Skenario C Blok 15 Tahun 2021

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 38,9 oC, 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 (+)
KlarifikasiIstilah
1. Diarrhea :Pengeluarantinjaberairberkali-kali yang tidak normal. (Kamus Dorland edisi
29)
2. Pus :Cairan kaya protein hasil proses peradangan yang
mengandungleukosit,debrisselular, dancairanencer. (Dorland)
3. Bowel Sound :Bunyigemericik, gemuruh, ataugeramandariperut yang
disebabkanolehkontraksiototperistaltik, proses yang
menggerakkanisiperutdanususkebawah. (Medicinenet)
4. Bloody Stool :Adanya hemoglobin yang terlihatatauterdeteksisecaraklinis di dalamtinja.
Darahmerahterang di tinjadikenalsebagai hematochezia. Hematochezia
mungkindisebabkanolehkelainananorektal, sepertiwasir, atauperdarahanakibatdivertikuli,
kanker, beberapabentukdisentri, atauangiodysplasiausus (di antarapenyebablainnya).
Kadang-kadangterjadiakibatpendarahanhebatdarisalurangastorintestinalbagianatas.
(Medical Dictionary by Farlex)
5. Lethargy :Penurunantingkatkesadaran, ditandaidenganlesu, mengantuk, danapati.
(Dorland)
6. Anal Orifice :Pembukaansaluranpencernaanbagianbawah. Hal initerkaitsfingter anal
danterletak di celahantarabokong, di mana materitinjadiekstrusi. (Farlex Medical
Dictionary)
7. ORS :Pengembalian air ataukandungancairankedalamtubuhpasienatausubstansi yang
telahmengsalamidehidrasidenganmenambahkancairan yang
mengandungkarbohidratdanelektrolit. (NCBI)
8. Sunken Frontanella :Ubun-ubun yang
cekungterutamapadabayidisebabkanolehdehidrasiataumalnutrisi. Indikatorklinis lain yang
mendukung diagnosis dehidrasiadalahselaputlendirkering, matacekung, produksi air mata
yang buruk, penurunanperfusiperifer. (NCBI)
9. Sunken Eye :Mata anak yang mengalamidehidrasiterlihatcekung. (WHO)
10. Shuffle :Suarabisingberdenyutakibatpropulsi gas ataucairanmelewatiusus. (dorland)
11. Slum Area :Kawasankumuh. (Jurnal UGM)
12. KetonBodies :Keton Bodies : Salah satudaritigasenyawaasamasetoasetat, aseton,
danasam beta-hidroksibutirat yang merupakanzatantara normal dalammetabolismelemak,
terakumulasidalamdarahdanurindalamjumlah abnormal dalamkondisimetabolisme yang
terganggu (Merriam-Webster Dictionary)
13. Non Projectile Vomitting :Tidakmengalamimuntah yang tiba-
tibadansangatkuatsehinggamuntahdiproyeksikandenganpaksakekejauhan (Merriam-
Webster Dictionary)
14. EntamoebaColi :Genus amoeba yang bersifatparasitikpadaintestinum vertebra yang
ditemukanpadasaluran intestinal. (Kamus Dorland edisi 29)
15. Mild
Fever :Demamtingkatrendahbiasanyamengacupadasuatukondisidengansuhutubuhterus-
menerusatausesekaliantara 37,5 dan 38,3 C. (IJCP)
IdentifikasiMasalah
No Kalimat Keterangan
.

1. Budi, a boy, 13 month, was KeluhanUtama

hospitalized due to diarrhea.
Alasan : merupakankeluhan yang
menyebabkanpasienberobatkedokterdanharusditanganisegera
.
2. Four days before admission, the KeluhanTambahan&RiwayatPerjalananPenyakit
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.

3. Physical Examination PemeriksaanFisik

Patient looks severely ill, compos
mentis but weak (lethargic), BP
70/50mmHg, RR 38x/m, HR 144 x/m
regular but weak, body temperature
38,9 oC, 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

4. Laboratory Examination Pemeriksaan Lab

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 (+)
AnalisisMasalah
1. Budi, a boy, 13 month, was hospitalized due to diarrhea.
a. Apajenisdiarepadakasusini?
b. Apakahhubunganjeniskelamindanumurdengankeluhan yang
dialamipasienpadakasus?
c. Bagaimanapatofisiologidanpatogenesisdiare?
d. Bagaimanamekanismediarepadakasus?
e. Apasajaklasifikasidaridiare?
f. Apa diagnosis banding diare?
g. Bagaimanatatalaksanaawaldanedukasidiarepadakasusini?
h. Bagaiamanaepidemiologidiare di indonesia?
i. Apasajakomplikasidiare?
j. Apasajafaktorrisikodiare?
k. Bagaimanaetiologidiarepadakasusini?
l. Apasajamanifestasiklinisdiarepadakasusini?
m. Bagaimanaindikasirawatpadapasiendiare?
n. Bagaimana prognosis diarepadakasusini?
2. 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.
a. Bagaimanapengaruhlingkungantempattinggal Budi terhadapkasus?
b. Bagaimanapatofisiologikeluhantambahanpadakasus?
c. Bagaimanahubunganantargejala-gejala yang terjadipadakasus?
d. Bagaimanapatofisiologi non projectile vomiting padakasus?
e. Mengapamenjelang 4 haritersebutmuntahberhentinamundiaretetapberlanjut?
f. BagaimanaindikasipenggunaanORS?
 g. Bagaimanapatofisiologi bloody stool, mild fever, letargi, danurin yang
lebihsedikitdaribiasanya?
h. Bagaimanakriteria BAB normal?
i. Apakahpenggunaan ORS padakasussudahtepatdanbagaimanapengaruhpemberian
ORS terhadapkasus?
j. Apa yang menyebabkandiatidakmauminumpadaseharisebelummasuk RS?
k. Apahubungantempattinggaldenganpenyakit yang dialamipadakasus?
3. 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 38,9 oC, 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
a. Bagaimananilai normal daninterpetasihasilpemeriksaanfisikpadakasusini?
b. Bagaimanamekanisme abnormal darihasilpemeriksaanfisik?
c. Bagaimanaklasifikasidehidrasidanpadatingkatanapa yang terjadipada Budi?
4. LaboratoryExamination
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 (+)
a. Bagaimananilai normal daninterpetasihasilpemeriksaanlaboratoriumpadakasusini?
b. Bagaimanamekanisme abnormal darihasilpemeriksaanlaboratorium?

Learning Issues
A. Diare
a. Definisi
b. Etiologi
c. Epidemiologi
d. PatofisiologidanPatogenesis
e. ManifestasiKlinis
f. FaktorRisiko
g. Komplikasi
 h. Diagnosis
i. Diagnosis Banding
j. Tatalaksana&Edukasi
k. Prognosis
l. SKDI
B. Dehidrasi
a. Definisi
b. Klasifikasi
c. Tatalaksana
d. Patofisiologi
C. PemeriksaanFisik
D. PemeriksaanLaboratorium