Gea

GASTROENTERITIS AKUT

OLEH : dr. Waisul Choroni Trenggono, S. !"

RU#AH SAKIT U#U# !ANE#$AHAN SENO!ATI $ANTUL %&'(

i

"A)TAR ISI

Hala*an DAFTAR ISI....................................................................................................................................ii BAB I.............................................................................................Error+ $oo*ar no- deined. TINJAUAN PUSTAKA..................................................................................................................3 1.

Definisi.................................................................................................................................4

2.

Etiologi.................................................................................................................................4

3.

Patofisiologi..........................................................................................................................4

4.

Manifestasi lini.................................................................................................................!

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Diagnosis..............................................................................................................................#

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Ana$nesis.........................................................................................................................#

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%a&o'ato'i($.....................................................................................................................)

Penatalasanaan..................................................................................................................11 

Penggantian *ai'an +an elet'olit...................................................................................11

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Anti &ioti.......................................................................................................................12

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,&at anti +ia'e.................................................................................................................13

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P'o&ioti..........................................................................................................................14

*a'a -en(la'an +an Fato' 'esio.......................................................................................14 

Fato' ($('.....................................................................................................................14

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Infesi asi$to$ati.........................................................................................................14

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Fato' $(si$..................................................................................................................14

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E-i+e$i +an -en+e$i......................................................................................................1"

Ko$-liasi..........................................................................................................................1!

BAB II...........................................................................................................................................1 RIN/KASAN................................................................................................................................1 DAFTAR PUSTAKA.....................................................................................................................1)

ii

$A$ I TIN/AUAN !USTAKA

'. "einisi

/ast'oente'itis a+ala0 infla$asi $e$&'ane $(osa la$&(ng +an (s(s 0al(s. /ast'oente'itis a(t +itan+ai +engan +ia'e +an -a+a &e&e'a-a as(s $(nta0$(nta0 ang  &e'ai&at e0ilangan ai'an +an elet'olit ang $eni$&(lan +e0i+'asi +an gangg(an esei$&angan elet'olit. 5%nn Bet6277)8 Dia'e a+ala0 &(ang ai' &esa' 5+efeasi8 +engan 9($la0 tin9a ang le&i0 &ana +a'i  &iasana 5no'$al 177277 :9a$ tin9a8. Dengan tin9a &e'&ent( ai' :setengan -a+at +a-at +ise'tai f'e(ensi ang $eningat. Men('(t ;<, 51)78 +ia'e a+ala0 &(ang ai' &esa' ene'  le&i0 +a'i 3 = se0a'i. Dia'e te'&agi 2 &e'+asa'an $(la +an la$ana  ait( +ia'e a(t +an 'onis 5Mans9oe'A.1)))"718. So a+ala0 s(at( ea+aan +i$ana osigenasi 9a'ingan +an -e'f(si 9a'ingan ti+a  a+e(at ang +ise&a&an a'ena a+ana gangg(an si'(lasi. So a+ala0 -'oses -atofisiologi o$-les ang se'ing &e'asal +a'i sin+'o$ +isf(ngsi +an e$atian &e&e'a-a o'gan. So ait( 0a$&atan +i +ala$ -e'e+a'an +a'a0 -e'ife' ang $ene&a&an -e'f(si  9a'ingan ta ((- (nt( $e$en(0i e&(t(0an sel aan 6at $aanan +an $e$&(ang sisa $eta&olis$e 5 T0eo+o'e )3 8 ata( s(at( -e'f(si 9a'ingan ang ('ang se$-('na. So $en(n9(an -e'f(si 9a'ingan ang ti+a a+e(at. ala(-(n a+a &e'$aa$ $aa$ -ene&a&. So +i0asilan ole0 +isf(ngsi e$-at siste$ ang te'-isa0 na$(n saling  &e'aitan ait( ? 9ant(ng @ol($e +a'a0 'esistensi a'te'iol 5&e&an a0i'8 +an a-asitas @ena. Jia sala0 sat( fato' ini aa( +an fato' lain ti+a +a-at $ela(an o$-ensasi $aa aan te'9a+i so. A>alna teanan +a'a0 a'te'i $(ngin no'$al se&agai o$-ensasi -eningatan isi se(n(- +an ('a0 9ant(ng. Jia so &e'lan9(t ('a0 9ant(ng $en('(n +an @asoont'isi -e'ife' $eningat. So 0i-o@ole$i $e'(-aan ti-e so ang -aling ($($ +itan+ai +engan  -en('(nan @ol($e int'a@as(la'. *ai'an t(&(0 te'an+(ng +ala$ o$-a'te$en int'asel(la'  +an est'asel(le'. *ai'an int'a sel(le' $ene$-ati 0a$-e' 2:3 +a'i ai' t(&(0 total se+angan

ai'an t(&(0 est'asel(le' +ite$(an +ala$ sala0 sat( o$-a'te$en int'a@as(la' +an inte'sisial. ol($e ai'an inte'stitial a+ala0 i'ai'a 34= +a'i ai'an int'a@as(la'. So 0i-o@ole$i te'9a+i 9ia -en('(nan @ol($e inta@as(le' 1" sa$-ai 2".
%. E-iologi •

Fato' infesi C Bate'i 5 S0igella S0al$onella i&'io 0ole'a8 i'(s 5Ente'o@i'(s8  -a'asit 5aing8 Kan+i+a 5*an+i+a Al&ians8.

