DIARRHEA

Definitions

Defecation with liquid or semi-liquid stool

(contains water of 200 ml / 24 hours)

Watery defecation with frequency of more than

3 times a day

May or may not contain mucus or blood

Classification
Based on:

1. Time
Acute
Chronic
Persistent

2. Patophysiological Mechanism
Osmotic
Secretory
3. Infectious Causal
Infective
Non invective

4. Organical Causal
Organic
Non organic (functional)
 ACUTE DIARRHEA

Less than 15 days

Or
Less than 14 days (WGO, 2005)
Etiology (WGO Global Guidelines, 2005)

1. Infection
Bacteries: Shigella sp, pathogenic E.coli,
Salmonella sp, Vibrio cholera, Yersinia entero
colytica, Compylobacter jejuni,
V.parahaemoliticus, V.NAG., Staphylococcus
aureus, Streptococcus, Klebsiella,
Pseudomonas, Aeromonas, Proteus, etc.

Viruses: Rotavirus, Adenovirus, Norwalk virus,

Norwalk like virus, Cytomegalovirus (CMV),
echovirus.
 Parasites (protozoa): Entemoeba histolytica,
Giardia lamblia, Cryptosporidium parvum,
Balantidium coli.

Invasive: EIEC, Salmonella, Shigella, Yersinia,

C. Perferingens type C, E. Hystolitica, G.
Lamblia
Non invasive: V. Cholerae eltor, ETEC, C.
perferingens
2. Non Infection
Immunodeficiency
Medicines , antibiotics, corticosteroids
Certain treatments (Gastrectomy,
gastroenteroctomy, radiation terapy)
Others: Synd. Zollinger-Ellison, autonomic
neurophaty
Pathophysiology

1. Osmotic
2. Secretory
3. Bile acid, fat malabsorption
4. Electrolyte transport system defects
5. Abnormality of motility and transit time
6. Abnormality of permeability
7. Infection
Diagnosis
Treatments

1. Rehydration
Oral (Oralit)
IV (RL 50-200ml/kgBB/24h)
2. Diet
3. Anti-Diarrhea Medication
Anti-Motility: Loperamide, Difenoxilat
Stool hardener: Antapulgite
Anti-Secretory: Hidrase
4. Antimicrobial
Only recommended for invasive diarrhea,
traveler's diarrhea, or immunosuppressive
Kuinolon: Siprofloxaxine
Kotrimoxazol: Trimetoprim/Sulfametoxazol
 CHRONIC DIARRHEA

More than 14 days

Etiology
Based on:

1. Patophysiology
Osmotic
Secretory
Bile acid, fat malabsorption
Electrolyte transport system defects
Abnormality of motility and transit time
Abnormality of permeability
Fluid exudation
2. Location or Organs Abnormality
Pancreas (Cistic fibrosis, PEM, chronic
pancreatitis, enzyme deficiency)
Hepatobilier (bile atresia, obstructive
icteric, chronic hepatitis, hepar cirrhosis)
Bowel
3. Stool characteristics
Fatty stool / steatorrhoea
Bloody stool
Non fatty or bloody stool (watery and
semisolid)
4. Powell DWs
Steatorrhoea
Watery stool with respons to fasting
Watery stool with respons or no respon to
fasting
Watery stool with no respon to fasting
Inflamatory diarrhea
Diagnosis

1. Anamnesis
Time and frequency
Stool
Other complaints
Medicines
Foods / drinks
2. Physical Examination
3. Stool
Macroscopic
Microscopic
pH
4. Laboratory
Blood
Serology
Urine
5. Other
BNO (foto polos abdomen)
Barium enema
Sigmoidoskopi