• Diare adalah buang air besar (defekasi) dengan jumlah tinja yang lebih
banyak dari biasanya (normal 100 - 200 ml per jam tinja), dengan tinja
berbentuk cairan atau setengah cair (setengah padat), dapat pula disertai
frekuensi defekasi yang meningkat (Mansjoer, Arif., et all. 1999).
• Diare adalah buang air besar encer atau cair lebih dari tiga kali sehari ( WHO,
1980),
PATOFISIOLOGI
Penularan gastroenteritis bisa melalui fekal-oral dari satu klien ke klien yang
lainnya. Beberapa kasus ditemui penyebaran patogen dikarenakan makanan dan
minuman yang terkontaminasi.
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metabolik dan hipokalemia), gangguan gizi (intake kurang, output berlebih),
hipoglikemia dan gangguan sirkulasi darah.
GEJALA KLINIS
a. Diare.
b. Muntah.
c. Demam.
d. Nyeri abdomen
f. Fontanel cekung
KOMPLIKASI
a. Dehidrasi
b. Renjatan hipovolemik
c. Kejang
d. Bakterimia
e. Mal nutrisi
f. Hipoglikemia
a. Dehidrasi Ringan
Kehilangan cairan 2 – 5 % dari berat badan dengan gambaran klinik turgor kulit
kurang elastis, suara serak, klien belum jatuh pada keadaan syok.
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b. Dehidrasi Sedang
Kehilangan cairan 5 – 8 % dari berat badan dengan gambaran klinik turgor kulit
jelek, suara serak, presyok nadi cepat dan dalam.
c. Dehidrasi Berat
Kehilangan cairan 8 - 10 % dari berat badan dengan gambaran klinik seperti tanda-
tanda dehidrasi sedang ditambah dengan kesadaran menurun, apatis sampai koma,
otot-otot kaku sampai sianosis.
PENATALAKSANAAN MEDIS
a. Pemberian cairan.
b. Diatetik : pemberian makanan dan minuman khusus pada klien dengan tujuan
penyembuhan dan menjaga kesehatan adapun hal yang perlu diperhatikan :
• Memberikan asi.
• Memberikan bahan makanan yang mengandung kalori, protein, vitamin,
mineral dan makanan yang bersih.
c. Obat-obatan.
Pada klien dengan dehidrasi ringan dan sedang, cairan diberikan peroral berupa
cairan yang berisikan NaCl dan Na, HCO, K dan Glukosa, untuk Diare akut diatas
umur 6 bulan dengan dehidrasi ringan, atau sedang kadar natrium 50-60 Meq/l
dapat dibuat sendiri (mengandung larutan garam dan gula ) atau air tajin yang
diberi gula dengan garam. Hal tersebut diatas adalah untuk pengobatan dirumah
sebelum dibawa kerumah sakit untuk mencegah dehidrasi lebih lanjut.
b. Cairan parenteral.
Mengenai seberapa banyak cairan yang harus diberikan tergantung dari berat
badan atau ringannya dehidrasi, yang diperhitungkan kehilangan cairan sesuai
dengan umur dan berat badannya.
1. Dehidrasi ringan.
2. Dehidrasi sedang.
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1jam pertama 50 – 100 ml / Kg BB / oral, kemudian 125 ml / kg BB / hari.
3. Dehidrasi berat.
· 16 jam berikutnya 125 ml / kg BB oralit per oral bila anak mau minum,teruskan
dengan 2A intra vena 2 tetes / kg BB / menit atau 3 tetes / kg BB / menit.
- 7 jam kemudian 127 ml / kg BB oralit per oral,bila anak tidak mau minum dapat
diteruskan dengan 2A intra vena 2 tetes / kg BB / menit atau 3 tetes / kg BB / menit.
Terapi diatetik adalah pemberian makan dan minum khusus kepada klien dengan
tujuan meringankan, menyembuhkan serta menjaga kesehatan klien.
• · Memberikan Asi.
• · Memberikan bahan makanan yang mengandung cukup
kalori,protein,mineral dan vitamin, makanan harus bersih.
d. Obat-obatan.
· Obat antibiotik.
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PEMERIKSAAN PENUNJANG
a. Pemeriksaan laboratorium.
· Pemeriksaan tinja.
Gastroenteritis Overview
Viral infection is the most common cause of gastroenteritis but bacteria, parasites,
and food-borne illness (such as shellfish) can be the offending agent.
Many people who experience the vomiting and diarrhea that develop from these
types of infections or irritations think they have "food poisoning," and they may
indeed have a food-borne illness. Many people also refer to gastroenteritis as
"stomach flu," although influenza has nothing to do with the condition.
