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PENGERTIAN

• 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),

• Gastroentritis ( GE ) adalah peradangan yang terjadi pada lambung dan


usus yang memberikan gejala diare dengan atau tanpa disertai muntah
(Sowden,et all.1996).
• Gastroenteritis diartikan sebagai buang air besar yang tidak normal atau
bentuk tinja yang encer dengan frekuensi yang lebih banyak dari biasanya
(FKUI,1965).
• Gastroenteritis adalah inflamasi pada daerah lambung dan intestinal yang
disebabkan oleh bakteri yang bermacam-macam,virus dan parasit yang
patogen (Whaley & Wong’s,1995).
• Gastroenteritis adalah kondisi dengan karakteristik adanya muntah dan diare
yang disebabkan oleh infeksi,alergi atau keracunan zat makanan ( Marlenan
Mayers,1995 ).

Jadi dari keempat pengertian diatas penulis dapat menyimpulkan bahwa


gastroenteritis adalah peradangan yang terjadi pada lambung dan usus yang
memberikan gejala diare dengan frekuensi lebih banyak dari biasanya yang
disebabkan oleh bakteri,virus dan parasit yang patogen.

PATOFISIOLOGI

Penyebab gastroenteritis akut adalah masuknya virus (Rotravirus, Adenovirus


enteris, Virus Norwalk), Bakteri atau toksin (Compylobacter, Salmonella, Escherihia
Coli, Yersinia dan lainnya), parasit (Biardia Lambia, Cryptosporidium). Beberapa
mikroorganisme patogen ini menyebabkan infeksi pada sel-sel, memproduksi
enterotoksin atau Cytotoksin dimana merusak sel-sel, atau melekat pada dinding
usus pada gastroenteritis akut.

Penularan gastroenteritis bisa melalui fekal-oral dari satu klien ke klien yang
lainnya. Beberapa kasus ditemui penyebaran patogen dikarenakan makanan dan
minuman yang terkontaminasi.

Mekanisme dasar penyebab timbulnya diare adalah gangguan osmotik (makanan


yang tidak dapat diserap akan menyebabkan tekanan osmotik dalam rongga usus
meningkat sehingga terjadi pergeseran air dan elektrolit kedalam rongga usus, isi
rongga usus berlebihan sehingga timbul diare ). Selain itu menimbulkan gangguan
sekresi akibat toksin di dinding usus, sehingga sekresi air dan elektrolit meningkat
kemudian terjadi diare. Gangguan mutilitas usus yang mengakibatkan
hiperperistaltik dan hipoperistaltik. Akibat dari diare itu sendiri adalah kehilangan
air dan elektrolit (dehidrasi) yang mengakibatkan gangguan asam basa (asidosis

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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

e. Membran mukosa mulut dan bibir kering

f. Fontanel cekung

g. Kehilangan berat badan

h. Tidak nafsu makan

i. Badan terasa lemah

KOMPLIKASI

a. Dehidrasi

b. Renjatan hipovolemik

c. Kejang

d. Bakterimia

e. Mal nutrisi

f. Hipoglikemia

g. Intoleransi sekunder akibat kerusakan mukosa usus.

TINGKAT DEHIDRASI GASTROENTERITIS

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.

Pemberian cairan, pada klien Diare dengan memperhatikan derajat


dehidrasinya dan keadaan umum

a. Cairan per oral.

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.

1jam pertama 25 – 50 ml / Kg BB / hari, kemudian 125 ml / Kg BB / oral

2. Dehidrasi sedang.

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1jam pertama 50 – 100 ml / Kg BB / oral, kemudian 125 ml / kg BB / hari.

3. Dehidrasi berat.

Untuk anak umur 1 bulan – 2 tahun dengan berat badan 3 – 10 kg

· 1 jam pertama : 40 ml / kg BB / jam = 10 tetes / kg BB / menit (infus set 1 ml = 15


tetes atau 13 tetes / kg BB / menit.

· 7 jam berikutnya 12 ml / kg BB / jam = 3 tetes / kg BB / menit ( infus set 1 ml = 20


tetes ).

· 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.

Untuk anak lebih dari 2 – 5 tahun dengan berat badan 10 – 15 kg.

- 1 jam pertama 30 ml / kg BB / jam atau 8 tetes / kg BB / menit ( infus set 1 ml =


15 tetes ) atau 10 tetes / kg BB / menit ( 1 ml = 20 tetes ).

- 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.

Untuk anak lebih dari 5 – 10 tahun dengan berat badan 15 – 25 kg.

-1 jam pertama 20 ml / kg BB / jam atau 5 tetes / kg BB / menit ( infus set 1 ml = 20


tetes ).

-16 jam berikutnya 105 ml / kg BB oralit per oral.

c. Diatetik ( pemberian makanan ).

Terapi diatetik adalah pemberian makan dan minum khusus kepada klien dengan
tujuan meringankan, menyembuhkan serta menjaga kesehatan klien.

Hal – hal yang perlu diperhatikan :

• · Memberikan Asi.
• · Memberikan bahan makanan yang mengandung cukup
kalori,protein,mineral dan vitamin, makanan harus bersih.

d. Obat-obatan.

· Obat anti sekresi.

· Obat anti spasmolitik.

· Obat antibiotik.

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PEMERIKSAAN PENUNJANG

a. Pemeriksaan laboratorium.

