Gastroenteritis Revisi

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

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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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