GROUP 3-Problem 2 B

7/26/2019 GROUP 3-Problem 2 B

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GROUP 3 - Problem 2 B

Gastrointestinal system


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Unfamiliar terms

Diarrhea isthe frequent passing ofloose or watery stools


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&in &apping


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%r$ %aniel

Name NIM

'ri (artati )*+*,**)

Agutinus Bayu B )*+*,*#+)

Ray Leonar )*+*,*2*3

%imas Priyantono )*+*,*2*+

Putu Re.a )*+***2)

/ao /essi0a )*+***3,

1iyasari )*+***#

Riny 1ahyuni )*+**#,ran0is4a Lu0iana )*+**#5

Amana /ohanna )*+**22)

'tephanie )*+**23#

&elya )*+**2)2


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A6U78 %9ARR(8A


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%89:979O:

A0ute iarrhea is e;ne as anabnormally frequent is0harge ofsemisoli or


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8piemiology

8piemiology of a0ute iarrhea" e>elope >ersus

e>eloping 0ountries$


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6LA''996A79O:

7ime A0ute ?@ #) ays

6hroni0 ?C #) ays

Pathophysiology&e0hanism 'e0retori0

Osmoti0= et0

'e>ereness &il

'e>ere

9nfe0tious 0auses

9nfe0tion :on-9nfe0tion

Organi0 0auses Organi0

un0tional


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Pathogenesis %iarrhea

D#D# #*

Predisposition

Small Intestinal Dysfunction

Diarrhea

Malnutrition

Pancreatic &

Gastric DysfunctionSpecific

Deficiencies e.g Zn

Infection

Immune

Deficiency


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D#D# ##


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8EALUA79O: ofA6U78

%9ARR(8A


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8A7UR8' O %9ARR(8AL %9'8A'8

FEATURESLOCATION OF INFECTION

Small Bowel Large Bowel

Pathogens

V. cholerae

8786= 8P86= 8Agg86Rota>irus:orwal4 >irusGiardia

Shigella8986= 8(866ampyloba0terE.histolytica

Location of

ain&iabomen Lower abomen= re0tum

T!e of stool 1atery &u0oi anDor blooy

"ol#me ofstool

Large 'mall

Fre$#enc! 9n0rease (ighly in0rease


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8A7UR8' O %9ARR(8AL %9'8A'8

FEATURES

LOCATION OF INFECTION

Small Bowel Large Bowel

% Possibly +$+ C+$+

Recing s#'stances Possibly positi>e :egati>e

(BCs in stool +Dhigh power ;el6ommonly C#*Dhigh

power ;el

Ser#m (BCs :ormal Possible leu4o0ytosis

Protosco! :ormal&u0osal ul0ersFhemorhageF friablemu0os


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Clinical manifestations an&&iagnosis

8pisoes of iarrhea 0an be

0lassi;e into three 0ategories


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6lini0al features of infe0tion withsele0te iarrheal pathogens


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Ris4 a0tors

Ma)or

8n>ironmental 0ontamination

9n0rease to e!posure to enteropathogens

A&&itional oung age

9mmune e;0ien0y

&easles

&alnutrition

&i0ronutrient e;0ien0y

La04 of e!0lusi>e or preominant breast-

feeing


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6ompli0ation

Dehydration

Malnutrition

Micronutrient deficiencies Secondary infections


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7R8A7&8:7

Rehyration

'upplemental .in0 therapy=multi>itamins= an minerals

%iet

:onspe0i;0 antiiarrheal treatment

Antimi0robials Pre>ention


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7ypes of E.coli :

+ types of 8$ 0oli ha>e beenre0ogni.e as pathogens in theintestinal tra0t$

8a0h 0auses iarrhea by iHerentme0hanism= in>ol>ing a istin0t setof >irulen0e fa0tors an geneti0

elements$


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*+ Enteroathogenic E+ coli ,EPEC-

atta0h to the intestinal mu0osa= 0ausing iarrhea in

0hilren an aults$

7he pre0ise me0hanism of ersial$

6on>entional to!ins or in>asi>e me0hanisms ha>e not

been ienti;e$

'ubtle 0hanges in the mi0ro>illus surfa0e ha>e been

note in asso0iation with atta0he 8P86= an this

amage may 0ause iarrhea$

.+ Enteroto/igenic E+ coli ,ETEC-

0ause iarrhea by elaboration of two to!ins "

a heat-labile to!in ?L7= whi0h resembles 0holera to!in

a heat-stable to!in ?'7$

0+ Enteroin1asi1e E+ coli ,EIEC-

prou0e ysentery an a 0lini0al pi0ture that is

inistinguishable from that of 'higella$


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2+ Enterohemorrhagic E+ coli ,E%EC- ,E+coli

