I.
Skenario C blok 17
Amir. A boy, 12 month, was hospitalized due to diarrhea. Four days before admission, the patient had non projectile vomitting 6 times a day. He vomitted what he ate. The days before admission the patient got diarrhea 10 times a day around half glass in every defecation. There was no blood and mucous/pus in it. The frequency of vomitting decreased. Along those 4 days, he drank eagerly and was given plain water. He also got mild fever. Yesterday, he looked worsening, still had diarrhea but no vomiting. The amount of urination in 8 hours ago was less than usual. Amir s family lives in slum area. ’
Physical Examination
Patient looks severely ill, compos mentis but weak lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 oC, BW 8,8 kg, BH 75 cm Head: Sunken eye, no tears drop, an dry mouth. Thorax: similar movement on both side, retraction (-/-), vesicular breath sound, normal heart sound. Abdomen: flat, shuffle, bowel sound increase. Liver palpable 1 cm below arcus costa and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 seconds). Redness skin surrounding anal orifice. Extremities: cold hand and feet Laboratory Laboratory examination
Hb 12,8 g/dl, WBC 9.000/mm3, diff count: 0/1/16/48/35/0. Urin routine: Macroscopic: yellowish colour Macroscopic: WBC (-), RBC (-), protein (-) Feces rountine: Macroscopic: water more than waste material, blood (-), mucous (-) WBC: 2-4/HPF, RBC 0-1/HPF
II. Klarifikasi istilah
1. Diarrhea: pengeluaran tinja berair berkali kali yang tidak normal 2. Non projectile vomitting: muntah yang tidak disertai dengan semburan yang sangat kuat 3. Mucous: lendir bebas pada membran mukosa 4. Pus: cairan kaya protein hasil proses peradangan yang mengandung leukosit, debris seluler dan cairan encer atau liquor puris 5. Slum area: sebuah kawasan dengan tingkat kepadatan populasi yang tinggi umumnya dihuni oleh orang miskin. 6. Lethargic: tingkat kesadaran yang menurun dan disertai dengan pusing, berkurangnya fungsi pendengaran dan apatis 7. Sunken eye: bentuk mata yang cekung
8. Bowel sound: suara pergerakan tinja dalam saluran pencernaan
III. Identifikasi masalah
1. Amir. A boy, 12 month, was hospitalized due to diarrhea. Amir s family lives in ’
slum area. (chi ef complain) 2. Four days before admission, the patient had non projectile vomitting 6 times a day. He vomitted what he ate. 3. The days before admission the patient got diarrhea 10 times a day around half glass in every defecation, there was no blood and mucous/pus in it. The frequency of vomitting decreased 4. Along those 4 days, he drank eagerly and was given plain water. 5. He also got mild fever. 6. Yesterday, he looked worsening, still had diarrhea but no vomiting. 7. The amount of urination in 8 hours ago was less than usual 8. Physical Examination (M ain Problem)
Patient looks severely ill, compos mentis but weak lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 oC, BW 8,8 kg, BH 75 cm Head: Sunken eye, no tears drop, an dry mouth. Thorax: similar movement on both side, retraction (-/-), vesicular breath sound, normal heart sound. Abdomen: flat, shuffle, bowel sound increase. Liver palpable 1 cm below arcus costa and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 seconds). Redness skin surrounding anal orifice. Extremities: cold hand and feet 9. Laboratory examination
Hb 12,8 g/dl, WBC 9.000/mm3, diff count: 0/1/16/48/35/0. Urin routine: Macroscopic: yellowish colour Macroscopic: WBC (-), RBC (-), protein (-) Feces rountine: Macroscopic: water more than waste material, blood (-), mucous (-) WBC: 2-4/HPF, RBC 0-1/HPF
IV. Analisis Masalah
1. Amir. A boy, 12 month, was hospitalized due to diarrhea. Amir ’s family lives in slum area. a. Bagaimana anatomi dan fisiologi sistem digestif anak? Eka, bena, davi, alvi disintesis b. Bagaimana hubungan jenis kelamin, usia dan tempat tinggal? Yuli, Tuti c. Bagaimana penanganan awal pada kasus? Tuti, Shabrin d. Bagaimana kriteria diare yang harus dirawat? Shabrin, Ridha
2. Four days before admission, the patient had non projectile vomitting 6 times a day. He vomitted what he ate. a. Apa perbedaan muntah proyektil dan non proyektil? Ridha, Retno b. Bagaimana keterkaitan muntah dengan diare yang diderita? Retno, Divo c. Bagaimana mekanisme muntah non proyektil? Divo, Beka d. Bagaimana pengaruh frekuensi muntah 6 kali sehari terhadap kondisi pasien? Beka, qoqon e. Apasaja klasifikasi muntah? Qoqon, Alvi
3. The days before admission the patient got diarrhea 10 times a day around half glass in every defecation. There was no blood and mucous/pus in it. The frequency of vomitting decreased a. Apa pengaruh diare 10 kali perhari dengan kondisi pasien? Alvi, bena b. Mengapa feces tidak disertai darah dan mukus? Bena, aqil c. Adakah hubungan antara frekuensi diare yang meningkat dengan frekuensi muntah yang berkurang? Kalau ada jelaskan! Aqil, putri d. Mengapa muntah terjadi lebih dahulu dari diare? Putri, Faqih
