essentiale gastrointes problem

8/7/2019 Essentiale Gastrointes Problem

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Kasus 1Kasus 1 Ada anak umur2 tahun dengan keluhan

diare selama 2 hari, sebelumnya ada panas

2 hari, sehari 6 x, lembek cair, disertaimuntah-muntah.

Ada tanda2 dehydrasi berupa mata cekung,tonus turgor jelek.

BB 10.000Kg. Panas 39C. Tonsil pharynxmerah.


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Pertanyaan

Pertanyaan

Apa yang anda pikirkan ?

Apa diagnosenya?

Apa tindakan anda sebagai dokter umum?

Apa pencegahannya?


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INTRODUCTIONINTRODUCTION DIARRHEA :

a. ACUTE DIARRHEA

b. CHRONIC DIARRHEA

OBSTIPATION

RECCURENT ABDOMINAL PAIN


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DIARRHEADIARRHEA DEFINITION :

* changes of the frequency and

consistency of the stool

* National Seminar on Rehydration III, 1983

semiliquidwatery stool

frequncy 3 5 times per day

SIGNS AND SYMPTOMS


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SIGN AND SYMPTOMSSIGN AND SYMPTOMS

AETIOLOGICAL

DIARRHEA & VOMITING

COMPLICATION


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ETIOLOGICAL FACTORETIOLOGICAL FACTOR

INFECTION:

a. parenteral

b. enteral DIETETIC

PSYCHOLOGICAL

CONSTITUTION


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COMPLICATION OF DIARRHEACOMPLICATION OF DIARRHEA

DEHYDRATION water & electrolyt

a. dehydration d. hypocalcemia

b. dehyd & acidosis e. meteorismc. hypokalemia f. shock syndrome

NUTRITION malnutrition

MUCOSAL INJURY macromoleculea. allergy migration

b. septichemia


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MANAGEMENT OFMANAGEMENT OF

DIARRHEADIARRHEA(John Biddulp)(John Biddulp)

Five Ds : DEHYDRATION

DIAGNOSE

DIETETICAL PROCEDURE

DRUGS DISACCHARIDASE DEFFICIENCY


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REHYDRATIONREHYDRATION

BODY FLUID RESTORATION

ORALLY IS FIRST PRIORITY :

* oralyte : early, household fluid* gentelly, small portion but frequently

INTRAVENOUSLY:

* direct into intravenous compartment* heavy deplesite, severe dehydration

or high fever

* impossible by orally (vomiting)


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REHY

DRATIONREHY

DRATION NO DEHYDRATION :

* ORAL REHYDRATION

* ORAL PROBLEM & HYPERTHERMIA

SOME DEHYDRATION :

* ORAL REHYDRATION

* ORAL PROBLEM & HYPERTHERMIA SEVERE DEHYDRATION :

ROSESYSTEM


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PEDIATRIC REH

YDRATION

PEDIATRIC REH

YDRATION::

TOTAL VOLUME OF PEDIATRICBODY FLUID IS RELATIVE HIGH

RATIO OF CIRCULATING ANDDEPOT OF BODY FLUID IS SMALL

RESPONS CAPACITY OF THE

ORGANS ARE STILL LOW


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TOTAL BODY WATERTOTAL BODY WATER

(value in % )

INFANT MALE FEMALE

THIN 80 65 55

AVERAG. 75 60 50

FAT 65 55 45


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INTRVENOUS REHYDRATIONINTRVENOUS REHYDRATION

REPLACEMENT OF :

* fluid deplesit circulation failure

* oxygen deplesit & glucose deplesit FAST REPLACEMENT:

* initial dose : 10 15 ml/kg/hr

* maintenance dose 125 200 ml/day


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PHYS

ICAL EXAM

INATION:P

HYS

ICAL EXAM

INATION: HYDRATION STATUS

NUTRITION STATUS

ABDOMINAL EXAMINATION :to different with surgical abdominal cases

ETIOLOGICAL ASPECT : - enteral

- parenteral

COMPLICATION ASPECT :* Etiolgical dissorders

* Secretoric and electrolyte imbalance

* Nutrition dispersal


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NUTRITION TREATM

ENTNUTRITION TREATM

ENT SUFFICIENT ONCALORY AND

PROTEIN

AVOIDMALABSORTIONSYNDROM

MALABSORPTIONDIAGNOSTIC


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MALABSORPTIONMALABSORPTION DIAGNOSIS :

