SKENARIO C BLOK 17

Amir, a boy, 12 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, 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 severy ill, compos mentis but weak (lethargic), BP 70/50mmHg, RR 38x/m, HR
144x/m regular but weak, body temperature 38,7C, BW 8,8kg, BH 75cm
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 1cm below arcus costa and
xiphoid processus, spleen unpalpable. Pinch the skin of 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, differential count: 0/1/16/48/35/0
Urine routine
Macroscopic : yellowish colour
Microscopic : WBC(-), RBC (-), protein (-)
Faeces routine
Macroscopic : water more than waste material, blood(-), mucous(-)
WBC: 2-4/HPF, RBC 0-1/HPF

KLARIFIKASI ISTILAH
NO
1.

Klarifikasi Istilah
Diarrhea

Pengertian
Pengeluaran tinja berair sehari lebih dari
3 kali

2.
3.
3.
4.

Non projectile vomiting

Defecation
Drank eagerly
Lethargic

5.
6.
7.
8.

Abdomen shuffle
Redness skin surrounding anal orifice
Cold hand and feet
HPF

Penurunan tingkat kesadaran ditandai

dengan lesu, mengantuk, dan apatis

IDENTIFIKASI MASALAH
1.

kalimat 1, 4, dan 10 6v
Amir, a boy, 12 month, was hospitalized due to diarrhea. 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. Amirs family lives in slum area.
a. Apa hubungan usia, jenis kelamin dan lingkungan terhadap diare? Fadil, miranda
b. Apa definisi Diare? Endy, sherly
c. Bagaimana penyebab dan mekanisme diare? Butet, nabil
d. Apa saja klasifikasi diare? Helvie, aulia
e. Apa makna tidak ada darah dan mukus/pus? Akbar, windi
f. Apa Indikasi MRS pada penderita\diare? Eva, iqbal

2.

kalimat 2 dan 3 5v
Four days before admission, the patient had non projectile vomiting 6 times a day. He
vomited what he ate.
a. Apa definisi muntah? Iqbal, nabil
b. Apa saja klasifikasi muntah? Sherly, akbar
c. Bagaimana mekanisme muntah (nyemprot dan tidak nyemprot)? Eva, miranda

3.

kalimat 5 4v

The frequency of vomiting decreased.

a. Mengapa muntahnya berkurang setelah 3 hari? Butet, helvie
4.

Kalimat 6 dan 7 3v
Along those 4 days, he drank eagerly and was given plain water. He also got mild fever.
a. Mengapa minum air putih tetapi tetep haus? Aulia, eva
b. Apa definisi demam? Miranda, iqbal
c. Apa saja klasifikasi demam? Windi, helvie
d. Bagaimana mekanisme demam pada kasus? Endy, fadil

5.

Kalimat 8,9
Yesterday, he looked worsening, still had diarrhea but no vomiting. The amount of urination
in 8 hours ago was less than usual.
a. Mengapa masih diare tapi tidak muntah? Butet, Iqbal
b. Bagaimana penyebab dan mekanisme penurunan jumlah urin? Fadil, aulia
c. Apa indikasi penurunan jumlah urin? Sherly, helvie

6.

Pemeriksaan fisik
a. Bagaimana intepretasi dan mekanisme anbnormal pemeriksaan fisik? Nabil, Windi
b. Apa temuan pemeriksaan fisik yang dapat membantu menegakkan diagnosis? Endy,
miranda

7.

Pemeriksaan Lab
a. Bagaimana interpretasi dan mekanisme abnormal pemeriksaan fisik? Akbar, Nabila

8.

Hipotesis
Amir laki laki 12 bulan menderita diare akut disertai dengan dehidrasi
a. Bagaiman cara menegakkan diagnosis pada kasus? Butet, endy
b. Apa diagnosis banding pada kasus? Fadil, Eva
c. Apa diagnosis kerja pada kasus? Eva, Helvie
d. Apa definisi diagnosis kerja pada kasus? Aulia, akbar
e. Etiologi? Endy, windi

f. Epidemiologi? Iqbal, nabil

g. Faktor resiko? Sherly, aulia
h. Patofisiologi? Helvie, akbar
i. Patognesis? Eva, miranda
j. Manifestasi klinis? Miranda, sherly
k. Komplikasi? Butet, nabil
l. Pemeriksaan penunjang? Windi, endy
m. Prognosis? Iqbal, fadil
n. Tatalaksana? Fadil, helvie
o. Tindakan preventif? Helvie, endy
p. SKDI Aulia, miranda
Learning issue
1. Diare Aulia, Sherly, Endy
2. Dehidrasi Windi, Helvie, Fadil
3. Anatomi GI tract anak usia 12 bulan Akbar, Butet, Nabil
4. fisiologi GI tract anak usia 12 bulan Eva, Miranda, Iqbal