BAB I

PENDAHULUAN

1.1 Latar Belakang

Blok Kesehatan Reproduksi adalah Blok XVII pada Semester 6 dari

Kurikulum Berbasis  Kompetensi Pendidikan Dokter  Fakultas  Kedokteran

Universitas Muhammadiyah Palembang.

Pada kesempatan ini dilaksanakan tutorial studi kasus sebagai bahan

pembelajaran untuk menghadapi tutorial yang sebenarnya pada kesempatan

yang akan datang. Pada kesempatan kali ini akan memaparkan kasus  Ny. Y,
35 tahun, P4A1 datang dengan keluhan nyeri perut yang hebat dibagian
bawah terutama sebalah kanan sejak 6 jam yang lalu. Ny. Y sudah menyadari
bahwa terdapat benjolan di perut bawah kanan sebesar tinju orang dewasa
sejak 2 bulan yang lalu dan disarankan dokter untuk operasi namun Ny. Y
menolak. Ny. Y pernah diurut oleh dukun 3 hari yang lalu tetapi benjolan
tetap ada dan malah mulai terasa sakit.

1.2 Maksud dan Tujuan 

Adapun maksud dan tujuan dari laporan tutorial studi kasus ini, yaitu :

1. Sebagai laporan tugas kelompok tutorial yang merupakan dari sistem

pembelajaran   Kurikulum   Berbasis   Kompetensi   (KBK)   di   Fakultas

Kedokteran Muhammadiyah.

2. Dapat   menyelesaikan   kasus   yang   diberikan   pada   skenario   dengan

metode analisis dan pembelajaran kelompok.

3. Tercapainya tujuan dari metode pembelajaran tutorial. 

1
 BAB II

DISCUSSION

2.1 Data Tutorial

Tutor :   dr. Nyayu Fitriani, M.Bmd

Moderator :  Nanda Aisyah Humairah

Notulen :   Mentari Alisha

Secretary :  Roseline Natazsa Puri Gracia 

Time :  Tuesday, 26 September  2017

On 08.00 – 10.30 WIB

Thursday, 28 September 2017 

On 08.00 – 10.30 WIB

The Rule of Tutorial : 1. Non­active   the   phone   or   phone   in   silence

condition

2. Raising a hand as it will propose an argument

3. Get the permission when going out of the room

2.2  Case Scenario 

Ana, a 10 months old girl, visited the outpatient clinic RSMP with
recurrent diarrhea with her mother. She suffered from diarrhea almost every 1
time in a month since she was 4 months old. The length of diarrhea was 7 to
10 days. Her mother said that her daughter’s appetite was like ‘usual’. Ana is
not having fever, cough, cold, and hard to breathe now.
Ana weight was never weight (she was never taken to Public Health
Center). Highest weight was unknown. Ana was given exclusive
breastfeeding just until 3 months of age. Since her age was 3 months, she was

2
given only regular formula milk 6 times a day @ 90 cc until now. After her
age was 4 months, she was given instant porridge as a complementary feeding
(MP ASI) 2 times a day @ ½ sachet (1sachet is 80 kcal). She also was given
cooked rice water (tajin) 2 -3 times a day @ 50 cc since her age was 4
months.
The mother’s pregnancy and childbirth bistory
Ana is the first child from a 24 years old mother. During pregnancy, mother
was healthy and pre natal care to a midwife 4 times. Ana was delivered
sponataneously at 37 weeks gestation. Immediately cried after birthed,
APGAR score 1 minute 9 and 5 minutes 10. Birth weight was 2800 grams.
Birth length was 49 cm. Head circumference was 33 cm.
Immunization history: BCG 1 time but DPT, polio, hepatitis, and measles
were never given.
Growth history: image attachment of Ana’s KMS.
Development history: Ana can only sit with help.
Medication history: Ana was never got treatment.
Physical ecamination:
General status: child is not looking thin, round cheeks, pale, apathetic, whiny,
weight 5.5 kg, length 60 cm, head circumference 12 cm.
Vital signs: HR: 112x/minute, RR: 32x/minute, T: 36,5°C
Specific status:
Head:
 No dismorphic face
 Round cheeks,
 Easy revoked sheer yellowish red head hair
 Wistfull eyes
 Look and cry at the examiner
 Look towards when her name was called
Thoraks: noribs (piano sign)
Abdoment: bloated
Extramities:
3
  Edema in the four extremities
 No anatomy abdormalitis to noth legs and feet
 No baggy pants
Mata: there is abnormal nutrie
Skin: there is skin abnormalities (dermatosis) in the buttocks and groin.
Neurologicus status:
 Normal movements, motoric muscle strength 4
 Normal physiological reflexes
 Normal clonus and tone
 No uncontrollabe movement
 No pathological reflexes

