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Name
: Mrs. ER Age : 39 years old Marital state : married Admission date : May 2nd, 2013
10 STEPS VENNDIAG
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Define a Chief Complaint Draw a VennDiag & Fill It With Possible Disease Literature Review Scan on Patient Signs & Symptoms Make a Working Diagnosis Define Initial Treatment Further Investigation Make a Definitive Diagnosis Define Causative Treatment Show a Clinical Course of the Disease
STEP VENNDIAG
STEP 1 : Define the Chief Complaint
STEP VENNDIAG
STEP 1 : Define the Chief Complaint
Drugs Protozoa : Giardia, Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Thyroid Storm Acute Watery Acute appendicitis ACUTE DIARRHEA NON INFECTIOUS
Acute Bloody
INFECTIOUS
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica
1. 2.
Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clin ical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds.
STEP VENNDIAG
STEP 1 : Define the Chief Complaint
Protozoa : Giardia, Cryptospora Drugs Toxins Bacterial : Vibrio cholera Dietary: Intoleransi lactosa : Rotavirus, Norwalk Irritable Bowel Syndromme Viral Acute Watery Thyroid Storm Acute appendicitis ACUTE DIARRHEA
NON INFECTIOUS Acute Bloody Drugs: NSAIDs Inflammatory Bowel Disease INFECTIOUS
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica
1. 2.
Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clin ical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds.
Protozoa : Giardia lamblia Symptom : Sulfurous bleaching Flatus Loose stools with mucus (-) Extra intestinal : Urticaria Anterior uveitis Artritis Physical : Bloating abdominal
Diagnose : Antigens in the feces Cysts in the feces Trophozoites in the feces or small intestine
1.
INFECTIOUS
Protozoa : Cryptosporidium Symptom : Immunocompetent host Anorexia Weight loss Physical : Low fever Dehydration
Diagnose : Small oocyts , cyst, trophozoites in feces Direct immunofluorescent stains Enzyme immunoassay Biopsy specimen of the small bowel
1.
INFECTIOUS
1.
INFECTIOUS
1.
INFECTIOUS
1.
INFECTIOUS
Drugs Protozoa : Giardia, Cryptospora Toxins Bacterial : Vibrio cholera Dietary: Intoleransi lactosa Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm Acute appendicitis ACUTE DIARRHEA NON INFECTIOUS
Acute Bloody
INFECTIOUS
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica
1. 2.
Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clin ical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds.
INFECTIOUS
1.
Bacterial : Shigella
Symptom : 4 stages Incubation Period - Lasts 1-4 days - Transient fever (40-41c) Watery Diarhhea Mild abdominal discomfort severe cramps, tenesmus Dysentry Follow hours or days. Uninterupted excretion of small volume of bloody mucopurulent stool diarrhea with increased tenesmus and abdominal cramps Post infection Diagnosed - Isolation pathogen from fecal material Medium: agar mac conkey: nonlactose fermeting colonies: 0,5-1mm in diameter, convex, translucent, smooth surface
1.
INFECTIOUS
Bacterial : Campylobacter
Symptom Prodorme 12-48 hour before onset of diarrheal - Degree of diarrhea varies from several loose stool to grossly blood stool, > 10 bowel movement - Abdominal pain: cramping, general/local Physical - Abdominal pain: cramping, general/local Diagnosed - Direct microscopy: vibroid morphology - Isolate from culture of stool, blood
INFECTIOUS
1.
Bacterial : Salmonella
Symptom Incubation 10-14 days (3-21 days) - High fever characteristic - Coated tongue, splenomegaly, abdominal tenderness Physical - Coated tongue, splenomegaly, abdominal tenderness Diagnosed by - Leukopenia, neutropenia - Elevated liver function test and muscle enzyme level - Isolation of S. Typhi or S. Paratyphi from blood, bone marrow - Widal test - PCR and DNA assay : S.typhi in blood
INFECTIOUS
1.