•

Fato' -a'ent'al C Infesi +i&agian t(&(0 lain 5,MA se'ing te'9a+i -a+a anaana8.

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Fato' $ala&so'&si C Ka'&o0i+'at le$a -'otein.

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Fato' $aanan C Maanan &asi &e'a(n te'la$-a( &ana le$a sa('an +i$asa  (tang $atang.

•

Fato' Psiologis C Rasa ta(t e$as

(. !a-oisiologi

A+a 2 -'insi- $eanis$e te'9a+ina +ia'e ai' ait( see'eto'i +an os$oti. Mesi-(n +a-at $elal(i e+(a $eanis$e te'se&(t +ia'e se'eto'i le&i0 se'ing +ite$(an  -a+a infesi sal('an e'na. &egit( -(la e+(a $eanis$e te'se&(t +a-at te'9a+i &e'sa$aan  -a+a sat( ana. •

"iare os*o-i

M(osa (s(s 0al(s a+ala0 e-itel &e'-o'i ang +a-at +ilal(i ole0 ai' +an elet'olit +engan e-at (nt( $e$-e'ta0anan teanan os$oti anta'a l($en (s(s +engan ai'an est'asel. A+ana &a0an ang ti+a +ise'a- $ene&a&an &a0an int'al($inal -a+a (s(s 0al(s &agian -'osi$al te'se&(t &e'sifat 0i-e'toni +an $ene&a&an 0i-e'os$ola'itas. Ai&at  -e'&e+aan teanan os$ose anta'a l($en (s(s +an +a'a0 $aa -a+a seg$en (s(s 9e9(n($ ang &e'sifat -e'$ea&le ai' aan $engali' ea 'a0 9e9(n($ se0ingga aan &ana te'($-(l ai' +ala$ l($en (s(s. Na aan $engi(ti $as( e +ala$ l($en +engan +e$iian aan te'($-(l ai'an int'al($inal ang &esa' +engan a+a' Na no'$al. Se&agian eil ai'an ini aan +i&a>a e$&ali aan teta-i laina aan teta- tinggal +i l($en ole0 a'ena a+a &a0an ang ti+a +a-at +ise'a- se-e'ti Mg gl(osa s('ose latose $altose +i seg$en ile($ +an

4

$ele&i0i e$a$-(an a&so'&s olon se0inga te'9a+i +ia'e. Ba0an&a0an se-e'ti a'&o0i+'at +an 9(s &(a0 ata( &a0an ang $engan+(ng so'&itol +ala$ 9($la0 &e'la&i0an aan $e$&e'ian +a$-a ang sa$a.1 •

"iare Sere-ori

Dia'e sete'i +ise&a&an ole0 se'esi ai' +an elet'olit e +ala$ (s(s 0al(s ang te'9a+i ai&at gangg(an a&so'&s nat'i($ ole0 @il(s sal('an e'na se+angan se'esi lo'i+a teta- &e'langs(ng ata( $eningat. Kea+aan ini $ene&a&an ai' +an elet'olit el(a' +a'i t(&(0 se&agai tin9a ai'. ,s$ola'itas tin9a +ia'e se'eto'i isoos$ola' te'0a+a- -las$a. &e+a os$oti +a-at +i0it(ng +engan $eng((' a+a' elet'olit tin9a. Ka'ena Nat'i($ 5 Na8 +an ali($ 5K8 $e'(-aan ation (ta$a +ala$ tin9a os$olalitas +i-e'i'aan +engan $engalian 9($la0 a+a'   Na  +an K +ala$ tin9a +engan anga 2. Jia +ias($sian os$olalitas tin9a onstan 2)7 $,s$:% -a+a tin9a +ia'e $aa -e'&e+aan os$oti 2)72 5NaK8. Pa+a +ia'e os$oti tin9a $e$-(nai a+a' Na 'en+a0 5"7 $E:%8+an &e+a os$otina &e'ta$&a0 &esa' 5G1!7 $,s$:%8. Pa+a +ia'e se'eto'i tin9a +ia'e $e$-(nai a+a' Na tinggi 5G)7 $E:%8 +an  -e'&e+aan os$otin(a ('an +a'i 27 $,s$:%.

Dienal &a0an&a0an ang $ensti$(lasi se'esi l($en ait( ente'otosin &ate'i +an  &a0an i$ia ang +a-at $ensti$(lasi se-e'ti lasansia ga'a$ e$-e+( &ent( +i0i+'o= se'ta asa$ le$a 'antai -an9ang. Tosin -ene&a& +ia'e ini te'(ta$a &ee'9a +engan a'a $eningatan onsent'asi int'asel AMP /MP ata( *a ang selan9(tna aan $engatifasi -'otein inasi. Pengatifan -'otein inase aan $ene&a&an fosfo'ilase $e$&'ane -'otein se0ingga $egai&atan -e'(&a0an sal('an ion aan $ene&a&an *l +i 'i-ta el(a'. Dia'e +a-at 9(ga +iaitan +engan gangg(an $otilitas. Mesi-(n $otilitas 9a'ang $en9a+i -ene&a& (ta$a $ala&so'&si teta-i -e'(&a0an $otilitas $e$-(nai -enga'(0

