skenario c blok 17 b7

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SKENARIO C BLOK 17 TAHUN 2015 Amir, a boy, 12 month, was hospitalized due to diarrhea. Four days before admission, the patient had no projectile vomiting 6 times a day. He vomited hat he ate. Three days before admission the patient got diarrhea 10 times a day around half glass n every defecation, there was no blood and mucous/pus in it. The frecuency of vomiting decreased. Along those 4 days, he drank eagerly and was given plain water. He also got a mild fever. Yesterday, he looked worsening, still had diarrhea but no vomiting. The amount of urination in 8 hours ago was less then usual. Amir’s family lives in slum area. Physical eximination Patient looks severyly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm Head: 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 costae and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 second). Redness skin surrounding anal orifice. Extremities: Cool hand and feet Laboratory Examination HB 12,8 g/dl, WBC 9.000/mm3, differential count: 0/1/16/48/35/0. Urine routine Macroscopic: yellowish colour, Microscopic: WBC (-), RBC (-), protein (-)

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Page 1: Skenario c Blok 17 B7

SKENARIO C BLOK 17 TAHUN 2015

Amir, a boy, 12 month, was hospitalized due to diarrhea. Four days before admission, the patient had no projectile vomiting 6 times a day. He vomited hat he ate. Three days before admission the patient got diarrhea 10 times a day around half glass n every defecation, there was no blood and mucous/pus in it. The frecuency of vomiting decreased. Along those 4 days, he drank eagerly and was given plain water. He also got a mild fever. Yesterday, he looked worsening, still had diarrhea but no vomiting. The amount of urination in 8 hours ago was less then usual. Amir’s family lives in slum area.

Physical eximination

Patient looks severyly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm

Head: 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 costae and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 second). Redness skin surrounding anal orifice.

Extremities: Cool hand and feet

Laboratory Examination

HB 12,8 g/dl, WBC 9.000/mm3, differential count: 0/1/16/48/35/0.

Urine routine

Macroscopic: yellowish colour,

Microscopic: WBC (-), RBC (-), protein (-)

Faeces routine

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

WBC: 2-4/HPF, RBC 0-1/HPF

KLARIFIKASI ISTILAH

1. Diare : Pengeluaran tinja berair berkali-kali yang tidak normal.

Page 2: Skenario c Blok 17 B7

2. Muntah : Pengeluaran isi lambung dari mulut.3. Muntah tidak proyektil : Muntah yang tidak disertai dengan semburan yang sangat kuat.4. Mucus : Lendir bebas pada membrane mukosa terdiri dari sekresi kelenjar berbagai

garam sel yang berdeskuamasi dan leukosit. 5. Mata cekung : Tampak kehitaman yang terlihat pada infraorbital bawah kelopak mata

yang dapat disebabkan karena kehilangan elektrolit dan cairan secara berlebih. 6. Letargi : Penurunan tingkat kesadaran ditandai dengan lesu, mengantuk dan apatis.7. Bising usus : Suara yang dihasilkan dari gerakan peristaltic usus.8. Shuffle : Bunyi auskultasi yang halus seperti bunyi tiupan. 9. Orificium anal : Pintu masuk atau pintu keluar pada rectum.10. HPF : Berbagai jenis sel yang biasanya digambarkan sebagai jumlah tiap jenis ditemukan

per bidang daya rata-rata tinggi.

Identifikasi Masalah

1. Amir, a boy, 12 month, was hospitalized due to diarrhea.

2. 2.Four days before admission, the patient had no projectile vomiting 6 times a day. He vomited hat he ate.

3. Three days before admission the patient got diarrhea 10 times a day around half glass n every defecation, there was no blood and mucous/pus in it. The frecuency of vomiting decreased. Along those 4 days, he drank eagerly and was given plain water. He also got a mild fever. Yesterday, he looked worsening, still had diarrhea but no vomiting.

4. The amount of urination in 8 hours ago was less then usual. Amir’s family lives in slum area.

5. Physical eximination

Patient looks severyly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm

Head: 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 costae and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 second). Redness skin surrounding anal orifice.

Extremities: Cool hand and feet

6. Laboratory Examination

Page 3: Skenario c Blok 17 B7

HB 12,8 g/dl, WBC 9.000/mm3, differential count: 0/1/16/48/35/0.

Urine routine

Macroscopic: yellowish colour,

Microscopic: WBC (-), RBC (-), protein (-)

Faeces routine

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

WBC: 2-4/HPF, RBC 0-1/HPF

Analisis

1. Amir, a boy, 12 month, was hospitalized due to diarrhea.

a. Bagaimana Hubungan jenis kelamin, umur, dengan keluhan?(epidemiologi, data pravelensi), Bayu dini

b. Apa penyebab dan mekanisme diare pada kasus ini?, nia, sasini

c. Imunisasi apa saja yang seharusnya sudah didapat untuk anak umur 1 tahun? (pemerintah dan IDAI)jeje, bayu

d. Bagaimana klasifikasi diare pada anak?(lamanya, etiologi dan dehidrasi) dini nia

