Pathophysiology and Clinical Manifestations of Diarrhea

Pathophysiology and Clinical Manifestations of Diarrhea

Diarrhea is an increase in the frequency of bowel movements, an increase in the looseness of stool or both.

Diarrhea is caused by increased secretion of fluid into the intestine, reduced absorption of fluid from the intestine or rapid passage of stool through the intestine.

Pathophysiology of Diarrhea

The basic mechanisms that cause diarrhea are the first osmotic disruption, due to the presence of food or substances that are not absorbed will cause the osmotic pressure within the gut cavity rises, resulting in a shift of water and electrolytes into the intestinal cavity, excessive intestinal cavity contents, will stimulate the intestines to remove, causing diarrhea.

Second, due to certain stimuli (such as toxins) in the gut wall will be an increase of water and electrolytes into the gut cavity and subsequent diarrhea arises because there is an increase in intestinal cavity contents.

Third, motalitas intestinal disorders, the hyperperistaltic, will lead to less opportunity to absorb food intestine causing diarrhea, conversely, when the peristaltic intestinal bacteria decreases will result in excessive arise later can also cause diarrhea.

Besides diarrhea may also occur, due to the entry of microorganisms living in the gut after successfully passing through the stomach acid barrier, microorganisms proliferate, then release toxins and toxin occurs due to hypersecretion which in turn will cause diarrhea.

While the result of the diarrhea will occur of the following:

1. Loss of water (dehydration)

Dehydration occurs due to water loss (output) more than income (input), is the cause of death in diarrhea. Disorders of acid-base balance (metabik acidosis)
It occurs due to loss of Na-bicarbonate with feces. Lipid metabolism is not perfect so dirty stuff accumulate in the body, the accumulation of lactic acid due to anorexia tissue. Acidic metabolic products are increasing due to be issued by the kidneys (oliguria occurs / anuria) and the removal of Na ions from the extracellular fluid into the intracellular fluid.

2. Hypoglycemia

Hypoglycemia occurs in 2-3% of children suffering from diarrhea, more often in children who had previously been suffering from protein-calorie deficiency. This occurs because of the interference of storage / supply of glycogen in the liver and disruption of glucose absorption. Symptoms of hypoglycemia will occur if the blood glucose levels were 40 mg% in infants and 50% in children.

3. The occurrence of weight loss in a short time, this is caused by:
Food is often stopped by parents, for fear of diarrhea or vomiting intensified.
Although milk passed, often given to expenditures and of diluted milk was given too long.
Food given often can not be digested and absorbed properly because of hyperperistaltic.

4. Impaired circulation
As a result of diarrhea, hypovolemic shock can occur, resulting in reduced tissue perfusion and hypoxia, acidosis gain weight, can cause brain bleeding, decreased consciousness, and if not addressed client will die.


Clinical Manifestations of Diarrhea

1. At first, children / baby whiny anxiety, body temperature may be increased, decreased appetite.
2. Frequent bowel movements with liquid or watery stool consistency.
3. Stool color changed to greenish due to mixed bile.
4. Anus, and surrounding blisters because of frequent bowel movement and stool becomes more acidic due to the amount of lactic acid.
5. There are signs and symptoms of dehydration, clear skin turgor, fontanel and sunken eyes, dry mucous membranes and with weight loss.
6. Changes in vital signs, pulse and respiration rapid drop in blood press, rapid heart rate, the patient is very weak, decreased consciousness (apathy, samnolen, sopora komatus).
7. Reduced diuresis (oliguria to anuria).
8. If metabolic acidosis occurs, the client will look pale and breathing fast and deep.

Nursing Care in Children with Diarrhea and Typhoid

Nursing Care in Children with Diarrhea and Typhoid

Nursing Care in Children with Disorders of the Digestive System Caused by Diarrhea and Typhoid

Theoretical Overview

Gastrointestinal tract plays a role in a series of processes: the process of food ingestion, digestion of food process, aided by the digestive fluid produced by the salivary glands, liver and pancreas. The results of digestion of nutrients will be absorbed into the body. This process takes place starting from the mouth to the rectum.

