SKENARIO C BLOK 17 TAHUN 2017

Amir, a boy, 13 month, was hospitalized due to diarrhea. Four days before admission, the patient
had non projectile vomiting 6 times a day. He vomited what he ate. Three 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 vomiting decreased. Along those 4 days, he drank
eagerly and was given plain water. He also got mild fever. Yesterday, he looked worsening,
lethargy, didnt want to drink, 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 severly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38 x/m, HR
144 x/m regular but weak, body temperature 38,7 oC, BW 10 kg, BH 75 cm
Head : sunken frontanella, 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.
Extremities : cold hand and feet
Laboratory examination
Hb 12,8 g/dl, WBC 14000/mm3, diff count : 0/1/16/48/5/0.
Urine routine
Macroscopic : yellowish colour,
Microscopic : WBC (-), RBC (-), protein (-), keton bodies (+)
Feaces routine
Macroscopic : water more than waste material, blood (-), mucous (-)
WBC : 4-6 /HPF, RBC 0-1 /HPF, bacteria (++), E. coli (+), fat (+)
I. Klarifikasi Istilah
a) Diarrhea : pengeluaran tinja berair berkali kali yang tidak normal.
b) Non projectile vomiting : muntah yang ditandai dengan tidak adanya semburan.
c) Vomit : pengeluaran isi lambung melalui mulut.
d) Defecation : pembuangan tinja dari rectum.
e) Mild fever : peningkatan temperature di atas normal.
f) Lethargic : penurunan tingkat kesadaran ditandai dengan lesu,
mengantuk, dan apatis.
 g) Sunken frontanella : ubun-ubun yang cekung.
h) Sunken eye : mata yang terlihat cekung yang menandakan seseorang
mengalami dehidrasi.
i) Shuffle abdomen : defans muscular (-)
j) Anal orifice : lubang anus.
II. Identifikasi Masalah
a) Amir, a boy, 13 month, was hospitalized due to diarrhea. The amount of urination in
8 hours ago was less than usual. (V)
b) Four days before admission, the patient had non projectile vomiting 6 times a day. He
vomited what he ate.
c) Three 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
vomiting decreased.
d) Along those 4 days, he drank eagerly and was given plain water. He also got mild
fever.
e) Yesterday, he looked worsening, lethargy, didnt want to drink, still had diarrhea but
no vomiting.
f) Amirs family lives in slum area.
g) Physical examination

Patient looks severly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR
38 x/m, HR 144 x/m regular but weak, body temperature 38,7 oC, BW 10 kg, BH 75
cm

Head : sunken frontanella, 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.

Extremities : cold hand and feet

h) Laboratory examination

Hb 12,8 g/dl, WBC 14000/mm3, diff count : 0/1/16/48/5/0.

 Urine routine

Macroscopic : yellowish colour,

Microscopic : WBC (-), RBC (-), protein (-), keton bodies (+)

Feaces routine

Macroscopic : water more than waste material, blood (-), mucous (-)

WBC : 4-6 /HPF, RBC 0-1 /HPF, bacteria (++), E. coli (+), fat (+)