• Most people recover easily from a short bout with vomiting and diarrhea by
drinking fluids and easing back into a normal diet. But for others, such as
infants and the elderly, loss of bodily fluid with gastroenteritis can cause
dehydration, which is a life-threatening illness unless the condition is treated
and fluids restored.
Gastroenteritis Causes
Gastroenteritis has many causes. Viruses and bacteria are the most common.
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Viruses and bacteria are very contagious and can spread through contaminated
food or water. In up to 50% of diarrheal outbreaks, no specific agent is found.
Improper handwashing following a bowel movement or handling a diaper can
spread the disease from person to person.
Gastroenteritis caused by viruses may last one to two days. On the other hand,
bacterial cases can last for a longer period of time.
Viruses
• Adenoviruses
• Parvoviruses
• Astroviruses
Bacteria
Bacteria may cause gastroenteritis directly by infecting the walls of the stomach
and intestine. As well, some bacteria like Staphylococcus aureus can form a toxin
that is the cause of symptoms. Staph is a common type of food poisoning.
Escherichia coli can cause significant problems, and one type of the bacteria, E.
coli O157:H7 can also affect kidney function.
Clostridium difficile
Clostridium difficile (C difficile) bacteria may overgrow in the large intestine after a
patient has been on antibiotics for an infection.
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Parasites and protozoans
These tiny organisms are less frequently responsible for intestinal irritation. You
may become infected by one of these by drinking contaminated water. Swimming
pools are common places to come in contact with these parasites. Common
parasites include these:
Gastroenteritis Symptoms
By definition, gastroenteritis affects both the stomach and the intestines, resulting
in both vomiting and diarrhea.
• Mild-to-moderate diarrhea:
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Most often gastroenteritis is self-limiting, but it can cause significant problems with
dehydration. Should that be a concern, contacting your primary care provider is
reasonable.
Vomiting blood or having bloody or black bowel movements are not normal, and
emergency care should be accessed. Some medications, for example, bismuth
subsalicylate (Pepto-Bismol), turns stool black because of the bismuth in the
medication.
Fever, increasing severity of abdominal pain, and persistent symptoms should not
be ignored and contacting your primary care provider should be considered if these
symptoms are present.
If the symptoms persist for a prolonged period of time, the physician may want to
consider blood and stool tests to determine the cause of the vomiting and diarrhea.
The patient will be asked if other family or friends have similar exposure or
symptoms. The doctor will want to know about the duration, frequency, and
description of the patient's bowel movements and whether they are vomiting. The
patient will be asked how often and the amount they are urinating to help the
doctor determine if fluid loss is causing dehydration. Has the patient lost any
weight?
The doctor also will take a medical history, including the following:
• Diet change, food preparation habits, and storage: When the disease
occurs following exposure to undercooked or improperly stored or prepared
food such as potato salad at a picnic, food poisoning must be considered. In
general, symptoms caused by bacteria or their toxins will become apparent
after the following amount of time:
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o Clostridium 8-10 hours
Physical examination will look for the reasons for symptoms that may not be related
to infection. If there are specific tender areas in the abdomen, the doctor will want
to determine if the patient has appendicitis, gallbladder disease, pancreatitis,
diverticulitis, or other conditions that may be the cause of the patient's symptoms.
The doctor may perform other lab tests, including a complete blood count,
electrolytes, and kidney function tests. Stool samples may be tested for blood and
different types of infection
Gastroenteritis Treatment
Self-Care at Home
Clear fluids should be consumed for the first 24 hours, then gradually progress the
diet as tolerated. Clear fluids are anything you can see through. Popsicles and jell-o
work well, since they are ingested slowly. Drinking too much fluid too quickly will
distend the stomach and worsen the nausea.
Dehydration in children
For dehydration in children, they should be given oral rehydration solutions such as
Pedialyte, Rehydrate, Resol, and Rice-Lyte. They contain a good balance of
electrolytes that allow better absorption in the stomach than water alone. As well,
rehydration with plain water can affect the sodium concentration in the body and
lead to seizures.
• After each loose stool, children younger than two years should be given 1-3
ounces of any of the rehydration solutions. Older children should be asked to
drink 3-8 ounces. Adults should drink as much as possible.
• This guideline serves only to replace fluid loss due to diarrhea. Drink
additional fluid equal to the amount the patient normally drink.
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• In underdeveloped nations or regions without available commercial pediatric
drinks, the World Health Organization has established a field recipe for fluid
rehydration:
• After 24 hours, begin to offer bland foods with the BRAT diet - bananas, rice,
applesauce without sugar, toast, pasta, or potatoes.