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te'0a+a- a&so'&s. Bai -eningatan ata(-(n -en('(nan $otilitas e+(ana +a-at $ene&a&an +ia'e. Pen('(nan $otilitas +a-at $engai&atan &ate'i t($&(0 la$-a( ang $ene&a&an +ia'e. Pe'la$&atan t'ansit o&ato&atan ata( n(t'isi aan $eningatan a&so'&si Kegagalan $otilitas (s(s ang &e'at $ene&a&an statis intestinal &ea'i&at infla$asi +eon9(gasi ga'a$ e$-e+( +an $ala&so'&si. Dia'e ai&at 0i-e'-e'istalti -a+a ana 9a'ang te'9a+i. ;ate' +ia'e +a-at +ise&a&an a'ena 0i-e'$otilitas -a+a as(s olon i''ita&le -a+a &ai. /angg(an $otilitas $(ngin $e'(-aan -ene&a& +ia'e -a+a T0'otosiosis $ala&so'&si asa$ e$-e+( +an &e'&agai -eait lain. P'oses infla$asi +i (s(s 0al(s +an olon $ene&aan +ia'e -a+a &e&e'a-a ea+aan. Ai&at e0ilangan sel e-itel +an e'(saan tig0t 9(ntion teanan 0i+'ostati +ala$ -e$&(l(0 +a'a0 +an li$fati  $ene&a&an ai' elet'olit $((s -'otein +an se'ingali sel +a'a0 $e'a0 +an sel +a'a0  -(ti0 $en($-( +ala$ l($en. Biasana +ia'e ai&at infla$asi ini &e'0(&(ngan +engan ti-e +ia'e laina se-'ti +ia'e os$oti +an se'eto'i. Bate'i ente'al -at0ogen aan $e$-enaga'(0i st'(t(' +an f(ngsi tig0t 9(ntion $engin+(si ai'an +an elet'olit +an aan $engatifan asa+e infla$asi. Efe infesi  &ate'ial -a+a tig0t 9(ntion aan $e$e-enga'(0i s(s(nan anato$is +an f(nsi a&so'&s ait( toseleton +an -e'(&a0an s(s(nan -'otein. -enelitian ole0 Baes J + 2773 $en(n9(an  &a0>a -e'anan &ate'i ente'al -at0ogen -a+a +ia'e te'leta -e'(&a0an &a'ie' tig0t 9(ntion ole0 tosin ata( -'o+( ($an ait( -e'(&a0an -a+a ell(ala' toseleton +an s-esifi tig0t 9(ntion. Penga'(0 ini &ias -a+a e+(a o$-onen te'se&(t ata( sala0 sat( o$-onen sa9a se0ingga aan $ene&a&an 0i-e'se'esi lo'i+a ang aan +ii(ti nat'i($ +an ai'. Se&agai onto0 Clostridium difficile aan $engin+(si e'(saan toseleton $a(-(n -'otein  Bacteroides frigilis $ene&a&an +eg'a+asi -'oteoliti -'otein tig0t 9(ntion V. cholera $e$-enga'(0i +ist'i&(si  -'otein tig0t 9(ntion se+angan EPE* $ene&a&an a($(lasi -'otein toseleton.

0. #anies-asi lini 

Infesi (s(s $eni$&(lan tan+a +an ge9ala gast'ointestinal se'ta ge9ala laina &ila te'9a+i o$-liasi est'aintestinal te'$as( $anifestasi ne('ologi. /e9ala gast'ointestinal  &ias &e'(-a +ia'e 'a$ -e'(t +an $(nt0. Se+angan $anifestasi siste$i &e'@a'iasi te'gant(ng -a+a -ene&a&na. Pen+e'ita +engan +ia'e ai' $engel(a'an tin9a ang $engan+(ng se9($la0 ion nat'i($ lo'i+a +an &ia'&onat. Ke0ilangan ai' +an elet'olit ini  &e'ta$&a0 &ila a+a $(nta0 +an e0ilangan ai' 9(ga aan $eningat &ila a+a -anas.
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+a-at $ene&a&an +e0i+'asi asi+osis $eta&oli +an 0i-oale$ia. De0i+'asi $e'(-aan ea+aan

ang

-aling &e'&a0aa

a'ena +a-at

$ene&a&an

0i-o@ole$ia ola-s

a'+io@as(la' +an e$atian &ila ti+a +io&ati +engan te-at. De0i+'asi ang te'9a+i $en('(t tonisistas -las$a +a-at &e'(-a +e0i+'asi isotoni +e0i+'asi 0i-e'toni 5 0i-e'nat'e$i8 ata( +e0i+'asi 0i-otoni. Men('(t +e'a9at +e0i+'asina &ias tan-a +e0i+'asi +e0i+'asi 'ingan +e0i+'asi se+ang +e0i+'asi &e'at. Bila te'+a-at -anas +i$(nginan a'ena -'oses -e'a+angan ata( ai&at +e0i+'asi. Panas &a+an ($($ te'9a+i -a+a -en+e'ita +engan infla$$ato' +ia'e. Ne'i -e'(t ang le&i0 0e&at +an tenes$(s te'9a+i -a+a -e'(t &agian &a>a0 se'ta 'et($ $en(n9(an te'enana (s(s &esa'. M(al +an $(nta0 a+ala0 s$-to$ ang nons-esifi aan teta-i $(nta0 $(ngin +ise&a&an ole0 a'ena $i'oo'ganis$e ang $enginfesi sal('an e'na &agian atas se-'tiCente'i @i'(s &ate'i ang $e$-'o+(si ente'o'osin gia'+ia +an '-tos-o'i+i($. M(nta0 9(ga se'ing te'9a+i -a+a non infla$$ato' +ia'e. Biasana -en+e'ita ti+a -anas at( 0ana s(&fe&'is ne'i -e'(t-e'i($&ilial ti+a &e'at >ate' +ia'e $en(n9(an &a0>a sal('an $aan &agian atas ang te'ena. ,le0 a'ena -asien i$$(noo$-'o$ise $e$e'l(an -e'0atian 0(s(s info'$asi tentang a+ana i$(no+efisiensi ata( -enait. 1. "iagnosis •

