LAPORAN TUTORIAL SKENARIO C BLOK 15

Disusun oleh:
Kelompok A6
Tutor: dr. Hasri Salwan, Sp.A(K)
Riri Juliantika 04011181722002
Novira Parawansa 04011181722004
Syifa Inanta 04011181722044
Junoretta H. Ernanto 04011281722098
Irma Yolanda 04011281722102
Alya’ Tsabitah 04011281722104
Faiza Al Khlaifa Calista 04011281722118
Andrew Fabian 04011281722138
Nurul Hidayati 04011281722140
Fernaldy Wirawan 04011281722144
Anisa Fitri 04011281722154
Aprillya Permata Sari 04011981722235

FAKULTAS KEDOKTERAN
PENDIDIKAN DOKTER
UNIVERSITAS SRIWIJAYA
2019
 KEGIATAN TUTORIAL
Tutor : dr. Hasri Salwan, Sp.A(K)
Moderator :
Sekretaris I :
Sekretaris II :
Presentan :
Pelaksanaan : 13 Mei2019 – 17 Mei 2019
13.00-15.30 WIB
Peraturan selama tutorial:
1. Jika mau berbicara, angkat tangan terlebih dahulu.
2. Saling mendengarkan pendapat satu sama lain.
3. Izin ke toilet maksimal dua orang dalam satu waktu.
4. Diperbolehkan minum selama tutorial berlangsung.
5. Diperbolehkan membuka gadget selama masih berhubungan dengan tutorial.
 KATA PENGANTAR
Segala puji dan syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa, karena atas rahmat,
hidayah dan karunia-Nya penulis dapat menyelesaikan Laporan Tutorial Skenario C Blok XV
2019 dengan baik. Laporan ini bertujuan untuk memenuhi tugas tutorial yang merupakan bagian
dari sistem pembelajaran KBK di Fakultas Kedokteran Universitas Sriwijaya.
Atas segala kekurangan dan ketidaksempurnaan laporan ini, penulis sangat mengharapkan
masukan, kritik, dan saran yang bersifat membangun ke arah perbaikan dan penyempurnaan
laporan ini. Cukup banyak kesulitan yang penulis temui dalam penulisan laporan ini, tetapi
penulis menyeselesaikannya dengan cukup baik. Pada kesempatan ini penulis ingin
menyampaikan terima kasih kepada:
1. dr. Hasri Salwan, Sp.A(K) sebagai dosen di Fakultas Kedokteran Universitas Sriwijaya
dan sebagai tutor pada kelompok A6;
2. Seluruh mahasiswa kelas Alpha 2017 Fakultas Kedokteran Universitas Sriwijiaya.
Akhir kata penulis berharap semoga laporan ini dapat bermanfaat bagi semua pihak.
Tim penyusun

Kelompok A6
 DAFTAR ISI

KEGIATAN TUTORIAL ............................................................................................................... 2

KATA PENGANTAR ...................................................................................................................... 3
DAFTAR ISI..................................................................................................................................... 4
SKENARIO B Blok 15..................................................................................................................... 5
I. KLARIFIKASI ISTILAH .................................................................................................. ..... 6
II. IDENTIFIKASI MASALAH ...................................................................................................... ... 10
III. ANALISIS MASALAH ...................................................................................................... ..... 7
IV. KETERBATASAN ILMU PENGETAHUAN DAN LEARNING ISSUES ......................... Error! Bookmark not
V. SINTESIS MASALAH ....................................................................................................... Error! Bookmark not
VI. KERANGKA KONSEP ..................................................................................................... ... 48
VII. KESIMPULAN .................................................................................................................. ... 49
DAFTAR PUSTAKA....................................................................................................................
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 SKENARIO C Blok 15
Budi, a boy, 13 moth, 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 decresed. But two days before admission 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 rehydration 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 70/50 mmHg, RR 38x/m, HR
144x/m regular but weak, body temperature 38,90 C, 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 heart
sound.
Abdomen : flat, shuffle, bowel sound increases. Liver is palpable 1 cm below arcus costa and
xiphoid processus, speen 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 (+)
I. KLARIFIKASI ISTILAH
No. Istilah Pengertian
1. Diarrhea Pengeluaran tinja berair berkali-kali yang tidak normal.
(Dorland)
2. Non projectile vomiting Pengeluaran isi lambung melalui mulut tanpa disertai
semburan yang kuat. (Merriam Webster)
3. Defecation Pembuangan tinja dari rectum. (Dorland)
4. Bloody stool The presence of visible or clinically detectable
hemoglobin in faeces. Bright red blood in stool is
known as hematochezia. (Farlex)
5. Oral Rehydration Solution A liquid preparation developed by the WHO that
(ORS) candecrease fluid loss in persons with diarrhea. (Farlex)
6. Lethargy A lack of energy or a lack of interest in doing things ; a
lethargic feeling or state. (Merriam Webster)
7. Sunken Cekung.
8. Shuffle
9. Anal Orifice Lubang pada anus. (Dorland)
10. Entamoeba coli Parasit amebik non patogenik yang umum ditemukan di
dalam usus manusia dan mammalian lain. Terkadang
bingung untuk membedakannya dengan entamoeba
hystolitica penyebab disentri amebic. E. Coli agak
besar mempunyai banyak pseudophilia, pergerakannya
lambat. (Mosby’s Medical Dictionary)
Genus amoeba yang bersifat parasitic pada intestinum
vertebra yang ditemukan pada sluran intestinal.
(Dorland)
II. IDENTIFIKASI MASALAH
1. Budi, a boy, 13 month, was hospitalized due to diarrhea. 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. (VVV)
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 decresed. Along those 4 days, he drank eagerly and was given
ORS (oral rehydration solution). He also got mild fever.Two days before admission the
patient got bloody stool 12 times a day around quarter glass in every defecation. The
vomiting stopped. (VV)
3. Physical examination
Patient looks severely ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR
38x/m, HR 144x/m regular but weak, body temperature 38,90 C, 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
heart sound.
Abdomen : flat, shuffle, bowel sound increases. Liver is palpable 1 cm below arcus costa
and xiphoid processus, speen unpalpable. Pinch the skin of the abdomen : very slowly
(longer than 2 seconds). Redness skin surrounding anal orifice.
Extremities : cold hand and feet (V)
4. 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 (+) (V)
III. ANALISIS MASALAH
1. Budi, a boy, 13 month, was hospitalized due to diarrhea. 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. Bagaimana hubungan usia, jenis kelamin, dan tempat tinggal dengan keluhan yang
dialami oleh Budi ?
b. Bagaimana mekanisme diare ?
c. Mengapa jumlah urin lebih sedikit dibanding biasanya ?
d. Apa makna klinis dari keadaan memburuk, letargi, tidak mau minum dan diare tapi
tidak muntah ?
e. Berapa frekuensi dan volume normal BAB dan BAK pada Budi ?
f. Bagaimana struktur dan fungsi dari GIT pada anak ?