I. Analisis Masalah
a) Amir, a boy, 13 month, was hospitalized due to diarrhea. The amount of urination in
8 hours ago was less than usual. (V)
1. Apa hubungan usia, jenis kelamin dengan kasus ? 1
2. Bagaimana frekuensi dan konsistensi BAB normal bayi 13 bulan ? 1
3. Apa indikasi rawat inap pada kasus diare anak ? 1
4. Bagaimana klasifikasi dari diare ? 1
5. Bagaimana patofisiologi dari diare ? 1
6. Bagaimana tata laksana awal diare pada anak ? 1
7. Mengapa urine 8 jam yang lalu sedikit daripada biasanya ? 2
8. Apa penyebab diare tersering pada anak 13 bulan ? 1
9. Apa saja organ yang terlibat pada kasus ? 1
10. Berapa volume dan frekuensi normal urine bayi 13 bulan ? 2
b) Four days before admission, the patient had non projectile vomiting 6 times a day. He
vomited what he ate.
1. Bagaimana mekanisme muntah pada kasus ? 7
2. Bagaimana klasifikasi muntah ? 7
3. Apa saja yang menyebabkan muntah non projectile ? 7
4. Bagaimana hubungan muntah dan diare pada kasus ? 7
5. Apa dampak dari muntah 6 kali sehari ? 7
6. Apa saja makanan sisipan yang layak untuk bayi 13 bulan ? 7
7. Apa makna bahwa ia memuntahkan apapun yang ia makan ? 7
8. Bagaimana perbedaan muntah projectile dan non projectile ? 7
9. Apa saja yang makanan yang dapat memicu muntah pada bayi 13 bulan ? 7
c) Three 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
vomiting decreased.
1. Apa makna dari diare 10 kali sehari sebanyak setengah gelas ? 1
2. Mengapa frekuensi muntah menurun ? 1
3. Apa makna tidak ditemukannya darah dan mucus ? 1
 4. Apakah ada hubungan frekuensi diare dengan tingkat keparahan dehidrasi ? 1
2
d) Along those 4 days, he drank eagerly and was given plain water. He also got mild
fever.
1. Bagaimana mekanisme demam pada kasus ? 7
2. Bagaimana hubungan minum yang lahap dengan tingkat keparahan
dehidrasi ? 2 7
3. Cairan apa yang sebaiknya diberikan kepada pasien pada kasus ? 1 2
4. Bagaimana hubungan demam dengan muntah dan diare paa kasus ? 1 2 7
e) Yesterday, he looked worsening, lethargy, didnt want to drink, still had diarrhea but
no vomiting.
1. Bagaimana mekanisme terjadinya lethargi ? 4
2. Bagaimana keadaan amir sekarang dengan klasifikasi dehidrasi ? 2
3. Apa makna klinis dari lethargi, tidak mau minum pada kasus ? 2
f) Amirs family lives in slum area.
1. Bagaimana hubungan lingkungan dengan diare pada kasus ? 1
g) Physical examination

Patient looks severly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR
38 x/m, HR 144 x/m regular but weak, body temperature 38,7 oC, BW 10 kg, BH 75
cm

Head : sunken frontanella, 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.

Extremities : cold hand and feet

1. Bagaimana interpretasi dari pemeriksaan fisik pada kasus ? 4

2. Bagaimana mekanisme abnormal ? 4
3. Bagaimana cara menentukan derajat dehidrasi ? 2 4
4. Bagaimana grafik pertumbuhan anak usia 13 bulan ? 4
5. Apa yang dimaksud dengan compos mentis but weak (lethargic) ? 4
6. Bagaimana gambaran dari sunken fontanella, sunken eye, dry mouth pada
kasus ? 4
 7. Dimana dan bagaimana cara pemeriksaan turgor kulit ? 4
8. Bagaimana cara pemriksaan fisik abdomen pada anak ? 4
h) Laboratory examination

Hb 12,8 g/dl, WBC 14000/mm3, diff count : 0/1/16/48/5/0.

Urine routine

Macroscopic : yellowish colour,

Microscopic : WBC (-), RBC (-), protein (-), keton bodies (+)

Feces routine

Macroscopic : water more than waste material, blood (-), mucous (-)

WBC : 4-6 /HPF, RBC 0-1 /HPF, bacteria (++), E. coli (+), fat (+)

1. Bagaimana interpretasi dari pemeriksaan laboratorium pada kasus ? 5

2. Bagaimana mekanisme abnormal ? 5
3. Bagaimana cara pemeriksaan lab urine routine ? 5
4. Bagaimana cara pemeriksaan lab feces routine ? 5
5. Bagaimana scoring dalam pemeriksaan bakteri pada feces ? 5
II. Hipotesis
Amir, 13 bulan, menderita diare akut dengan dehidrasi berat kemungkinan karena rota
virus.
a) Definisi
b) DD
c) Diagnosis Kerja
d) Algoritma Penegakan Diagnosis
e) Klasifikasi
f) Etiologi
g) Epidemiologi
h) Faktor risiko
i) Patofisiologi
j) Patogenesis
k) Pem penunjang
l) Manifestasi klinis
m) Komplikasi
n) Tata laksana
o) Prognosis
p) Pencegahan dan edukasi
q) SKDI
III. LI
 1. Diare 13 6 7 5 1
2. Dehidrasi 12 5 8 3
3. Anatomi, histopatologi usus 11 4 10
4. Pemfis 10 3 9 2
5. Pemlab 9 2 11
6. Fisiologi usus 8 1 12
7. Mekanisme gejala 7 13 6 4

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