Bacterial : Escherchia.coli
Symptom Incubation 24 - 72 hours. Other symptoms may include: Distension abdominal Physical Gas in abdominal Bruises that happen easily Pale skin Red or bloody, reduced amount urine Diagnosed by - E. coli strains O157, is the most common method currently used to detect STEC/EHEC - Testing for Shiga toxins or toxin genes is more sensitive, specic, and rapid. It detects both non- O157 STEC/EHEC and sorbitol-fermenting strains of O157:H7 difcult to identify.
INFECTIOUS
Vorvick LJ. E.coli Enteritis. US National Library of Medicine NIH. Medline. 2011
Bacterial : Aeruginosa
- Immunocompromised host - Antibiotic associated - Profuse diarrhea, mucus +, blood + - Low-grade fever Diagnosed - Innoculation on blood agar plates and Mac Conkey agar plates, then incubated at 370c for 18-24 hours
Infectious
Porco EV, Visconte EB. Pseudomonas Aeruginosa as a Cause of Infectious Diarrhea Successfully Treated With Oral Ciprofloxacin. Department of Internal Medicine. Pubmed. USA. 1995 Nov;29(11):1122-3 Brad GF et al. Pseudomonas Aeruginosa and Antibiotic Associated Diarrhea In Children. Department of Pediatric, Victor Babes University Medicine and Pharmacy. Timisora. Jan 2011.
Drugs Toxins Protozoa Bacterial Dietary: Intoleransi lactosa Viral Irritable Bowel Syndromme Acute Watery Thyroid Storm Acute appendicitis ACUTE DIARRHEA
NON INFECTIOUS
Acute Bloody
INFECTIOUS
Drugs: NSAIDs Bacterial: Shigella, Campylobacter, Salmonella, Inflammatory Bowel Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica Disease
1. 2.
Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clin ical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds.
1.
NON INFECTIOUS
Lactose Intolerance
Symptom - Flatus - History of ingest carbohydrates that contain actively transported monosaccharide (ec: glucose, galactose) - Flatus - History of ingest carbohydrates that contain actively transported monosaccharide (ec: glucose, galactose)
Diagnosed by Stool fat/steatorrhea quantitative Test- Sudan III stain Blood breath and isotopic test Blood routine: depletion iron, folate, cobalamin, vitamins D and K Schilling test, D-xylose test, duodenal mucosal biopsy, small intestinal RO, test of pancreatic exocrine function
1.
NON INFECTIOUS
*Non Infectious
1.
Thyroid Storm
Agitation
Tachycardia Sweating Fever Seizure History of hypertiroidism
T1 dan T4
*Non Infectious
1.
Acute appendicitis
Anorexia
Pain in periumbilical goes to right upper quadrant
*Non Infectious
1.
Drugs Toxins Dietary: Intoleransi lactosa Acute Irritable Bowel Syndromme Thyroid Storm Acute Appendicitis
Protozoa : Giardia, Cryptospora Bacterial : Vibrio cholera Viral : Rotavirus, Watery Norwalk
NON INFECTIOUS
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica
1. 2.
Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clin ical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds.
Drugs
- Causes: NSAIDs - Mild side effects from short-term use may include diarrhea - Blood related ulcer because long term use Diagnosed by History of consumption Hematology routine : normal Feses routine : - Erytrocyte (-) - Leucocyte (-)
1.
NON INFECTIOUS
Laboratory
Rise in CRP, platelet count, ESR, leucocyte, and decrease Hb Spesific marker: - fecal lactoferin intestinal inflammation - Fecal calprotectin histologic inflammation, prognosis,
Rectal involvement with continuous superficial ulceration. Loss of haustra, continous ulceration, collar button ulcer
Endoscopy
Patchy involvement, rectal sparing, aphthous ulcers, ileal ulcers Stricture, fistulas, terminal ileal disease (string sign), skip lesieon
Radiology
NON INFECTIOUS
1.