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 decresed. Along those 4 days, he drank eagerly and was given
ORS (oral rehydration solution). He also got mild fever.Two days before admission the
patient got bloody stool 12 times a day around quarter glass in every defecation. The
vomiting stopped.
a. Apa makna klinis muntah non projectile 8 kali sehari ?
b. Bagaimana mekanisme muntah pada kasus?
c. Apa makna klinis diare 8 kali sehari sebanyak setengah gelas setiap defekasi ?
d. Apa makna klinis tidak adanya darah dan pus pada feses ?
e. Mengapa diare berdarah sejak 2 hari yang lalu ?
f. Mengapa frekuensi BAB meningkat dan disertai darah ?
g. Mengapa frekuensi muntah menurun dan akhirnya berhenti ?
h. Apa komposisi dari ORS dan dosisnya ?
i. Apa makna dari demam ringan pada Budi ?
 j. Bagaimana tata laksana awal dari diare ?

3. Physical examination
Patient looks severely ill, compos mentis but weak (lethargic), BP 70/50 mmHg, RR
38x/m, HR 144x/m regular but weak, body temperature 38,90 C, 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
heart sound.
Abdomen : flat, shuffle, bowel sound increases. Liver is palpable 1 cm below arcus costa
and xiphoid processus, speen unpalpable. Pinch the skin of the abdomen : very slowly
(longer than 2 seconds). Redness skin surrounding anal orifice.
Extremities : cold hand and feet
a. Bagaimana interpretasi dari Pemeriksaan fisik ?
b. Bagaimana mekanisme abnormal dari pemeriksaan fisik ?
c. Bagaimana cara menilai derajat dehidrasi ?

4. 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 (+) (V)
a. Bagaimana interpretasi dari pemeriksaan laboratorium ?
b. Bagaimana mekanisme abnormal dari pemeriksaan laboratorium ?
c. Apa saja kemungkinan bakteri yang terdapat pada feses Budi ?
d. Apa saja pemeriksaan tambahan yang dapat dilakukan untuk menegakkan diagnosis
pada Budi ?

HIPOTESIS
Budi, 13 bulan, mengalami dehidrasi berat et causa shigella disentry.

Learning Issue

1. Disentri (shigella disentri) (Andrew, tata, yola, alya, anis, novira)

a. Definisi
b. Etiologi
c. Epidemiologi
d. Faktor risiko
e. Klasifikasi
f. Patogenesi
g. Patofisiologi
h. Maniestasi klinis
i. Diagnosis banding
j. Algoritma penegakan
k. Pemeriksaan penunjang
l. Komplikasi
m. Tatalaksana
n. Pencegahan dan edukasi
o. Prognosis
p. SKDI

2. Diare dan dehidrasi (Syifa, fernaldy, nurul, juno, riri, alifa)

a. Definisi
b. Etiologi
c. Epidemiologi
d. Faktor risiko
e. Klasifikasi
f. Patogenesi
g. Patofisiologi
h. Maniestasi klinis
i. Diagnosis banding
j. Algoritma penegakan
k. Pemeriksaan penunjang
l. Komplikasi
m. Tatalaksana
n. Pencegahan dan edukasi
o. Prognosis
p. SKDI
3. Anatomi Fisiologi GIT (Andrew, fernaldy, juno, riri)
4. Pemfis (syifa, yola, alya, novira)
5. Pemlab dan tambahan (tata, nurul, anis, alifa)