ba&ia% luar ti%=a irita$i u$u$ be$ar

• Le%dir berca)(ur ti%=a irita$i (ada u$u$ halu$

• Malab$orb$i le)a'/(rotei% 9ol-be$ar#berbau

• Si%dro)a (ada u$u$ be$ar

ra(uh de%&a% darah da%le%dir

• E-coli / 'eracu%a% hita)#)udah )ele'at#9olu)ebe$ar#cair

• Shi&ella (erdaraha% ri%&a%/berat#%yeri (erut#berat

bada% )e%uru%

i' i' bi l i



!e)eri'$aa% Mi'robiolo&i

• Kultur / (e)bia'a% >

S(e$i)e% 6e$e$ di)a$u''a% 'e dala))edia u%tu' )e)beri 'e$e)(ata%'u)a%/(ara$it (atolo&i$ tu)buh H

ber'e)ba%&

ide%ti5'a$i =e%i$ da% =u)lah 'u)a%

• Te$ $e%$iti9ita$ >

Me%&u=i $e%$iti9ita$ 'u)a% (ato&e%

terhada( a%tibioti'aMe)ba%tu dala) (e)iliha% obat a%ti?

'u)a% ya%& terbai' dala) (e%&obata%

i%6e'$i

• !e)eri'$aa% &ra) >



• !e)eri'$aa% &ra) >

!e)eri'$aa% )or6olo&i 'u)a%/=a)urde%&a% (e+ar%aa% u%tu'ide%ti5'a$i#'u)a% &ra) (o$iti6 atau%e&ati6

• !e)eri'$aa% =a)ur >

!e)eri'$aa% terhada( =e%i$ =a)ur(ato&e% H o((ortu%i$ti'

Te$ 'o)(li)e% ide%ti5'a$i a%tiboditerhada( =a)ur

"a%dida (e)eri'$aa% complementation

• Ide%ti5'a$i 9iru$ >

Te$ $erolo&i$

!ENATALAKSANAAN NON FARMAKOLOBI DIARE



!ENATALAKSANAAN NON FARMAKOLOBI DIARE

• !erbai'a% &i@i

- !e)beria% )a'a%a% $e(erti bia$a

- Vita)i% A

- a%&a% beri'a% )a'a%a% berle)a'

• 4ed re$t

!ENATALAKSANAAN FARMAKOLOBI



DIARE• Pi%c

• A%tibioti'a

• Ad$orbe%

• A%ti)otilita$

• 4i$)uth

Pi%c



Pi%c

• De5$ie%$i @i%c $eri%& di %e&ara ber'e)ba%& )e%uru%%ya 6u%&$i i)u% da%)e%i%&'at%ya 'e=adia% i%6e'$i-

• Mi'ro%utrie% 'o)(o%e% (e%ti%& e%@i) dala)tubuh H u%tu' $i%te$i$ DNA-

• Me%uru%'a% i%$ide% diare $eba%ya' 3-• 20 )& (erhari $ela)a 0 C hari da% (ada

bayi * bula% 0 )& (erhari $ela)a 0 Chari-

A%tibioti'a



A%tibioti'a

• a%ya $eba&ia% 'ecil ya%& di$ebab'a% oleh

ba'teri (ato&e%-• Kebia$aa% %ya diare i%6e'$i adalah rota9iru$

ya%& tida' da(at dibu%uh de%&a%

a%ti)i'roba-

Penyebab Antibiotik pilihan Alternatif



y p

Kolera Tetracycline

12,5mg/kg

!" #ehari #elama $ hari

%rythromycin

12,5mg/kg

!" #ehari #elama 5 hari

&higella 'y#entry (iproflo"acin

15mg/kg

2" #ehari #elama $ hari

Pi)mecillinam

2*mg/kg

!" #ehari #elama 5 hari

(eftria"one

5*-1**mg/kg1" #ehari + #elama 2-5 hari

Amobia#i# etroniaole

$" #ehari #elama 5 hari

iaria#i# etroniaole$" #ehari #elama 5 hari

Ad$orbe%



Ad$orbe%

• "o%toh> 'aoli%# atta(ul&ite# $)ectite#

chole$tyra)i%e-• Me%&i'at da% )e%&i%a'ti9a$i to'$i% ba'teri

atau baha% lai% ya%& )e%yebab'a% diare-

• Ma)(u )eli%du%&i )u'o$a u$u$-

A%ti)otilita$



A%ti)otilita$

• "o%toh> lo(era)ide hydroclhoride# tu%ctura

o(ii# (are&oric# codei%-• Me%&ura%&i 6re'ue%$i diare (ada de+a$a da%

tida' (ada a%a'-

• Me)(er(a%=a%& i%6e'$i de%&a%)e)(erla)bat eli)i%a$i dari or&a%i$)e(e%yebab-

4i$)uth $ub$alicylate



4i$)uth $ub$alicylate

• 4ila diberila% $etia( C =a) da(at )e%&ura%&i

'eluara% ti%=a (ada a%a' de%&a% diare a'ut$eba%ya' ,0# a'a% teta(i cara i%i =ara%&di&u%a'a%-