Ana$nesis

Pa+a ana$nesis -e'l( +itanaan 0al0al se&agai &e'i(t C la$a +ia'e f'e(ensi @ol($e onsistensi tin9a >a'na &a( a+a:ti+a len+i' +an +a'a0. Bila +ise'tai $(nta0 @ol($e +an f'e(ensina. KeningC &iasa &e'('ang 9a'ang ata( ti+a ening +ala$ !9a$ te'a0i'. Maanan +an $in($an ang +i&e'ian sela$a +ia'e. A+aa00 -anas ata( -enait lain ang $ene'tai se-e'tiC &at( -ile otitis $e+ia a$-a. Tin+aan ang tela0 +ila(an i&( sela$a ana +ia'eC $e$&e' o'alit $e$a&>a &e'o&at e -(ses$as ata( e '($a0 sait +an o&ato&atan ang +i&e'ian se'ta 'i>aat i$(nisasina. Pe$e'isaan fisi

Pa+a -e$e'isaan fisi -e'l( +i-e'isa C &e'at &a+an s(0( t(&(0 f'e(ensi +en(t  9ant(ng +an -e'na-asan se'ta teanan +a'a0. Selan9(tna -e'l( +ia'i tan+atan+a ta$&a0an lainaC(&(n(&(n &esa' e(ng ata( ti+a $ataC o>ong ata( ti+a a+a ata( ti+a a+ana ai' 

#

$ata &i&i' $(osa $(l(t +an li+a0 e'ing ata( &asa0. Pe'n-asan ang e-at +an +ala$ in+iasi a+ana asio+osis $eta&oli. Bising (s(s ang le$a0 ata( ti+a a+a &ila te'+a-at 0i-oale$ia. Pe$e'isaan est'e$itas -e'l( a'ena -e'f(si +an a-illa' 'efill +a-at $enent(an +e'9at +e0i+'asi ang te'9a+i. Penilaian &e'atna ata( +e'a9at +e0i+'asi +a-at +itent(an +engan a'aC o&9etif ait( +engan $e$&an+ingan &e'at &a+an se&el($ +an ses(+a0 +ia'e.



•

%a&o'ato'i($ Pe$e'isaan la&o'ato'i($ lenga- -a+a +ia'e a(t -a+a ($($na ti+a 

+i-e'(an 0ana -a+a ea+aan te'tent( $(ngin +i-e'l(an $isalna -ene&a& +asa'na ti+a +ieta0(i ata( a+a se&a&se&a& lain selain +ia'e a(t ata( -a+a -en+e'ita +engan +e0i+'asi &e'at. *onto0C -e$e'isaan +a'a0 lenga- (lt(' ('ine +an tin9a -a+a se-sis ata( infesi sal('an e$i0. Pe$e'isaan la&o'ato'i($ ang a+anga+ang +i-e'l(an -a+a +ia'e a(tC •

+a'a0 C +a'a0 lenga- se'($ elet'olit analisa gas +a'a0 gl(osa +a'a0 (lt(' +an tes e-eaan te'0a+a- anti&iotia

•

('ineC ('ine lenga- (lt(' +an test e-eaan te'0a+a- anti&iotia

•

tin9a Pe$e'isaan $a'oso-i tin9a -e'l( +ila(an -a+a se$(a -en+e'ita +engan

+ia'e $esi-(n -e$e'isaan la&ota'i($ ti+a +ila(an. Pe$e'isaan $a'oso-i 

)

