Acute Gastroenteritis in Adult: DR - Umar Zein, SPPD, Mha, DTMH, Kpti

Acute
Gastroenteritis
in Adult
Dr.Umar Zein, SpPD, MHA, DTMH, KPTI

Ka.Divisi Penyakit Tropik dan Infeksi
Bagian Ilmu Penyakit Dalam
FK USU
Diarrhea is a common symptom in
adults. Most patients with diarrhea
never seek medical attention, but
patients who have had symptoms for
more than a few days or who have
coexisting fever, prostration, or rectal
bleeding are likely to present for
evaluation
Diarrhea is a response of the bowel to infection,
drugs, foods, or disease.
Three factors can lead to the passage of
unformed stools.
• An increase in intestinal fluid and electrolyte

secretion (osmotic or secretory diarrhea)
• Malabsorption of intraintestinal contents (due to

damaged intestinal lining of small bowel)
* Altered intestinal motility (dysmotility diarrhea).

"Diarrhea”
(Gastroenteritis)
ACUTE
CHRONIC
INFECTIOUS
NON INFECTIOUS
CHILDREN
ADULT
Infectious diarrhea
 Communicable diseases
 Morbidity in Indonesia : 21.22 per 1000 peoples (1996)
 Highest Morbidity in Aceh (69.54/1000 peoples)
 CFR = 2.4% (1996)

DIARRHEA EPISODE
 Children under 5 years : 1.6 – 2.2 times/year
 For all age : 230 - 330 per 1000 peoples

DEFINITION AND CLASSIFICATION OF
DIARRHEA
Most patients consider increased liquidity of stool

as the essential characteristic of diarrhea.
Because this characteristic is
difficult to quantitate, researchers often have used
stool frequency or stool weight as surrogate
markers of diarrhea. Three or
more bowel movements per day are abnormal,
and the upper limit of stool weight is generally
agreed to be 200 g/d.
Definition of Diarrhea
 Increase of abnormal stools weight
(unformed stools)
 Man : > 235 g/day
 Woman : > 175 g/day
 Increase of abnormal defecation frequency more than
twice in a day
 But ;
 Defecation twice in a day is diarrhae
 Defecation thrice in a day but normal
consistency is not diarrhae
*Sleisenger & Fordtran

These quantitative criteria should not be
applied strictly, however. Some individuals
may have stool weights of 300 g/d because
of fiber ingestion but do not complain of
diarrhea because their stool consistency is
normal. Other patients have normal stool
weight but complain of diarrhea because their
stools are loose or watery.
Etiology of Acute GE
Virus
Bacterial
GI tract
Drugs
Parasite
Others
0 10 20 30 40 50 60
Sumber : Marcel Simadibrata
Etiology of Acute GE in Adult
Survey in France
Others (5%)
Unknown (6%)
Parasitic (1%)
Bacterial (7%)
‘Drug
Induced’
(8%)
Non infectious/ Viral

GI Tract (51%)
(26%)
Source : Allemand H et al. Gut 1996; 39 (Suppl 3): A173. General practitioners survey in France (4200 adults)
ETIOLOGY OF DIARRHEA
The main cause of Infection by virus

Acute GE is virus commonly in small
(Rota Virus) 38-60% intestine
ETIOLOGY OF DIARRHEA
In normal condition Infection process in Crypta epithelial cells

have an equilibrium the GI tract mucosa migrate to villi
state between fluid cause disconnect surface, this cells is
absorbtion & epithelial cells immature, can cause
secretion disturbance of the
function of fluid
absorbtion, therefor
diarrhae is appear.
Photo Vili
Surface villi
Intestine villi Parietal cells

Following Symptoms in Adult
Acute GE
90
84%
80
70
60
50
42%
40 39%
33%
30 25%
20
13%
10
3%
0
Abdominal pain Headache Vomiting Fever Myalgia Arthralgia Dehidration
Source : Allemand H et al. Gut 1996; 39 (Suppl 3): A173. General practitioners survey in France (4200 adults)
Table 1 :
Characteristics in 3 Types of Acute
GE
Characteristic Non Inflamatory Inflamatory Penetrating
Stools appearences Watery Bloody, mucuos mucuos

Volume >> Volume moderate Small Volume MN
Leucocyte (-) PMN Leucocyte
Leucocyte
Fever (-) (+) (+)
Abdominal pain (-) (+) (+)/(-)
Dehidration (+++) (+) (+)/(-)
Tenesmus (-) (+) (-)
Complications Hypovolemic Toxic Sepsis

Table 2 :
Types of Diarrhea Caused by
Enteropathogen
Enteropatogen Acute Dysentry Persistent
Watery
Bacteries :
V.cholerae (+) (-) (-)