· Pemeriksaan tinja.

· Pemeriksaan gangguan keseimbangan asam basa dalam darah astrup, bila


memungkinkan dengan menentukan PH keseimbangan analisa gas darah atau
astrup, bila memungkinkan.

· Pemeriksaan kadar ureum dan creatinin untuk mengetahui fungsi ginjal.

b. Pemeriksaan elektrolit intubasi duodenum untuk mengetahui jasad renik


atau parasit secara kuantitatif, terutama dilakukan pada klien diare kronik.

Gastroenteritis Overview

Gastroenteritis is a condition that causes irritation and inflammation of the stomach


and intestines (the gastrointestinal tract). Diarrhea, crampy abdominal pain,
nausea, and vomiting are the most common symptoms.

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.

Travelers to foreign countries may experience "traveler's diarrhea" from


contaminated food and unclean water.

• The severity of infectious gastroenteritis depends on the immune system's


ability to resist the infection. Electrolytes (these include essential elements of
sodium and potassium) may be lost as you vomit and experience diarrhea.

• 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

Fifty to seventy percent of cases of gastroenteritis in adults are caused by the


noroviruses.

Rotavirus is the leading cause of infection in children.

Other viruses that cause gastrointestinal symptoms include:

• 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.

Salmonella, Shigella and Campylobacter

Salmonella, Shigella and Campylobacter are also common causes of illness.

• Salmonella - the cause of typhoid fever is contracted from handling poultry or


reptiles such as turtles that carry the germs

• Campylobacter - from the consumption of undercooked meat, unpasteurized


milk

• Shigella - typically spread from person to person

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:

• Giardia - The most frequent cause of waterborne diarrhea, causing giardiasis

• Cryptosporidium - Affects mostly people with weakened immune systems and


causes watery diarrhea

Other common causes

Gastroenteritis that is not contagious to others can be caused by chemical toxins,


most often found in seafood, food allergies, heavy metals, antibiotics, and other
medications

Gastroenteritis Symptoms

By definition, gastroenteritis affects both the stomach and the intestines, resulting
in both vomiting and diarrhea.

Common symptoms may include:

• Low grade fever to 100°F (37.7°C)

• Nausea with or without vomiting

• Mild-to-moderate diarrhea:

• Crampy painful abdominal bloating

More serious symptoms

• Blood in vomit or stool

• Vomiting more than 48 hours

• Fever higher than 101°F (40°C)

• Swollen abdomen or abdominal pain

• Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry


mouth and lack of sweat and tears are characteristic findings

When to Seek Medical Care

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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.

Exams and Tests

Gastroenteritis is often self-limiting, and the care is supportive to control symptoms


and prevent dehydration. Tests may not be needed.

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.

As always, taking a thorough history is of great value, as is the physical


examination.

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:

• Travel history: Travel may suggest E. coli bacterial infection or a parasite


infection from something the patient ate or drank.

• Exposure to poisons or other irritants: Swimming in contaminated water


or drinking from suspicious fresh water such as mountain streams or wells
may indicate infection from Giardia - an organism found in water that causes
diarrhea.

• 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:

o Staphylococcus aureus in 2-6 hours

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o Clostridium 8-10 hours

o Salmonella in 12-72 hours

• Medications: If the patient has used broad-spectrum or multiple antibiotics


recently, they may have antibiotic-associated irritation of the gastrointestinal
tract.

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.

Other noninfectious gastrointestinal diseases like Crohn's disease or ulcerative


colitis must also be considered. The doctor also will feel the abdomen for masses. A
rectal examination may be considered, in which the physician inspects the anus for
any abnormalities and then inserts a finger in to the rectum to feel for masses. Stool
obtained during this test may be tested for the presence of blood.

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

The mainstay of home treatment of gastroenteritis is hydration. Dehydration will


make the symptoms of nausea and vomiting worse and compound symptoms.

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:

o Mix 2 tablespoons of sugar (or honey) with ¼ teaspoon of table salt


and ¼ teaspoon of baking soda. (Baking soda may be substituted with
¼ teaspoon of table salt.) Mix mixture in 1 liter (1 qt) of clean or
previously boiled water.

• 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).

In infants, depending upon the level of dehydration, intravenous fluids may be


delayed to consider trying oral rehydration therapy. Frequent feedings, as small as
a 1/6 ounce (5cc) at a time, may be used to restore hydration.

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

Diarrhea is one of the leading causes of infant sickness. Worldwide, diarrhea


accounts for 3-5 million deaths yearly for all age groups. In general, most adults and
children recover after they are appropriately rehydrated

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.

• If symptoms continue or worsen, call a doctor.

• 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.

• Always wash your hands.

• Eat properly prepared and stored food.

• Bleach soiled laundry.

• 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.

Virus dan parasit (misalnya Giardia) juga bisa menyebabkan gastroenteritis.


Rotavirus merupakan penyebab dari hampir separuh kasus diare berat.

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.

Gejala lainnya yang mungkin ditemukan:


- nafsu makannya berkurang
- mulutnya kering
- demam
- produksi air kemihnya berkurang
- merasa haus
- berat badannya menurun.

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.

Jika penyebabnya virus, tidak perlu diberikan antibiotik.


Jika diare terjadi ketika tengah mengadakan perjalanan keluar kota dan diarenya
berat atau menetap, seringkali diberikan antibiotik

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