Dehydration in adults
Although adults and adolescents have a larger electrolyte reserve than children,
electrolyte imbalance and dehydration may still occur as fluid is lost through
vomiting and diarrhea. Severe symptoms and dehydration usually develop as
complications of medication use or chronic diseases such as diabetes or kidney
failure, however, symptoms may occur in healthy people.
• Clear fluids are appropriate for the first 24 hours to maintain adequate
hydration.
• After 24 hours of fluid diet without vomiting, begin a soft-bland solid diet such
as the BRAT diet.
Medical Treatment
Upon seeking medical attention, if the patient cannot take fluids by mouth because
of vomiting, the doctor may insert an IV to put fluid back into the body
(rehydration).
Medications
Doctors usually don't prescribe antibiotics until bacteria have been identified.
Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella,
and Vibrio cholerae, if properly identified through laboratory testing. Otherwise,
using any antibiotic or the wrong antibiotic can worsen some infections or make
them last longer.
Some infections, like salmonella, are not treated with antibiotics. With supportive
care of fluids and rest, the body is able to resolve the infection without antibiotics.
For adults, the doctor may give medications to stop vomiting (antiemetics) such as
promethazine (Phenergan, Anergan), prochlorperazine (Compazine), or ondansetron
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(Zofran). Sometimes these medications are prescribed as a suppository. Doctors
usually do not recommend antiemetics for infants. Children who are a little older
may be offered antiemetic medication.
Doctors generally avoid antidiarrheal medications for all age groups if they suspect
the infection is caused by a toxin. The most common antidiarrheal agents for people
older than three years are over-the-counter medications such as diphenoxylate
atropine (Lomotil, Lofene, Lonox) or loperamide hydrochloride (Imodium)
Next Steps
Follow-up
• After an infection or irritation of the digestive tract, the patient may not be
able to eat a regular diet. Some people may be unable to tolerate dairy
products for several weeks after the disease has run its course. The patient
should continue to advance slowly from bland nondairy soups and grain
products to a solid diet.
• Food handlers should not return to work until their symptoms have resolved.
Salmonella infections are a special case; those who work in the medical
profession or who are food handlers need to have negative stool cultures for
Salmonella before being allowed to return to work
Prevention
With most infections, the key is to block the spread of the organism.
• Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been
developed. Rotavirus vaccination is recommended for infants in the U.S.
Vaccines for S. typhi and V. cholerae may be administered to individuals
traveling in at-risk areas.
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Gastroenteritis Infeksiosa
Gastroenteritis Infeksiosa
DEFINISI
Gastroenteritis Infeksiosa adalah suatu infeksi saluran pencernaan yang
menyebabkan muntah dan diare.
PENYEBAB
Gastroenteritis bisa disebabkan oleh sejumlah bakteri. Beberapa bakteri
menyebabkan gejala melalui racun yang dihasilkannya, sedangkan bakteri lain
tumbuh di dalam dinding usus. Jika bakteri tumbuh di dalam dinding usus, mereka
bisa masuk ke dalam aliran darah.
GEJALA
Biasanya gastroenteritis menyebabkan muntah dan diare.
Dalam waktu 24 jam setelah terjadinya gastroenteritis, bayi yang berumur dibawah
6 bulan bisa mengalami dehidrasi (kehilangan sejumlah besar cairan dan elektrolit).
Jika muntah dan diarenya berat sedangkan asupan cairannya sedikit, dalam waktu
24 jam setiap anak bisa mengalami dehidrasi.
Dehidrasi berat bisa menyebabkan mata menjadi cekung dan kering, serta ubun-
ubun menjadi cekung. Anak tampak mengantuk.
Pada bayi yang lebih tua dan anak-anak yang gemuk, dehidrasi bisa menyebabkan
mereka tampak lemas, kulitnya hangat, kering serta keriput dan matanya kering.
DIAGNOSA
Diagnosis ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik.
Untuk menentukan penyebabnya, dilakukan pemeriksaan terhadap tinja penderita.
PENGOBATAN
Untuk menggantikan cairan yang hilang karena muntah dan diare, segera diberikan
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cairan dan elektrolit, biasanya dalam bentuk minuman atau jika dehidrasinya berat,
diberikan dalam bentuk infus.
Kepada bayi yang lebih tua, antibiotik hanya diberikan jika penyebabnya adalah
bakteri atau parasit.
Kepada bayi yang berumur kurang dari 6 bulan atau menderita gangguan sistem
kekebalan, diberikan antibiotik meskipun tidak terdapat tanda-tanda infeksi di luar
usus.
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