GROUP 3 - Problem 2 B

Gastrointestinal system

Unfamiliar terms
Diarrhea is the frequent passing of
loose or watery stools

LO
Able to understand and explain the
things below :
1. Diarrhea
2. Dehydration

Mind Mapping

Dr. Daniel
Name

NIM

Sri Hartati

405080094

Agutinus Bayu B

405080154

Ray Leonard

405080203

Dimas Priyantono

405080205

Putu Reza

405090024

Jao Jessica

405090038

Widyasari

405090091

Riny Wahyuni

405090168

Franciska Luciana

405090176

Amanda Johanna

405090224

Stephanie

405090231

Melyda

405090242

ACUTE DIARRHEA

DEFINITION
Acute diarrhea is defined as an
abnormally frequent discharge of
semisolid or fluid fecal matter from
the bowel, lasting less than 14 days

Epidemiology

Epidemiology of acute diarrhea: developed versus

developing countries.

CLASSIFICATION
Time
Acute (=< 14 days)
Chronic (> 14 days)

Infectious causes

Pathophysiology
Mechanism

Infection
Non-Infection

Secretoric
Osmotic, etc

Organic causes

Severeness
Mild
Severe

Organic
Functional

Pathogenesis Diarrhea
Predisposition

Small Intestinal Dysfunction

Immune
Deficiency
Infection

6/19/16

Specific
Deficiencies e.g Zn

Diarrhea
Malnutrition
Pancreatic &
Gastric Dysfunction
10

6/19/16

11

EVALUATION of
ACUTE
DIARRHEA

FEATURES OF DIARRHEAL DISEASE

LOCATION OF INFECTION
FEATURES
Small Bowel

Large Bowel

Pathogens

V. cholerae
ETEC, EPEC, EAggEC
Rotavirus
Norwalk virus
Giardia

Shigella
EIEC, EHEC
Campylobacter
E.histolytica

Location of
pain

Midabdomen

Lower abdomen, rectum

Type of stool

Watery

Mucoid and/or bloody

Volume of
stool

Large

Small

Frequency

Increased

Highly increased

FEATURES OF DIARRHEAL DISEASE

LOCATION OF INFECTION
FEATURES
Small Bowel

Large Bowel

pH

Possibly <5.5

>5.5

Reducing substances

Possibly positive

Negative

WBCs in stool

<5/high power field

Commonly >10/high
power field

Serum WBCs

Normal

Possible leukocytosis

Normal

Mucosal ulcers;
hemorhage; friable
mucos

Protoscopy

Clinical manifestations and

diagnosis

Episodes of diarrhea can be

classified into three categories

Clinical manifestations and

diagnosis

Linking the main symptoms to the causes of acute diarrhea.

EHEC, enterohemorrhagic Escherichia coli.

Clinical features of infection with

selected diarrheal pathogens

Risk Factors
Major
Environmental contamination
Increased to exposure to enteropathogens
Additional
Young age
Immune deficiency
Measles
Malnutrition
Micronutrient deficiency
Lack of exclusive or predominant breastfeeding

Complication

Dehydration
Malnutrition
Micronutrient deficiencies
Secondary infections

TREATMENT
Rehydration
Supplemental zinc therapy,
multivitamins, and minerals
Diet
Nonspecific antidiarrheal treatment
Antimicrobials
Prevention

Types of E.coli :
5 types of E. coli have been
recognized as pathogens in the
intestinal tract.
Each causes diarrhea by different
mechanism, involving a distinct set
of virulence factors and genetic
elements.

1. Enteropathogenic E. coli (EPEC)

attach to the intestinal mucosa, causing diarrhea in
children and adults.
The precise mechanism of fluid and electrolyte loss is
still somewhat controversial.
Conventional toxins or invasive mechanisms have not
been identified.
Subtle changes in the microvillus surface have been
noted in association with attached EPEC, and this
damage may cause diarrhea.

