Materi UAS

1. Diare/ Konstipasi
2. (2 kelompok)
3. Emesis
4. Kasus (2 kelompok)
5. Hepatitis Virus
6. Sirosis Hepatik
7. Kasus (2 kelompok)
 DIARE

Chynthia Pradiftha Sari M. Sc.,

Apt
Definisi DIARE
Buang air besar (defekasi) berbentuk cair
atau setengah cair (setengah padat),
kandungan air tinja lebih dari 200 gram
atau 200 ml/24 jam - frekuensi lebih dari
2-3x sehari atau didapatkan penurunan
konsistensi dan peningkatan
frekuensi BAB dibandingkan yang
biasanya
 Klasifikasi berdasar
penyebab
Diare spesifik:
tanda yang muncul spesifik: adanya lendir dan darah di

feses, demam
FESES
Bau langu infeksi virus
Bau busuk, ada lendir, darah agen enteroinvasif

(Shigella, Salmonella, Campylobacter, Staphylococcus,

and Escherichia coli)
Bau asam gangguan osmolaritas
Diare non spesifik:
feses cair, lembek, tidak ada darah, tidak ada ledir dan

demam
Penyebab: makanan, malabsorbsi, stress
 Klasifikasi diare brdsrkan
durasi kejadian
Akut:
berlangsung 3 hari (72 jam)self limiting
disease
Kronik:
berlangsung 14 hari cari tahu
penyebabpilih obat yang sesuai
Persisten:
berlangsung lebih dari 30 hari
 ETIOLOGY
PRIMER (body defense mechanism)
Food
Infections
Malabsorption
Medications
Stress
SECUNDER (the other disease)
Inflammatory Bowel Disease
Cancer
Etc.
 PATOFISIOLOGI
Gangguan absorbsi
Infeksi/malnutrisisel epitel
rusakmalabsorbsidiare
Gangguan sekresi
Kuman/toksinsel memacu siklik
AMP(CAMP) di sel epitel ususCAMP
memacu pengeluaran ion Cl yg
berlebihintrasel lebih positiv
homeostasis ion Na di eksresikan Na
keluar H2O keluar feses encer
 Lanj Patofis.
Ganguan motilitas
Pacuan neural&hormonal (Ach) Motilitas
meningkatAbsorbsi terganggu masa
feses yg belum saatnya dikeluarkan dipaksa
keluar frekuensi (tidak encer, hanya
lembek)
Gangguan Omolaritas
Berkurangnya enzim Kh. tidak terdigesti /
gagal terabsorbsi diubah mjd asam laktat
osmolaritas naik usus menarik cairan
hipotonis Diare banyak dan cair
Cyclic AMP-CAMP
OUTCOMES & STRATEGY

Goal therapy: Strategi:

Prevent Diet

dehydration and Management

malnutrition Rehydration

Stop diarhe Antidiarrhe

Relieve symtom Therapy

causative
Symptomatic

treatment
Rekomendasi Terapi
Lanjutan

 Home treatment for

diarrhea
Jika diare tidak terlalu berat (tidak ada tanda
dehidrasi), maka dapat dilakukan perawatan di
rumah :
Pencegahan dehidrasi
Berikan ORS, atau food-based fluids (sop, air tajin, air
kelapa, jus buah yang tidak manis, dll), atau larutan gula-
garam (oralit)
Jika masih ASI,teruskan ASI, atau susu yang lebih 2 kali
lebih encer dari biasanya
Teruskan asupan makanan,tambah makanankecil ekstra
Berikan suplemen Zinc(bisa dilarutkan dalam air atau susu,
atau bentuk syrup)
Jika tidak ada perbaikan kondisi dalam 3 hari, segera di
bawa ke RS/dokter
 REHIDRASI
Tanpa dehidrasi : dgn Cairan Rumah
tangga
(1gelas air+2 sdm gula+1 sdt garam)
Untuk dehidrasi ringan oralit (lihat dosis
oralit) !!
Untuk dehidrasi berat: Ringer Laktat iv,
NaCl isotonis, Bicnat/Nabict
 ORALIT/PHAROLIT
Dosis: sesuai keadaan
>1 th : 2jam pertama 2 gelas
larutan:selanjutnya gelas tiap buang
air besar
1-5 th: 2jam pertama 4 gelas larutan,
selanjutnya 1 gelas tiap buang air besar
>5th &dewasa: 2jam pertama 6 gelas,
selanjutnya 2 gelas tiap buang air besar
 SIGN OF DEHYDRATION
Kondisi di Rumah sakit:
Vomiting, kesadaran apatis, tensi sistolik <90,
nadi > 120/menit, nafas > 30/menit, turgor kulit
menurun, jari tangan keriput, ektremitas dingin
score 1
Serak, koma, sianosis, tensi diastolik <60
score 2

