KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS SRIWIJAYA
FAKULTAS KEDOKTERAN
UNIT PENDIDIKAN KEDOKTERAN DAN KESEHATAN (UPKK)
Zona F. Gedung I Kampus Unsri Indralaya OI Sumatera Selatan, Indonesia Telp. 0711 – 580061
atau / or Jl. dr. Muh. Ali Komplek RSUP Palembang 30126, Indonesia, Telp. 0711 – 352342, Fax. 0711 – 373438

SKENARIO C BLOK 15 TAHUN 2019

Budi, a boy, 13 month, was hospitalized due to diarrhea. Four days before admission, the patient had non
projectile vomiting 8 times a day. He vomited what he ate. Three days before admision the patient got
diarrhea 8 times a day around half glass in every defecation, there was no blood and mucous/pus in it.
The frequency of vomiting decreased. But two days before admision the patient got bloody stool 12 times
a day around quarter glass in every defecation. The vomiting stopped. Along those 4 days, he drank
eagerly and was given ORS (oral rehidration solution). He also got mild fever. Yesterday, he looked
worsening, lethargy, didn’t want to drink, still had diarrhea but no vomiting. The amount of urination in 8
hours ago was less than usual. Budi’s family lives in slum area.
Physical Examination
Patient looks severely ill, compos mentis but weak (lethargic), BP 70/50mmHg, RR 38x/m, HR 144 x/m
regular but weak, body temperature 38,9oC, 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 heartsound.
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 20.000/mm3, differential count 0/1/2/83/20/4.
Urine routine
Macroscopic: yellowish colour,
Microscopic : WBC (-), RBC (-), protein (-), keton bodies (+).
Faeces routine
Macroscopic: water more than waste material, blood (+), mucous (+)
WBC: 20/HPF , RBC full, bacteria (++), Entamoeba coli (+), fat (+)