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Transcript of Gastroenteritis Revisi
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5/27/2018 Gastroenteritis Revisi
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CHAPTER I
INTRODUCTION
1.1 Background
Emergency situation can happen to a person or group of people at any time and anywhere.
This can be either sudden illness, accident or natural disaster. This situation requires immediate
action that can first aid until the other treatments in the hospital. Such actions are intended to save
life, to prevent or to limit disability, and alleviate the suffering of patients.
In addition to aid, this situation also requires knowledge and good skills of the helper.
Therefore, as a health resource insist to skilled in handling all matters relating to the things that
threaten human life.
This paper will discuss the emergency response in patients with gastroenteritis. This case is
mostly found in hospitals and even in our environment everyday. Therefore, as a writer we hope
this paper can be useful as a guide in dealing with cases of Gastritis.
e also would be very grateful if there are any suggestions and criticisms to make this paper
better .
1.2 Formulation o t!" Pro#l"m$
!.".! hat is gastroenteritis#
!."." hat causes of gastroenteritis#
!.".$ %ow to prevent and treat it#
1.% &oal o t!" Pro#l"m$
!.$.! To know the definition of gastroenteritis
!.$." &nowing the cause of gastroenteritis
!.$.$ &nowing how to prevent and cure of disease gastroenteritis
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CHAPTER II
DI'CU''ION
2.1 Anatom( and P!($iolog( o &I Tract
The intestine is a long, continuous, tube inside the body. It lets the body absorb nutrients from
food and liquids. The intestine is about "" feet long. It includes the large intestine 'colon( and
the small intestine.
The small intestine has three parts)
a( Duod"num)
*onnects to the stomach
+uodenum is a short tube like organ, which is usually considered as the first segment of
the small intestine. The other two parts of the small intestine are eunum and ileum. In
humans, duodenum is about "- to $ cm in length, and it connects the stomach and the
eunum. /s one of the most important parts of the digestive system, duodenum is
concerned with both digestion of foods and absorption of nutrients. In fact, it is the maor
site for iron absorption. Several ducts from pancreas, liver and gallbladder open into the
duodenum to facilitate the its main functions. 0elow here are some more information
about duodenum function in digestive system, along with its structure and location.
+uodenum is located ust below the stomach, and its first part is quite close to the liver
and the pancreas. +uodenum is located between the stomach and the eunum.
/natomically, this small organ is divided into four parts or segments, which are known as
the superior, descending, hori1ontal and ascending duodenum. +uodenum is a *2shaped
organ, inner lining of which is made of crypts. These crypts are responsible for increasing
the surface area of the intestinal membrane and thereby ensure better digestion.
+uodenum also contains smooth muscles, which help it to move the waste materials
down to the large intestine. In addition to these, duodenum receives several ducts coming
from the pancreas, gallbladder and liver.
The main function of duodenum is to receive the partially digested foods from the
stomach, and complete the process of digestion. In the stomach, foods are mi3ed with stomach
acids. This mi3ture of semi digested foods and stomach acids is known as chyme. +uodenum
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receives this chyme from the stomach, and then starts the breakdown foods with the help of
en1ymes and intestinal uice. It also receives bile from the liver and the gallbladder, and
pancreatic uice from the pancreas. These secretions are of immense importance for ensuring
the proper digestion of foods in the duodenum.
/long with digesting foods, duodenum is responsible for regulating the rate of gastric
emptying, as well as triggering the hunger signals. Gastric emptying refers to the emptying of
the stomach, i.e. the process of food leaving the stomach and entering the duodenum. These
functions are facilitated by the hormones secreted from the duodenal epithelium. There is a
small circular opening between the stomach and the duodenum, known as pylorus, which
releases the chyme into the duodenum. The cells present in the epithelium of duodenum in turn,
release two hormones known as secretin and cholecystokinin. Secretin is released in response
to too much acid in the small intestine or duodenum, while secretion of cholecystokinin is
stimulated by the presence of amino acids and fatty acids. These two hormones stimulate the
liver and the gallbladder to release bile, as well as the pancreas to secrete en1ymes 'lipase,
amylase and trypsin( into the duodenum.