4. Along those 4 days, he drank eagerly and was given plain water. a.
Apa hubungan minum banyak dengan keluhan diare dan muntah? Faqih, Davi
b.
Bagaimana mekanisme munculnya rasa haus? Davi, Eka
c.
Apa yang seharusnya diberikan pada pasien yang menderita diare dan muntah? Eka, Yuli
5. He also got mild fever. a. Bagaimana mekanisme mild fever terkait kasus? Yuli, Tuti b. Apasaja klasifikasi demam? Tuti, Shabrin c. Mengapa demam pada pasien ini ringan? Shabrin, Ridha
6. Yesterday, he looked worsening, still had diarrhea but no vomiting. a. Mengapa keadaan Amir memburuk? Ridha, retno b. Mengapa Amir tidak muntah lagi tetapi masih diare? Retno, Divo
7. The amount of urination in 8 hours ago was less than usual a. Berapakah jumlah dan frekuensi urin normal perhari pada anak 12 bulan? Divo, beka b. Bagaimana mekanisme berkurangnya urin pada kasus? Beka, alvi c. Mengapa urin berkurang padahal minum banyak? Alvi, bena d. Bagaimana riwayat perjalanan penyakit pasien? Bena, aqil e. Bagaimana clinical findings pada dehidrasi? Aqil, putri
8. Physical E xamination (M ain Pr oblem)
Patient looks severely ill, compos mentis but weak lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 oC, BW 8,8 kg, BH 75 cm. Head: Sunken eye, no tears drop, an dry mouth. Thorax: similar movement on both side, retraction (-/-), vesicular breath sound, normal heart sound. Abdomen: flat, shuffle, bowel sound increase. Liver palpable 1 cm below arcus costa and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 seconds). Redness skin surrounding anal orifice. Extremities: cold hand and feet a. Bagaimana interpretasi dan mekanisme abnormal pada pemeriksaan fisik?(KMS) putri, faqih, Davi, Eka, Yuli b. Bagaimana klasifikasi dehidrasi? Tuti, Shabrin 9. Laboratory examination Hb 12,8 g/dl, WBC 9.000/mm3, diff count: 0/1/16/48/35/0. Urin routine: Macroscopic: yellowish colour. Macroscopic: WBC (-), RBC (- ), protein (-) Feces rountine: Macroscopic: water more than waste material, blood (-), mucous (-). WBC: 2-4/HPF, RBC 0-1/HPF a. Bagaimana interpretasi dan mekanisme abnormal dari pemeriksaan laboratorium? Ridha, retno, divo, beka
b. Apa tujuan pemeriksaan laboratorium? Alvi, bena, aqil
V. Hipotesis Amir, 12 bulan menderita dehidrasi dikarenakan diare akut dan muntah. VI. Learning Issue
1. Anatomi dan fisiologi sistem digestif anak (Eka, Bena, Davi, alvi) Anatomi digestif anak normal, perbedaannya dengan dewasa. Fisiologi, perjalanan makanan mulai dari mulut sampai anus pada anak. 2. Diare (yuli, Retno, Aqil, Divo, Qonitah, Tuti, Ridha) DD WD Penegakan diagnosis Definisi Klasifikasi Etiologi Epidemiologi Faktor resiko Patogenesis Patofisiologi Manifestasi klinis Tatalaksana Komplikasi Prognosis SKDI
3. Dehidrasi (Putri, Beka, Faqih, Shabrin) Penegakan diagnosis Definisi Klasifikasi Tatalaksana dll
