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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. Amirs 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
o
C, 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 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. Amirs family lives in
slum area. (chief 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 (Main 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
o
C,
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. Amirs 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 Examination (Main 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
o
C, 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
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