2. Enterotoxigenic E. coli (ETEC)

cause diarrhea by elaboration of two toxins :
a heat-labile toxin (LT), which resembles cholera toxin
a heat-stable toxin (ST).

3. Enteroinvasive E. coli (EIEC)

produce dysentery and a clinical picture that is
indistinguishable from that of Shigella.

4. Enterohemorrhagic E. coli (EHEC) (E.coli

0157:H7)
causes a severe colitis with the passage of grossly bloody
stools.
These organisms produce a Shiga-like toxin that damages
the large bowel mucosa.
Besides diarrheal disease this organism may also cause the
hemolytic-uremic syndrome (HUS).

5. Enteroaggretative (EaggEC)
causes disease by attachment of the organism to the small
intestine and subsequent damage to the mucosal lining.

Bacterial infection

Parasit infection

Fungal infection
Candida sp
C. albicans is most common cause of Candida enteritis
Characterized by watery diarrhea and abdominal pain.
Predisposing factors :prolonged antibiotic or
immunosuppressive therapy yeast forms are
ubiquitous and occur in fecal flora of normal persons, their
presence alone is not diagnostic.
Definitive diagnosis requires demonstration of intestinal
mucosal invasion by Candida on biopsy or isolation of
Candida from ulcerative lesions.

Candida albicans
Usually infected :
premature infants
those who consume antibiotics & corticosteroid in
long term
malnutrition
diabetes melitus.

Commonly infects neonatus dan early infancy

Symptoms :
diarrhea, oral trush, onikia, paronokia, dermatitis

Laboratory finding :
(+) if yeasts & micellium are found

Therapy :
Nistatin, Amfoterisin B, Fatty acid resin complex

CHRONIC DIARRHEA

CHRONIC DIARRHEA
Chronic diarrhea is defined as loose
stools that last for at least four
weeks
A wide range of problems can cause
chronic diarrhea; some of the most
common causes include irritable
bowel syndrome, inflammatory bowel
disease (Crohn's disease and
ulcerative colitis), malabsorption
syndromes, and chronic infections.

DIAGNOSIS of
CHRONIC
DIARRHEA

DEHYDRATION

Dehydration
The body needs the correct amount of
water and electrolytes (salts) to function
properly.
Diarrhea causes excess loss of fluids and
essential electrolytes from the body. When
fluid lost in the stools is not replaced,
diarrhea can lead to dehydration
(abnormally low water content in the
body).
Dehydration can be a life-threatening
complication of diarrhea for some
individuals, especially infants, small
children and elderly people

PATHOPHYSIOLOGY

Levels of dehydration in children

with acute diarrhea

Complications

Kidney failure
Coma
Shock
Heat-related illnesses & associated complications
Electrolyte abnormalities

In dehydration, electrolyte abnormalities may occur since

important chemicals (like sodium and potassium) are lost
from the body through sweat.
If rehydration is done too slowly :
--> hypotensive & in shock for too long
If done too quickly :
--> water and electrolyte concentrations within organ cells
can be negatively affected --> causing cells to swell --> die.

Treatment of
Dehydration

Conclusion
Probably this child is suffered by
acute diarrhea + moderate
dehydration

Suggestion
Further testing is required to find the
appropriate therapy

REFERENCES
Price, Sylvia A., Wilson, Lorraine M.
Patofisiologi vol 1. Ed 6. Jakarta :
EGC, 2006.
Fauci, Braunwald, Kasper, dkk.
Harrisons Principles of Internal
Medicine vol II. Ed 17.United Stated :
mcGraw-Hills, 2008.
Sherwood, Lauralee. Physiology from
Cells to Systems. Ed 6. United Stated
: Thomson Higher Education, 2007.

 William wh,Myron jl, Judith ms,dkk.

Current Diagnosis And Treatment in
Pediatrics 18 th ed. New York: Lange
Medical Books; 2007.
Fauci, Braunwald, Kasper, dkk.
Harrison Principal Internal Medicine
17th ed. New York : Mc Graw Hill;
2008.