STEP VENNDIAG
STEP 1 : Define the Chief Complaint
Characteristic: Acute Diarrhea started 12 hours before admission Diarrhea characteristic : Watery Mucus (+) Bad stink - Frequency > 8 times/day - Stool volume > 250 ml
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeruginosa Protozoa: Entamoeba hystoliytica
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
Continous
No spesific characteristic
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
Nausea
Vomit (-)
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeromonas Protozoa 6.Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
Weight Loss
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
in the street
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Diarrhea
Possible : 1,2,3,4,6
7. NSAIDs 8. Inflammatory Bowel Disease Acute Bloody Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeromonas Protozoa 6.Entamoeba hystoliytica
HISTORY TAKING
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
Protozoa : Giardia, Drugs Cryptospora Toxins Dietary: Intoleransi lactosa Bacterial : Vibrio cholera Viral : Rotavirus, Norwalk Irritable Bowel Syndromme Acute Watery Thyroid Storm ACUTE DIARRHEA
Acute Bloody
Bacterial: Shigella, Campylobacter, Salmonella, Escherchia coli, Aeromonas Protozoa: Entamoeba hystoliytica
Acute Diarrhea Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeromonas Protozoa 6.Entamoeba hystoliytica
Acute Bloody
HISTORY TAKING
HISTORY TAKING
Vital sign:
General appearance : moderately ill Conciousness : compos mentis
Blood Pressure
Pulse Respiratory rate H/W BMI
Possible : 1,2,3,4,6 Less :5
: 100/60 mmHg
: 96x/min ( reguler rhythm, strong, and full in palpation ) : 22x/min : 154 cm / 57 kg : 24,1 kg/m2 (overweight)7. NSAIDs
8. Inflammatory Bowel Disease
Acute Diarrhea Bacterial Acute 1.Shigella Bloody 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
PHYSICAL EXAMINATION
: normocephaly : conjunctiva anemic -/: normal : normal : dry mucosa lip and oral : nodul lymph not palpable
Acute Diarrhea Bacterial 7. NSAIDs Acute 1.Shigella 2.Campylobacter 8. Bloody .3.Salmonella Inflammatory 4. Escherchia coli Bowel 5. Aeromonas Disease Protozoa 6.Entamoeba hystoliytica
PHYSICAL EXAMINATION
Lungs ( normal ) Inspection : symetric in both static and dynamic state. Palpation : fremitus tactile equal on both lungs. Percussion : sonor Auscultation : vesicular breath sounds, no additional sound.
Heart : Inspection Palpation Percussion - upper border - right border - left border Auscultation : ictus cordis visible : ictus cordis is palpable in ICS V linea midclavicularis sinistra : ICS 3 linea parasternalis sinistra : linea sternalis dextra : linea midclavicularis sinistra : regular heart sound, no additional sound Acute Diarrhea Bacterial 7. NSAIDs Acute 1.Shigella 2.Campylobacter 8. Bloody .3.Salmonella Inflammatory 4. Escherchia coli Bowel 5. Aeruginosa Disease Protozoa 6.Entamoeba hystoliytica
PHYSICAL EXAMINATION
: convex : pain (+) lower abdominal hepatosplenomegaly : timpani : bowel sound 12-13x/minute : CRT < 2 second, warm : turgor normal
Acute Diarrhea Bacterial 7. NSAIDs Acute 1.Shigella 2.Campylobacter 8. Bloody .3.Salmonella Inflammatory 4. Escherchia coli Bowel 5. Aeruginosa Disease Protozoa 6.Entamoeba hystoliytica
PHYSICAL EXAMINATION
Female 39 years old, came with acute diarrhea 12 hours before admission. - Diarrhea characteristic : watery+, mucus (+), blood (+) no gross, no pus, frequency > 8 times/day, stool volume >250 ml, high fever 38c = 1,3,4,5, 6 - Nausea = 2,4,5, 6 - Weight loss = 6, 8 - History of comsumption food in the street = 1,2,3,4, 6
Acute Diarrhea
RESUME
Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
- History of her children was admitted hospital because of amoeba diarrhea = 6 - History of diabetes mellitus, her medication since 3 years ago : glimepirid 1x1 gr and metformin 1x500 mg.
