SKENARIO C BLOK 17
Amir, a boy, 13 month, was hospitalized due to diarrhea. Four days before admission, the patient had non projectile vomiting 6 times a day. e vomited what he ate. !hree days before admission the patient got diarrhea 1" times a day around half glass in every defecation, there was no blood and mucous# pus in it. !he fre$uency of vomiting decreased. Along those % days, he dran& eagerly and was given plain water. e also got mild fever. 'esterday, he loo&ed worsening, lethargy, didn(t want to drin&, still had diarrhea but no vomiting. !he amount of urination in ) hours ago was less than usual. Amir(s family lives in slum area. Physical examination:
*atient loo&s severely ill, compos mentis but wea& +lethargic, -* "#/" mmg, 00 3)#m, 0 1%%#m regular but wea&, body temperature te mperature 3),o 2, - 1" &g, - /cm ead4 sun&en frontanella, sun&en eye, no tears drop, and dry mouth. !hora4 similar movement on both side, retraction +5#5, vesicular breath sound, normal hearth sound. Abdomen4 Abdomen4 flat, shuffle, bowel sound sound increase. iver is palpable palpable 1 cm below arcus costa and iphoid processus, spleen unpalpable, pinch the s&in of the abdomen4 very slowly +longer than 7 seconds. 0edness s&in surrounding anal orifice. 8tremities4 cold hand and feet Laboratory examination:
b 17,) g#dl, -2 1%."""#mm3, differential count4 "#1#16#%)#3/#" 9rine routine4 macroscopic4yellowish colour, microscopic4 -2 +5, 0-2 +5, protein +5, &eton boides +:. Faeces routine4 macroscopic4 water more than waste material, blood +5, mucous +5, -24 %5 6#*F, 0-2 "51#*F, bacteria +::, entamoeba coli +:, fat f at +:
I KLARI!IKASI IS"ILA# 1. ;iar ;iarrh rhea4 ea4 peng pengel elua uaran ran feses feses deng dengan an &ons &onsis iste tens nsii yang yang cair cair dan dan fre& fre&ue uens nsii yang yang
abnormal
7. awasan dengan populasi yang padat II
I$EN"I!IKASI %ASALA# 1. Amir, a boy, 13 month, was hospitalized due to diarrhea +1 7. Four days before admission, the patient had non projectile vomiting 6 times a
day. e vomited what he ate +% 3. !hree days before admission the patient got diarrhea 1" times a day around half glass in every defecation, there was no blood and mucous# pus in it. !he fre$uency of vomiting decreased.+3 %. Along those % days, he dran& eagerly and was given plain water. e also got mild fever 'esterday, he loo&ed worsening, lethargy, didn(t want to drin&, still had diarrhea but no vomiting. !he amount of urination in ) hours ago was less than usual +7 /. Amir(s family lives in slum area.+/ 6. Physical examination: &'( *atient loo&s severely ill, compos mentis but wea& +lethargic, -* "#/" mmg, 00 3)#m, 0 1%%#m regular but wea&, body temperature 3),o 2, - 1" &g, - /cm ead4 sun&en frontanella, sun&en eye, no tears drop, and dry mouth. !hora4 similar movement on both side, retraction +5#5, vesicular breath sound, normal hearth sound. Abdomen4 flat, shuffle, bowel sound increase. iver is palpable 1 cm below arcus costa and iphoid processus, spleen unpalpable, pinch the s&in of the abdomen4 very slowly +longer than 7 seconds. 0edness s&in surrounding anal orifice. 8tremities4 cold hand and feet 7 Laboratory examination:
b 17,) g#dl, -2 1%."""#mm3, differential count4 "#1#16#%)#3/#"
9rine routine4 macroscopic4yellowish colour, microscopic4 -2 +5, 0-2 +5, protein +5, &eton boides +:. Faeces routine4 macroscopic4 water more than waste material, blood +5, mucous +5, -24 %5 6#*F, 0-2 "51#*F, bacteria +::, entamoeba coli +:, fat +:
III
