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ESSENTIAL

GASTROINTESTINAL

PROBLEMS

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INTRODUCTION

DIARRHEA :

a. ACUTE DIARRHEA

b. CHRONIC DIARRHEA

OBSTIPATION

RECCURENT ABDOMINAL PAIN

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DIARRHEA

DEFINITION :

* changes of the frequency and consistency of

the stool

* National Seminar on RehydrationIII, 1983

semiliquidwatery stool

frequncy3 5 times per day

SIGNS AND SYMPTOMS

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SIGN AND SYMPTOMS

AETIOLOGICAL

DIARRHEA & VOMITING

COMPLICATION

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ETIOLOGICAL FACTOR

INFECTION:

a. parenteral

b. enteral

DIETETIC

PSYCHOLOGICAL

CONSTITUTION

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MECHANISM OF DYSBIOSIS

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COMPLICATION OF DIARRHEA

DEHYDRATIONwater & electrolyt

a. dehydration d. hypocalcemia

b. dehyd& acidosis e. meteorism

c. hypokalemia f. shock syndrome

NUTRITION malnutrition

MUCOSAL INJURY macromolecule migration

a. allergy

b. septichemia

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MANAGEMENT OF DIARRHEA

(John Biddulp)

Five Ds :

DEHYDRATION

DIAGNOSE

DIETETICAL PROCEDURE

DRUGS

DISACCHARIDASE DEFFICIENCY

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REHYDRATION

BODY FLUID RESTORATION

ORALLY IS FIRST PRIORITY :

* oralyte: early, household fluid

* gentelly, small portion but frequently

INTRAVENOUSLY:

* direct into intravenous compartment

* heavy deplesite, severe dehydration or high fever

* impossible by orally (vomiting)

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REHYDRATION

NO DEHYDRATION :

* ORAL REHYDRATION

* ORAL PROBLEM & HYPERTHERMIA

SOME DEHYDRATION :

* ORAL REHYDRATION

* ORAL PROBLEM & HYPERTHERMIA

SEVERE DEHYDRATION :

ROSESYSTEM

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PEDIATRIC REHYDRATION

TOTAL VOLUME OF PEDIATRIC BODY FLUID

IS RELATIVE HIGH

RATIO OF CIRCULATING AND DEPOT OF

BODY FLUID IS SMALL

RESPONS CAPACITY OF THE ORGANS ARE

STILL LOW

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TOTAL BODY WATER

( value in % )

45

55

65FAT

506075AVERAGE

556580THIN

FEMALEMALEINFANT

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INTRVENOUS REHYDRATION

REPLACEMENT OF :

* fluid deplesitcirculation failure

* oxygen deplesit& glucose deplesit

FAST REPLACEMENT:

* initial dose : 10 15 ml/kg/hr

* maintenance dose 125 200 ml/day

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PHYSICAL EXAMINATION

HYDRATION STATUS

NUTRITION STATUS

ABDOMINAL EXAMINATION :

to different with surgical abdominal cases

ETIOLOGICAL ASPECT : -enteral

-parenteral

COMPLICATION ASPECT :

* Etiolgicaldissorders

* Secretoricand electrolyte imbalance

* Nutrition dispersal

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NUTRITION TREATMENT

SUFFICIENT ON CALORY AND PROTEIN

AVOID MALABSORTION SYNDROM

MALABSORPTION

DIAGNOSTIC

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MALABSORPTION

DIAGNOSIS :

* physical : meteoristic, excoriation

watery,voluminous, acid stool

* reduction test of stool

PROGRESS CONDITION:

* mucosal injury

* microbial overgrowth

* maldigestion

* allergy

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NUTRITION TREATMENT

ACCEPTABILITY :

a. taste and flavour

b. performance

AVOID MALABASORTION

formula composition for :

* intolerance

* maldigestion

* allergy

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CHRONIC DIARRHEA IN

CHILDREN

I.SUDIGBIA

Department of Child Health

Medical Faculty of Diponegoro

University

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INTRODUCTION

MORE THAN 2 WEEKS

LEBENTHAL (1983) :

* prolonged small intestine mucosal injury

M.BABA (2001) :

* Osmotic * Secretory

* Intestinal transit * Exudative

INCIDENCE & MORTALITY :

Problem for young infant with high risk :

* complication

* mortality rate

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MAJOR CAUSES OF CHRONIC

DIARRHEA I

(Vanderhoof,1993)

INFANTS :

* Intractable diarrhea of infancy

* Proctactedinfectious enteritis

* Milk and soy intolerance

* Autoimmune enteropathy

* Hirschprungsdisease

TOODLERS :

* Chronic nonspecific diarrhea

* Proctactedviral enteritis

* Giardiasis

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MAJOR CAUSES OF CHRONIC

DIARRHEA II

(Vanderhoof,1993)

* Ulcerative colitis

* Tumor secretorydiarrhea

* Celiac disease

SCHOOL AGE CHILDREN :

* Inflamatorybowel disease

* Apendicealabces

* Primary acquairedlactase deficiency

* Constipation with encopresis

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RECURRENT

ABDOMINAL PAIN

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INTRODUCTION

DEFINITION :

* AT LEAST 3 EPISODES IN 3 MONTHS PERIOD

* INTERFERES WITH NORMAL CONDITION

* SCHOOL AGE : 5 14 YEARS OF AGE

* LOCALIZED PERIUMBILLICAL PAIN DUE TO

BOWEL MUSCLE TENSION

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PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY POORLY

UNDERSTOOD

IS NOT SYNONYM WITH IMMAGINARY OF

CHILD EXPIRIENCE OF ABDOMINAL PAIN

BOWEL MOTILITY DISTURBANCE

DISTENSION OR SPASM

INCREASED MUSCLE TENSION

PAIN ORIGIN IS NERVE ENDING IN

MUCUSA, MUSCLE AND SEROSA

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FACTORS INFLUENCE ON

RECURRENT ABDOMINAL PAIN

* LOWERED THRESHOLD OF PAIN

* ENVIROMENTAL INFLUENCES

responsof family members

* physically

* psychologically

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STUDIES ON FACTORS WHICH

INFLUENCED REC.ABD.PAIN

Hodge et al (1984) : significantly difference in

life stress experiences

Greene et al (1985) : significantly higher stress in

adolescens

Mc.Grathet al (1987): no significantly deffernce

in life stress

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