* physical : meteoristic, excoriation

watery,voluminous,acid stool

* reduction test of stool PROGRESS CONDITION:

* mucosal injury

* microbial overgrowth* maldigestion

* allergy


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NUTRITION TREATM

ENTNUTRITION TREATM

ENT ACCEPTABILITY:

a. taste and vlafour

b. performance AVOIDMALABASORTION

formula composition for

* intolerance

* maldigestion* allergy


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CHRONIC DIARRHEA INCHRONIC DIARRHEA IN

CHILDRENCHILDREN


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Kasus ke

2Kasus ke

2 Anak umur 8 bulan datang dengan keluhan

diare selama 18 hari, lembek cair dan tak

ada darah, berbau. Perut sering kesakitan

Tak ada tanda2 dehydrasi

BB 5,500 kg dan panas 37.8C. Clini test positif


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INTRODUCTIONINTRODUCTION

MORE THAN 2 WEEKS

LEBENTHAL (1983) :

* prolonged small intestine mucosal injury

M.BABA (2001) :

* Osmotic * Secretory

* Intestinal transit * Exudative

INCIDENCE & MORTALITY :Problem for young infant with high risk :

* complication

* mortality rate


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MAJOR CAUSES OF CHRONIC DIARRHEA IMAJOR CAUSES OF CHRONIC DIARRHEA I

(Vanderhoof,1993)(Vanderhoof,1993)

INFANTS :* Intractable diarrhea of infancy

* Proctacted infectious enteritis

* Milk and soy intolerance* Autoimmune enteropathy

* Hirschprungs disease

TOODLERS :* Chronic nonspecific diarrhea

* Proctacted viral enteritis

* Giardiasis


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MAJOR CAUSES OF CHRONIC DIARRHEA IIMAJOR CAUSES OF CHRONIC DIARRHEA II

(Vanderhoof,1993)(Vanderhoof,1993)

* Ulcerative colitis

* Tumor secretory diarrhea

* Celiac disease

SCHOOL AGE CHILDREN :

* Inflamatory bowel disease

* Apendiceal abces

* Primary acquaired lactase deficiency

* Constipation with encopresis


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MECHANISM OF DYSBIOSISMECHANISM OF DYSBIOSIS


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RECURRENTRECURRENTABDOMINAL PAINABDOMINAL PAIN


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INTRODUCTIONINTRODUCTION

DEFINITION :

* AT LEAST 3 EPISODES IN 3 MONTHSPERIOD

* INTERFERES WITH NORMAL

CONDITION* SCHOOL AGE : 5 14 YEARS OF AGE

* LOCALIZED PERIUMBILLICAL PAINDUE TO BOWEL MUSCLE TENSION


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PATHOPHYSIOLOGYPATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGYPOORLYUNDERSTOOD

ISNOT SYNONYM WITH IMMAGINARYOF

CHILDEXPIRIENCEOF ABDOMINAL PAIN BOWEL MOTILITYDISTURBANCE

DISTENSIONORSPASM

INCREASEDMUSCLE TENSION PAINORIGINISNERVE ENDING IN

MUCUSA, MUSCLE ANDSEROSA


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FACTORS INFLUENCE ONFACTORS INFLUENCE ON

RECURRENT ABDOM

INALP

AINRECURRENT ABDOM

INALP

AIN

* LOWERED THRESHOLD OF PAIN

* ENVIROMENTAL INFLUENCESrespons of family members

* physically

* psychologically


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STUDIES ON FACTORS WHICHSTUDIES ON FACTORS WHICH

INFLUENCED REC.ABD.P

AININFLUENCED REC.ABD.P

AIN

Hodge et al (1984): significantly difference in life

stress experiences Greene et al (1985): significantly higher stress in

adolescens

Mc.Grath et al (1987)

:no significantly defferncein life stress


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essentiale gastrointes problem

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