/fter the completion of digestion, duodenum absorbs the nutrients, from where the
nutrients enter the bloodstream. To sum up, the main duodenum functions in the digestive
systemare, digestion of foods, absorption of nutrients, controlling the rate of gastric emptying,
and regulating hunger and the movement of food throughout the gastrointestinal tract. It has
been found that more foods and nutrients are absorbed in duodenum than stomach. Gastric
bypass surgeryoften involves the duodenum, due to its immense importance in the absorption
of nutrients, and regulation of hunger and movement of food. In gastric bypass surgery, usually
the duodenum is bypassed in an attempt to lower the absorption of nutrients and calories.
b( )"*unum)
4iddle portion of the small intestine
The second and largest section of the small intestine'comprising "5- of the total length(,
located between the duodenumand the ileum. The surface area of the lining of the
eunum is greatly increased by many small, finger2like outgrowths called villi. This
3
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makes it easier for digested material to be absorbed, which is the main function of the
eunum.
The word derives from the 6atin jejunus, which means 7empty of food7 or 7hungry.7
The ancient Greeks noticed at death that this part of the intestine was always empty of food.
8eunal biopsy is removal of a piece of the mucosa 'lining( of the eunum. This can be
done by a surgical operation but is usually performed by a gastroduodenoscope or a special
metal capsule, swallowed by the patient. hen the capsule is in the eunum a small knife
within it is triggered by suction on an attached tube, cutting off a small piece of mucosa.
The specimen may be e3amined microscopically to assist in the diagnosis of celiac disease,
hipple9s disease, or intestinal infections, or its en1yme content may be measured to detect,
for e3ample, lactase deficiency.
c+ Il"um)
6ower portion of the small intestine that connects to the cecum 'first part of the large
intestine(, the final and longest segment of the small intestine. It is specifically
responsible for the absorption of vitamin 0!" and the reabsorption of conugated bile
salts. The ileum is about : metres '!$ feet( long and e3tends from the eunum 'the
middle section of the small intestine( to the ileocecal valve,which empties into the colon
'large intestine(. The ileum is suspended from the abdominal wall by the mesentery, a
fold of serous 'moisture2secreting( membrane.
The smooth muscle of the ileum;s walls is thinner than the walls of other parts of the
intestines, and its peristaltic contractions are slower. The ileum;s lining is also less
permeable than that of the upper small intestine. Small collections of lymphatic tissue
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small intestine in the fetus fails to atrophy and close. / small number of cases require
surgical removal because of intestinal bleeding and inflammation.
Inury or disease affecting the terminal ileum produces vitamin 0!" deficiency and
e3tensive diarrhea, the latter resulting from the interference of bile salts on water
absorption in the large intestine.
The ileum performs some vital functions. It helps assimilate vitamin 0!" through special
receptors. *ells lining its wall secrete en1ymes that facilitate further breakdown of
proteins and carbohydrates. It is also the site of fluid and electrolyte absorption. The
ileum reabsorbs bile salts and thus helps maintain an adequate level of bile salts for
digestion and absorption of dietary fat in the small intestine.
The ileal wall is composed of smooth muscle, has a few folds in it, and typically is
thinner than the wall of the eunum. Its wall is lined with proecting structures called the
villi and microvilli. The villi help take up nutrientsthat become available through the
digestive process, and conduct them to the bloodstream and the liver.
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e common
sourceoutbreaks
occur=
highest in
warmer
months
common2
sourceoutbreaks
occur out2
breaks occur=
high in areas
of poor
sanitation and
during warm
months
highest in
childrenunder !