$ena(- >a'na tin9a onsistesi tin9a &a( tin9a a+ana len+i' a+ana +a'a0 a+ana  &(sa. ;a'na tin9a ti+a te'lal( &ana &e'ole'asi +engan -ene&a& +ia'e. ;a'na 0i9a( t(a &e'0(&(ngan +engan a+na >a'na e$-e+( ai&at ga'a$ e$-e+( ang +ion9(gasi ole0 &ate'i anae'o& -a+a ea+aan &ate'ial o@e'g'o>t0. ;a'na $e'a0 ai&at a+ana +a'a0 +ala$ tin9a ata( o&at ang +a-at $ene&a&an >a'na $e'a0 +ala$ tin9a se-e'ti 'ifa$-isin. Konsistensi tin9a +a-at ai' le$&e -a+at. Tin9a ag &e'&(sa $en(n9(an a+ana gas +ala$ tin9a ai&at fe'$entasi &ate'i. Tin9a ang &e'$ina lenget +an  &e'ilat $en(n9(an a+ana le$a +ala$ tin9a. %en+i' +ala$ tin9a $engga$&a'an elainan +i olon  0(s(sna ai&at infesi &ate'i. Tin9a ang sangat&e'&a( $engga$&a'an a+ana fe'$entasi ole0 &ate'i anae'o& +iolon. Pe$e'isaan -< tin9a $engg(naan e'tas la$(s +a-at +ila(an (nt( $enent(an a+ana asa$ +ala$ tin9a. Asa$ +ala$ tin9a te'se&(t a+ala0 asa$ le$a 'antai -en+e ang +i0asilan a'ena fe'$entasi latosa ang ti+a +ise'a- +i (s(s 0al(s se0ingga $as( e (s(s &esa' ang  &ana $engan+(ng &ate'i o$ensial. Bila -< tin9a! +a-at +aingga- se&agai $ala&so'&si latosa.

Infesi &ate'i in@asi@e +itan+ai +engan +ite$(anna se9($la0 &esa' le(osit +ala$ tin9a ang $en(n9(an a+ana -'oses infla$asi. Pe$e'isaan le(osit tin9a +engan a'a $enga$&il &agian tin9a ang &e'len+i' se(9(ng li+i +an +i&e'i H tetes eosin ata(  Nal lal( +ili0at +engan $i'oso- a0aaC" •

 &ila te'+a-at 1" le(osit -e'la-ang -an+ang &esa' +ise&(t negati@e

•

 &ila te'+a-at "17 le(osit -e' la-ang -an+ang &esa' +ise&(t 58

•

 &ila te'+a-at 1727 le(osit -e' la-ang -an+ang &esa' +ise&(t 58

•

 &ila te'+a-at le(osit le&i0 +a'i H la-ang -an+ang &esa' +ise&(t 58

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 &ila le(osit $e$en(0i sel('(0 la-ang -an+ang &esa' +ise&(t 58 A+ana le$a +a-at +i-e'isa +engan a'a -e'>anaan tin9a +engan s(+an III ang

$engan+(ng alo0ol (nt( $engel(a'an le$a aga' +a-at +i>a'nai sea'a $i'oso-is +engan -e$&esa'n 47 ali +ia'i &(ti'an le$a +engan >a'na (ning ata( 9ingga. Penilaian &e'+asa'an 3 'ite'iaC

17

•

58 &ila ta$-a sel le$a eil +engan 9($la0 ('ang +a'i 177 &(a0 -e' la-ang  -an+ang ata( sel le$a $e$en(0i 1:3 sa$-ai H la-ang -an+ang

•

58 &ila ta$-a sel le$a +negan 9($la0 le&i0 177 -e' la-ang -an+ang ata( sel $e$en(0i le&i0 +a'i H la-ang -an+ang

•

58 &ila +i+a-atan sel le$a $e$en(0i sel('(0 la-ang -an+ang

2. !ena-alasanaan •

!enggan-ian Cairan dan ele-roli-

As-e -aling -enting +a'i te'a-i +ia'e a+ala0 (nt( $en9aga 0i+'asi ang a+e(at +an esei$&angan elet'olit sela$a e-iso+e a(t. Ini +ila(an +engan 'e0i+'asi o'al +i$ana 0a'(s +ila(an -a+a se$(a -asien e(ali ang ti+a +a-at $in($ ata( ang te'ena +ia'e 0e&at ang $e$e'l(an 0i+'asi inta@ena ang $e$&a0aaan 9i>a.1# I+ealna ai'an 'e0i+'asi o'al 0a'(s te'+i'i +a'i 3" g Nat'i($ lo'i+a +an 2" g Nat'i($ &ia'&onat 1" g ali($ lo'i+a +an 27 g gl(osa -e' lite' ai'.24 *ai'an se-e'ti it( te'se+ia sea'a o$e'sial +ala$ -aet-aet ang $(+a0 +isia-an +engan $ena$-('an +engan ai'. Jia se+iaan sea'a o$e'sial ti+a a+a ai'an 'e0i+'asi o'al -engganti +a-at +i&(at +engan $ena$&a0an H sen+o te0 ga'a$ H sen+o te0 &aing so+a +an 2  4 sen+o $aan g(la  -e' lite' ai'. D(a -isang ata( 1 angi' 9(s 9e'( +i&e'ian (nt( $engganti ali($.. Pasien 0a'(s $in($ ai'an te'se&(t se&ana $(ngin se9a $e'ea $e'asa 0a(s -e'ta$a alina.3 Jia te'a-i int'a @ena +i-e'l(an ai'an no'$otoni se-e'ti ai'an saline no'$al ata( latat Ringe' 0a'(s +i&e'ian +engan s(-le$entasi ali($ se&agai$ana -an+(an i$ia +a'a0. Stat(s 0i+'asi 0a'(s +i$onito' +engan &ai +engan $e$-e'0atian tan+atan+a @ital  -e'na-asan +an ('in +an -enes(aian inf(s 9ia +i-e'l(an. Pe$&e'ian 0a'(s +i(&a0 e ai'an 'e0i+'asi o'al sesege'a $(ngin. J($la0 ai'an ang 0en+a +i&e'ian ses(ai +engan 9($la0 ai'an ang el(a' +a'i &a+an. Ke0ilangan ai'an +a'i &a+an +a-at +i0it(ng +engan $e$aai a'a C +i(ti- +a'i  BD -las$a +engan $e$aai '($(s C Ke&(t(0an ai'an  BD Plas$a  172"  Be'at &a+an 5Kg8  4 $l 7771 Meto+e Pierce &e'+asa'an ea+aan linis C  De0i+'asi 'ingan e&(t(0an ai'an "  KgBB 11

