Gastroenteritis Ppt Cha Dengan Diare

7/29/2019 Gastroenteritis Ppt Cha Dengan Diare

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GASTROENTERITIS

created by: Elizabeth Margaretha


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GASTROENTERITIS

An infection or inflammation

of the digestive tract,

particularly the stomach andintestines

It is frequently referred to as

the stomach or intestinal flu



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CAUSES

Viruses such as

caliciviruses, rotaviruses,

astroviruses andadenoviruses.



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CAUSES

Bacteria such as

the Campylobacterbacterium



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CAUSES

Parasites such

as Entamoeba histolytica,

Giardialamblia and Cryptosporidium



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CAUSES Bacterial toxins poisonous by-

products caused by bacteria can

contaminate food

-Some strains of staphylococcal

bacteria produce toxins that can

cause gastroenteritis



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Epidemiology

Food borne botulism

Commercial sterilization Toxin destroyed by heating foods

Wound botulism

deep crushing wounds

Infant botulism

Inhalation or ingestion of spores Commonly associated with honey

or juices
http://blogs.wyomingnews.com/blogs/everyonegives/files/2009/01/canned-food.jpg


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CAUSES

Chemicals lead

poisoning, for example,

can trigger gastroenteritis



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CAUSES

Drugs certain drugs,

such as antibiotics, can

cause gastroenteritis insusceptible people and

can irritate the digestive

tract



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INFECTIOUS GASTROENTERITIS

Escherichia coli infection

this is a common

problem for travelers

to countries with poorsanitation. Infection is

caused by drinking

contaminated water

or eating

contaminated raw

fruits and vegetables.

Campylobacter infection

the bacteria are found in

animal feces. Infection is

caused by, for example,consuming contaminated

food or water, eating

undercooked meat

(especially chicken), and

not washing your hands

after handling infected

animals.



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Cryptosporidium infection

parasites are found in the

bowels of humans and

animals. Infection is caused

by, for example, swimming ina contaminated pool and

accidentally swallowing

water, or through contact with

infected animals. An infectedperson may spread the

parasites to food or surfaces

if they dont wash their hands

after going to the toilet..

Giardiasis

parasite infection of the

bowel. Infection is caused

by, for example, drinking

contaminated water,handling infected animals

or changing the nappy of

an infected baby and not

washing your handsafterwards.



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Salmonellosis

Bacteria are found in

animal feces. Infection is

caused by eatingcontaminated food or

handling infected animals.

An infected person may

also spread the bacteria to

other people or surfaces by

not washing their hands

properly.

Shigellosis

bacteria are found in

feces. An infected

person may spreadthe bacteria to food or

surfaces if they dont

wash their hands after

going to the toilet.



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Cholera

Causative agent: Vibrio cholerae

High infectious dose

Bacteria sensitive to stomach acid

Adheres to small intestine and multiply

Bacteria dont enter cells


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Viral Gastroenteritis

viruses are found in human

feces. Infection is causedby person-to-person

contact such as touching

contaminated hands, feces

or vomit, or by drinkingcontaminated water or food.



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Viral Gastroenteritis

Common causative agents: Rotaviruses and Noroviruses

Both naked RNA viruses

Star-like Noroviruses

Wheel -like Rotaviruses


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Epidemology

Infect intestinal cells causing cell death

Typically self-limiting

Norovirus epidemics cause 90% ofcases

Rotaviruses responsible for 50% infant

cases of serious diarrhea

600,000 worldwide annual fatalities Oral vaccine available


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Cholera toxin

Potent exotoxin

Causes intestinal cells

to rapidly pump out

electrolytes

Passive osmotic H2Oloss follows

Metabolic acidosis

Shock


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Heavy loss of fluid

rice-water stool Up to 20L of fluids lost per day

May discharge 1 million bacteria per ml of feces

Untreated cases potentially fatal

Fluid/electrolyte replacement

Tetracycline reduces toxin production


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Shigellosis Causative Agent: Shigella sp.

