Chronic Diarrhea in Infants and Children

By definition, chronic diarrhea is diarrhea continued until 2 weeks or more with orwithout failuregrowth (failure to Thrive). Many of the names given to such intractable diarrheachronic diarrhea,
diarrhea that can not be treated or cured, protracted diarrhea, diarrhea slowed ordelayed
recovery from gastroenteritis, prolonged diarrhea, or prolonged diarrhea lasting more than 7 days,
recurrent diarrhea, diarrhea that repeatedly for 3 months and at least one timeeach month episode
diarrhea, persistent diarrhea, persistent diarrhea.
It has been known to us that in the face of a patient with acute diarrhea shoulddifikirkan whether
patient-but terse entry in the clinical group of acute diarrhea which of the fivegroups, namely: (1)
Acute diarrhea (pure), (2) + complications of acute diarrhea, (3) + acute diarrheacomorbidities (bronkopnemoni, sepsis,
encephalitis, or other protein-energy malnutrition, (4) which continued to be acutediarrhea chronic diarrhea or phase acute from chronic diarrhea, and (5) diarrhea in a surgical bowel disease.
So, when we talk about chronic diarrhea diarrheal intended discuss the clinical group to-4 them.

Chronic diarrhea problem is more complex than acute diarrhea. Approachneeded to be a problem
(anamnesis, clinical examination, laboratory and investigation) is very careful toget
a more precise diagnosis so that treatment can be successful. Furthermore,each faces, see colors (yellow,
green, white or other), appearance (appearance) (watery, fatty, bloody) and odor(rotten, sour or
The usual classification obtained based on the nature of stools, watery, fatty,bloody, so more can
help in dealing with the problem.

Pathophysiology CHRONIC DIARRHEA
The mechanism of chronic diarrhea depends on the basic disease. Often leading to more than one kind so that
the effect is a combination of these causes. Pathophysiological mechanisms of chronic diarrhea can be as:
1. Osmotic diarrhea.
The accumulation of materials that can not be absorbed in the intestinal lumen resulting in a state of hypertonic
and elevated intra-luminal osmotic pressure that hinders absorption of water and electrolytes and there was diarrhea. Example:lactose intolerance, malabsorption of bile acids.
2. Intestinal secretion of secretory diarrhea accompanied by the secretion of ions
actively is an important factor in secretory diarrhea.
Recent knowledge gained from studies of this mechanism diarrhea due to Vibrio cholerae. Pathophysiology in cholera is one of examples of active anion secretion in the intestine as a result enterotoxin stimulation. In Zollinger Ellison syndrome, hipergastrinemia clearly induces the secretion of gastric and diarrhea.
3. Bacteria grow old, bile acids and acid fat. Under normal circumstances, the small intestine of children is relatively sterile. Tumbuhlampau bacteria can occur in any condition stasis leading to intestinal contents. The number of intestinal bacteria can increased in infants with persistent nonspecific diarrhea and the secondary monosaccharide intolerance. Coliform organisms usually predominant, although anaerobic bacteria (such as
Bacteroides) may be increased quantitatively. Dekonjugasi bile salts by bacteria resulting in formation of dihydroxy bile acids ataupunmenurunnya conjugated bile salts that cause interference fat absorption. Fat in the diet is converted to hydroxy fatty acids by colonic flora (and possibly by intestinal flora abnormal). Both of dihydroxy bile acids and-hydroxy fatty acids is a well-established colonic secretagogues and cause diarrhea.
Presence of free bile acids in the lumen of the jejunum seem to have a negative effect on the absorption of monosaccharides.
Resection of the distal ileum causing discharge asamasam dekonjugasi menujukolon bile, where dekonjugasi
bacteria induce the formation of dihydroxy bile diarrheogenic acids or also called by some authors with cholerrhoeic diarrhea. to the mechanism of ion absorption in the active usually present in normal circumstances.
The classic example is chloridorrhea congenital disease. In this disease, patients not able to actively absorb chloride because of defects on an anion exchange system of the ileum. This resulted in decreased absorption of fluid, the contents of the bowel lumen acidification and high chloride concentration in the liquid does not terabsorpsi live in the lumen of the ileum and colon. Chloride concentration of fecal far exceed the combined concentrations of sodium and potassium.
5. Mucosal damage. Reduced mucosal surface
or damage to mucosal surfaces can lead to disruption of the permeability of water and electrolytes. In celiac sprue there is a loss of surface area and decreasing effective pore size real jejunal mucosa. Damage to intestinal epithelium smooth diffuse occurs in most types of enteritis due to infections, Crohn’s disease and in diseases such as colon diseases ulseretiva colitis, granulomatous colitis and infectious colitis.
6. Abnormal intestinal motility.
Abnormalities of intestinal motility cause digestive disorders and / or absorption. Reduced motility facilitate the occurrence of stasis and bacterial grow past, while the increase in motility would result in
rapid transit of nutrients in the intestines and cause prolonged contact with mucosal inadequate. Decreased intestinal motility found in diabetes and scleroderma. Intestinal motility increases associated with an elevated intestinal contents (such as in osmotic diarrhea), inflammatory bowel and circumstances the presence of circulating humoral agents (such as prostaglandin and serotonin) are actively growing. In short bowel syndrome (often post-surgery), there is the surface area inadequate absorption combined with transit
quickly which will result in diarrhea. Gastric hypersecretion the transient hypergastrinemia can also produce
diarrhea immediately after surgery. Babies with bowel. less smooth than 40 cm are rarely able to live, especially when valvula ileosekalresected.
7. Chronic diarrhea syndrome. 
Most infants with severe, protracted diarrhea will indicate changes in mucosal the form of small intestine villus atrophy, loss of nutrients continue and the entry of calories that lead to inadequate depletion meaningful and protein malnutrition. In the depletion protein, morphologic and functional regeneration of the small intestine will disturbed; raises malabsorption thorough and persistent diarrhea, and there was a vicious circle.
8. Other mechanisms.
 Deficiency of zinc (Zn) are associated with Chronic diarrhea as in akrodermatitis enteropatika. Mechanisms of diarrhea in allergic gastroenteropati still need investigated, although there is reason to meduga that
mucosal damage and impaired function. This should be discussed separately in the discussion are allergic to cow’s milk or cow’s milkprotein sensitive enteropathy. CMPSE.

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