 De0i+'asi se+ang e&(t(0an ai'an   KgBB  De0i+'asi &e'at e&(t(0an ai'an 17  KgBB

Meto+e Dal+iono &e'+asa'an ea+aan linis ang +i&e'i -enilaian:so' 5ta&el 18  'asa 0a(s:$(nta0 1  Teanan +a'a0 sistoli !7)7 $$ensi Na+iG 127 =:$enit 1  esa+a'an a-atis 1  Kesa+a'an so$nolen so-o' ata( o$a 2  F'e>ensi nafas G 37 =:$enit 1  Faies 0ole'ia 2 o=0ole'ia 2  T('go' (lit $en('(n 1  ;as0e'Ls >o$anLs 0an+ 1  Est'e$itas +ingin 1 Sianosis 2  U$(' "7!7 ta0(n 1  U$('G !7 ta0(n 2 Ke&(t(0an ai'an  So':1"  17  KgBB  1 lite'  •

An-i 3io-i

Pe$&e'ian anti&oti sea'a e$-i'is 9a'ang +iin+iasian -a+a +ia'e a(t infesi a'ena 47 as(s +ia'e infesi se$&(0 ('ang +a'i 3 0a'i tan-a -e$&e'ian anti &ioti. Pe$&e'ian anti&ioti +i in+iasian -a+a C Pasien +engan ge9ala +an tan+a +ia'e infesi se-e'ti +e$a$ feses &e'+a'a0 le(osit -a+a feses $eng('angi es'esi +an onta$inasi ling(ngan -e'sisten ata( -enela$atan 9i>a -a+a +ia'e infesi +ia'e -a+a -elanong +an  -asien immunocompromised . Pe$&e'ian anti&ioti sea'a e$-i'is +a-at +ila(an 5ta&el 28 teta-i te'a-i anti&ioti s-esifi +i&e'ian &e'+asa'an (lt(' +an 'esistensi ($an

12

•

O3a- an-i diare

Kelo*o an-iseresi sele-i

Te'o&osan te'&a'( +ala$ $ileni($ ini a+ala0 $(lai te'se+iana sea'a l(as racecadotril ang &e'$anfaat seali se&agai -eng0a$&at en6i$ enkephalinase se0ingga ene-0alin +a-at &ee'9a e$&ali sea'a no'$al. Pe'&aian f(ngsi aan $eno'$alan se'esi +a'i elet'olit se0ingga esei$&angan ai'an +a-at +ie$&alian sea'a no'$al. Di In+onesia saat ini te'se+ia +i &a>a0 na$a 0i+'ase se&agai gene'asi -e'ta$a 9enis o&at &a'( anti +ia'e ang +a-at -(la +ig(naan le&i0 a$an -a+a ana.14 Kelo*o oia-

Dala$ elo$-o ini te'golong o+ein fosfat lo-e'a$i+ <*l se'ta o$&inasi +ifenosilat +an at'o-in s(lfat 5lo$otil8. Pengg(naan o+ein a+ala0 1"!7$g 3= se0a'i lo-e'a$i+ 2  4 $g: 3  4= se0a'i +an lo$otil "$g 3  4 = se0a'i. Efe elo$-o o&at te'se&(t $eli-(ti -eng0a$&atan -'o-(lsi -eningatan a&so'&si ai'an se0ingga +a-at $e$-e'&aii onsistensi feses +an $eng('angi f'e>ensi +ia'e.Bila +i&e'ian +engan a'a ang &ena' o&at ini ((- a$an +an +a-at $eng('angi f'e>ensi +efeasi sa$-ai 7. Bila +ia'e a(t +engan ge9ala +e$a$ +an sin+'o$ +isent'i o&at ini ti+a +ian9('an.17 Kelo*o a3sor3en-

A'ang atif atta-(lgit atif &is$(t s(&salisilat -etin aolin ata( s$etit +i&e'ian atas +asa' a'g($entasi &a0>a 6at ini +a-at $enea- &a0an infesi(s ata( tosintosin. Melal(i efe te'se&(t $aa sel $(osa (s(s te'0in+a' onta langs(ng +engan 6at6at ang +a-at $e'angsang se'esi elet'olit.