S. dysenteriae, S. flexneri, S. boydii, S. sonnei

Low infecting dose

Bacteria not sensitive to stomach acid

Characterized by fever and dysentery


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Infects cells of large intestine and

initiates intense inflammatoryresponse

Dead cells slough off

Produces areas covered with

pus and blood


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All species produce enterotoxin and type III

secretion systems

S. dysenteriae produces powerful endotoxin

shiga-toxin Ciprofloxacin, rifampin or azithromycin may reduce

duration and infectivity


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Salmonellosis and Typhoid Fever

Causative agent: Salmonella enterica 2000 strains (serotypes)

Typhimurium and Enteritidis commonly cause

Salmonellosis

Typhi and Paratyphicause Typhoid Fever


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Common intestinalflora of many animals

Contaminated animal

products are reservoir

Reptiles, eggs and

undercooked

poultry


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Virulent strains tolerate stomach

acid and pass to intestines

Toxin induces phagocytosis in

intestinal cells

Pathogen reproduces inside

phagosome killing host cell

Bacteria (Typhi) may pass

through intestinal cells intobloodstream


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Typhoid fever is an

enteric fever Macrophages carry

bacteria to liver, spleen,

bone marrow and

gallbladder

Treated with ciprofloxacinor ampicillin

Surgical removal of

gallbladder


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High risk groups

Young age groups

Immune deficient individuals

Measles

Malnutrition Travel to endemic areas

Lack of breast feeding

Exposure to unsanitary conditions

Attendance to child care centers

Poor maternal education


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SYMPTOMS

Loss of Appetite

Bloating



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SYMPTOMS

Nausea and Vomiting

Diarrhea



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SYMPTOMS

Abdominal Pain and

Cramps Body Aches



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SYMPTOMS

Bloody stools (in some

cases)

Pus in the stools (in some

cases)



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SYMPTOMS Lethargy

These symptoms are

sometimes alsoaccompanied by Fever and

Weakness



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COMPLICATION The greatest danger presented by

gastroenteritis is dehydration. The loss of

fluids through diarrhea and vomiting can

upset the body's electrolyte balance, leadingto potentially life-threatening problems such

as heart beat abnormalities (arrhythmia)

The risk of dehydration increases as

symptoms are prolonged. Dehydrationshould be suspected if a dry mouth,

increased or excessive thirst, or scanty

urination is experienced created by: Elizabeth Margaretha


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COMPLICATION If symptoms do not resolve within a

week, an infection or disorder more

serious than gastroenteritis may be

involved. Symptoms of great concerninclude a high fever (102 F [38.9 C] or

above), blood or mucus in the diarrhea,

blood in the vomit, and severe

abdominal pain or swelling. Thesesymptoms require prompt medical

attention.



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DIAGNOSIS The symptoms of

gastroenteritis are usually

enough to identify the

illness

It is important to establish

the cause, as different

types of gastroenteritis

respond to different

treatments. Diagnostic

methods may include:

- Medical history

- Physical

examination

General appearance

Hydration Status

Mild

Moderate

severe

Systemic Examination

Extraintestinal

manifestations

- Blood tests

- Stool tests



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General approach

Clinical assessment:Historical points : Diarrhea :

duration & severity

Stool consistency

Mucous & blood

Associated symptoms : GI

Fever

Neurological Symptoms

Others

Risk factors

Social & family History

Dehydration


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created by: Katherine L. Laud, SN

No dehydration Some dehydration Severe

dehydration

Condition Well, alert Restless, irritable Lethargic orunconscious

Eyes Normal Sunken Sunken

Thirst Drinks normally, not

thirsty

Thirsty, drinks

eagerly

Drinks poorly, or

not able to drink

Skin pinch Goes back quickly Goes back slowly Goes back very

slowly

Treatment Plan A Plan B Plan C

Fluid deficit < 5% of body wt or 10% of body wtor > 100 ml/kg of

body wt

Dehydration


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TREATMENTTreatment depends on the cause

but may include:

