I.

Skenario
A 30-yo white male present to the emergency department (ED) complaining of the sudden onset of abdominal bloating and back pain. The patient states that he was sleeping comfortably but the sudden onset of severe, constant pain that radiates from his right back to his abdomen and down toward his scrotum caused him to awaken. He is unable to find a comfortable position and feels best when ambulating. He admits to having had occasional hematuria but denies ever having this type of pain before. He has no other significant medical problems. On physical exam the patient is diaphoretic and in moderate distress. His BP is 128/76 mmHg, HR is 90 bpm, temp is 37,4oC and his RR is 28 bpm. His CV exam reveals tachycardia without murmur. Lung exam is clear to auscultation. Abdominal exam demonstrates good bowel sounds, no abdominal distention, and costovertebral angle tenderness. A midstream voided urine specimen demonstrates gross hematuria. BNO demonstrates a well circumscribed calcification 0,6 cm in the right upper quadrant at the level of L3.

II.

Klarifikasi masalah
1. Abdominal bloating : penggembungan pada bagian antara thorax dan pelvis 2. Back pain : nyeri bagian posterior tubuh dari leher-pelvis 3. Sevre and constant pain : nyeri yang parah dan menetap 4. Scrotum : kantung yang berisi testis dan organ penyertanya 5. Ambulating : berjalan 6. Diaphoretic : berkeringat berlebihan 7. Moderate distress : sakit sedang 8. Midstream voided : 9. Bowel sounds : suara yang berasal dari usus (bising usus) 10. Tenderness : nyeri/ketidaknyamanan ketika daerah yang bermasalah disentuh 11. Abdominal distention : peregangan pada bagian antara thorax dan pelvis

III.

Identifikasi masalah
1. A 30-yo white male present to the emergency department (ED) complaining of the sudden onset of abdominal bloating and back pain. 2. The patient states that he was sleeping comfortably but the sudden onset of severe, constant pain that radiates from his right back to his abdomen and down toward his scrotum caused him to awaken. 3. He is unable to find a comfortable position and feels best when ambulating. 4. He admits to having had occasional hematuria but denies ever having this type of pain before. He has no other significant medical problems. 5. The patient is diaphoretic and in moderate distress. His BP is 128/76 mmHg, HR is 90 bpm, temp is 37,4oC and his RR is 28 bpm.

6. His CV exam reveals tachycardia without murmur. Lung exam is clear to auscultation. 7. Abdominal exam demonstrates good bowel sounds, no abdominal distention, and costovertebral angle tenderness. 8. A midstream voided urine specimen demonstrates gross hematuria. 9. Pemeriksaan BNO.