Skenario 6

A 35-year-old man came with a complaint of fever for 10 days. The patient also complained of nausea,
vomiting, calf pain and urinating like tea. On examination of vital signs, blood pressure was 100/60
mmHg, pulse was 100 beats per minute, and axillary temperature was 38 C. On physical examination,
jaundice and scleral injection were found. One week earlier the patient's house was flooded.

KEY WORDS

1. A 35 year old man

2. Fever for 10 days
3. The patient also complained of nausea, vomiting, calf pain and urinating like tea
4. Blood pressure was 100/60 mmHg
5. Pulse was 100 beats per minute
6. Axillary temperature was 38 C
7. On physical examination, jaundice + and scleral injection were found
8. One week earlier the patient's house was flooded

DIFFICULT WORDS

1. Jaundice : A yellow discoloration of the sclera, mucous membranes and skin due to
accumulation of bilirubin in the tissues or interstitial fluid
2. Scleral injection : A popular term for eyes that appear red due to dilation of the conjunctival
vessels overlying the sclera

QUESTIONS

1. Explain the definition, classification, etiology of fever ( nadhifa puput )

2. Explain what tropical desease that can cause fever and their etiology ( farah, fajar )
3. Explain the pathomecanism of the main complaint ( fever ) based on the scenario ( widya )
4. Explain the diagnostic step of the scenario ( tami )
5. What are the differential diagnosis related to the scenario ( lepto puputs, malaria afda, tetanus
syua )
6. What the treatment can be given to the patient ? ( tary )
7. What are the complications that can occur regarding the scenario? ( tara )
8. Perspective islam based on scenario ( afdha )

THE ANSWERS

1. Explain the definition, classification, etiology of fever

Fever is the body’s natural procces to fight infections that enter the body when the temperature
rises above the normal body temperature.
Classification : Septic fever, remittance fever, intermittent fever, continuous fever, cyclic
Etiology : fever is causen by infection. Causes by fever in addition to infection can also be caused
by a state of toxemia, malignancy or reaction to drug use, as well as central temperature
regulation centers.
2. Explain what tropical desease that can cause fever and their etiology
Typoid fever, Dengue fever, Malaria caused by mosquito that bite the human, difteri, varicella,
influenza, ebola, hepatitis, rubella

3. Explain the complaint pathomecanism related to the scenario ( fever, vomiting, urine like tea )
FEVER : it start from pyrogen eksogen
Vomiting : increased intracranial pressure, stimulates intracranial pressure receptors, stimulates
the vomiting center in the dorsolateral reticularis, contracts in the duodenum and stomach
antrum, increases intra-abdominal pressure, retrograde peristalsis, stomach feels full and
diaphragm rises, intrathoracic pressure increases, then the esophageal sphincter opens, and
vomiting occurs.
Urine like tea : the colour of urine. Sometimes called hemolitic jaundice. Conjugated bilirubin
dalam darah meningkat, konjugasi bilirubin tidak larut dalam air makanya tidak bisa larut dalam
kemih. Meningkat karena peningkatan beban bilirubin yang load of the liver

4. Explain the diagnostic step of the scenario

Anamnesis : Identitas, Keluhan utama, Keluhan penyerta, Riwayat penyakit sebelumnya
Pemfis : Tekanan Nadi, suhu, Tekanan darah

5. What are the differential diagnosis related to the scenario

YELLOW FEVER
A virus belonging to the genus Flavivirus. Transmitted to the humas through the mosquitos
vectors. There is no specific treatment. The acute fase : a high fever

LEPTOSPIROS
Demam, icterus, kerusakan ginjal
Etiology : penyakit infeksi yang disebabkan oleh leptospirosis
Epidemiologi : Penyakin zonosis dengan distribusi luas
Patogenesis : Masuk ke manusia terutama lewat air dan tanah
Diagnosis : Mikroskopis, kultur

MALARIA
A serious injures desease. Through mosquito bites. Plasmodium falciparum

TETANUS

6. What the treatment can be given to the patient ?

Pemberian antibiotic perlu diberikan sedini mungkin ( penicillin, ceftriaxone, kortikosteroid )
Supportive : ensure that patient adequately dehydrated, blood transfusion

7. What are the complications that can occur regarding the scenario?
Leptospirosis can cause serious complications : kidney or liver failure, meningitis, difficulty
breathing, and bleeding
8. Perspective islam based on scenario
“ Janganlah kamu mencaci maki penyakit demam, karena sesungguhnya Allah akan
menghapuskan dosa dosa anak Adam sebagaimana tungku api menghilangkan kotoran kotoran
besi “