CASL kLCk1 SLSSICN

Aeur warery dIarbea wIrb mlld dehydraLlon

ec lnfecLlon wIrb PKTB
presenred by
SueI NurannIsa Yusut
AdvIser : dr. AnIk DwIanI, Sp. A
A1ILN1 IDLN1I1
Fu|| Name :An. X
8ex : fema|e
P|ace and date of b|rth: antu|, 10 August 2009
Futher's nume : Mr, S Age: 31 yeurs
Futher's occupution : entepreneur
Futher's educution : Senior High SchooI
Mother's nume : Mrs, N Age : Z yeurs
Mother's gob : House wife
Mother's educuton : SMEA
Addres : untuI
Admittion time : ZZ August Z011 9,30 um
Entrunce diugnose : ucut wutery diurrheu with miId
dehydrution
FRST DAY
MAJOR COMPLAINT : FEVER, WATERY DIARRHEA
AND VOMIT
ADDITIONAL COMPLAINT : COUGH AND COLD
Present Case History :
chiId came from IGD with major compIaint of fever (2 days), diarrhea 4x in
3 hour, vomiting 3x. There's no mucus and bIoody feces. And then coId
and cough more than 2 weeks.
FamiIy case history :
Mother : -
Father : -
ConcIusion: there is no history of famiIy iIIness reIated to the patient.
amlly hlsLory

