Diarrhea is an increase volume, keenceran or frequency of bowel movements. Diarrhea caused by health issues usually are immense numbers, could reach over 500 grams / day. Individuals who eat plenty of vegetable fibers, in normal circumstances can produce over 500 grams, but the normal consistency and no liquid. Under normal circumstances, the feces contain 60-90% water, the water diarrhea could reach over 90%.
PATOFISIOLOGY
Diarrhea can be caused by or more of the mechanisms / pathophysiology of such
Osmotic Diarrhea
Osmotic diarrhea occurs when sure materials that can not be absorbed in to the blood, left in the intestines. Material causes an increase in fecal water content, leading to diarrhea. Sure foods (fruits and nuts) and heksitol, sorbitol also mannitol (a sugar substitute in dietetic foods, sweet and chewing gum) may cause osmotic diarrhea.
Causes include:
Bacterial toxins, such as cholera and accompanied with toksigenik strains of E. coli, attaches itself to receptors on the luminal membrane of the intestine before it enters the cell and activate adenyl-cyclase, which facilitate secretion of chloride and bicarbonate is actively ..
Fatty acids and bile-dihydroxy bile acid (cheno-and deoxycholic acid) and acid-long chain fatty acids cause a reduction of liquid absorption malabsorption syndrome.
Secretory diarrhea
Secretory diarrhea occurs when the tiny intestine and large intestine out of salt (chiefly sodium chloride) and water in to the chair. This may even be caused by sure toxins such as cholera and other infectious diarrhea.
Diarrhea eksudatif
Eksudatif Diarrhea occurs when a layer of large intestine become inflamed or ulcers forming, then releasing protein, blood, mucus and other fluids, which would increase the fiber content. Diarrhea can be caused by various diseases such as:
Malabsorption syndrome caused by several circumstances such as:
- Non-tropical Sprue
- Pancreatic insufficiency
- Appointment of partial bowel.
Abnormal motility
Changes in intestinal motility may cause diarrhea.
To get normal consistency, chair ought to stay in the giant intestine for a sure time. Plenty of conditions and medications that can shorten the presence of feces in the intestine, including:
* Ulcerative colitis
* Crohn's disease (regional enteritis)
* Tuberculosis.
Weakened intestinal permeability
Morphological abnormalities occur in the intestinal epithelial membrane-specific that permeablitas mucosa of colon and tiny intestine is interrupted, if the permeability is disrupted water absorption in the tiny intestine and large intestine, causing less diarrhea.
* Hyperthyroidism
* Abdominal Surgical procedure
* Treatment of ulcers that cutting the vagus nerve.
A. General
Besides causing discomfort, disgrace because often ketoilet and disruption of every day activities, extreme diarrhea can also cause loss of fluids (dehydration) and loss of electrolytes such as sodium, potassium, magnesium and chloride. If a large amount of liquid and electrolyte loss, blood pressure will fall and may cause fainting, abnormal heartbeat (arrhythmia) and other serious disorders.
This risk occurs chiefly in kids, the elderly, people with weak condition and extreme diarrhea. The loss of bicarbonate may cause acidosis, a disturbance of acid-base balance in the blood.
DIARRHEA SYMPTOMS
B. Acute
Infection can occur suddenly cause diarrhea, vomiting, fever, bloody stools, decreased appetite / kelesuhan.
� Diarrhea is often accompanied by dehydration (dehydration).
� Dehydration causes only mild dry mouth.
� Dehydration wrinkles are included skin, eyes and a sunken fontanel.
Signs of dehydration:
� Weight loss.
� Decrease in frequency of urination.
� The color of the urine becomes darker and more concentrated, speedy pulse.
C. Chronicle
Common signs of diarrhea that can last a long time for weeks or months either persist or recur, sometimes mixed with blood, mucus, overweight, and bubbly.
Diarrhea may cause loss of liquid and electrolytes (eg sodium and potassium), so to be fussy, heart rhythm disturbances occurred.