13

4a- Hidroili

Est'a t($&(0t($&(0an ang &e'asal +a'i  Plantago oveta  Psyllium, Karaya (Strerculia)  spraghulla, Coptidis +an Catechu +a-at $e$&ent( olloi+ +engan ai'an +ala$ l($en (s(s +an aan $eng('angi f'e>ensi +an onsistensi feses teta-i ti+a +a-at $eng('angi e0ilangan ai'an +an elet'olit. Pe$aaianna a+ala0 "17 : 2= se0a'i +ila'(tan +ala$ ai' ata( +i&e'ian +ala$ &ent( a-s(l ata( ta&let.) •

!ro3io-i

Kelo$-o

-'o&ioti

ang

te'+i'i

+a'i  !acto"acillus

+an  Bifido"acteria

ata(

Saccharomyces "oulardii &ila $engala$i -eningatan 9($la0na +i sal('an e'na aan $e$ilii efe ang -ositif a'ena &e'o$-etisi (nt( n(t'isi +an 'ese-to' sal('an e'na. Sa'at -engg(naan +an e&e'0asilan $eng('angi:$eng0ilangan +ia'e 0a'(s +i&e'ian +ala$  9($la0 ang a+e(at. 5. Cara enularan dan )a-or resio

*a'a -en(la'an +ia'e -a+a ($($na $elal(i feal o'al ait( $elal(i $aanan ata( $in($an ang te'e$a' ole0 ente'o-atogen ata( onta langs(ng tangan +engan  -en+e'ita ata( &a'ang&a'ang ang tela0 te'e$a' tin9a -en+e'ita ata( ti+a langs(ng $elal(i lalat. 54F fiel+ flies finge's fl(i+8. Fato' 'esio ang +a-at $eningatan  -en(la'an ente'o-atogen anta'a lainCti+a $e$&e'ian ASI sea'a -en(0 sela$a 4!  &(lan -e'ta$a e0i+(-an &ai ti+a $e$a+aina -ene+iaan ai' &e'si0 -ene$a'an ai'  ole0 tin9a ('angna sa'ana e&e'si0an ata( M*K e&e'si0an ling(ngan +an -'i&a+i ang &('( -enia-an +an -eni$-anan $aanan ang ti+a 0igienis +an a'a  -ena-i0an ang ti+a &ai. Selain 0al0al te'se&(t &e&e'a-a fato' -a+a -en+e'ita +a-at $eningatan

een+e'(ngan

(nt(

+i9angiti

+ia'e

anta'a

lainC

gi6i

&('(

i$(no+efisiensi &e'('angna easa$an la$&(ng $en('(na $otilitas (s(s $en+e'ita a$-a +ala$ 4 $ingg( te'a0i' +an fato' geneti. •

Fato' ($(' Se&agian &esa' e-iso+e +ia'e te'9a+i -a+a 2 ta0(n -e'ta$a e0i+(-an. Insi+ensi te'tinggi te'9a+i -a+a elo$-o ($(' !11 &(lan -a+a saat +i&e'ian $aanan  -en+a$-ing ASI. Pola ini $engga$&a'an o$&inasi efe -en('(nan a+a' anti&o+

14

i&( &e'('angna

ee&alan

atif

&ai -engenalan $aanan ang $(ngin

te'onta$inasi &ate'i tin9a +an onta langs(ng +engan tin9a $an(sia ata( &inatang  -a+a saat &ai $(lai $e'anga. Ke&anaan ente'o-atogen $e'angsang -aling ti+a  se&agian ee&alan $ela>an infesi ata( -enait ang &e'(lang ang $e$&ant( $en9elasan $en('(nna insi+en -enait -a+a ana ang le&i0 &esa' +an -a+a o'ang +e>asa. •

Infesi asi$to$ati Se&agian &esa' infesi (s(s &e'sifat asi$to$ati +an -'o-o'si asi$to$ati ini $eningat setela0 ($(' 2 ta0(n +ia'enaan -e$&ent(an i$(nitas atif. -a+a infesi asi$to$ati ang $(ngin &e'langs(ng &e&e'a-a 0a'i ata( $ingg( tin9a -en+e'ita $engan+(ng @i'(s &ate'i ata( ista -'oto6oa ang infesi(s. ,'ang +engan infesi ang asi$to$ati &e'-e'an -enting +ala$ -ene&a'an &ana enete'o-atogen te'(ta$a  &ila $e'ea ti+a $ena+a'i a+ana infesi ti+a $en9aga e&e'si0an +an &e'-in+a0  -in+a0 +a'i sat( te$-at e te$-at ang lain.

•

Fato' $(si$ a'iasi -ola $(si$an +ia'e +a-at te'9a+i $en('(t leta geog'afis. +i +ae'a0 t'o-is +ia'e a'ena &ate'i le&i0 se'ing te'9a+i -a+a $(si$ -anas se+angan +ia'e a'ena @i'(s te'(ta$a 'ota@i'(s -(nana te'9a+i -a+a $(si$ +ingin. +i+ae'a0 t'o-i 5te'$as(  In+onesia8 +ia'e ang +ise&a&an 'ota@i'(s +a-at te'9a+i se-an9ang ta0(n +engan  -eningatan se-an9ang $(si$ e$a'a( se+angan +ia'e a'ena &ate'i te'(s $eningat  -a+a $(si$ 0(9an.

•

E-i+e$i +an -en+e$i Vi"rio cholera 7.1 +an Shigella dysentriae 1 +a-at $ene&a&an e-i+e$i +an  -an+e$i +an $engai&atan tinggina anga esaitan +an e$atian -a+a se$(a golongan (sia. se9a ta0(n 1)!1 0ole'a ang +ise&a&an ole0 v. cholera 7.1 &ioti-e elto'  tela0 $ene&a' e nega'anega'a +i af'ia a$e'ia latin asia ti$(' tenga0 +an  &e&e'a-a +ae'a0 +i a$e'ia (ta'a +an e'o-a. +ala$ ('(n >at( ang sa$a Shigella dysentriae 1 $en9a+i -ene&a& >a&a0 ang &esa' +i a$e'ia tenga0 +an te'a0i' +i af'ia

1"

tenga0 +an asia selatan. Pa+a ta0(n 1))2 +ienal st'ain &a'( Vi"rio cholera #$%& ang $ene&a&an e-i+e$i +i Asia +an le&i0 +a'i 11 nega'a $engala$i >a&a0.

