Skenario

Amir, a boy , 12 month, was hospitalized due to diarrhea. Four days before admission the
patient had non projectile vomitting 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 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. Budis family lives in slum area.
Physical Examination
Patient looks severely ill, compos mentis but weak, BP 70/50 mmHg, RR 38x/m regular but
weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm
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 was increase. Liver was 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 surounding anal orifice.
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(-)
Microscopic :WBC: 2-4/HF, RBC 0 1/HPF

Klarifikasi Istilah
1. Diarrhea : pengeluaran tinja berair berkali- kali yang tidak
normal
2. non projectile vomitting : keluarya isi dari lambung yang disertai kontraksi
lambung dan abdomen tetapi tidak menyembur
3. sunken eye :
4. shuffle abdomen : lemas pada bagian abdomen
5. bowel sound : suara abdominal yang disebabkan oleh dorongan isi
dari yang melewati bagian dari bagia bawah kolon. Normalnya bubling dan bulging
6. mukus : lendir bebas membran mukosa, terdiri dari sekresi
kelenjar, berbagai garam, sel yang berdesquamasi dan leukosit
7. letargi : tingkat kesadaran yang menurun, disertai dengan
pusing, pendengaran yang berkurang dan apatis
Identifikasi Masalah
1. Amir, a boy , 12 month, was hospitalized due to diarrhea.Budis family lives in slum
area.
2. Four days before admission the patient had non projectile vomitting 6 times a day. He
vomited what he ate.
3. Three days before admission the patient got diarrhea 10 times a day around half glass
in every defecation, there was no blood and mucous in it. The frequency of vomiting
decreased.
4. Along those 4 days, he drank eagerly and was given plain water. He also got mild
fever
5. Yesterday, he looked worsening, still had diarrhea but no vomiting.
6. The amount of urination in 8 hours ago was less than usual.
7. Physical Examination
Patient looks severely ill, compos mentis but weak, BP 70/50 mmHg, RR 38x/m
regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm
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 was increase. Liver was 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 surounding anal orifice.
8. 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(-)
Microscopic :WBC: 2-4/HF, RBC 0 1/HPF

Analisis Masalah
1. Amir, a boy , 12 month, was hospitalized due to diarrhea.Budis family lives in slum
area.
a. Bagaimana anatomi dan fisiologi GIT pada anak?cuni, nisa, salman, pradit
b. Apakah hubungan jenis kelamin, umur dan tempat tinggal terhadap
kasus?Ismel,widya
c. Bagaimana karakteristik daerah kumuh?cuni, nisa, salman, pradit
d. Apa penyebab dan mekanisme diare?Sucong, dina

2. Four days before admission the patient had non projectile vomitting 6 times a day. He
vomited what he ate.
a. Bagaimana mekanisme dan penyabab muntah non proyektil?Sandria, hazem
b. Apa saja jenis jenis muntah? (frekuensi, warna, jenis)ami, vivi
c. Bagaimana akibat dari muntah sebanyak 6 kali?Muthia, hazem
d. Mengapa amir memuntahkan makanan yang dia makan?Vivi, sandria

3. Three days before admission the patient got diarrhea 10 times a day around half glass
in every defecation, there was no blood and mucous in it. The frequency of vomiting
decreased.
a. Mengapa diare muncul dan frekuensi muntah menurun?
b. Mengapa diarenya tidak disertai darah dan lendir/nanah?Tifa, aci
c. Bagaimana BAB normal pada anak 12 bulan?Ismel, widya
d. Kapan bisa dikatakan diare?Tifa, aci
e. Apa dampak diare?Sucong, dina
f. Apa saja klasifikasi diare?Tifa, aci

4. Along those 4 days, he drank eagerly and was given plain water. He also got mild
fever
a. Apakah plain water dapat membantu mengatasi diare? Jelaskansucong,dina
b. Cairan apa yang sebaiknya diberikan pada amir?Ismel,widya
c. Apa hubungan banyak minum dengan keluhan yang dialami amir?Sucong,dina
d. Bagaimana mekanisme demam pada kasus?Ami, hazem
e. Bagaimana klasifikasi demam?muthia

5. Yesterday, he looked worsening, still had diarrhea but no vomiting.
a. Apa indikasi dikatakan keadaan memburuk?Ami, muthia
b. Mengapa keadaan amir semakin memburuk?Sandria, vivi

6. The amount of urination in 8 hours ago was less than usual.
a. Berapa jumlah urin normal pada bayi usia 12 bulan?Ismel, widya, tifa
b. Mengapa jumlah urin amir berkurang? (kalo bisa jelasin mekanisme nya)sucong.
Aci, dina

7. Physical Examination
Patient looks severely ill, compos mentis but weak, BP 70/50 mmHg, RR 38x/m
regular but weak, body temperature 38,7 C, BW 8,8 kg, BH 75 cm
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 was increase. Liver was 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 surounding anal orifice.
a. Bagaimana interprestasi dan mekanisme abnormal dari pemeriksaan fisik?
(gambar)cuni, salman
b. Bagaimana cara pemeriksaan fisik pada bayi 12 bulan?Cuni, nisa
c. Bagaimana status gizi amir dan hubungannya dengan penyakit yang dialami?Nisa,
pradit
d. Apa indikasi dilakukan pemeriksaan pinch the skin of the abdomen?Salman,
pradit

8. 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(-)
Microscopic :WBC: 2-4/HF, RBC 0 1/HPF
a. Bagaiman interprestasi dan mekanisme abnormal pemeriksaan
laboratotium?mutia,ami,vivi,hazem,sandria

Hipotesis
Amir 12 bulan menderita dehidrasi et cause diare
9. Klinissucong, tifa, aci, widya, dina, ismel
a. Difinisi
b. Etiologi
c. Epidemiologi
d. Faktor resiko
e. Penegakan diagnosis
f. Dd
g. Wd
h. Patofisiologi
i. Manifestasi klinis
j. Tatalaksana
k. Komplikasi
l. Prognosis
m. SKDI
Keterkaitan Antar Masalah
Learning Issue
1. Anatomi dan fisiologi GIT anak 12 bulancuni, nisa, salman, pradit
2. Diare sucong, tifa, aci, widya, dina, ismel
3. Dehidrasi (yang berhubungan kasus) fisiologi cairan
jugamutia,ami,vivi,hazem,sandria

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