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PENGERTIAN DIARE
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ETIOLOGI DIARE
1.
Faktor infeksi
a. Infeksi enteral infeksi pada
GIT
(penyebab utama)
Bakteri : Vibrio cholerae, Salmonella spp, E.
coli dll
Virus : Rotavirus (40-60%), Coronavirus,
Calcivirus dll
Parasit: Cacing (Ascaris, Oxyuris,dll),
Protozoa (Entamoba histolica,Giardia
Lambia, dll) Jamur (Candida Albicans)
b. Infeksi parenteral infeksi di
luar GIT
(otitis media akut, bronkopneumonia,
Ensefalitis,dll)
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ETIOLOGI DIARE
2.
3.
4.
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PATOFISIOLOGI
PATOFISIOLOGI
BAKTERI NON INFASIF
(Vibrio cholerae, E. coli patogen) masuk
lambung duodenum berkembang biak
mengeluarkan enzim mucinase (mencairkan
lap lendir) bakteri masuk ke membran
mengeluarkan subunit A & B
mengeluarkan (cAMP) menstimulasi
sekresi cairan usus, menghambat absobsi
tanpa menimbulkan kerusakan sel epitel
tersebut volume usus dinding usus
teregang DIARE
7
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PATOFISIOLOGI
BAKTERI INFASIF
BERDASARKAN PATOFISIOLOGI
Diare osmotik : diare akibat adanya
bahan yang tidak dapat diabsorbsi oleh
lumen usus hiperosmoler
hiperperistalsis
Diare sekretorik : terjadi akibat
stimulasi primer dari enterotoksin atau
oleh neoplasma
Diare akibat gangguan motilitas usus :
gangguan pada kontrol otonomik
9
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KOMPLIKASI
Kehilangan air dan elektrolit
Dehidrasi, Hipokalemia, Asidosis
metabolik, Kejang, Alkalosis
metabolik
Gangguan sirkulasi darah Syok
hipovolemik
Gangguan gizi Hipoglikemia,
Malnutrisi energi protein, Intolerasi
laktosa sekunder
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10
MANAGEMENT DIARE
bismuth salts
11
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MANAGEMENT
Rehidrasi
DIARE PERSISTEN
Loperamide
Diphenoxylate / atropine
Tincture of opium
Octreotide
12
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DIARE AKUT
INFLAMMATORY
Demam dan
perdarahan, terdapat
kerusakan kolon
sekunder
Penyebab : Shigella,
Salmonella, Amebiasis,
C.diff, E coli toxin,
Ischemia,, Crohns,
Cytomegalovirus
Non-INFLAMMATORY
Volume cairan normal,
volume >1L/ 24 jam ,
akibat adanya penyakit
pada usus
Penyebab : Rota virus,
entrotoxins seperti
Giardia, Staph aureus,
Cholera, E coli, Bile
acid, Laxatives,
Malabsorpi
13
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MANAGEMENT
Inflammatory
Hindarkan obat-obat
antidiare
Kondisi menengah sampai
berat ; terapi dengan
antibiotik : Ciprofloxacin,
TMP-sulfametoksazol,
Erythromycin
Obati penyebab penyakit :
C diff, Amebiasis, Enteric
fever, Shigella,
Non-inflammatory
Rehidrasi merupakan
faktor terpenting
Beri loperamid,
Anticholinergic
dikontraindikasikan
pada megakolon
Obati penyebab
penyakit : Cholera,
Giardiasis, Travelers
diarrhea
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14
FARMAKOTERAPI
15
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PENGOBATAN DIARE
Tujuan
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PENGOBATAN DIARE
Terapi suportif
Resiko akibat diare adalah dehidrasi dan
ketidakseimbangan elektrolit
Terapi pengganti cairan dan elektrolit secara
oral
17
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TREATMENT OF DIARRHEA
Cairan untuk rehidrasi
Oral atau parenteral
Cairan yang mengandung garam atau
elektrolit .
Oral rehydration therapy
Dimulai sesegera mungkin saat onset
diare.
18
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ANTIBIOTICS
19
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OPIOIDS
Obat
Agonis
Bersifat
motility
Efektif
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OPIOIDS
Codeine
Opioid
21
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OPIOIDS
22
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23
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24
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EFEK SAMPING
Tinnitus.
25
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26
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OCTREOTIDE
27
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BULK-FORMING DAN
HYGROSCOPIC AGENTS
28
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29
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KONSTIPASI
30
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PATOFISIOLOGI
31
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PENYEBAB
Congenital.
Asupan serat dan cairan yang tidak adekuat
Mengabaikan keinginan defekasi .
Obat dan toksin.
Kondisi Neurogenic, metabolic dan endokrin
Abnormalitas struktural pada GIT.
32
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TUJUAN TERAPI
Meningkatkan kandungan air pada feses
Meningkatkan motilitas usus
33
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TERAPI
Laxatives
Enema
34
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35
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LAKSATIF
36
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LAKSATIF
Konstipasi
Digunakan
Untuk
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KONTRAINDIKASI
Obstruksi
38
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39
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LAXATIVES
Mekanisme
Bulk
40
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LAXATIVES
Mekanisme kerja
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42
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EFEK SAMPING
Reaksi alergi .
Obstruksi usus
43
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44
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KALSIUM POLIKARBOFIL
45
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46
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LAKSATIF GARAM
47
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LAKSATIF GARAM
Jangan
Berasa
pahit.
Menyebabkan
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sorbitol, mannitol.
Karbohidrat
Resistant
to digestion.
Relatively
safe.
49
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50
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LACTULOSE
51
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POLYETHYLENE GLYCOL
(PEG)-ELECTROLYTE
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STIMULANT LAXATIVES
Menstimulasi peristaltk.
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53
STIMULANT LAXATIVES
Diphenylmethane derivatives
(phenolphthalein and bisacodyl).
Phenolpthalein-potential carcinogen.
54
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BISACODYL
Tablet salut enterik dan supositoria.
Untuk aktivasinya butuh hidrolisis sehingga
harus diminum sekuarngnya 6 jam
Jangan digunakan lebih dari 10 hari
Overdosis : dapat menyebabkan gangguan
keseimbangan elektrolit .
55
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STIMULANT LAXATIVES
56
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