@?=
outbreaks
common in
crowded
living
condition
common=
epidemics and outbreaks occur
sporadic and in
outbreaks= highestin infant and young
children
Etiologic
agent
Campylobact
er jejuni
Enteroto3igeni
c, invasive, or
enteropathoge
nic strains of
E. Coli
Arom
different
groups of
shigella
bacteria,
with many
strains
4any serotypes
of parovirus like
agents
4any types of
rotaviruses
Beservoir +omestic and
wild animal
and birds
Infected
humans, who
are often
asymptomatic
%umans %umans %umans=
pathogenicity of
animal viruses
undetermined
Transmissi
on
Ingestion of
water or food
contaminated
with
organism
from feces=
contact with
infected
animals or
infants= fecal
oral
Aecal
contamination
of food, water,
or fomites=
transmitted to
infant during
delivery= fecal
oral, by hand
+irect or
indirect
fecal2oral
transmissio
n from
infected
person or
carrier
Aecal2oral route=
food2borne and
water2borne
transmittion
Aecal2oral= possibly
fecal2respiratory
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Incubation
period
$2- d= range)
!2! d
!"2C" h !2C d,
usually !2$d
Dsually ":2: h,
range) !2-!h
: h
Suscepbilit
y and
resistance
General Infants very
susceptible=
duration of
acquired
immunity
unkown
General=
more severe
in children
and elderly
and
debilitated
individuals=
strain2
specific
antibodies
develop
General= sort2term
'!:wk( immunity
may follow
infection with
specific serotypes
0y age " yr most
individuals have
acquired antibodies
against most
serotypes
2.% Etiolog(
!. Aood and 0everagea. Futrient deficiencies, hunger 'stomach empty(, especially when the stomach is
empty in a long time, then filled with food and beverages in large quantities at the
same time, especially foods that are fatty, too sweet, lots of fiber or may be because
they lack the white substance eggs.
b. Fot resistant to certain foods 'protein, carbohydrate, fat( that can cause allergies.
c. Aood
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:. Infection outside the gastrointestinal tract that can cause gastroenteritis are encephalitis
'brain inflammation(, ?4/ '?rtitis 4edia /cute inflammation dikuping(,
Tonsilofaringitis 'inflammation of the tonsils in the neck(, 0ronchopeneumonia
'pneumonia(.
-. /ir changes often cause a person to feel uncomfortable the stomach, bloating, diarrhea
and lead to a sense of weakness, because of bodily fluid drained.
H. Environmental Aactors ) Environmental hygiene can not be ignored. In rainy season, in
which the water brings trash and other debris, and also at the time of drought where the
flies can not be avoided especially with increasing wind big enough, so that transmission
is more easily occur. *lean water supply is less so was forced to use makeshift water, and
sometimes forget to wash your hands before and after meals.
2. Pat!o0!($iolog(
Transmission usually through the faecal oral gastroenteritis from one patient to another.
Several cases of the spread of pathogens encountered due to contaminated food and beverages. The
basic mechanism is a disorder causing osmotic diarrhea 'food that can not be absorbed will cause
osmotic pressure in the cavity of the intestine increased resulting in a shift of water and elektrolt
into the cavity of the intestine, the contents of the gut cavity, causing e3cessive diarrhea(. /lso
secretion disruption due to to3ins in the intestinal wall, so that water and electrolyte secretion
increases then occur diarrhea. +isorders that cause intestinal multilitas hiperperistaltik and
hipoperistaltik. /s a result of diarrhea itself that is losing water and electrolytes 'dehydration( that
lead to acid2base disturbances 'acidosis 4etbolik and hypokalemia(, impaired nutrition 'intake less,
the output is e3cessive(, hypoglycemia and blood circulation disorders.
2. Clinical '(m0tom$
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breathing frequency 'respiratory kusmaul(. In the event of severe hypovolemic shock, the fast pulse
rate 'more than !" times 5 minute( decreased blood pressure immeasurable, patient an3iety, pallor,
cold e3tremities and sometimes the tip cyanosis, lack of potassium can cause cardiac arrhythmias.
&idney perfusion can be decreased causing anuria, so if lack of fluids can not be addressed
immediately arise acute tubular necrosis. In clinical considered diarrhea due to acute infection were
divided into two groups first, kolerifrom, with diarrhea which mainly consists of liquids only.
Second disentriform, at the time of diarrhea obtained thick mucus and sometimes blood.
Gastroenteritis often involves stomach pain or spasms, diarrhea and5or vomiting, with
noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.
The condition is usually of acute onset, normally lasting !H days, and is self2limiting.
a. Fausea and vomiting
b. +iarrhea
c. 6oss of appetite
d. Aever
e. %eadaches
f. /bnormal flatulence
g. /bdominal pain
h. /bdominal cramps
i. 0loody stools 'dysentery 2 suggesting infection by amoeba, *ampylobacter,
Salmonella, Shigella or some pathogenic strains of Escherichia coli.