Volume cairan yg ditambahkan dalam 2 jam

Score/15 X 10% X BB(kg) X 1Liter
 Pediatric Diare
Zinc Supplementationis now recommended for all children
with diarrhea.
Dose:
20mg/day for children 6 months of age or older (1 tablet);
10mg/day for infants less than 6 months of age (1/2 tablet)
Duration:10/14 days even if diarrhea has stopped.
Supplement: Dissolvable tablets and syrups (in some
countries)
Administration: Tablets can be chewed or dissolved in clean
water, ORS or breastmilk ORS, or breastmilk.
Side Effects: Vomiting is common in diarrhea and sometimes
children vomit after taking a zinc supplement. Unless
vomiting is severe this should not prevent giving the zinc
supplement.
 ANTI DIARE
ADSORBEN mengabsorbsi ion disekitar
lumen usus (attapulgit *newdiatap,
enterostop)
DEMULCEN (kaolin-pectin)
ASTRINGENT (diapet)
ANTIMOTILITY (OPIAT) (loperamid)
ANTISECRETORI (bismut subsalisilat)
PROBIOTIK (lactobacilus *lacto-B)
 OPIOID
Agonist at opioid receptors of GI muscle
Reduce muscle movement, but increase
tone of contraction of rectal sphincter
Reduce fluid & electrolyte secretion in GI
Fast action
Cause addiction (long term usage)
Caution to use in children
Loperamide (ImodiumR), diphenoxylate
(LomotilR) : potency > opium tincture
 THE OTHERS
Adsorbent - charcoal, kaolin, chalk: trap
toxin, substance into their suface
Astringent - tea leaves: precipitate surface
protein reduce diarrhea
Bismuth subsalicylate: inhibit PG secretion
inhibit diarrhea
Octreotide: somatostatin receptor binding
inhibit GI fluid secretion
Probiotic : recolonisasi (lactobacillus)
 TUGAS

Buat resume obat antidiare yg beredar di

Indonesia (Mekanisme obat dan dosis)
a. demulcen, adsorben

b. Astringent

c. Antimotilitas (opioid)

d. Probiotik

e. Antisekretori
DIARE INFEKSIUS
Diare Infeksi
 CAMPYLOBACTER

Second most commonly reported cause of

diarrhea in US
1-6 million cases per year
Sources: raw poultry, meat, unpasteurized
milk
Incubation period: 2-5 days
Symptoms: diarrhea, abdominal cramps,
fever, bloody
stools, vomiting (C. jejuni, C. coli), bacteremia
(C. fetus)
Duration: 2-10 days
Treatment: macrolides (C. jejuni), quinolones,
carbapenem (C. fetus)
 SALMONELOSIS

Recently replaced Campylobacter as most

commonly reported cause of diarrhea in U.S.
Sources: Poultry (microwaveable stuffed
chicken products), reptiles (pet turtles),
livestock, pets (nontyphi); humans (typhi),
raw eggs (CSC cake batter ice cream)
Incubation period: 1-3 days
40,000 (non-typhi) and 350 (typhi) cases
reported in the
Duration: 4-7 days
Treatment: antibiotics not routinely needed;
may prolong transmission period and cause
relapse
 SHIGELA
Sources: milk, dairy products, potato salad
(food/water
contaminated with fecal matter)
Incubation period: 24-48 hours (highly
contagious)
Serogroups: dysenteriae, flexneri, boydii,
sonnei*
Symptoms: abdominal cramps, diarrhea,
fever, bloody/mucus stool
Duration: 4-7 days
Treatment: FQ (cipro OK in kids),
ceftriaxone/cefixime (efficacy varies),
azithromycin,
Shorten duration, reduces transmission
 TERAPI ANTIBIOTIK
PENYEBAB KEBERHASILAN
- Rotavirus tidak efektif

- Enterotoksin tidak efektif

- Shigella efektif
efektif, bila cepat
- Campylobacter
diberikan
- Vibrio Colera
efektif
- Salmonela nontify
tidak efektif,
kec.komplikasi
- E. Histolitica efektif
PILIHAN ANTIBIOTIK
Shigella :
Kotrimoksazol (4X500/5 hari), Asam
nalidisat dan Ampisilin (dibeberapa daerah)
4X250/10 hari
Campylobacter :
Eritromisin (3X500/7 hari)
Vibrio Colera:
Kotrimoksazol (2X3,2X2, dlm 6 hari),
Kloramfenikol (4X500/7hari) dan Eritromisin
E. Histolitika atau amuba lain:
Metronidazol (4X500/3 hari)
 DIARE TRAVELLERS
Rapid, dramatic change in GI flora
Include potential pathogens:
Bacterial (60%)
Campylobacter (0-30%)
Salmonella (0-15%)
Shigella (0-15%)
- E. coly >30%
Viral (10%)
Rotavirus (0-20%)
Parasitic (3%)
Unknown (20-30%)
 TERAPI DIARE TRAVELLERS
Oral fluids: in most cases, all that is needed
Decreased frequency of stools 16-18%
Shortened duration of illness
Antimotility agents:
Decrease stool frequency by 50%; reduce duration
to hours
Avoid in patients with blood in stool or high fever
Antibiotics:
Illness can be shortened to 1-1.5 days
Three days of treatment recommended, but single
dose therapy is an option
 PENCEGAHAN DIARE

1. HIGYENE YANG BAIK

2. SANITASI, sumber
air

3. DAYA TAHAN, gizi,

imunisasi, vit.A