DIARE

AKUT
PADA
ANAK
Amaliah Harumi Karim
Pembimbing : dr. Dedy
Rahmat, SpA
Case-Based Discussion

DEFINISI
BAB pada bayi / anak > 3 kali/hari,
disertai perubahan konsistensi tinja
menjadi cair, dengan/ tanpa lendir dan
darah , < 7 hari. (IDAI)
Untuk bayi dengan ASI frekuensi BAB
/ konsistensi jadi cair.
<3 kali, konsistensi cair diare (pada
yang mendapat ASI )

FAKTOR RISIKO USIA

I. Insidensi tertinggi 2 tahun pertama
kehidupan , di usia 6-11 bulan

KLASIFIKASI

Diare

s/d 7
hari
8-14
hari
> 14
hari

Akut
Melanjut
Bukan
infeksi

Kronik

Terbukti
Infeksi

Persiste
n

PEMBAGIAN DIARE BERDASAR

ETIOLOGI

PEMBAGIAN DIARE BERDASAR

PATOMEKANISME 1. GANGGUAN
ABSORPSI (DIARE OSMOTIK)
Bahan yang tidak
diserap

Bahan
intraluminal pada
usus halus
proksimal jadi
hipertonis

hiperosmolaritas

Terkumpul banyak
air di lumen usus

Maka pada
segmen jejunum
yg permeabel : air
mengalir ke arah
lumen jejunum

Adanya
perbedaan
tekanan osmotik
antara lumen usus
dan darah

diare

PEMBAGIAN DIARE BERDASAR

PATOMEKANISME 2.
MALABSORPSI UMUM

 Noninfectious causes of acute

diarrhea include drug eff ects, food allergy (most
common
in infants with milk or soy protein sensitivity), carbohydrate malabsorption from sucrase-isomaltase defi ciency
and hypolactasia (lactose intolerance), radiation- or
che-motherapy-related enteritis, and anatomic
conditions such
as appendicitis or intussusception. Less common
causes of
acute diarrhea include niacin defi ciency and toxicity
from
excess copper, tin, or zinc

 Secretory diar-rhea, often infectious in nature, is

accompanied by a high
stool chloride content and normal stool osmotic gap.
Osmotic gap equals the measured stool osmolality
2(2
[Na 1K]), and normal is less than 50 mOsm. The stool
osmolality can be estimated at 290 mOsm when
accurate
measurement is not possible. Secretory diarrhea does
not
resolve in a fasting state.

 Osmotic diarrhea, often not in-fectious in nature, will

have an increased stool anion gap
(.100 mOsm/kg) and does improve during fasting.

 Diar-rhea originating in the small bowel is marked by

high stool
sodium content, whereas diarrhea originating in the
colon
has low stool sodium content.

 Infl ammation can be used to further classify

secretory diarrhea

 Noninfl ammatory
secretory diarrhea results when the infection (or
entero-toxin) promotes secretion of fl uid and
electrolytes or re-duces absorption in the small bowel

 Infl ammatory
secretory diarrhea, caused by invasion of the bowel
mu-cosa, often presents with blood, mucus, and pus
in the
stool and tenesmus, severe cramps, and fever.

ANAMNESIS
onset, duration, fre-quency, pattern, and severity of
the diarrhea
the stools contain blood or mucus and whether
fasting (if done) decreases stooling amount.

 amount of oral intake, including breast milk, other

fl uids and food, and symptoms of dehydration including decreased frequency of urination, decreased
activ-ity level, irritability, weight loss and decreased
tearing

 Note associated gastrointestinal symptoms such as

vomiting, abdominal pain (including location and intensity), and anorexia

 as fever, cough, coryza, arthralgias/arthritis and rash.

Identify any potential precipitating factors including
ingestions. Ask if other family members or contacts
have recently had diarrhea. Past medical history
should focus on underlying medical problems, recent
infections, medications used, and human immunodefi ciency (HIV) status.