This examination is divided in to, among others:
EXAMINATION OF DIARRHEA
one.Pemeriksaan general:
Found weight loss and malabsorption, in thyrotoxicosis. Anemia, in colitis, Crohn's disease tiny intestine. Fever indicates an inflammatory method.
Special three.Pemeriksaan:
Abdominal examination was not much help). While holding plug rectal fistula noted the existence of fissures and perianal area usually present in patients with chronic diarrhea is accompanied by chair examination rektosigmoidoskopi the macroscopic and microscopic.
Laboratory tests (blood tests)
In the method of inflammation are elevated ESR but in the case of Crohn's disease and colitis are sometimes the LED normal.Pada malapsorpsi and inflammatory processes can occur anemia.Albumin modestly in Crohn's and celiac disease. In malapsropsi found hypocalcaemia and avitaminosis D, raising the blood sugar or protrombin.Pemeriksaan glikosa tolerance check needs to be done for patients with pancreatitis.
Radiological
On plain abdominal images can be found calcification (calcification) in the pancreas that shows the chance of chronic pancreatitis, usually heavy drinkers who usually suffer from diarrhea with steatorea.
Barium meal
Can be found there gastrokolik fistula caused by gastric carcinoma and peptic tungkak kronik.Barium follow-through: You can find abnormalities, radiological tiny bowel Crohn's disease and diverticulosis jejunum.Barium enema: to show abnormalities of the colon, among others: skip lesion and apthosa ulcers in Crohn's disease, filling defects in colonic carcinoma, colonic spasm syndrome iritabel, the picture is not accompanied by a pile of mush haustre barium in colitis.
Colonoscopy
Colonoscopy examination may be recommended on suspicion of colonic colitis, although the images with multiple contrast showed that normal.koloskopi picture is still recommended on suspicion of colonic inflammation method, because with colonoscopy they can see the whole colon and terminal ileum even biopsy tissue.
Appeal and Laboratory Diagnosis
To start with, first ascertained whether the diarrhea arises suddenly and temporarily or permanently.
Views also whether:
Diagnosis based on signs and results of chair samples. Chair examination through its form (liquid or solid), the smell, the discovery of overweight, blood or substances that can not be digested, and the numbers within 24 hours.
Laboratory tests are important to help establish the diagnosis is by chair examination of the patient.
If diarrhea persists, do a microscopic examination of feces for:
Looking for cells, mucus, overweight and other ingredients.
Find the blood and sure materials that cause osmotic diarrhea. Looking for infectious organisms, including sure bacteria, amoeba and giardia. When secretly taking laxatives, the laxative is taken can be present in chair samples. To examine the lining of the rectum and anus can be done sigmoidoiskopi. Sometimes a biopsy is necessary (lining of the rectum for sampling for microscopic examination). In addition, the diagnosis is established based on signs and physical examination, blood tests done to select the levels of electrolytes and blood cell count putih.Untuk knowing the cause made culturing the organism against fecal samples.
- Macroscopic
To start with must think about the macroscopic state of the patient feces, among them: whether soft or liquid, the presence or absence of mucus, pus, blood, overweight or not. For example, liquid stools are often found on psikhogenik diarrhea, internal fistula, short intestine caused enterektomi, regionalis enteritis, enterocolitis.
Bloody feces and mucus accompanied tenesmi rancid smell, usually present in dysentery (basiler or ambiasis), ulserosa colitis, enteritis regionalis, but never on carcinoma of the sigmoid colon, diverticulitis coli, tuberculosis colitis, polyposis coli or colonic carcinoma who difus.Pada rekti, usually will come out smelling fresh blood, and the patient felt there was feces (skibala) in dalam.Divertikulitis coli usually will lead to bloody diarrhea with pus and mucus without never accompanied tenesmi.
Because of plenty of reasons, need to be observed at all , and if found germs entamuba histolitika, then amubiasis as a cause of chronic diarrhea. Conversely, if no germ is found to be done to better make sure breeding. If not found plenty of overweight with no or tiny bubbles with leucocytes and erythrocytes, it is necessary two times conducted a check of overweight and fatty acids, to select tiger malabsorption syndrome.
