SKENARIO C BLOK 15 Tahun 2018

Budi, a boy, 13 month, was hospitalized due to diarrhea. Four day before admission, the patient
had non projectile vomiting 8 times a day. He vomited what he ate. Three days before admission
the patient got diarrhea 8 times a day around half glass in every defecation, there was no blood and
mucous/pus in it. The frequency of vomiting decreased but two days before admission the patient
got bloody stool 12 times a day around quarter glass in every defecation. The vomiting stopped.
Along those 4 days, he drank eagerly and was given ORS(Oral rehiration solution). He also got
mild fever. Yesterday, he looked worsening, lethargy, didn’t;t want to drink, still had diarrhea but
no vomiting. The amount of urination in 8 hours ago was less than ususal. Budi’s family lives in
slum area.
Physical Examination
Patient looks severly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38x/m, HR
144x/m regular but weak, body temperature 38,9o BW 10 kg, BH 75 cm
Head: sunken frotanella, sunken eye, no tears drop, and dry mouth.
Thorax: Similar movement on both side, retraction(-/-), vesicular breath sound, normal heart
sound.
Abdomen: Flat, shuffle, bowel sound increases. Liver is 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.
Extremeities: cold hand and feet
Laboratory Examination
Hb 12,8 g/dl, WBC 20.000/mm3, differential count 0/1/2/83/20/4.
Urine Routine
Macroscopic: yellowish colour,
Microscopic: WBC(-),RBC(-), protein (-), Keton bodies (+)
Faeces Routine
Macroscopic: water more than waste material, blood (+), mucous(+)
WBC: 20/HPF, RBC Full, bacteria (++), Encamoeba coli (+), fat (+)
 I. Klarifikasi Istilah
1. Diarrhea : Pengeluaran tinja berair yang berkali-kali yang tidak normal.(Dorland)
: Keluarnya (konsistensi) tinja yang lunak atau cair dengan frekuensi >= 3x perhari
dengan atau tanpa darah atau lendir dalam tinja. (WHO)
2. Lethargy : Penurunan tingkat kesadaran, ditandai dengan lesu, mengantuk,dan
apatis. Keadaan tidak acuh. (Dorland)
3. Sunken Frontanella : Soft spot on a baby skull with a noticeable inward
curve(Healthline)
4. Sunken Eye : Mata cekung ke dalam(gambar)
5. Non Projectile Vomiting : Muntahan yang tidak ditandai dengan semburan
muntahan yang sangat kuat.(Dorland)
6. Vomiting : Pengeluaran paksa isi lambung dari perut
II. Identifikasi Masalah
1. Budi, a boy, 13 month, was hospitalized due to diarrhea. Yesterday, he looked
worsening, lethargy, didn’t want to drink, still had diarrhea but no vomiting. The
amount of urination in 8 hours ago was less than ususal. Budi’s family lives in slum
area. ***
a) Bagaimana mekanisme diare pada kasus ?
b) Bagaimana mekanisme lethargi pada kasus?
c) Bagaimana hubungan jenis kelamin, usia, dan tempat tinggal dengan diare pada
kasus?
d) Apa indikasi keluahn yang membuat budi harus dirawat di rumah sakit?
e) Apa makna klinis dari jumlah urin yang berkurang pada 8 jam lalu?
f) Bagaimana tatalaksana awal yang tepat untuk Budi?
2. Four days before admission, the patient had non projectile vomiting 8 times a day. He
vomited what he ate. Three days before admission the patient got diarrhea 8 times a
day around half glass in every defecation, there was no blood and mucous/pus in it. The
frequency of vomiting decreased.
a) Bagaimana mekanisme muntah pada kasus?
b) Mengapa frekuensi muntah Budi berkurang pada hari ke-3?
c) Apa hubungan diare dengan muntah?
d) Apa akibat dari muntah dan diare 8x sehari?
e) Apa makna klinis tidak ada darah dan mucus/pus pada feses ?
f) Apa makna klinis muntah non proyektil?
3. Two days before admission the patient got bloody stool 12 times a day around quarter
glass in every defecation. The vomiting stopped. **
a) Apa makna klinis dari feses berdarah?
b) Mengapa muntahnya berhenti pada 2 hari sebelum masuk rumah sakit?
c) Bagaimana mekanisme feses berdarah?
4. Along those 4 days, he drank eagerly and was given ORS(Oral rehiration solution). He
also got mild fever. **
a) Mengapa selama 4 hari tersebut Budi banyak minum?
b) Bagaimana mekanisme demam pada kasus?
 c) Bagaimana cara kerja ORS ?
5. Physical Examination *
Patient looks severly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR
38x/m, HR 144x/m regular but weak, body temperature 38,9o BW 10 kg, BH 75 cm
Head: sunken frotanella, sunken eye, no tears drop, and dry mouth.
Thorax: Similar movement on both side, retraction(-/-), vesicular breath sound, normal
heart sound.
Abdomen: Flat, shuffle, bowel sound increases. Liver is 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.
Extremeities: cold hand and feet
a) Apa interpretasi dari hasil pemeriksaan fisik?
b) Bagaimana mekanisme abnormalitas pemeriksaan fisik?
6. Laboratory Examination*
Hb 12,8 g/dl, WBC 20.000/mm3, differential count 0/1/2/83/20/4.
Urine Routine
Macroscopic: yellowish colour,
Microscopic: WBC(-),RBC(-), protein (-), Keton bodies (+)
Faeces Routine
Macroscopic: water more than waste material, blood (+), mucous(+)
WBC: 20/HPF, RBC Full, bacteria (++), Entamoeba coli (+), fat (+)
a) Apa interpretasi dari hasil pemeriksaan laboratorium?
b) Bagaimana mekanisme abnormalitas pemeriksaan laboratorium?

III. Analisis Masalah

IV. Hipotesis
Budi, laki-laki 13 bulan mengalami diare et causa infeksi bakteri Entamoeba coli.
V. Learning Issues
1. Anatomi Fisiologi saluran pencernaan (Chandra,imaniar,nimardeep,citra)
2. Diare pada anak (wajib)
3. Pemfis( Ridho, selly,friendly,fernando)
4. Pemlab( doro, meiliza,riswan,narvin)