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

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 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 ,e,unum and ileum. In humans, duodenum is about "- to $. cm in length, and it connects the stomach and the ,e,unum. /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 ma,or 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 ,e,unum. /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
2

small

intestine.

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 system are, 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 surgery often 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 duodenum and the ileum. The surface area of the lining of the ,e,unum is greatly increased by many small, finger2like outgrowths called villi. This

makes it easier for digested material to be absorbed, which is the main function of the ,e,unum. 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. 8e,unal biopsy is removal of a piece of the mucosa 'lining( of the ,e,unum. 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 ,e,unum 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 con,ugated bile salts. The ileum is about : metres '!$ feet( long and e3tends from the ,e,unum '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 '<eyer patches( are embedded in the ileum wall, and specific receptors for bile salts and vitamin 0!" are contained e3clusively in its lining= about >. percent of the con,ugated bile salts in the intestinal contents is absorbed by the ileum. Two percent of all humans are born with a congenital ileum malformation, called 4eckel diverticulum, that consists of a side channel up to - cm '" inches( long e3tending from the intestinal wall. The malformation occurs when the duct leading from the navel to the

small intestine in the fetus fails to atrophy and close. / small number of cases require surgical removal because of intestinal bleeding and inflammation. In,ury 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 ,e,unum. Its wall is lined with pro,ecting structures called the villi and microvilli. The villi help take up nutrients that become available through the digestive process, and conduct them to the bloodstream and the liver. <eyer;s patches, which are bundles of lymphatic cells are located in the ileal lining. These cells may be involved in body;s immune mechanisms. 2.2 D" inition o &a$tro"nt"riti$ Is inflammation of the stomach and intestines that give the symptoms of diarrhea, with or without vomiting, and often accompanied by increased body temperature. +iarrhea is meant bowel movements many times 'with the amount in e3cess of : times, and form a liquid stool, can be accompanied by blood or mucus(. Ta#l", O-"r-i". o Acut" Bact"rial and /iral &a$tro"nt"riti$. Cam0(lo#ac t"r Ent"riti$ Diarr!"a Cau$"d #( E. Coli ?ccurrenc orldwide= orldwide= orldwide= orldwide= and orldwide= '!ig"llo$i$ E0id"mic /iral Rota-iru$ &a$tro"nt"riti$ &a$tro"nt"riti$

common source outbreaks occur= highest warmer months

common2 source outbreaks occur

highest children under out2 @?=

in common= !. breaks occur

sporadic

and

in

epidemics and out outbreaks= highest in infant and young children

in breaks occur= outbreaks high in areas common in of during poor crowded warm condition 4any of agents serotypes 4any types of sanitation and living months Enteroto3igeni Arom c, invasive, or different enteropathoge E. Coli groups bacteria, with many %umans %umans= pathogenicity animal +irect indirect of viruses strains %umans often nic strains of shigella

Etiologic agent

Campylobact er jejuni

of parovirus like rotaviruses

Beservoir

+omestic and Infected wild animal humans, who are asymptomatic of Aecal and birds

Transmissi on

Ingestion

undetermined or Aecal2oral route= Aecal2oral= possibly food2borne water2borne transmittion and fecal2respiratory

water or food contamination contaminated with organism from infected animals oral or infants= fecal or feces= infant

of food, water, fecal2oral fomites= transmissio from or during infected carrier transmitted to n

contact with delivery= fecal person oral, by hand

Incubation period Suscepbilit y and resistance

$2- d= range) !"2C" h !2!. d General Infants duration acquired immunity unkown

!2C

d, Dsually ":2:E h, :E h

usually !2$d range) !.2-!h very General= General= sort2term 0y age " yr most more severe '!:wk( immunity individuals of in children may and elderly infection and debilitated individuals= strain2 specific antibodies develop with against serotypes have most follow acquired antibodies

susceptible=

specific serotypes

2.% Etiolog( !. Aood and 0everage a. 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 <oisoning ". Infections or the Investment <arasites 0acteria, viruses, and parasites are often found) a. Gibrio cholerae, E. coli, Salmonella, Shigella, *ompylobacter, /eromonas. b. Enterovirus 'Echo, *o3sakie, <oliomyelitis(, /denovius, Botavirus, /stovirus. c. Some worms include ) /scaris, Trichurius, ?3yuris, strongyloides, <roto1oa such as Entamoeba histolytica, Giardia lamblia, Tricomonas hominis.