Disorders of the gastrointestinal tract in infants and children can be caused by congenital abnormalities. Disorders caused by abnormalities that can be caused by either trauma or infection of the gastrointestinal tract or the outside of the gastrointestinal tract. Congenital abnormalities can occur in the mouth, esophagus, pylorus, and duodenum in the passage disorder, rectal atresia, and imperforate anus, Hirschsprung disease, biliary obstruction, and omphalocele. While the disorder can be caused by an infection caused by a fungus "Candida albicans"; bacillus coli "Escherichia coli", viruses; germ: Salmonella, Shigella, Vibrio cholerae and parasites.

Various gastrointestinal disorders are common in children such as diarrhea and typhoid, the disease can affect gastrointestinal function and immune reaction that would lead to acute symptoms and complications that will stimulate the occurrence of changes in the digestive tract itself.

Diarrhea can be caused by various infections, in addition to other causes such as malabsorption. Diarrhea especially in infants need to get immediate action because it can lead to disaster if tackled late. Food and drinks were contaminated as stale food and toxic, is one of the factors causing diarrhea, so the disease is considered to be highly vulnerable to children going through a period of growth and development.

Diarrhea


Definition of Diarrhea

Diarrhea is a state frequency of bowel movements more than 4 times in infants and more than 3 times in children, with the consistency of watery, green can be, or can be mixed with mucus and blood or mucus alone.

Diarrhea is a symptom that occurs because of abnormalities involving the functions of digestion, absorption, and secretion. Diarrhea is caused by the transport of water and electrolytes in the gut abnormal. In the world there are approximately 500 million children suffering from diarrhea each year, and 20% of all deaths in developing countries living associated with diarrhea and dehydration. Diarrheal disorders can involve disorders of the stomach and intestines (gastroenteritis), small intestine (enteritis), colon, or the colon and intestines. Diarrhea is usually classified as acute and chronic diarrhea. (Dona L.Wong, 2008)

Clinical Manifestation

At first the patient whiny, insecure, body temperature usually increases, decreased appetite or no, then arise diarrhea. Liquid stool, possibly with mucus, or mucus and blood. The longer the stool color turns greenish because it is mixed with bile. Anus and surrounding area blisters arise due to frequent defecation and fecal increasingly acidic as a result of the more lactic acid derived from lactose that is not absorbed by the intestine during diarrhea. Symptoms of vomiting can occur before or after the diarrhea and stomach can be caused by inflammation or due to interference contribute acid-base and electrolyte balance. If the patient has a lot of fluid and electrolyte loss, dehydration symptoms begin to appear, ie weight loss, reduced turgor, eyes and large fontanel becomes concave (in infants, lips and mucous membranes of the mouth and the skin looks dry.


Typhoid

Definition of Typhoid

Typhoid fever is an acute infectious disease that usually affects the gastrointestinal tract with symptoms of fever more than a week, digestive disorders and disorders of consciousness. The cause of this disease is Salmonella typhi, gram-negative bacillus that moves with fur shakes, no spores.

Clinical Manifestation

Clinical Manifestation of typhoid fever in children are usually milder than in adults. Future shoots 10-20 days. The shortest 4 days if the infection occurs through food, whereas if through drink longest 30 days. During the incubation period may be found prodromal symptoms, ie feeling of malaise, lethargy, headache, dizziness not excited and lack of appetite.

Clinical features commonly found are:

1. Fever
In the typical case, the fever lasts 3 weeks, and remittances are febrile temperature is not very high. During the first week, the temperature gradually increased each day, usually down in the morning and rose again on the afternoon and evening. In the second week the patient continues to be in a state of fever, in the third week of temperatures going down and back to normal by the end of the third week.

2. Disorders of the gastrointestinal tract.
In the mouth there is a breath smells, lips dry and chapped. Tongue covered with dirty white membrane (coated tongue), red tip and edges, often accompanied by tremors. Abdominal bloating can be found condition (meteorismus). Enlarged liver and spleen accompanied by pain on palpation. Usually frequent constipation or diarrhea, but can also be normal.

3. Disorders of consciousness
Patient awareness generally decreased, although not in the apathetic until somnolence, rare sopor, coma or nervous (except severe illness and delayed treatment).Clinical Manifestation
Clinical Manifestation of typhoid fever in children are usually milder than in adults. Future shoots 10-20 days. The shortest 4 days if the infection occurs through food, whereas if through drink longest 30 days. During the incubation period may be found prodromal symptoms, ie feeling of malaise, lethargy, headache, dizziness not excited and lack of appetite.