Nadya GIT 3 (1)

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    Problem 3

    GIT

    Nadya Aulia Rahmandini

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    Kelompok 1

    Tutor : dr. Irma

    Ketua : Stevania Nuralia T. I

    Sekertari! : Nadya Aulia Rahmandini

    Penuli! : "e#illia $oun

    Anota : %epri A. Ka&i

    $okvi

    "indy 'eoni

    (u!tika Rukmana

    (o#hammad Karunia&an

    (ike ). *anane

    "itra Septiani

    Seba!tian "handra

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    Problem 3An +,year!,old irl pre!ented to the emeren#y

    room &ith 3 day! o- &atery diarrhea &ithout bloodand mu#ou! on !tool about three to -our time! aday a##ompanied &ith #ramp abdominal painnau!ea and vomitin. She al!o had -ever and !evere

    heada#he -or / day!. The -ever in#rea!ed in thea-ternoon. She had a bit o- eatin !treet -ood andmedium rare !teak re#ently. 0n eamination !helook! &eak and her temperature &a! 32o" and

    heart rate 2 beat! per minute. (outh eamination:mu#ou! membrane appeared dry4 #oated tonue.Abdominal eamination reveal! di!tention &ithdeep palpation. The !pleen and liver are notenlared.

    5er -ather 67 year! old al!o eperien#e -re8uent

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    n-amiliar Term!

    "oated toune : ada !elaput di lidah

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    Rumu!an (a!alah

    1. Apakah ada predilek!i u!ia ; > dari penyakit ini9 ?diare #air tanpa lendir dan darah 3,6@hari !elama 3 hari

    6. (enapa pa!ien mual muntah dan keram perut9

    /. Apakah ada hubunan mual muntah denan diare9 )ika adaapa hubunannya9

    . Penyakit apa yan menyebabkan !indrom ter!ebut9 ?mualmuntah kram perut diare #air tanpa darah ; muku! demamdan !akit kepala !elama / hari

    B. (enapa demam meninkat pada !ore hari9

    +. Penyakit apa yan kha!nya demam meninkat pada !ore hari9

    2. %aaimana hubunan kebiaan pa!ien

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    Rumu!an (a!alah

    17.Interpreta!i pemerik!aan C!ik pa!ien9

    11.Apa yan menyebabkan muko!a mulut kerin dan

    ada !elaput di lidah9

    1=.Apa yan menyebabkan abdominal di!tention9

    13.>> apa yan bi!a di!inkirkan terkait denan ha!ilpemerik!aan limpa dan liver yan tidak membe!ar9

    16.Apakah ada hubunan keluhan ayah denan anak9

    1/.Apakah penyakit ayah akut atau kroni!9

    1.Apakah penaruh umur ayah denan penyakit nya9

    1B.Apa >> diare #air tanpa demam ; muntah !elama3 bulan9

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    "urah Pendapat

    1. Predilek!i bi!a ada bi!a tidak.

    =. Akut.

    3. >> : Ga!troenteriti! %akteri ?S. ThypiiTyphoid Diru!?Rotaviru! Adenoviru! )amur ?"andida Intoleran!i makanankera#unan makanan para!it.

    6. Karena ada endotok!in.PatC! ?9

    /. Ada. patC! ?9

    . In-ek!i ?karna ada demam.

    B. PatC! meninkatnya demam pada !ore hari pada typhoid -ever.

    +. Typhoid -ever.2. Re!iko in-ek!i para!it ; bakteri. Epidemioloi ?9 !erta ada

    -ood,handler !ebaai #arrier kontamina!i -e#al oral ?yanditran!mi!kan ?9

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    "urah Pendapat

    17.>emam 5R normal.

    11.(uko!a kerin dehidra!i demam. "oatedtoune >> : In-ek!i

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    'earnin 0bi!. 0- ab!orbtion. P. 1B3

    =. Typhoid ever ? harri!onF! 13B.Salmonello!i! pae +2B

    3. >iarrhea emeren#y manaement?Ro!en! emeren#y medi#ine."hat =3 p.1B

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    >IARR5EA

    Defnition #lini#ally diarrhea deCned a! !tool! that are loo!er

    and@or more -re8uent than normal4 or =6 h !tool &eihtH=77 ?phy!ioloi#al deCnition le!! u!e-ul #lini#ally

    Classifcation a#ute v!. #hroni#

    !mall volume ?table!poon! o- !tool4 typi#al o- #oloni#di!ea!e! ver!u! lare volume ?H1@= #up !tool4 typi#al

    o- !mall bo&el di!ea!e! &atery ?bo&el di!ea!e v!. !teatorrhea

    !e#retory ?diarrhea per!i!t! &ith -a!tin v!. o!moti#?diarrhea !top! &ith -a!tin

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    A"TE >IARR5EA

    Defnition pa!!ae ore8uent un-ormed !tool! -or J16 d

    Etiology mo!t #ommonly due to in-e#tion!

    mo!t in-e#tion! are !el-,limitin and re!olve &ithin B d

    Risk Factors -ood ?!ea-ood #hi#ken turkey e! bee-

    medi#ation!: antibioti#! laative!

    other!: hih ri!k !eual a#tivity in-e#tiou! outbreak! -amily hi!tory ?I%>

    Classifcation broadly divided and #la!!iCed into inammatory and non,inammatory

    diarrhea

    me#hani!m!: !timulation o- inte!tinal &ater !e#retion and inhibition o- &aterab!orption ?i.e. !e#retory problem

    in inammatory diarrhea orani!m! and #ytotoin! invade mu#o!a killinmu#o!al #ell! -urther perpetuatin the diarrhea

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    Investigations !tool #ulture!@mi#ro!#opy ?";S@0;P

    ";S only te!t! Campylobacter, Salmonella, Shigella,E. Coli other orani!m! mu!t be ordered !eparately

    eible !imoido!#opy: u!e-ul i- inammatorydiarrhea !u!pe#ted

    biop!ie! are the mo!t u!e-ul method o- di!tinui!hinidiopathi# I%> ?"rohnL! di!ea!e and ul#erative #oliti!