$. Aungus '*andida /lbicans(

:. 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. 2.1 Pat!o0!($iolog( Transmission usually through the faecal oral gastroenteritis from one patient to another. Several cases of the spread of pathogens encountered due to contaminated food and beverages. The basic mechanism is a disorder causing osmotic diarrhea 'food that can not be absorbed will cause osmotic pressure in the cavity of the intestine increased resulting in a shift of water and elektrolt into the cavity of the intestine, the contents of the gut cavity, causing e3cessive diarrhea(. /lso secretion disruption due to to3ins in the intestinal wall, so that water and electrolyte secretion increases then occur diarrhea. +isorders that cause intestinal multilitas hiperperistaltik and hipoperistaltik. /s a result of diarrhea itself that is losing water and electrolytes 'dehydration( that lead to acid2base disturbances 'acidosis 4etbolik and hypokalemia(, impaired nutrition 'intake less, the output is e3cessive(, hypoglycemia and blood circulation disorders. 2.2 Clinical '(m0tom$ <atients with diarrhea due to infection often e3perience nausea, vomiting, abdominal pain to stomach cramps, fever and diarrhea occurred hypovolemic shock should be avoided dehydration caused the patient will feel thirst, dry tongue, prominent cheekbones, decreased skin turgor, and the voice becomes hoarse, disruption such biochemical metabolic acidosis will lead to more rapid
8

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 !IH days, and is self2limiting. a. b. c. d. e. f. g. h. i. ,. k. Fausea and vomiting +iarrhea 6oss of appetite Aever %eadaches /bnormal flatulence /bdominal pain /bdominal cramps 0loody stools 'dysentery 2 suggesting infection by amoeba, *ampylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli. Aainting and %eartburn eakness

The main contributing factors include poor feeding in infants. +iarrhea is common, and may be followed by vomiting. Giral 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.
9

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. <atients who travel may be e3posed to E. *oli infections or parasite infections contacted from beverages or food. Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardia 2 an organism found in water that causes diarrhea. Aood poisoning must be considered in cases when the patient was e3posed to undercooked or improperly stored food. +epending on the type of bacteria that is causing the condition, the reactions appear in " to C" hours. +etecting the specific infectious agent is required in order to establish a proper diagnosis and an effective treatment plan. The doctor may want to find whether the patient has been using broad2spectrum or multiple antibiotics in their recent past. If so, they could be the cause of an irritation of the gastrointestinal tract. +uring the physical e3amination, the doctor will look for other possible causes of the infection. *onditions such as appendicitis, gallbladder disease, pancreatitis or diverticulitis may cause similar symptoms but a physical e3amination will reveal a specific tenderness in the abdomen which is not present in gastroenteritis.

10

+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. <repare equipment to help the airway if necessary c. If there is worsening of the airway immediately contact an intensivist and take it to the I*D !." 0reathing a. /ssess respiratory rate b. /ssess o3ygen saturation c. *hest /uscultation d. 4ake checks rontgent !.$ *irculation a. /ssess heart rate b. 4onitor blood pressure c. /ssess capillary refill time d. Becord temperatures e. +o cultures if pyreksia f. <erform strict monitoring g. If there is nausea and vomiting, give antiemetics IG. !.: +isability /ssess level of consciousness by using /G<D, E3posure a. Beview the history detailed as possible b. /ssess the food and beverages consumed preferencess
11

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. <erform abdominal e3amination g. <erform abdominal 32ray e3amination h.Give anti2diarrhea , for instance are like loperamide until culture results are known i. +o not give antibiotics until culture results are known ,. Beport if you have poisoned food ". Implementation To be distinguished on the case management of adults and children
a.

Aor adults

'(m0tom$ and $ign$, *linically divided into two forms) Gastroenteritis *holeriform The causes include) an <arachemolitica Gibrio, Gibrio Eltor, E. *oli, *lastridia, food poisoning. The main symptoms of diarrhea and vomiting. +iarrhea that occurs without tenesmus and no nausea. Gastroenteritis disentriform ) The causes include %istolitica is Entamoeba, Shigella, Salmonella. This form is rarely lead to dehydration. The symptoms are colic, diarrhea, tenesmus, feces containing blood and mucus which are all called dysentery syndrome. 4anag"m"nt, <rinciple B3 is) a. Beplace fluids lost and overcome shock b. Beplace lost electrolytes c. Identify and overcome the complications that occur d. Eradicate the cause Action $"5u"nc" i$,

12

+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. <ulse rateL !".rpm C. Bespiratory L$.rpm E. +ecreased turgor >. *old e3tremities !.. Go3 cholerica !!. Aacies cholerica !". *yanosis b. Aor children '(m0tom$ and $ign$, The main symptom is the occurrence of diarrhea, whereas symptoms of vomiting occurred before or after diarrhea. If the patient has a lot of lost fluids and electrolytes, the symptoms of dehydration begin Gisible. +ehydration is divided according to the amount of fluid lost, becomes) a. b. c. 4ild dehydration, if the fluid lost .2-M or an average of "- ml 5 kg 4oderate dehydration if fluid loss of -2!.M or an average of C- ml 5 kg 0 Severe dehydration, fluid loss ,iika average !.2!-M or rata!"- ml 5 kg 4anag"m"nt, ?vercoming +ehydration 4ild and moderate dehydration Given ?BS salt "2- cups 5 day for "2$ days. 4ilk is given. Should penberian ?BS with a spoon, not with a bottle, because the dot on the bottle can stimulate the throat that caused vomiting. The e3istence of vomiting is not a contra indication for the provision of ?BS= in these circumstances, the granting of a little2sedikittapi often and if vomiting can not
13