Acute Diarrhea Acute 7. NSAIDsBloody 8. Inflammatory Bowel Disease Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Not related : 8
RESUME
Physical examination found - Axillary temperature 39,6 C - Dry lip and oral mucosa - Abdomen seemed convex, pain in lower abdominal, tympani, bowel sound 12 -13x/minute = 1,2,3,4, 6 = 1,2,3,4,5, 6 = 1,2,3,5, 6
Possible
: 1,2,3, 6
Acute Diarrhea Acute 7. NSAIDs Bloody 8. Inflammatory Bowel Disease Bacterial 1.Shigella 2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Less Possible
: 4,5
RESUME
STEP VENNDIAG
Step 3 : Make a Brief Literature Review of Each Disease
WORKING DIAGNOSIS
Acute Gastroenteritis et causa Entamoeba hystolytica
Acute Gastroenteritis et causa Shigella Acute Gastroenteritis et causa Campylobacter Acute Gastroenteritis et causa Salmonella
Acute Diarrhea
Bacterial 7. NSAIDs Acute 1.Shigella Acute Gastroenteritis et causa Escherchia coli 8. Bloody 2.Campylobacter Inflammatory .3.Salmonella Bowel 4. Escherchia coli Disease 5. Aeruginosa EXCLUDED Protozoa Acute Gastroenteritis et causa Aeruginosa 6.Entamoeba Acute Gastroenteritis et causa NSAIDs hystoliytica Acute Gastroenteritis et causa Inflammatory Bowel Disease
Acute Gastroenteritis et causa Aeruginosa No history consumption antibiotic No immunocompromised host Low grade fever
EXCLUDED
STEP VENNDIAG
Step 4 : Scan on Patients Sign & Symptoms
INITIAL TREATMENT
Female 39 years old, came with acute diarrhea 12 hours before admission. 1. Diarrhea characteristic : watery+, mucus (+), blood (+) no gross, no pus, frequency > 8 times/day, stool volume >250 ml, got dry lip and oral mucosa. For this condition : REDUCE the diarrhea with Antispasmodic (Buscopan 10 mg 1 tab)
CORRECT for mild dehydration Begin IV fluid with isotonic fluid Fluid theraphy = maintenance + 5% deficit of body weight = 30 ml/kgBB + 5% BB(kg) = (30x57) + 5/100 x 57 = 1710 + 162.45 1872.45 cc/24 jam 2000 cc/24 jam
Guillot AP. Fluid and Electrolyte Management Theraphy. University of Vermont Collenge of Medicine
INITIAL TREATMENT
2. Her past temperature, fever 38c. Now, the temperature was 39,6 C The theraphy was Antipyretic (Paracetamol 500 mg 3 tab) 3. She felt nausea but no vomit Antinausea (Domperidone 10 mg 2tab) 4. She felt her weight had some loss but never been scaled
Education for eat more food, but no stimulated the stomach like spicy food
STEP VENNDIAG
Step 3 : Make a Brief Literature Review of Each Disease
FURTHER INVESTIGATION
Acute Diarrhea 7. NSAIDs 8. Inflammato ry Bowel Disease Bacterial Acute 1.Shigella Bloody2.Campylobacter .3.Salmonella 4. Escherchia coli 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
HEMATOLOGY Hemoglobine Leukocyte Erythrocyte Hematocrit Platelet 13 18 4 11 4.5 - 6.5 40 54 150 450 80 96 27 32 32 36 11.6 - 14.8 10 50 0.7 - 1.2 g% 103 /ul 106 /ul % 103 /ul fl pg g/dl % mg/dl mg/dl 14.4 11.9 5.66 41.0 164 82.4 27.4 35.1 13.6 25 0.84
ERYTHROCYTE INDEX
MCV MCH MCHC RDW-CV Kidney Function Ureum Creatinine
Possible : 1,2,3,4,5, 6
Exclude : 7,8