. Aainting and eakness
k. %eartburn
The main contributing factors include poor feeding in infants. +iarrhea is common, and may
be followed by vomiting. iral diarrhea usually causes frequent watery stools, whereas blood
stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is
empty, bile can be vomited up.
/ child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs
of dehydration 'which include dry mucous membranes(, tachycardia, reduced skin turgor, skin color
discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion
and ultimately shock.
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2.3 Diagno$tic A$$"$m"nt
Gastroenteritis is diagnosed based on symptoms, a complete medical history and a physical
e3amination. /n accurate medical history may provide valuable information on the e3istence or
ine3istence of similar symptoms in other members of the patient9s family or friends. The duration,
frequency, and description of the patient9s bowel movements and if they e3perience vomiting are
also relevant and these question are usually asked by a physician during the e3amination.
Fo specific diagnostic tests are required in most patients with simple gastroenteritis. If
symptoms including fever, bloody stool and diarrhea persist for two weeks or more, e3amination of
stool for *lostridium difficile may be advisable along with cultures for bacteria including
Salmonella, Shigella, *ampylobacter and enteroto3ic Escherichia coli. 4icroscopy for parasites,
ova and cysts may also be helpful.
/ complete medical history may be helpful in diagnosing gastroenteritis. / complete and
accurate medical history of the patient includes information on travel history, e3posure to poisons or
other irritants, diet change, food preparation habits or storage and medications.
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+iagnosing gastroenteritis is mainly an e3clusion procedure. Therefore in rare cases when
the symptoms are not enough to diagnose gastroenteritis, several tests may be performed in order to
rule out other gastrointestinal disorders. These include rectal e3aminations, complete blood count,
electrolytes and kidney function tests. %owever, when the symptoms are conclusive, no tests apart
from the stool tests are required to correctly diagnose gastroenteritis especially if the patient has
traveled to at2risk areas.
1. /ssessment
/lways use the /0*+E approach
!.! /irway
a. 4ake sure the airway
b.
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c. Beview of you can use Jincubation periode J
d. /ssess whether any family member or friend affected
e. +oes the new previous travel#
f.
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+etermining the value to calculate the amount of fluid needed. Guidelines
specify a value for count amount of fluid required in handling cases of gastroenteritis
'(m0tom 'cor"
!. /pathetic
". Somnolent, sophorous
:. T+S K> mm%g
-. T+S KH mm%g
H.
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be overcome given anti2vomiting medication. In simple and practical, salt ?BS can be
prepared by) into ! 6 sterile water mi3ed with N teaspoon of pressed Fa*l, O teaspoon of
sodium bicarbonate pressed and pressed " tablespoons tablespoons glucose
+ehydration eight
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$>.-2:*) procaine2penicillin and chloramphenicol C- mg 5 kg 5 day in : divided doses
4ore than : *) /mpicillin ! mg 5 kg 5 day, divided into : doses and gentamicin - mg 5 kg 5 day
in " divided doses
Feonates 5 60) giving antibitika be aggressive given ampicillin and gentamicin
El"ctrol(t" corr"ction
Dsually be resolved by giving fluids and +arrow Glucose $/. %owever, if there is
hypokalemia 'with symptoms of bloating( may be given "2: mEq 5 kg &*l 005": hour or given
orally C- mg 5 kg 5 day. hen the resulting bloating, must carefully diagnose, because bloating that
occur before diarrhea is suspected symptoms of paralytic ileus, ileus obstruction or invaginasi.
*omplications, complications that may occur) sei1ures, sepsis, bronchopneumonia,
encephalitis.
2.9 T!"ra0(
/ctions that can be done as therapy )
!. Giving 6iquid 5 Behidration
Aluid is an initial action that can be done. Should be given fluids containing
electrolytes or known as ?BS.
The speed of fluids, especially in the first H hours is useful to overcome the
fluid out and prevent dehydration 'lack of fluids(.
Aluid administration was stopped when the number of diarrhea in the last H
hours less than " cc and signs of dehydration have disappeared.
".
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!. using clean water and good santasi.
". cooking food and drinking water until cooked.
$. wash hands with soap before and after meals.
