PROGRAM STUDI PENDIDIKAN SPESIALIS

ILMU PENYAKIT DALAM

FAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYA

VISI
Menghasilkan Dokter Spesialis Penyakit Dalam yang kompeten, aktif, inovatif, dan
mampu meningkatkan kualitas kesehatan masyarakat dengan mengedepankan tata laksana
penyakit kronis secara komprehensif, serta memiliki daya saing global Tahun 2030.

MISI
1. Menyelenggarakan pendidikan, penelitian, dan pengabdian masyarakat di bidang
llmu Penyakit Dalam sesuai perkembangan ilmu pengetahuan dan teknologi
kedokteran yang berstandar kompetensi internasional untuk menghasilkan lulusan
yang beriman dan bertakwa kepada Tuhan YME serta berbudi luhur.
2. Menyelenggarakan tata kelola Program Studi Pendidikan Dokter Spesialis Penyakit
Dalam yang unggul serta perbaikan manajemen yang adil dan berkelanjutan.
3. Menciptakan peran program studi sebagai agen pembaruan, pelopor dan penyebar
ilmu pengetahuan, teknologi, berdasar pada nilai kearifan lokal dan luhur guna
memenuhi kebutuhan kesehatan masyarakat luas
MEDICAL CONSULTATION
from Urology Department

Patient with

1. Burst abdomen post biopsy + post repair ileum

2. Septic condition dt no 1
3. Anemia NN dt chronic inflammation concommitant with
acute blood loss
4. Severe hypoalbuminemia dt wound loss dd renal loss
5. DM type 2 normoweight on OAD

The aim of consultation :

Management of Diabetes Melitus type 2
 Summary of Database
Mrs. IS / 51 yo / Cisadane Ward
HISTORY OF PRESENT ILLNESS :
- The patient was treated by Urology Department with burst abdomen post renal biopsy and
planned exploration laparotomy and resection of stoma if the condition was stable (waiting
for improvement of haemoglobin and albumin serum)
- Initially she is complain about a lump in the right waist since February 2022, the longer it
gets bigger, accompanied by continuous pain.
- - History of weight loss 7 kg in 2 months. History of hypertention (-), Diabetes melitus (+)
since 5 years ago, regularly taking Metformin 3x500 mg
 Summary of Database
Family History:
There is no remarkable history nor malignancy from Family
Social History:
She is married, had daily activities as housewife, but decreased in daily living activity since
she was sick
Past Medical History:
There was no remarkable past medical history
Review of System:
Urination and defecation were within normal limit
 Physical Examination
General appearance look moderately ill Sat O2 96% on Room Air
GCS 456 BB 48 kg TB 155 cm BMI 20 kg/m² (normoweight)
BP 135/78 mmHg PR 72 bpm regular strong RR 20 tpm Tax 36,7 oC
Head Conjuctiva Anemic (+)
Neck JVP R+ 3cmH20
Chest Symmetrical, retraction (-)
Lung Sonor | Sonor Vesicular | Vesicular Rhonkhi : - | - Wheezing : -|-
Sonor | Sonor Vesicular | Vesicular -
|- -|-
Sonor | Sonor Vesicular | Vesicular -
|- - |-
Cardio Ictus invisible, palpable at MCL (S) ICS V MCL S
LHM ~ ictus, RHM ~ SL (D) S1 S2 single, regular, murmur (-) gallop (-)

Abdomen distended, post op wound uk 15x3cm and 4x3cm covered by gauze and underpath,
exposed colon, feces (+), pus (-), blood (-). Bowel sounds (+) increased, tenderness
(+)

Extremities Edema (-), pale (-), MMT 5 | 5 ; Lateralisation (-)

5|5
 Laboratory Findings 12/05/2022
LAB VALUE NORMAL LAB VALUE NORMAL

Leucocyte 51.140 4.700 – 11.300 /µL Ureum 98,4 20-40 mg/dL

Hemoglobine 8,3 11,4 - 15,1 g/dl Creatinine 1,26 <1,2 mg/dL

PCV 26,3% 38 - 42% SGOT 30 30-35 U/L

Thrombocyte 711.000 142.000 – 424.000 /µL SGPT 33 30-35 U/L

MCV 81,9 80-93 fl Albumin 1,78 3,5-5 g/dL

MCH 25,9 27-31 pg Swab Antigen SARS Cov2 Negative

Eo/Bas/Neu/ 0,2/0,2/92,4/3,4/3, 0-4/0-1/51-67/ Natrium 134 135-145 mmol/L

Limf/Mon 8% 25-33/2-5
Kalium 3,39 3,5-5,0 mmol/L
Procalcitonin 11,65 Chloride 108 96-108 mmol/L
CRP 24,32 RBS 159
Chest X-Ray (12/5/2022)
 Chest X-Ray (09/05/2022)
• AP position, symmetric, enough KV, less inspiration
• Soft tissue was thin and bone was normal
• Trachea in the middle
• Hemidiaphragm D and S was dome-shaped
• Phrenico-costalis angle D and S was sharp
• Pulmo: bronchovesicular pattern was normal
• Cor: site and size N, CTR 63 %, elongation aorta (-), cardiac waist
(-), aorta calcification (+)