e. Imunsisasi untuk pencegahan diare? Sasini jeje

2. Four days before admission, the patient had no projectile vomiting 6 times a day. He vomited hat he ate.

a. Bagaimana penyebab dan mekanisme muntah tanpa proyektil?panji salih

b. Apa perbedaan muntah dengan proyektil dan tanpa proyektil? Panji, salih

c. Apa dampak muntah 6 kali sehari?(frekuensi, volume) ressi chaita

d. Apa makna klinis Amir memuntahkan apa yang dia makan?sasini, nia

e. Bagaimana klasifikasi muntah?bayu, dini

f. Bagaimana hubungan muntah dan diare pada kasus ini? Ressi charita

Page 4: Skenario c Blok 17 B7

3. Three days before admission the patient got diarrhea 10 times a day around half glass n every defecation, there was no blood and mucous/pus in it. The frecuency of vomiting decreased. Along those 4 days, he drank eagerly and was given plain water. He also got a mild fever. Yesterday, he looked worsening, still had diarrhea but no vomiting.

a. Apa makna klinis diare 10 kali sehari sebanyak setengah gelas serta tidak ada darah dan mucus di fesesnya? Matius ray,

b. Mengapa muntah berkurang dan kemudian berhenti pada kasus ini? Nay, ray

c. Apa makna klinis dari Amir banyak minum air putih? Matius fahmi

d. Apa penyebab dan mekanisme demam ringan pada kasus ini? Jeje, dini

e. Apa pengaruh pemberian air minum pada kasus ini? Fahmi, nay

f. Bagaimana klasifikasi defekasi?(kualitas dan kuantitas) fahmi nay

g. Bagaimana hubungan antar gejala? Matius, ray

4. The amount of urination in 8 hours ago was less then usual. Amir’s family lives in slum area.

a. Bagaimana volume, konsentrasi, warna, frekuensi, bau urin normal per hari pada anak 1 tahun? Bayu, sasini

b. Mengapa urinasi berkurang dalam 8 jam yang lalu? Jeje nia

c. Apa pengaruh faktor lingkungan terhadap keluhan pada kasus ini? Ray matius

5. Physical eximination

Patient looks severyly ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR 38x/m, HR 144x/m regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm

Head: Sunken eye, no tears drop, and dry mouth

Thorax: similar movement on both side, retraction (-/-), vesicular breath sound, normal heart sound

Page 5: Skenario c Blok 17 B7

Abdomen: flat, shuffle, bowel sound increases. Liver is palpable 1 cm below arcus costae and xiphoid processus, spleen unpalpable. Pinch the skin of the abdomen: very slowly (longer than 2 second). Redness skin surrounding anal orifice.

Extremities: Cool hand and feet

a) Bagaimana interpretasi dari pemeriksaan fisik? Panji salih

b) Bagaimana mekanisme abnormal dari pemeriksaan fisik? Panji salih

c) Bagaimana klasifikasi dehidrasi? Fahmi, nay

6. Laboratory Examination

HB 12,8 g/dl, WBC 9.000/mm3, differential count: 0/1/16/48/35/0.

Urine routine

Macroscopic: yellowish colour,

Microscopic: WBC (-), RBC (-), protein (-)

Faeces routine

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

WBC: 2-4/HPF, RBC 0-1/HPF

a. Bagaimana interpretasi dari pemeriksaan laboratorium? Carita, ressy

b. Bagaimana mekanisme abnormal dari pemeriksaan laboratorium? Charita ressy

7. Analisis masalah aspek klinis

a. Bagaimana cara penegakan diagnosis pada kasus ini? Ray, nia

b. Bagaimana DD pada kasus ini? Dini, jeje

c. Apa saja pemeriksaan penunjang pada kasus ini? Panji, salih

d. Apa working diagnosis pada kasus ini? Charita, sasini

e. Apa etiologi pada kasus ini? Bayu, nay

f. Apa epidemiologi pada kasus ini? Sasini, ressy

Page 6: Skenario c Blok 17 B7

g. Apa faktor resiko pada kasus ini? Fahmi, matius

h. Bagaimana patofisiologi pada kasus ini? Panji, charita

i. Bagaimana patogenesis pada kasus ini? Ressy, salih

j. Apa Komplikasi pada kasus ini? Bayu, matius

k. Bagaimana tatalaksana pada kasus ini? Dini, charita

l. Apa pencegahan dan edukasi pada kasus ini? Ray jeje

m. Apa prognosis pada kasus ini? Bayu, sasini

n. Skdi pada kasus ini? Fahmi, nay

Hipotesis

Amir, 12 bulan mengalami diare akut disertai dehidrasi berat

Learning Issue1. Diare pada anak Bayu, Andini, nia, sasini, jeje2. Dehidrasi pada anak Fahmi, Nadya, ray, matius3. Anatomi dan fisiologi sistem pencernaan pada anak, Panji, Ressy, charita, salih,

KETENTUAN BERLAKU 1. TIME NEW ROMANS 12, SPACING 1,5, JUSTIFY2. LIST PARAGRAPH 3. DAFTAR PUSTAKA HARVARD4. APABILA ADA GAMBAR & TABEL BUAT DAPUS LANGSUNG DIBAWAH

GAMBAR & TABEL5. SAVE 97-2003

TERIMA KASIH