- Microscopic
Every patient with chronic diarrhea reverse their feces microscopically examined. This check is not only to see the presence or absence of mucus, leucocytes, erythrocytes, leftovers, but must also think about the kinds of germs. With the discovery of plenty of leftovers without mucus, leucocytes and erythrocytes showed gastric abnormalities as the cause. Similarly, if present in plenty of worms oksiuris aksaris or without leucocytes and erythrocytes, the diarrhea can be caused by helmentiasis. On direct examination preparations, if found plenty of leucocytes and erythrocytes, can be present in patients with dysentery (basiler or amubiasis), ulserosa colitis, ileitis terminalis, enterocolitis, tuberculosis colitis, diverticulitis coli.
This check is not only to see the presence or absence of mucus, leucocytes, erythrocytes, leftovers, but must also think about the kinds of germs. In these patients, the amount of overweight content in feces would exceed the normal, ie over 6% of the total weight of feces found for 24 hours.
Other laboratory tests
Patients with chronic diarrhea in addition to fecal examination either macroscopic or microscopic, ought to even be equipped with other tests. The maximum must even be examined blood and urine method.
MANAGEMENT
Management of diarrhea in general, among others:
Rehydration
Such aggressive management of intravenous fluids or oral rehydration with isotonic fluids containing sugar or starch elektrolik and ought to be given.
Diet
Patients are encouraged to drink in lieu of fruit-juice drinks, teas, drinks are not gaseous, basically digested foods such as bananas, rice, chips and soup.
* The most effective of opioid derivatives such as loperamide, atropine, and tincture difenoksilat-opium.penyakit.
* Drugs that hardened feces: atapulgite three x three tabs / day, smectite two x one sachets given every diarrhea / CHAPTER dilute until the diarrhea stops.
Anti-diarrhea medicine
These medications can reduce signs.
* The most effective of opioid derivatives such as loperamide, difenoksilat-atropine, and tincture of opium. Loperamide most preferred because it is not addictive and have side effects smallest. Bismuth subsalicylate is another drug that can be used but are contraindicated in patients with HIV because it may cause bismuth encephalopathy. Drug antimotilitas its consumer ought to be cautious in the heat dysentery patients (including Shigella infection) if without the anti-microbial, as it can prolong the healing of disease.
* Drugs that hardened feces: atapulgite three x three tabs / day, smectite two x one sachets given every diarrhea / CHAPTER dilute until the diarrhea stops.
* Anti-secretory drugs or anti enkephalinase: Hidrasec two x one tab / day.
Antimicrobial Drugs:
Because most patients have mild disease, self-limited disease due to viral or non-invasive bacteria, empiric treatment is not recommended in all empirical pasien.Pengobatan indicated in patients suspected of having invasive bacterial infection, tourist diarrhea (traveler's diarrhea) or immunosuppressive. Drug choices of quinolones (eg ciprofloxacin 500 mg three x / day for 5-7hari). The drug is lovely against pathogenic bacteria invarsif including Campylobacter, Shigella, Salmonella, Yersiniadan, Aeromonas, species. As an alternative that is kotrimokzatol (trimethoprim / sulfamethoxazole, 160/800 mg three x / day, or erythromycin 250-500 mg three x / day). Metronidazole 250 mg two x / day for 7 days is given for the dicurigasi giardiasis.
Tips For Prevention of Diarrhea:
* Preparation of food hygiene
* The provision of neat drinking water
* Personal hygiene
* Wash hands before eating
* Exclusive breastfeeding
* Dispose of water in place (toilet, toilet)
* Place trash adequate
* Fight not get attacked by flies for food
* A healthy environment
Diarrhea is usually transmitted through three M, namely Food, Feces, Fly and Finger. Therefore, practical efforts to prevent diarrhea is to break the transmission chain. Some efforts are simple to implement are:
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