Conclusion: Cardiomegaly with aorta sclerosis

Electrocardiography (13/05/2022)
 Electrocardiography (13/5/2022)
 Sinus rhythm HR 94 bpm
 Frontal Axis : Normal
 Horizontal Axis : Normal
 P Wave : Normal
 PR interval : 0.13”
 QRS complex : 0.09”
 Q wave : Normal
 QT interval : 0.36”
 ST Segmen : Normal, isoelectric
 T Wave : Normal

Conclusion : Sinus rhythm, HR 94 bpm

 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mrs. IS / 51 yo / Cisadane 1. Burst - - Treatment from Urology PMo.

Ward abdomen department S, Vs, SpO2
post biopsy management:
Subjective + post repair PEd
- The patient was treated ileum Surgical: Education
by Urology Department - planned exploration about
with burst abdomen laparotomy and resection diagnosis,
post renal biopsy of stoma treatment
and
Objective prognosis
Stable haemodinamik
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mrs. IS / 51 yo / Cisadane 2. Septic - Wound Treatment from Urology PMo.

Ward condition dt culture and department S, Vs, SpO2
no 1 DST management:
Subjective Non pharmachology PEd
- The patient was treated -Bed rest Education
by Urology Department -Soft diet hchp about
with burst abdomen 1700kcal/day diagnosis,
post renal biopsy -Wound care once a day treatment
and
Objective Pharmacology prognosis
Leucosit 51.140 -IVFD NaCl 0.9%
CRP 24,32 1500cc/24jhour
Procalcitonin 11,65 -IV Cefoperazone 2x1g
-IV Metamizol 3x1 gr
-
Surgical:
- planned exploration
laparotomy and resection
of stoma
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mrs. IS / 51 yo / Cisadane 3. Anemia 3.1 chronic Retyculocyte, Treatment from Urology PMo.
Ward NN inflammation blood smear department S, Vs, SpO2
3.2 acute blood management:
Subjective loss PEd
- The patient was treated Non Pharmacology: Education
by Urology Department - Transfusion of PRC 1 about
with burst abdomen pack/day until Hb>10 diagnosis,
post renal biopsy gr/dL treatment
and
Objective prognosis
Hb 8,3
MCV 81,9
MCH 25,9
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mrs. IS / 51 yo / Cisadane 4. Severe 4.1 wound loss - Treatment from Urology PMo.
Ward hypoalbumin 4.2 renal loss department S, Vs, SpO2
emia management:
Subjective Non Pharmacology: PEd
- The patient was treated - Transfusion of Albumin Education
by Urology Department 20% 100 until albumin about
with burst abdomen serum > 2,5 gr/dL diagnosis,
post renal biopsy treatment
and
Objective prognosis
Albumin 1,78
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mrs. IS / 51 yo / Cisadane 5. DM type 2 - - Non Pharmacology: PMo.

Ward normoweigh - Soft diet 1700 kcal/day S, Vs, SpO2
t on OAD according to BROCA (50% GDP/
Subjective KH, 20% fat, 30% protein) GD2PP,
HbA1c, UL,
-History of Diabetes melitus Pharmacology lipid profile
(+) since 5 years ago, - PO OAD -->
postpone, planned
regularly taking Metformin
switch insulin basal PEd
3x500 mg waiting for the result Education
of FBG/2HPP about
Objective - Target RBS diagnosis,
RBS 159 perioperative 140- treatment
BMI 20 kg/m2 180 mg/dL and
prognosis
 We suggest this patient

- Patient diagnosed with Diabetes Melitus type 2

- Planning Diagnosis: GDP/ GD2PP, HbA1c, UL, lipid profile

- Soft diet 1700 kcal/day according to BROCA (50% KH, 20% fat,
30% protein)
- PO OAD --> postpone, planned switch insulin basal waiting for
the result of FBG/2HPP
- Target RBS perioperative 140-180 mg/dL
- Patients will be Collaborative care with Endocrine Divisions
 Condition this Morning

• GCS : 456
• BP : 130/65 mmHg
• HR : 71 bpm
• RR : 18 tpm
• Tax : 36,7oC