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 <atients hospitali1ed and given intravenous fluids. N"onat"$ Aluid given was :) ! '-2!.M glucose fluid) Sodium 0icarbonate P :) !(. The amount of fluid in a ":2hour requirement is "-. 3 0 droplets Q5E. drops 5 min Ba#( 6not n"onat"$+ Aour hours of the first given number of droplets of liquid with H 3 00 5 drops 5 min. Aour hours of the two given fluids with droplet $/ $ 3 00 5 drops 5 min. Si3teen hours later, given fluids +G '+arrow Glucose( with a total drop of $ Q 00 5 drops 5 min. 7B8 N"onat"$ Given fluid is the fluid :) !. The amount of fluid in a ":2hour requirement is "-. 3 0 'in **(. hereas In the dehydration that is repeated when the child has fallen in dehydration refeeding returned, then the mild dehydration and is being cultivated to multiply the intake by G?S , in severe dehydration then started again as the above principle. ?n suspicion of cholera 'with bowel symptoms such as rice washing water, pre2shock or shock( was given Binger 6actate fluid at ! hour the first number of droplets is !. 3 00 5 drops 5 minute and the ne3t C hours is $ 3 00 5 drops 5 min. If after ! hour has been resolved, continue up to ! hour. If after ! hour is not resolved, continue until resolved. Anti#iotic If the cause can not found, we can use the antibiotics. The administration of antibiotics are as follow )Given the above age Feonates Temperatures up to $E.-. c) not given antibiotics $E.-. *2$>, -.*) procaine2penicillin -. ... D 5 kg 5 day
14

'in **(, : O the first hour is given by the number of droplets

Q5:E drops 5 minute, ". hours brikutnya, the remaining liquid evenly divided by the number of

$>.-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. ". <rovision of Aood +uring the administration of fluids, liquid foods such as liquid porridge, broth, or slurry may be filtered, but the vegetables 'fiber( may be granted if the acute situation has been resolved and the provision of fiber can be given gradually to normal feeding. $. Grant of 4edicine If the gastroenteritis is caused by infection or parasites investment, it would require drug administration, immediately to the clinic, a doctor, or to the hospital for treatment and further handling. Tips to avoid Gastoenteritis
15

!. 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 <ercentage of rotavirus tests with positive results, by surveillance week, Dnited States, 8uly "...228une "..>. 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 Gibrio 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. Giral 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
16

Gastroenteritis is usually an acute and self2limited disease that does not require pharmacological therapy. The ob,ective 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. <lain water may be used if specific ?BS are unavailable or not palatable. 2.11 Di"t It is recommended that breastfed infants continue to be nursed on demand and that formula2 fed infants should continue their usual formula immediately after rehydration with oral rehydration solutions. 6actose2free or lactose2reduced formulas usually are not necessary. *hildren receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Aoods high in simple sugars should be avoided because the osmotic load might worsen diarrhea= therefore substantial amounts of soft drinks, ,uice, and other high simple sugar foods should be avoided. The practice of withholding food is not recommended and immediate normal feeding is encouraged. The 0B/T diet 'bananas, rice, applesauce, toast and tea( is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.

2.12 4"dication$

17

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. <seudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronida1ole or vancomycin. c. /ntimotility agents /ntimotility drugs have a theoretical risk of causing complications= clinical e3perience, however, has shown this to be unlikely. They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever. 6operamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea. 6operamide is not recommended in children as it may cross the immature blood brain barrier and cause to3icity. 0ismuth subsalicylate '0SS(, an insoluble comple3 of trivalent bismuth and salicylate, can be used in mild2moderate cases. d. /ntispasmotics 0utylscopolamine '0uscopan( is useful in treating crampy abdominal pain. 2.1% Alt"rnati-" 4"dicin" a. <robiotics Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis. They reduce both the duration of illness and the frequency of stools. Aermented milk products 'such as yogurt( also reduce the duration of symptoms. b. Rinc

18

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.

19

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 <arasites 0acteria, viruses, and parasites

are often found)

c. Aungus '*andida /lbicans( d. 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(.
e. /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.
f. Environmental Aactors

$. <athophysiology) disorders of osmotic, seksresi disorders, intestinal motility disorders :. /ssessment includes the /0*+E '/irway, 0reathing, *irculation, +isability, and E3posure(. -. B3 principles are) a. Beplace fluids lost and overcome shock b. Beplace lost electrolytes c. Identify and overcome the complications that occur d. Eradicate the cause
20

%.2 'ugg"$tion Students can perform the role as a good nurse by knowing more about gastroenteritis and how treatment

REFERENCE'
21

http)55nursingspirit.blogspot.com5html. "- ,uni "..E. asuhan keperawatan gawat darurat pada gastroenteritis. /ccess on ednesday, "$rd ".!! time !".!. I0

http)55askep.blogspot.com5html. .E ,anuari "..E. /suhan &eperawatan pada /nak dengan Gastroenteritis. /ccess on ednesday, "$rd ".!! time !".!. I0

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