    -rom in-e#tiou! #oliti! or a#ute !el-,limited #oliti! ". difcile toin: indi#ated &hen re#ent@remote

    antibioti# u!e ho!pitaliMation nur!in home or re#ent#hemotherapy

    T t t

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    Treatment luid and ele#trolyte repla#ement orally in mo!t #a!e! intravenou! i-

    !evere etreme! o- ae@#oma

    anti,diarrheal!

    antimotility aent!: diphenoylate loperamide ?Imodium4

    #ontraindi#ated in mu#o!al inammation !ide ee#t!: abdominal #ramp! toi# mea#olon

    ab!orbant!: kaolin@pe#tin ?Kaope#tate methyl#ellulo!ea#tivated attapulite

    a#t by ab!orbin inte!tinal toin!@mi#ro,orani!m! or by #oatininte!tinal mu#o!a

    mu#h le!! ee#tive than antimotility aent

    modiCer! o- uid tran!port: bi!muth !ub!ali#ylate ?Pepto,%i!molmay be help-ul

    antibioti#!: rarely indi#ated

    ri!k! proloned e#retion o- enteri# pathoen ?e!pe#ially Salmonella)

    dru !ide ee#t! ?in#ludin ". difcile in-e#tion

    development o- re!i!tant !train!

    indi#ation! -or antimi#robial aent! in a#ute diarrhea: Septi#emia

    proloned -ever &ith -e#al blood or leuko#yte!

    #learly indi#ated: Shigella, V. cholerae, ". difcile, travellerL! diarrhea?enterotoieni# E. coli ?ETE" Giardia, Entamoeba histolytica,

    Cyclospora !ituational: Salmonella, Campylobacter, Yersinia, non,enterotoieni# E.

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    "5R0NI" >IARR5EA Defnition

    pa!!ae o- -re8uent un-ormed !tool -or H16 d

    dierential i! !imilar to that o- a#ute diarrhea e#ept that the ma

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    Investigations Guided by hi!tory

    !tool analy!i! -or: ". difcile toin ";S 0;P O -e#al -at *%"

    blood -or: "%" #hemi!try "RP TS5 #elia# !eroloy ?anti,tTG proteinele#trophore!i!

    #olono!#opy and ileo!#opy &ith biop!y

    Small bo&el biop!y

    upper GI endo!#opy &ith duodenal biop!y

    &irele!! !mall bo&el endo!#opy #ap!ule ?la!t re!ort , very #o!tly

    rial o- la#to!e -ree diet

    may delay diano!i! o- I%> and #elia# di!ea!e

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    (aldie!tion ;malab!orbtion

    Defnition maldie!tion: inability to break do&n

    lare mole#ule! in the lumen o- the

    inte!tine into their #omponent !mallmole#ule!

    malab!orption: inability to tran!portmole#ule! a#ro!! the inte!tinal mu#o!ato the #ir#ulation

    mala!!imilation: en#ompa!!e! bothmaldie!tion and malab!orption

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    Etiology

    (aldie!tion

    inade8uate miin o- -ood &ith enMyme! ?e.. po!t,a!tre#tomy

    pan#reati# eo#rine deC#ien#y

    primary di!ea!e! o- the pan#rea! ?e.. #y!ti# Cbro!i! pan#reatiti! #an#er

    %ile !alt deC#ien#y

    terminal ileal di!ea!e ?impaired re#y#lin ba#terial overro&th ?de#on

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    "lini#al eature! Symptom! u!ually vaue unle!! di!ea!e

    i! !evere

    &eiht lo!! diarrhea !teatorrhea&eakne!! -atiue

    mani-e!tation! o-

    malab!orption@deC#ien#y

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    Investigations B= h !tool #olle#tion ?&eiht -at #ontent

    !erum #arotene -olate "a= (= vitamin %1=albumin -erritin !erum iron !olution INR@PTT

    !tool -at lobule! on -e#al !mear !tained &ithSudan ?rarely u!ed

    other te!t! !pe#iC# -or etioloy ?e.. "T !#an@(RIto vi!ualiMe pan#rea!

    trial o- therapy &ith pan#reati# enMyme!

    Treatment dependent on underlyin etioloy

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    Celiac Disease (GlutenEnteropathy /Sprue

    Defnition abnormal !mall inte!tine mu#o!a due to inte!tinal rea#tion to liadin a #omponent o- luten

    Etiology

    only autoimmune di!ea!e in &hi#h antien ?a.,liadin i! re#oniMed

    a!!o#iated &ith other autoimmune di!ea!e! e!pe#ially thyroid di!ea!e

    luten a protein in #ereal rain! broken do&n to liadin i! toi# -a#tor

    5'A,>Q= ?#hromo!ome -ound in +7,27 o- patient! #ompared &ith =7 in eneral

    population4 al!o a!!o#iat