2.3 Identification of Problems

1. Ana, a 10 months old girl, visited the outpatient clinic RSMP with
recurrent diarrhea with her mother. She suffered from diarrhea almost
every 1 time in a month since she was 4 months old. The length of diarrhea
was 7 to 10 days. Her mother said that her daughter’s appetite was like
‘usual’. Ana is not having fever, cough, cold, and hard to breathe now.
2. Ana weight was never weight (she was never taken to Public Health
Center). Highest weight was unknown.
3. Ana was given exclusive breastfeeding just until 3 months of age. Since
her age was 3 months, she was given only regular formula milk 6 times a
day @ 90 cc until now. After her age was 4 months, she was given instant
porridge as a complementary feeding (MP ASI) 2 times a day @ ½ sachet
(1sachet is 80 kcal). She also was given cooked rice water (tajin) 2 -3
times a day @ 50 cc since her age was 4 months.
4. The mother’s pregnancy and childbirth history
Ana is the first child from a 24 years old mother. During pregnancy,
mother was healthy and pre natal care to a midwife 4 times. Ana was
delivered sponataneously at 37 weeks gestation. Immediately cried after

4
 birthed, APGAR score 1 minute 9 and 5 minutes 10. Birth weight was
2800 grams. Birth length was 49 cm. Head circumference was 33 cm.
5. Immunization history: BCG 1 time but DPT, polio, hepatitis, and measles
were never given.
Growth history: image attachment of Ana’s KMS.
Development history: Ana can only sit with help.
Medication history: Ana was never got treatment.
6. Physical examination:
General status: child is not looking thin, round cheeks, pale, apathetic,
whiny, weight 5.5 kg, length 60 cm, head circumference 12 cm.
Vital signs: HR: 112x/minute, RR: 32x/minute, T: 36,5°C
Specific status:
Head:
 No dismorphic face
 Round cheeks,
 Easy revoked sheer yellowish red head hair
 Wistfull eyes
 Look and cry at the examiner
 Look towards when her name was called
Thoraks: noribs (piano sign)
Abdoment: bloated
Extramities:
 Edema in the four extremities
 No anatomy abdormalitis to noth legs and feet
 No baggy pants
Skin: there is skin abnormalities (dermatosis) in the buttocks and groin.
Neurologicus status:
 Normal movements, motoric muscle strength 4
 Normal physiological reflexes
 Normal clonus and tone

5
  No uncontrollabe movement
 No pathological reflexes

2.4 Problem Analysis

1. Ana, a 10 months old girl, visited the outpatient clinic RSMP with
recurrent diarrhea with her mother. She suffered from diarrhea almost
every 1 time in a month since she was 4 months old. The length of diarrhea
was 7 to 10 days. Her mother said that her daughter’s appetite was like
‘usual’. Ana is not having fever, cough, cold, and hard to breathe now.
1a. What are causes of diarrhea?
1b. What is the meaning of: She suffered from diarrhea almost every 1
time in a month since she was 4 months old. The length of diarrhea
was 7 to 10 days?
1c. How is the patophysiology of diarrhea and recurrent diarrhea?
1d. What is the meaning of: Ana is not having fever, cough, cold, and hard
to breathe now?
1e. What is the meaning of: Ana’s appetite was like ‘usual’?
1f. What are the possible illness with recurrent diarrhea symptom?