ETEC, EPEC (+) (-) (-)
EIEC (+) (+) (-)
EHEC (+) (+) (+)
Shigella,Salmonella (+) (+) (+)
C.jejuni,Y.enteroclitica (+) (+) (+)
C.defficile (+) (+) (+)
M.tuberculosa (-) (+) (+)
Aeromonas (-) (+) (-)
Modification from : Sirivichayakul C : Acute Diarrhea in Children, In : Tropical Pediatrics for DTM&H 2002, Faculty of
Tropical Medicine, Mahidol Univesity, Bangkok, Thailand,1-13.
Enteropathogen Acute Dysentry Persistent
Watery
Viruses: (+) (-) (-)
Protozoas :
G.lamblia (+) (-) (+)
E.histolytica (+) (+) (+)
C.parvum (+) (-) (+)
Microsporidium spp (+) (-) (+)
Isospora belli (+) (-) (+)
Cyclospora cayatenensis (+) (-) (+)
Helminths :
Strongyloides stercoralis (-) (-) (+)
Schistosoma spp (-) (+) (+)
Capilaria philippinensis (+) (-) (+)
Trichuris trichuria (-) (+) (+)
DIAGNOSIS
 Anamnese
 Faeces Rutine
 Faeces culture
Stool examinations for ova and
parasites may be indicated in patients
when the illness originated during travel
to high-risk areas or when illness
persists longer than 2 weeks.
Differential Diagnosis of Acute GE
Infections
Bacterial
Parasitic
Viral
Food poisoning
Medications
Treatment
 Self limited
 Following Symptoms :
 Dehidration
 Fever
 Abdominal pain
 Condition of the Patient :
 Elderly
 Immunocompromised
Preventing dehydration is a major goal of
therapy, and either OTC preparations or home
remedies are often effective.
In the case of large-volume diarrhea, glucose-
containing oral fluid-electrolyte solutions are
more appropriate.
Treatment
An adequate history is essential to

understanding its cause and severity.
For patients with mild to moderate acute
diarrhea, a diagnostic workup may not be
necessary; empiric, supportive treatment is
usually sufficient.
Treatment (Cont’)
 Rehidration and diet
 Specific : Antibiotika and

Antiparasite drugs :
 Empiric
 Specific
 Symptomatic : Anti diarrhae

Antibiotic therapy is generally not
necessary for acute diarrheal episodes
except when treatable parasites or
some bacterial agents are known to
cause the infection.
REHIDRATION :
Depends on a dehidration states

Goldberger :
Mild : volume loss 2% BW
Moderate : volume loss 6% BW
Severe (Shock) : volume loss > 7% BW
ANTI DIARRHAE DRUGS
Kaolin
Pectin
Attapulgite
Diphenoxilat
Loperamide
Bismuth Subsalisilate
Oral Rehydration Therapy
(ORALIT)
 Effective to children and elderly
 For mild and moderate dehidration and no vomiting
Probiotics
 No evidence to benefit effect as a supplement therapy for
acute GE
Sumber : Wingate et al. : Alimentary Pharmacology Therapeutics 2001

Terimakasih . . .
MAAF !!
Toilet rusak.
Gunakan
toilet
berikutnya
50km lagi


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Acute

Dr.Umar Zein, SpPD, MHA, DTMH, KPTI

• An increase in intestinal fluid and electrolyte

• Malabsorption of intraintestinal contents (due to

* Altered intestinal motility (dysmotility diarrhea).

 Morbidity in Indonesia : 21.22 per 1000 peoples (1996)

 Highest Morbidity in Aceh (69.54/1000 peoples)

 CFR = 2.4% (1996)

 Children under 5 years : 1.6 – 2.2 times/year

 For all age : 230 - 330 per 1000 peoples

Most patients consider increased liquidity of stool

*Sleisenger & Fordtran

Non infectious/ Viral

The main cause of Infection by virus

In normal condition Infection process in Crypta epithelial cells

Intestine villi Parietal cells

Stools appearences Watery Bloody, mucuos mucuos

Fever (-) (+) (+)

Abdominal pain (-) (+) (+)/(-)

Dehidration (+++) (+) (+)/(-)

Tenesmus (-) (+) (-)

Complications Hypovolemic Toxic Sepsis

V.cholerae (+) (-) (-)

Viruses: (+) (-) (-)

An adequate history is essential to

 Rehidration and diet

 Specific : Antibiotika and

 Symptomatic : Anti diarrhae

Depends on a dehidration states

Sumber : Wingate et al. : Alimentary Pharmacology Therapeutics 2001

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