Acute Diarrhea Bacterial 7. NSAIDs 1.Shigella Acute 8. 2.Campylobacter Bloody Inflammato .3.Salmonella ry Bowel 4. Escherchia coli Disease 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
HEMATOLOGY Eosinophil Basophil Neutrophil Lymphocyte Monocyte LED 1 jam LED 2 jam Liver Function Test SGOT 0-38 U/l 13 1-6 1-2 40-80 20-40 2-10 10 -15 10 - 15 % % % % %
mm/jam mm/jam
SGPT
Renal Function Test Asam Urat Diabetes Glukosa
0-41
3.4-7 70 - 110
U/l
U/l mg/dl
13.9
5.6 285
Possible : 1,2,3,4,5, 6
HbA1c
<6.5
8.6
Exclude : 7,8
Diabetes mellitus
Acute Diarrhea Bacterial 7. NSAIDs 1.Shigella 8. Acute 2.Campylobacter Inflammato Bloody .3.Salmonella ry Bowel 4. Escherchia coli Disease 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica
Electrolyte
Natrium Kalium 136 145 3.3 - 5.1 % % 130 3.0
Chlorida
Fat LDL HDL TG
98-106
< 150 > 40 < 150
g/dl
g/dl g/dl g/dl
99
65 15 197
Hypertrygliserida
Macroscopic Consistency liquid brown + 0 0 0 Color Mucus Blood Pus Worm Microscopic
Acute Diarrhea Bacterial 7. NSAIDs Acute 1.Shigella 8. Bloody 2.Campylobacter Inflammato .3.Salmonella ry Bowel 4. Escherchia coli Disease 5. Aeruginosa Protozoa 6.Entamoeba hystoliytica Possible : 6
Leucocytes
Erytrocytes Worm eggs Amoeba Other parasites
20 - 25
10 - 15 0 Cyst + 0
STOOL TEST
STEP VENNDIAG
STEP 5 : Make a working diagnosis STEP 6 : Define Initial Treatment Step 7 : Further Investigation STEP 8 : Make a Definitive Diagnosis STEP 9 : Define the Causative Treatment STEP 10 : Show Clinical Course of the Disease
DEFINITE DIAGNOSIS
Definite Diagnosis : Acute gastroenteritis ec amoeba) (amoeba cyst +) Milld dehydration Diabetes mellitus type 2 Excluded: Acute Gastroenteritis et causa Shigella Acute Gastroenteritis et causa Campylobacter Acute Gastroenteritis et causa Salmonella Acute Gastroenteritis et causa Escherchia coli
STEP VENNDIAG
STEP 5 : Make a working diagnosis
STEP VENNDIAG
STEP 5 : Make a working diagnosis STEP 6 : Define Initial Treatment Step 7 : Further Investigation STEP 8 : Make a Definitive Diagnosis STEP 9 : Define the Causative Treatment STEP 10 : Show Clinical Course of the Disease
gastroenteritis
mostly recovered (self limited) death dehydration shock
Hyperglicemia
Diabetes Mellitus
Diabetic Ketoacidosis
acute
Complication
chronic
Hyperglicemic hyperosmolar
Eye Skin Cardiovascular Abdominal Renal Genitourinary Neurophathy Lower extremity Dhermatologic Infection
REFERENCES
1. Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders. 2nd eds. Philadelphia : Mosby Elsevier. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th eds. Stern, Scott D. C. 2010. Symptom to Diagnosis: An Evidence Based Guide. 2nd eds. Guillot AP. Fluid and Electrolyte Management Theraphy. University of Vermont Collenge of Medicine
2. 3. 4.
Metode yang beguna dalam menegakkan diagnosis karena dari awal kita diajak memikirkan segala kemungkinan diagnosa yang mungkin terjadi pada pasien sehingga menemukan yang paling tepat dan bisa memberikan terapi yang terbaik bagi pasien.
VENNDIAG IS....
SPECIAL THANKS to