2. Ana weight was never weight (she was never taken to Public Health
Center). Highest weight was unknown.
2a. What are the impact Ana was never taken to PHC (Public Health
Center)?
2b. How many the ideal visit frequency to PHC?
2c. What are the objectives and benefits of checks performed in KMS?
2d. Bagaimana pertumbuhan normal anak seumur Ana?
2e. What are the assessments in KMS?
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3. Ana was given exclusive breastfeeding just until 3 months of age. Since
her age was 3 months, she was given only regular formula milk 6 times a
day @ 90 cc until now. After her age was 4 months, she was given instant
porridge as a complementary feeding (MP ASI) 2 times a day @ ½ sachet
(1sachet is 80 kcal). She also was given cooked rice water (tajin) 2 -3
times a day @ 50 cc since her age was 4 months.
3a. Berapa lama pemberian ASI eksklusif yang ideal?
3b. What of including nutrients in ASI and the benefits of ASI?
3c. What is the impact that ASI only given just until 3 months of age?
3d. Berapa cc normal pemberian susu formula per hari pada bayi 10
bulan?
3e. What of the bad effect and benefit of cooked roce water (tajin)?
3f. How diet pattern of the baby? (from neonatus – 10 month age)
3g. What is the meaning of: Ana was given instant porridge as a
complementary feeding 2 times a day @ ½ sachet ?
3h. Apa hubungan pemberian nutrisi dengan diare berulang yang di alami
Ana?

4. The mother’s pregnancy and childbirth history

Ana is the first child from a 24 years old mother. During pregnancy,
mother was healthy and pre natal care to a midwife 4 times. Ana was
delivered sponataneously at 37 weeks gestation. Immediately cried after
birthed, APGAR score 1 minute 9 and 5 minutes 10. Birth weight was
2800 grams. Birth length was 49 cm. Head circumference was 33 cm.
4a. Apa makna riwayat kehamilan ibu Ana?
4b. Apa makna riwayat kelahiran Ana?

5. Immunization history: BCG 1 time but DPT, polio, hepatitis, and measles
were never given.
Growth history: image attachment of Ana’s KMS.
7
 Development history: Ana can only sit with help.
Medication history: Ana was never got treatment.
5a. Apa hubungan riwayat imunisasi dengan diare berulang yang dialami?
5b. What are the impacts that imunization was given incompleted?
5c. Bagaimana jadwal pemberian imunisasi?
5d. Bagaimana interpretasi dari KMS Ana?
5e. Bagaimana perkembangan normal untuk anak ( Ana?
5f. Bagaimana interpretasi riwayat perkembangan Ana?
5g. Bagaimana interpretasi riwayat pemberian obat pada Ana?

6. Physical examination:
General status: child is not looking thin, round cheeks, pale, apathetic,
whiny, weight 5.5 kg, length 60 cm, head circumference 12 cm.
Vital signs: HR: 112x/minute, RR: 32x/minute, T: 36,5°C
Specific status:
Head:
 No dismorphic face
 Round cheeks,
 Easy revoked sheer yellowish red head hair
 Wistfull eyes
 Look and cry at the examiner
 Look towards when her name was called
Thoraks: noribs (piano sign)
Abdoment: bloated
Extramities:
 Edema in the four extremities
 No anatomy abdormalitis to noth legs and feet
 No baggy pants
Skin: there is skin abnormalities (dermatosis) in the buttocks and groin.
Neurologicus status:

8
  Normal movements, motoric muscle strength 4
 Normal physiological reflexes
 Normal clonus and tone
 No uncontrollabe movement
 No pathological reflexes

2.5 Hypothesis 

Ana, 10  

2.6 Conseptual Framework 

Idiopatik

Terbentuk kistra ovarii dextra

Diurut Torsio kistra ovarii dextra

Nyeri perut hebat kanan bawah