6. Ko*liasi •

•

/angg(an elet'olit o


o


o


o


De$a$ De$a$ se'ing te'9a+i -a+a infesi s0igella +isent'iae +an 'ota@i'(s. Pa+a ($(na

+e$a$ aan ti$&(l 9ia -ene&a& +ia'e $enga+aan in@asi e +ala$ sel e-itel (s(s. De$a$ 9(ga +a-at te'9a+i a'ena +e0i+'asi. De$a$ ang ti$&(l ai&at +e0i+'asi -a+a ($(na ti+a tinggi +an aan $en('(n setela0 $en+a-at 0i+'asi ang ((-. De$a$ ang tinggi $(ngin +ii(ti e9ang +e$a$. Pengo&atanC o$-'es +an: anti-i'etia. Anti&iotia  9ia a+a infesi.3 •

E+e$a:o@e'0i+'asi Te'9a+i &ila -en+e'ita $en+a-at ai'an te'lal( &ana. Tan+a +an ge9ala ang ta$-a 

 &iasna e+e$a elo-a $ata e9ange9ang +a-at te'9a+i &ila a+a e+e$a ota. E+e$a -a'(  -a'( +a-at te'9a+i -a+a -en+e'ita +e0i+'asi &e'at ang +i&e'i la'(tan ga'an faali. Pengo&atan +engan -e$&e'ian ai'an int'a@ena +an ata( o'al +i0entian o'tioste'oi+ 9ia e9ang.3 •

Asi+osis $eta&oli Asi+osis $eta&oli +itan+ai +engan &e'ta$&a0na asa$ ata( 0ilangna &asa ai'an

est'asel(le'. Se&agai o$-ensasi te'9a+i alalosis 'es-i'ato'i ang +itan+ai +engan  -e'nafasan ang +ala$ +an e-at 5(s6$a(ll8. -e$&e'ian o'alit ang ((- $enga+(ng  &ia'&onas ata( sit'as +a-at $e$-e'&aii asi+osis. •

Ile(s -a'aliti Ko$-liasi ang -enting +an se'ing fatal te'(ta$a te'9a+i -a+a ana eil se&agai ai&at

 -engg(naan o&at anti$otilitas. Tan+a +an ge9ala &e'(-a -e'(t e$&(ng $(nta0 -e'istalti

1!

(s(s &e'('ang ata( ti+a a+a. Pengo&atan +engan ai'an -e' o'al +i0entian &e'i ai'an  -a'ente'al ang $engan+(ng &ana K.

1#

$A$ II RINGKASAN

/ast'oente'itis a(t $e'(-aan $asala0 ang se'ing te'9a+i &ai +i nega'a &e'e$&ang $a(-(n nega'a $a9(. Se&agian &esa' &e'sifat  self limiting se0ingga 0ana -e'l( +i-e'0atian esei$&angan ai'an +an elet'olit. Bila a+a tan+a +an ge9ala +ia'e a(t a'ena infesi &ate'i +a-at +i&e'ian te'a-i anti$i'o&ial sea'a e$-i'i ang e$(+ian +a-at +ilan9(tan +engan te'a-i s-esifi ses(ai +engan 0asil (lt('. Pengo&atan si$to$ati +a-at +i&e'ian a'ena efetif +an ((a$an &ila +i&e'ian ses(ai +engan at('an. P'ognosis +ia'e a(t infesi &ate'i &ai +engan $o'&i+itas +an $o'talitas ang $ini$al. Dengan 0igiene +an sanitasi ang &ai $e'(-aan  -enega0an (nt( -en(la'an +ia'e infesi &ate'i.

1

"A)TAR !USTAKA S(&ago B +an Santoso NB. Dia'e a(t +ala$ B(( A9a' /ast'oente'ologi>>.;0o.int:@aine'esea'0:+isease:+ia''0oeal:en:in+e= 0t$l. +i(n+(0 tanggal 17 J(li 277#O 3. S('aat$a9a S(+a'at. Dia'e +ala$ Ka-ita Seleta /ast'oente'ologi Ana. Jaa'taC Sag(ng Seto. 277#C124 4. Soena'to et al. B('+en of Se@e'e Rota@i'(s Dia''0ea In In+onesia. T0e Jo('nal of Infetio(s +isease 277C S1)4 277). ". S('aat$a9a S(+a'at. Masala0 Re0i+'asi ,'al +ala$ Ka-ita Seleta /ast'oente'ologi Ana. Jaa'taC Sag(ng Seto. 277#C44"3 !. Pie'ing %K. /ast'oente'itis in Nelson te=t&oo of -e+iat'is 1) t0 e+ition. Unite+ State+ of A$'ia %i--inot >ilia$s #. /a('ino et al. E('o-ean Soiet fo' Pe+iat'i /ast'oente'olog
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