GASTROENTERITIS (DIARRHEA)

A. DEFINITIONS

1. Gastroenteritis is

 Inflammation of the large intestine, small intestine accompanied by diarrhea were

caused by infection with a lot of foods that contain bacteria or viruses
 Condition where there is abnormal defecation frequency (more than 3 times / day)
and liquid feces consistence.
 Can be acute and chronic

2. According to WHO (1980) gastroenteritis are watery bowel movements or liquid

more than three times a day.

B. ETIOLOGY
1. Factors infection
a. Enteral infection; gastrointestinal infections are a major cause of gastroenteritis,
including bacterial infection (Vibrio, E. coli, Salmonella, Shigella,
Campylobacter, Yersinia, Aeromonas, etc.), viral infections (enterovirus,
Adenovirus, Rotavirus, Astrovirus, etc.), parasitic infections (E . hystolytica,
G.lamblia, T. hominis) and fungi (C. albicans)

b. Parenteral infection; an infection outside the digestive system that can cause
gastroenteritis such as acute otitis media, tonsillitis, bronchopneumonia,
encephalitis, and so on.

2. Factors malabsorption
Carbohydrate malabsorption: a disaccharide (lactose intolerance, maltose and
sucrose), monosaccharides (glucose intolerance, fructose and galactose). Lactose
intolerance is the most important cause of gastroenteritis in infants and children. In
addition, it is also possible malabsorption of fat and protein.

3. Factor of Food:
Gastroenteritis may occur due to eating spoiled food, toxic and allergic to certain
foods.

4. Psychological Factors
Gastroenteritis may occur due to psychological factors (fear and anxiety).

C. TYPES OF DIARRHEA
 1. Acute watery diarrhea
Exit watery feces and often no visible blood, which ended less than 14 days.
2. Dysentery
Diarrhea with blood in the feces, frequent frequency, and feces a little.
3. Persistent diarrhea
Diarrhea ended in 14 days or more, starting from acute diarrhea or dysentery.

D. SIGNS AND SYMPTOMS

1. Diarrhea.
2. Vomiting.
3. Fever.
4. Abdominal pain.
5. The mucous membranes of the mouth and dry lips.
6. Fontanel concave.
7. Losing weight.
8. No appetite.
9. Body feels weak

E. DEHYDRATION
Diarrhea causes dehydration, divided into
1. Mild dehydration
Symptoms: fontanel and sunken eyes, drinking normal, normal urination.
2. Moderate dehydration
Symptoms: restless, very thirsty, pulse and respiration rather quickly, fontanel and
sunken eyes, a little piss and drink normally.

3. Severe dehydration
Symptoms: apathy, rapid heart rate, weak pulse, blood pressures down, the color of
urine is pale, breathing fast and deep, very ugly turgor, fontanel and sunken eyes
once, and did not want to drink
Or say dehydration if:
1. Mild dehydration: loss of fluid 2-5% or an average of 25ml / kg.
2. Dehydration was: 5-10% fluid loss or an average of 75ml / kg.
3. Severe dehydration: loss of fluid 10-15% or an average of 125ml / kg.

F. PATHOPHYSIOLOGY
The occurrence of diarrhea can be caused by various factors including the possibility
of the first factor of infection, this process can be initiated microorganisms (germs) that
goes into the digestive tract which later evolved in the gut and intestinal mucosal cell
damage that can reduce the surface area of the intestine. Furthermore, a change in the
capacity of the intestine that eventually resulted in bowel function disorders
meneyebabkan active transport system in the intestine so irritated mucous cells were then
secretion of fluids and electrolytes will increase. The second factor is the failure to
 malabsorption absorption resulting in increased osmotic pressure resulting in a shift of
water and electrolytes into the intestinal cavity which can increase the contents of the
intestinal cavity so there was diarrhea. Third dietary factors, this occurs when the toxin
that is not able to be absorbed properly. Resulting in increased intestinal peristalsis
resulting in decreased opportunities to absorb the food which then causes diarrhea.
Fourth, psychological factors may influence the occurrence of an increase in intestinal
peristalsis which ultimately affect the absorption of food can cause diarrhea.

G. COMPLICATIONS
1. Loss of electrolytes (potassium)
2. Decreased urine output (30 ml / hour for 2-3 hours in a row)
3. Hypotension
4. Muscle weakness

H. MEDICAL MANAGEMENT
1. Give fluids to replace lost fluids. Oral rehydration (containing electrolytes and
glucose)
2. Monitor and correction of input and output nutrition.
3. Electrolytes.
4. Drugs - drugs: give antibiotics and drugs to lower motility

I. DIAGNOSTIC EXAMINATION
1. Feces examination by microscopic and macroscopic.
2. Examination of blood chemistry
3. Urinalysis
4. Examination of the complete blood hematology
5. Feces Routine Examination (infectious organisms or farasit)

J. ASSESSMENT
1. The pattern of diarrhea and elimination pattern previously
2. The daily nutrient intake
3. Abdominal cramps and pain
4. Frequency and drive eject feces
5. Weighing BB, hypotension, tachycardia
6. The consistency, color and smell of feces

K. DIAGNOSTICS AND INTERVENTIONS

1. Disorders of fluid and electrolyte balance associated with dehydration
Intervention:
 Assess the cause dehydrated
 Assess fluid intake and output
  Instruct patient to drink plenty
 Perform a physical examination
 Monitor the patient's vital signs

2. Impaired nutritional needs income less than body requirements related to abdominal
distension
Intervention:
 Assess the cause of nausea and vomiting
 Assess the patient's eating habits
 Explain the importance of nutrition for both body
 Instruct patient to eat little by little but often
 Collaboration: give medicine appetite enhancer / multivitamin