Kotri)o'$a@ol



Kotri)o'$a@ol

• Obat a%tiba'teri ya%& )e%&a%du%&

$ul6a)etho8a@ole da% tri)etho(ri)-• Sa%&at $eri%& di&u%a'a% u%tu' )e%&obati

i%6e'$i dari uri%ari# re$(iratori da%

&a$troi%te$ti%al-

A$a) %alidi'$at



A$a) %alidi'$at

• A%tibioti'a $i%teti' $e(erti ci(roo8aci%#

oo8aci%-• 4erti%da' de%&a% i%a'ti9a$i e%@i)# DNA

&yra$e ya%& (e%ti%& u%tu' re(li'a$i

)i'roor&a%i$)e-• Seri%& di&u%a'a% u%tu' or&a%i$)e ya%&re$i$te% (ada a%tibioti'a-

A)(icili%



A)(icili%

• A%tibioti'a ya%& da(at )e%&obati ba%ya'

)aca) i%6e'$i ter)a$u' di uri%ari#re$(iratory da% $alur i%te$ti%al-

• Di i%a'ti9a$i oleh (e%icilli%a$e da% tida'

boleh di&u%a'a% (ada )i'roor&a%i$)e ya%&bi$a )e)(rodu'$i e%@i) i%i-

KOM!LIKASI DIARE



KOM!LIKASI DIARE

• Dehydratio% Dehydratio%?e8ce$$i9e lo$t o6 body uid?)o$t 6atal co%ditio%?)ore

da%&erou$ % co)o% i% childre% % i%6a%t$-

Di)i%i$hed uri%e out(ut

'id%ey 6ailure#

"o%6u$io%

*aea& !n3nt!nene4 Failure o6 9olu%tary co%trol o6 the a%al%ph!nter%# +ith i%9olu%tary (a$$a&e o6 5ee% a%d 6at'%

Ma&n'tr!t!3n

A!3%!%



A!3%!%

E&etr3&yte% $!nera&% a&%3 are &3%t 7!th 7ater7hen !arrhea !% pr3&3nge 3r %e8ere, an

$!nera& 3r e&etr3&yte e9!en!e% $ay 3'r:The $3%t 3$$3n e9!en!e% 3'r 7!th%3!'$ an p3ta%%!'$

.yp3$agne%e$!a4 S';n3r$a& ;&33 %er'$

3nentrat!3n 35 $agne%!'$< $ay a'%e3n8'&%!3n% an 3n'rrent hyp3a&e$!a

-hyp3$g a5ter pr3&3nge !arrhea an a'%etetany

.yp383&e$! %h3k

.yp3ka&e$!a

.yp3a&e$!

(ar!a y%rhyth$!a% 'e t3 hyp3ka&e$!a an

h!p3ka&%e$!

!ROBNOSIS DIARE



!ROBNOSIS DIARE

• De%&a% (e%&&a%tia% caira% ya%& ade'uat#

(era+ata% ya%& )e%du'u%&# da% tera(ia%ti)i'robial =i'a dii%di'a$i'a%# (ro&%o$i$diare i%6e'$iu$ ha$il%ya $a%&at bai' de%&a%)orbidita$ da% )ortalita$ ya%& )i%i)al-

!EN"EBAAN DIARE



!EN"EBAAN DIARE

• 4rea$t6eedi%&

• I)(ro9ed 6eedi%& (ractice$

• U$e o6 $a6e +ater

• a%d+a$hi%&

• Food $a6ety

• U$e o6 latri%e$ a%d $a6e di$(o$al o6 $tool$

• Mea$le$ i))u%i@atio%

KESIM!ULAN



KESIM!ULAN

A%a' D )e%&ala)i !cute bloody diarrhea

a'ibat i%6e'$i Shigella da% berada dala)'eadaa% dehidra$i ri%&a%?$eda%&-



TERIMA KASI

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