Plenty of fluids and Right Diet

Oral rehydration drinks,

available from your chemist

Admission to hospital and

intravenous fluid replacement,

in severe cases



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TREATMENT Antibiotics, if bacteria are the cause

Drugs to kill the parasites, if

parasites are the cause

Avoiding anti-vomiting or anti-

diarrhea drugs unless prescribed or

recommended by your doctor,

because these medications willkeep the infection inside your body



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Specific therapy

Anti-microbial therapy : Indications are organism-dependant.

Salmonella : Infants< 3months, typhoid

fever, bacteremia , disseminated disease

with local suppuration. Shigella : all cases

Vibrio cholera : all cases

Aeromonas: dysentery like, prolonged

diarrhea.

C. difficile: moderate to severe disease.

E.coli.

Anti diarrheal agents


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Antibiotics / drugs :

Shigelosis (WHO) : Kotrimoksazol

(trimetoprim dan sulfametoksazol)Alternatif : Ampisilin, Cefixime, Ceftriaxone,

Asam nalidiksat.

Amoeba : metronidazole

Salmonella : ciprofloxacin, ampisillin,cloramfenicol, ceftriaxon

Alternatif : fluoroquinolon, cephalosporine

Cholera : trimethoprim, sulfametoxazole,

tetrasiklin Campylobacter : gentamisin, furazolidone,

doxicycline dan cloramfenicol.

Viral : antiviral ex acyclovircreated by: Elizabeth Margaretha


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BACTERIAL FOOD INTOXICATION

Treatment

Antitoxin

Gastric washing and surgical removal of tissues

Artificial respiration may be required

Anti-microbials given to kill bacteria in infant and wound

botulism

Prevention

Proper sterilization and sealing of canned food

No honey or unpasteurized juices for infants!!


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PREVENTIONGeneral suggestions on how to reduce the risk of

gastroenteritis include:

Wash hands thoroughly with soap and

water after going to the toilet or changingnappies, after smoking, after using a

handkerchief or tissue, or after handling

animals

Wash your hands thoroughly with soap

and water before preparing food or eating



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PREVENTION Use disposable paper towels to dry

your hands rather than cloth towels,

since the bacteria can survive for

some time on objects

Keep cold food cold (below 5C) and

hot foot hot (above 60C) to

discourage the growth of bacteria Make sure foods are thoroughly

cookedcreated by: Elizabeth Margaretha


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PREVENTION Clean the toilet and bathroom

regularly, especially the toilet seat,

door handles and taps

When travelling overseas to countries

where sanitation is suspect, only drink

bottled water. Dont forget to brush

your teeth in bottled water too. Avoidfood buffets, uncooked foods or peeled

fruits and vegetables, and ice in drinkscreated by: Elizabeth Margaretha


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PROGNOSIS Gastroenteritis is usually resolved

within 2 to 3 days and there are no

long-term effects. If dehydration

occurs, recovery is extended by afew days



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DISEASE PROCESS



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CLINICAL FEATURES OF

GASTROENTERITIS



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THANK YOU!!!

By: Elizabeth Margaretha

coass IPD. Periode 1 juli 7 sept

2013.


