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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#iated &ith 5'A,>Q+

Epi!emiology

more #ommon in &omen

-amily hi!tory: 1/ o- Cr!t,deree relative!

may pre!ent any time -rom in-an#y ?&hen #ereal! introdu#ed to elderly

peak pre!entation in in-an#y

Clinical Features #la!!i#ally: diarrhea &eiht lo!! anemia !ymptom! o-vitamin@mineral deC#ien#y -ailure to

thrive4 no& more #ommonly bloatin a! iron deC#ien#y

improve! &ith luten,-ree diet deteriorate! &hen luten reintrodu#ed

di!ea!e i! u!ually mo!t !evere in proimal bo&el

thu! iron #al#ium and -oli# a#id deC#ien#y more #ommon than vitamin %1= deC#ien#y

luten enteropathy may be a!!o#iated &ith dermatiti! herpeti-ormi! !kin eruption epilep!y

myopathy depre!!ion paranoia in-ertility bone -ra#ture!@metaboli# bone di!ea!e

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Investigations !mall bo&el mu#o!al biop!y ?u!ually duodenum i! u!ually

diano!ti#:

villou! atrophy and #rypt hyperpla!ia in#rea!ed number o- pla!ma #ell! and lympho#yte! in lamina

propria

in#rea!ed intraepitheliallympho#yte!

!imilar patholoy in: !mall bo&el overro&th "rohnL!lymphoma Giardia 5ID

#on!ider "T enteroraphy to vi!ualiMe !mall bo&el to rule outlymphoma

eviden#e o- malab!orption ?lo#aliMed or eneraliMed

Steatorrhea

lo& level! o- -erritin@iron !aturation "a= e albumin#hole!terol #arotene %1= ab!orption

improvement &ith a luten,-ree diet4 !hould not be !tartedbe-ore anti,tTG and biop!y

!eroloi#al te!t!

!erum anti,tTG antibody IA i! 27,2+ !en!itive 26,2B!pe#iC#

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Treatment

>ietary #oun!ellin luten -ree diet: avoid barley rye &heat

oat! allo&ed i- not #ontaminated by other rain!

ri#e and #orn our are a##eptable

iron -olate !upplementation ?&ith !upplementation o- other vitamin! a! needed

i- di!appointin re!pon!e to diet #on!ider: in#orre#t diano!i!

non,adheren#e to luten,-ree diet

un!u!pe#ted #on#urrent di!ea!e ?e.. mi#ro!#opi# #oliti! pan#reati# in!u#ien#y

development oCnte!tinal ?enteropathy,a!!o#iated T,#ell lymphoma ?abdominal pain

&eiht lo!! palpable ma!!

development o-diu!e inte!tinal ul#eration #hara#teriMed by aberrant intraepithelial T,#ell population ?pre#ur!or to lymphoma

"rognosis

a!!o#iated &ith in#rea!ed ri!k oymphoma #ar#inoma ?e.. !mall bo&el and

#olon ri!k o- malinan#y may be lo&ered by dietary luten re!tri#tion

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