:. avoid foods that have been tekontaminasi by flies.
-. do not consume foods that are stale.
H. avoid foods that can cause diarrhea.
C. eat and drink regularly.
2.: Pr"-"ntion
.
Since ", the implementation of a rotavirus vaccine has decreased the number of cases of
diarrhea due to rotavirus in the Dnited States.
Gastroenteritis may be prevented through immuni1ation. The D.S. Aood and +rug
/dministration approved in "H a rotavirus vaccine called Botateq that may be given to infants
aged H to $" weeks to prevent getting infected with viral gastroenteritis. The vaccines may however
have side effects that are similar to the mild flu symptoms.
+ifferent types of vaccinations are available for Salmonella typhi and ibrio cholera and
which may be administered to people who intend traveling in at2risk areas. %owever, the vaccines
that are currently available are effective only on rotavirual gastroenteritis.
+octors recommend that food be properly cooked and stored to prevent gastroenteritis.
/void suspect food or drink. Thoroughly wash both hands before eating and after using the
bathroom or changing diapers. iral gastroenteritis is a highly contagious disease and thus avoiding
crowded spaces such as markets, theaters or shopping centers may also help in preventing infection
for those who have weak resistance. household surfaces may help prevent spreading bacteria.
2.; 4anag"m"nt
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Gastroenteritis is usually an acute and self2limited disease that does not require pharmacological
therapy. The obective of treatment is to replace lost fluids and electrolytes. ?ral rehydration is the
preferred method of replacing these losses in children with mild to moderate dehydration.
2.1< R"!(dration
The primary treatment of gastroenteritis in both children and adults is rehydration, i.e.,
replenishment of water and electrolytes lost in the stools. This is preferably achieved by giving the
person oral rehydration therapy '?BT( although intravenous delivery may be required if a decreased
level of consciousness or an ileus is present. *omple32carbohydrate2based oral rehydration therapy
such as those made from wheat or rice may be superior to simple sugar2based ?BS.
Sugary drinks such as soft drinks and fruit uice are not recommended for gastroenteritis in
children under - years of age as they may make the diarrhea worse.
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a. /ntiemetics
/ntiemetic drugs may be helpful for vomiting in children. ?ndansetron has some utility
with a single dose associated with less need for intravenous fluids, fewer hospitali1ations, and
decreased vomiting. 4etoclopramide also might be helpful. %owever there was an increased
number of children who returned and were subsequently admitted in those treated with ondansetron.
The intravenous preparation of ondansetron may be given orally.
b. /ntibiotics
/ntibiotics are not usually used for gastroenteritis, although they are sometimes used if
symptoms are severe 'such as dysentery( or a susceptible bacterial cause is isolated or suspected. If
antibiotics are decided on, a fluoroquinolone or macrolide is often used.
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The orld %ealth ?rgani1ation recommends that infants and children receive a dietary
supplement of 1inc for up to two weeks after onset of gastroenteritis. / "> trial however
did not find any benefit from supplementation.
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CHAPTER III
CONC7U'ION AND 'U&&E'TION
%.1 Conclu$ion
The conclusion that we take from this paper is)
1. Gastrointestinal is inflammation of the stomach and intestines that give
the symptoms of diarrhea, with or without vomiting, and often
accompanied by increased body temperature.
2. Etiology )
a. Aood and 0everage
b. . Infections or the Investment
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%.2 'ugg"$tion
Students can perform the role as a good nurse by knowing more about gastroenteritis and
how treatment
REFERENCE'
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http)55nursingspirit.blogspot.com5html. "- uni ". asuhan keperawatan gawat darurat pada
gastroenteritis. /ccess on ednesday, "$rd "!! time !".! I0
http)55askep.blogspot.com5html. anuari ". /suhan &eperawatan pada /nak dengan
Gastroenteritis. /ccess on ednesday, "$rd "!! time !".! I0
Sampurna,0udi. ". &edaruratan 4edik. 0inarupa aksara ) Grogol, 8akarta 0arat.
Bab, Tabrani. !>>. *ritical *are. 4aret ". http)55%arna;sblog.com5html. Gastroenteritis. /ccess on ednesday,
"$rd "!! time !".! I0
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