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DIARE


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PENDAHULUAN

Diare adalah BAB cair atau setengah cair,

kandungan air tinja > normal (> 200 gr, >

200 cc/24 jam).Atau: BAB encer > 3x

sehari

Diare akut: < 15 hari

Diare infektif: penyebabnya infeksi,

sebaliknya disebut diare non infektif

Diare organik: penyebabnya kelainan

anatomik, bakteriologik, hormonal atautoksikologik; sebaliknya disebut diare

fungsional


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KLASIFIKASI

1. LAMA DAN WAKTU DIARE: AKUT -

KRONIK

2. MEKANISME PATOFISIOLOGIK:

OSMOTIK - SEKRETORIK

3. BERAT - RINGAN

4. INFEKTIF NON INFEKTIF

5. ORGANIK - FUNGSIONAL


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ETIOLOGI

A. INFEKSI

1. ENTERAL

2. PARENTERAL

B. MAKANAN

C. IMUNODEFISIENSI:hipogamaglobulinemia, penyakitgranulomatosa kronik, def IgA dll

D. TERAPI OBAT: antibiotik, kemoterapi,

antasidE. TINDAKAN TERTENTU: gastrektomi,

radiasi

F. LAIN-LAIN: sindroma Zollinger Ellison,neuropati autonomik

ETIOLOGI DIARE AKUT DI RS PERSAHABATAN JAKARTA


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ETIOLOGI DIARE AKUT DI RS.PERSAHABATAN JAKARTA

ETIOLOGI FREKUENSI

E.coli 38,29%

Vibrio cholerae Ogawa 18,29%

Aeromonas sp 14,29%

Shigella flexneri 6,29%

Salmonella sp 5,71%

Entamoeba histolytica 5,14%

Ascaris lumbricoides 3,43%

Rotavirus 2,86%

Candida sp 1,71%

Vibrio NAG 1,14%

Trichuris trichiura 1,14%

Plesiomonas shigelloides 0,57%

Ancylostoma duodenalis 0,57%

Blastocystis hominis 0,57%


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INFEKSI

1. ENTERAL

Bakteri: Shigella, Salmonella, E coli

Virus: rotavirus, adenovirus, CMV,HIV

Parasit (protozoa): E histolytica, Glamblia

Worm: A lumbricoides, T trichiura

Fungus: candida, monilia

2. PARENTERAL: OMA, pneumonia, E.coli3. Travelers diarrhea: E coli, G lamblia,

Shigella, E histolytica


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MAKANAN

Intoksikasi makanan: makanan beracun atau

mengandung logam berat, makanan

mengandung bakteri/toksin: C perfringens, S

aureus dll Alergi makanan: susu sapi, makanan tertentu

Malabsorbsi/maldigesti:

Karbohidrat: monosakarida (laktosa),

disakarida (sakarosa) Protein: asam amino tertentu, celiac spure

Lemak: rantai panjang trigliserida


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KELOMPOK RESIKO TINGGI

1. Baru bepergian/melancong

2. Makanan atau keadaan makan yangtidak biasa

3. Homoseksual, pekerja seks, pengguna

obat intravena, risiko infeksi HIV4. Baru saja menggunakan obat

antimikroba pada institusi: institusikejiwaan/mental, rumah perawatan,rumah sakit

PATOFISIOLOGI


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PATOFISIOLOGIDiare dapat disebabkan 1/ lebih keadaan

berikut:

1. Diare Osmotik: osmotik isi lumen usus2. Diare Sekretorik: sekresi cairan usus3. Malabsorbsi (asam empedu dan lemak):

gangguan pembentukan micelle

empedu4. Defek sistem pertukaran anion/transportelektrolit aktif di enterosit gangguanabsorbsi Na+ dan air

5. Motilitas dan waktu transit ususabnormal

6. Gangguan permeabilitas usus7. Inflamasi dinding usus: diare

inflamatorik8. Infeksi dinding usus: diare infeksi


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PATOGENESIS DIARE INFEKSI

1. DIARE ENTEROTOKSIGENIK: karenabakteri non invasif seperti: V cholerae Eltor,ETEC (Enterotoxigenic E coli), Cperfringens. Toksin pada mukosa sekresiaktif anion klorida diikuti oleh air, ionbikarbonat, kation natrium dan kalium

2. DIARE ENTEROVASIF: EIEC (EnteroinvasifE coli), Salmonella, Shigella, Yersinia.Kerusakan dinding usus nekrosis danulserasi diare sekretorik eksudatif, tinjadapat bercampur lendir- darah