3*456%5-

0auses a se>ere 0olitis with the passage of grossly blooy

stools$

7hese organisms prou0e a 'higa-li4e to!in that amages

the large bowel mu0osa$

Besies iarrheal isease this organism may also 0ause the

hemolyti0-uremi0 synrome ?(U'$

4+ Enteroaggretati1e ,EaggEC-0auses isease by atta0hment of the organism to the small

intestine an subsequent amage to the mu0osal lining$


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Bacterial infection


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Parasit infection


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Fungal infection

Candida sp

C. albicans is most common cause of Candida enteritis

Characteried by !atery diarrhea and abdominal pain.

Predisposing factors "prolonged antibiotic or

immunosuppressi#e therapyyeast forms are

ubi$uitous and occur in fecal flora of normal persons% their

presence alone is not diagnostic.

Definiti#e diagnosis re$uires demonstration of intestinal

mucosal in#asion by Candida on biopsy or isolation of

Candida from ulcerati#e lesions.


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Candida albicans

Usually infe0te " premature infants

those who 0onsume antibioti0s I 0orti0osteroi inlong term

malnutrition

iabetes melitus$

6ommonly infe0ts neonatus an early infan0y

'ymptoms "

iarrhea= oral trush= oni4ia= parono4ia= ermatitis Laboratory ;ning "

?J if yeasts I mi0ellium are foun

7herapy "

:istatin= Amfoterisin B= atty a0i resin 0omple!


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6(RO:96 %9ARR(8A


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6(RO:96 %9ARR(8A

6hroni0 iarrhea is e;ne as loosestools that last for at least fourwee4s

A wie range of problems 0an 0ause0hroni0 iarrheaF some of the most0ommon 0auses in0lue irritable

bowel synrome= ine 0olitis= malabsorption

synromes= an 0hroni0 infe0tions$


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%9AG:O'9' of6(RO:96%9ARR(8A


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%8(%RA79O:


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%ehyration

7he boy nees the 0orre0t amount ofwater an ele0trolytes ?salts to fun0tionproperly$

%iarrhea 0auses e!0ess loss of


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PA7(OP('9OLOG


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PA7(OP('9OLOG


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l f h i i hil


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Le>els of ehyration in 0hilren

with a0ute iarrhea


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6ompli0ations

7i&ne! fail#re Coma Shoc8 %eat9relate& illnessesI asso0iate 0ompli0ations

Electrol!te a'normalities 9n ehyration= ele0trolyte abnormalities may o00ur sin0eimportant 0hemi0als ?li4e soium an potassium are lostfrom the boy through sweat$

9f rehyration is one too slowly "

--C hypotensi>e I in sho04 for too long 9f one too qui04ly "

--C water an ele0trolyte 0on0entrations within organ 0ells0an be negati>ely aHe0te --C 0ausing 0ells to swell --C ie$

7 t t f


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7reatment of

%ehyration


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6on0lusion

Probably this 0hil is suHere bya0ute iarrhea J moerateehyration


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REFERENCES

Pri0e= 'yl>ia A$= 1ilson= Lorraine &$Patofsiologi vol 1$ 8 $ /a4arta "8G6= 2**$

au0i= Braunwal= asper= 44$(arrisonMs Prin0iples of 9nternal&ei0ine >ol 99$ 8 #5$Unite 'tate "m0Graw-(ills= 2**,$

'herwoo= Lauralee$ Physiology from6ells to 'ystems$ 8 $ Unite 'tate" 7homson (igher 8u0ation= 2**5$


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1illiam wh=&yron Nl= /uith ms=44$6urrent %iagnosis An 7reatment inPeiatri0s #, th e$ :ew or4" Lange

&ei0al Boo4sF 2**5$ au0i= Braunwal= asper= 44$

(arrison Prin0ipal 9nternal &ei0ine

#5th e$ :ew or4 " &0 Graw (illF2**,$

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GROUP 3-Problem 2 B