ANALISIS %ASALA# 1. Amir, a boy, 13 month, was hospitalized due to diarrhea +1 a. Apa saja etiologi diare pada ana& usia 13 bulan? b. -agaimana &lasifi&asi diare? c. -agaimana &riteria diare pada ana& 13 bulan? d. -agaimana &aitan antara usia dan jenis &elamin dengan diare? e. -agaimana me&anisme diare ter&ait &asus? 7. Four days before admission, the patient had non projectile vomiting 6 times a
day. e vomited what he ate +% a. -agaimana &eter&aitan antara muntah dan diare? b. -agaimana &ondisi pasien setelah muntah sebanya& enam &ali dalam sehari? c. -agaimana perbedaan me&anisme muntah projectile dengan muntah non projectile? d. Apa ma&na dari ia memuntah&an yang sebelumnya dima&an? 3. !hree days before admission the patient got diarrhea 1" times a day around half glass in every defecation, there was no blood and mucous# pus in it. !he fre$uency of vomiting decreased.+3 a. @engapa fre&uensi muntah ber&urang? b. -erapa fre&uensi dan jumlah -A- normal pada ana& 13 bulan? c. Apa ma&na tida& adanya darah dan lendir# pus pada feces? d. Apa hubungan fre&uensi -A- yang mening&at dengan fre&uensi muntah yang menurun? %. Along those % days, he dran& eagerly and was given plain water. e also got mild fever. 'esterday, he loo&ed worsening, lethargy, didn(t want to drin&, still had diarrhea but no vomiting. !he amount of urination in ) hours ago was less than usual +7 a. -agaimana &lasifi&asi dehidrasi? b. Apa hubungan banya& minum dengan &eluhan diare dan muntah? c. @engapa diare tetap terjadi mes&ipun Amir sudah tida& ingin minum? d. @engapa ana& dengan dehidrasi berat cenderung tida& ingin minum? e. -agaimana me&anisme demam pada &asus? f. @engapa jumlah urin ber&urang pada &asus? /. Amir(s family lives in slum area.+/ a. Apa hubungan daerah &umuh dengan diare?
6. Physical examination: &'( *atient loo&s severely ill, compos mentis but wea& +lethargic, -* "#/" mmg, 00 3)#m, 0 1%%#m regular but wea&, body temperature 3),o 2, - 1" &g, - /cm ead4 sun&en frontanella, sun&en eye, no tears drop, and dry mouth. !hora4 similar movement on both side, retraction +5#5, vesicular breath sound, normal hearth sound. Abdomen4 flat, shuffle, bowel sound increase. iver is palpable 1 cm below arcus costa and iphoid processus, spleen unpalpable, pinch the s&in of the abdomen4 very slowly +longer than 7 seconds. 0edness s&in surrounding anal orifice. 8tremities4 cold hand and feet a. -agaimana interpretasi dari hasil pemeri&saan fisi&? b. -agaimana me&anisme abnormalitas dari hasil pemeri&saan fisi&? c. -agaimana gambaran dari hasil pemeri&saan fisi&? 7 Laboratory examination: &'( b 17,) g#dl, -2 1%."""#mm3, differential count4 "#1#16#%)#3/#" 9rine routine4 macroscopic4yellowish colour, microscopic4 -2 +5, 0-2 +5, protein +5, &eton boides +:. Faeces routine4 macroscopic4 water more than waste material, blood +5, mucous +5, -24 %56#*F, 0-2 "51#*F, bacteria +::, entamoeba coli +:, fat +: a. -agaimana interpretasi dari hasil pemeri&saan laboratorium? b. -agaimana me&anisme abnormalitas dari hasil pemeri&saan laboratorium? *B!8==4 Amir, ana& la&i5la&i 13 bulan, menderita diare a&ut disertai dehidrasi berat !8@*A!84 1. ;; 7. ; 3. ;efinisi
%. 8tiologi /. 8pidemiologi 6. Factor risi&o . @anifestasi &linis ). ow to diagnose C. *emeri&saan penunjang 1". *athogenesis dan patofisiologi 11. !atala&sana 17. *encegahan dan edu&asi 13. >ompli&asi 1%. *rognosis 1/. =>; earning issues4 1. 7. 3. %.
;iare pada ana& ;ehidrasi &arena diare *emeri&saan fisi& *emeri&saan laboratorium