Umumnya patogen usus halus tidak invasif,sebaliknya patogen ileokolon mengarah keinvasif


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DIARE ENTEROTOKSIGENIK: (Non invasif )

Toksin pada mukosa sekresi aktif anion kloridadiikuti oleh air, ion bikarbonat, kation natrium dankalium

KLINIS: TANPA DEMAM, TANPA DARAH

tinja air banyak, tidak ada leukosit di tinja, sering

disertai nausea, sering pada diare turis (85%),


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Patogen: bakteri non invasif sepertiETEC (penyebab tersering diare turis),G lamblia, rotavirus, V cholera, jamur

kolera: tinja seperti cucian beras,

disertai muntah Sebab lain: bahan toksik pada

makanan (logam berat misalnyapreservatif kaleng, nitrit, pestisida,histamin pada ikan)

Diagnosis: pemeriksaan tinja: tidak adaleukosit di tinja


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DIARE ENTEROVASIF:

EIEC (Enteroinvasif E coli), Salmonella, Shigella,

Yersinia. Kerusakan dinding usus nekrosis dan

ulserasi diare sekretorik eksudatif, tinja dapatbercampur lendir- darah

KLINIS ADA DEMAM DAN TINJA BERDARAH

Disebabkan oleh mo invasif, sering di kolon, diare

berdarah, sering tapi volume sedikit, sering diawali

diare air


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Shigela spp, Campylobacter jejuni,Salmonella spp, Kultur tinja untuk

Salmonella, Shigella, Campylobacter,

Yersinia

Diferensiasi klinik sulit, terutamamembedakan dengan penyakit usus

inflamatorik idiopatik non infeksi

Banyak leukosit di tinja (patogen infasif)


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DEHIDRASI

DERAJAT DEHIDRASI DITENTUKAN BERDASARKAN :

1. KEADAAN KLINIS1. Dehidrasi ringan: kehilangan cairan 2-5% BB. Turgor

kurang, suara serak, (vox choleroca), belum presyok

2. Dehidrasi sedang: kehilangan cairan 5-8% BB. Turgor

buruk, suara serak, presyok/syok: nadi cepat, napas cepatdalam

3. Dehidrasi berat: kehilangan cairan 8-10% BB. Tandadehidrasi sedang ditambah kesadaran menurun, ototkaku, sianosis

2. BERDASARKAN BERAT JENIS PLASMA

3. BERDASARKAN PENGUKURAN (CVP)

Central Venous Pressure (CVP < +4 CM H20)


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DIAGNOSIS

ANAMNESIS: jenis diare

PEMERIKSAAN FISIK: bunyi usus, distensi abdomen,

nyeri tekan

PEMERIKSAAN PENUNJANG

Lab: darah tepi, elektrolit, ureum kreatinin,

pemeriksaan tinja, pemeriksaan giardiasis ELISA,

serologi amuba

Foto abdomen

Rektoskopi/sigmoidoskopi: atas indikasi (diare

berdarah)


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PENATALAKSANAAN

1. REHIDRASI: oral, NGT, IV2. DIET

- Tidak puasa

- Minuman yang tidak mengandung gas

- Hindari kafein dan alkohol (motilitas)

-Makanan yang mudah dicerna

- Hindari susu sapi karena def laktase transienpada diare

3. OBAT ANTI DIARE Antimotilitas: loperamid

Pengeras tinja: atapulgite (4x2 tab/hari)4. OBAT ANTIMIKROBA.

Pengobatan empirik tidak dianjurkan padakasus ringan, virus, atau bakteri non invasif


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REHIDRASI

JUMLAH CAIRAN: PEMBERIAN CAIRAN:

1. BJ PLASMA 1. Tahap 1 : Rehidrasi inisial (2jam)

1. METODE PIERCE sebanyak total kebutuhan cairan

Ringan: 5% BB (kg) 2. Tahap 2 (1 jam) tergantungkehilangan

Sedang: 8% BB (kg) cairan dalam tahap 1

Berat: 10% BB (kg) 3. Tahap 3 berdasarkan kehilangan

2. METODE DALDIYONO cairan melalui tinja berikutnya dan

IWL

JENIS CAIRAN: Oral: oralit, diberikan bila skor


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BJ PLASMA

- Klasifikasi berdasarkan BJ Plasma:

1. Berat : BJ 1,032-1,0402. Sedang : BJ 1,028 1,032

3. Ringan : BJ 1,025 1,028

Rumus kebutuhan cairan:

x Berat Badan x 4

ml

BJ PLASMA 1,025

0,001


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METODE DALDIYONO

KEBUTUHAN CAIRAN

SKOR

________ x 10% x Kg BB x 1

liter

15

SKOR DEHIDRASI


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SKOR DEHIDRASI

Klinis Skor Klinis Skor

Rasa

haus/muntah

1 Facies cholerica 2

TD sistolik 60-

90 mmHg

1 Vox cholerica 2

TD sistolik < 60

mmHg

2 Turgor kulit

menurun

1

Frekuensi nadi

> 120/mnt

1 Washer

womans hand

1

Kesadaran apati 1 Ekstremitas

dingin

1

Somnolen,

sopor, koma

2 Sianosis 2

Frek napas >

30/mnt

1 Usia 50-60

tahun

1

Usia > 60 tahun 2

OBAT ANTIMIKROBA


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OBAT ANTIMIKROBA

PENYEBAB TERAPI

Shigelosis Siprofloksasin 2 x 500 mg 3 hari

S (para) typhi Siprofloksasin 2 x 500 mg 10 hari,

Amoksisilin 4x750 mg 14 hari

Campylobacter Eritromisin 4x250mg 5 hari

Disentri ameba Tinidazol 1 x 2 gram 3 hari

V cholerae Siprofloksasin 1 x 1 gram

Giardia lamblia Tinidazol 1 x 2 gram

Schistosoma Praziquantel 1 x 40 mg/kgBB

Strongiloides Albendazol 1 x 400 mg 3 hari

Isospora belli Kotrimoksazol 3 x 960mg 14 hari


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ALGORITME TATALAKSANAAnamneses

Lama,

Epidemiologi,

Bepergian,

Makanan, air

Karakteristi

k

Tinja, air,

berdarah

Nyeri

abdomen

Kolitia akut

Penyakit

usus/

inflamasi

Penyakit

lain,

Obat-obatan

PEMERIKSAANFISIKUmum,

Keseimbanga

n

Cairan,

suhu, nutrisi

Abdomen

Nyeri tekan

distensi

Pemeriksaa

n

Rektal,

Fecal occult

Blood test

PEMERIKSAAN

AWAL

Toksik

Penyakit berjalan terus

Darah di tinja

Dehidrasi

Nontoksik

Lama penyakit

Sebentar

Tidak berdarah

Tidak nyeri

tekan

Terapi simtomatik

Cairan rehidrasi oral

Obat antidiare

TIDAK RESPON RESPON


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Replesi cairan /

elektrolit

Evaluasi

laboratorium

Pemeriksaan darah

tepi lengkap

Hemokonsentrasi

Diferensial leukosit

Kimia darah

Elektrolit

Ureum

Kreatinin

Serologi

ameba

Pemeriksaan tinja

Pem telur & parasit

Antigen Giardia

Toksin clostridium

difficile

Leukosit tinja

Positif

Negatif

Kultur tinja

Sigmoidoskopi atau

Kolonoskopi denganBiopsi

Terapi antibiotik

empirik

Terapi spesifik


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THANK YOU!!!

By: Elizabeth Margaretha

coass IPD. Periode 1 juli 7 sept

2013

Documents

Gastroenteritis Ppt Cha Dengan Diare