60 thn

50 thn


55 thn

57 thn

38 thn

31 thn

26 thn

22 thn

18 thn
2Lhn 2 bln
LkSCNAL nIS1Ck
1 Case h|story of pregnancy and b|rth
Antenata| Care (ANC)
Dur|ng th|s pregnancy the mother got antenata| care |n the r|mary nea|th
Care often w|th m|dw|fe A|ways got v|tam|n and good nutr|t|on n|story of
|||ness before pregnancy |s den|ed n|story of |||ness dur|ng pregnancy |s no
|||ness
Conc|us|on the ANC was good
Nata| Care
8aby born from 24 years o|d mother G10A0 38 weeks day gestat|ona| age
b|rth w|egt 3000 gr Spontaneous on 10 august 2011
Appropr|ate 8|rth We|ght]aterm]Appropr|ate for Gestat|ona| Age
ost Nata| Care
Mother gave baby exc|us|ve breast feed|ng
2 Iood n|story
ua||ty enough
uant|ty enough
3 Deve|opment and c|everness
Gross motor|c musc|e tone (+)
I|ne motor|c good
Speak (+)
Soc|a| (+)
4 Vacc|nat|on
lmmunlzaLlon was done ln approprlaLe age and compleLe
accordlng Lo Lhe PealLh ueparLmenL 8l l
3 n|story prev|ous case
coughs and colds for a long Llme
6 Soc|a| econom|c and ne|ghbourhood
aLhers lncome ls sLable SLay aL home conslsLs of 3 persons Cood relaLlons
wlLh nelghbors Around Lhe nelghborhood Lhere aren'L sufferlng from
dlarrhea
Conc|uss|on soc|a| and env|ronment was good econom|c cond|t|on
wasn't good enough
n|story tak|ng (Anamnes|s) system
Cerebrosp|na| system febr|s (+) convu|s|on ()
Card|vascu|ar system s|anos|s () pa|p|tat|on ()
kesp|ratory system cough (+) co|d (+) wheezh|ng ()
dyspnea ()
Gastro|ntest|ne system ora| cand|d|as|s () vom|t (+)
d|arrhea (+) watery no mucus no b|oody
Urogen|ta|e system prob|em |n ur|nate defecat|on ()
Muscu|osce|eta| system extrem|ty norma| act|ve
Integumentum system |cter|c () rash ()
Conc|us|on the ch||d suffer|ng d|arrhea
nSICAL LkAMINA1ICN
GLNLkAL ALAkANCL (|n IGD) f|rst day
Age 2 years 2 mount
VI1AL SIGN
u|se ] nk 140 x]m|nutes
1emperature 38 C
8reath 2S x]m|nutes
AN1nkCCML1k
We|ght 89 kg
Age 2 years 2 mount
Nutr|t|on status we|gh]age ma|nutr|t|on 2 Su 3Su
Sk|n s|anos|s () turgor good rash ()
Lymph node cerv|ca||s outgrow (+) dextra chewy s|ng|e mob||e
ax||ar|s outgrow() |ngu|na| outgrow ()
Musc|e eutrof|
8one deform|ty ()
Io|nt deform|ty () swo||en () free movement
SLCIAL LkAMINA1ICN
nead fontane|a c|ose (+)
Lye secret ] con[ungt|va anem|c ] sc|era |cter|c ]
Nose secret +]+ hyperem| mucosa ]
Lar serumen +]+ |nf|amat|on ]
Mouth red ||ps d|rty tounge fung|
har|ng hyperem| eksudat
1ooth +
Neck papab|e |ymph node dextra st|ff neck
1nCkAk
CCk
neart sound heart's sound I norma| heart sound II norma| regu|ar
Conc|us|on heart sound norma|
ULMC Dextra S|n|stra
Inspect|on symetr|c retract|on () |eft movement ()
a|pat|on |eft movement ()
ercuss|on sonor
Auscu|tat|on ves|cu|ar (norma|)
A8DCMLN
Inspect|on d|stent|on () mass ()
Auscu|tat|on per|sta|t|k (++)
ercuss|on t|mpan| (+)
a|pat|on unpapab|e hepar unpapab|e ||en unpapab|e mass
Lxtrem|ty warm free movement
1onus eutrof|
ato|ogyc ref|ect 8ab|nsk| () Cppenhe|m () Caddock ()
Men|ngea| S|gn 8rudz|nk| I () 8rudz|nk| II () Neck st|ffness ()
LA8CkA1CkIUM CCMLL1L 8LCCD 1LS1
IIkS1 DA
nb 123 gr 1216
AL 13 r|bu]u| 912
AL 48 [uta]u| 40S0
A1 468 r|bu]u| 1S04S0
nmt 3S2 3646
Los|nof|| 0 24
8asof|| 0 01
8atang 0 2S
Segmen 81 S16
L|mfos|t 1S 203S
Monos|t 4 48
Natr|um 1326 mmo|]L 13S148
ka||um 3S8 mmo|]L 3SS3
k|or|da 10S mmo|]L 9810
Ck 21 mg]L 6 was done |n second days |n
hosp|ta|
A Lhoraclc radlograph of chlldren
Looks perlhller lnfllLraLes and hllar
compacLlon dexLra
lmpresslon k18
kontgen 1horax was done |n the 3th day |n hosp|ta|
D|fferent|a| D|agnose
acut watery d|arrhea w|th m||d dehydrat|on ec |nfeks| entera|
acut watery d|arrhea w|th m||d dehydrat|on ec |nfeks|
parentera|
Work|ng D|agnose acut watery d|arrhea w|th m||d dehydrat|on ec |nfeks|
parentera|
k18 from rontgen
ma|nutr|t|on
|an therapy
lnfus kALn 38 3 Lpm
ln[ Amplsllln 3x230 mg
ln[ CefoLaxlm 3x230
romuba slrup 3x11/3 cLh (3x133mg)
Sanmol slrup cLh (90 mg) kp
Lblo 2x1 sacheL
vomeLa LableL 3 mg kp
uleL 3 x bubur/nasl
Susu 3
Lducat|ona| |an
1ake care of hyglene washlng hands before eaLlng
Wlpe uslng soap
drlnklng clean waLer and cooklng waLer bolllng
eaL a healLhy and safeLy food
Suggest|on for Laboratory exam|nat|on
sLool examlnaLlon
Cerm culLure Lo search for Lhe germs LhaL cause
dlarrhea
Mlcroscopls look for leukocyLes
Scorlng LxamlnaLlon Lo dlagnose 18
ACU1 WA1Lk DIAkknLA
D|arrhea an |ncrease |n the number of stoo|s per day
and]or an |ncrease |n the|r |ooseness |s a common prob|em
that genera||y |asts on|y a few days D|arrhea that has |asted
for |ess than one week |s ca||ed "acute"
1he most common causes of acute d|arrhea are
V|ruses bacter|a and paras|tes
Iood po|son|ng
Med|cat|ons espec|a||y ant|b|ot|cs
Iood a||erg|es
Lnzyme def|c|enc|es (as |n |actose |nto|erance)
1ox|c substances
akLor reslko Ler[adlnya dlare anLara laln
1ldak memberlkan ASl secara penuh unLuk 46 bulan perLama
kehldupan
Menggunakan alr mlnum yang Lercemar oleh bakLerl yang berasal
darl Lln[a
1ldak mencucl Langan sesudah buang alr besar sesudah membuang
Lln[a aLau sebelum memasak makanan
k|as|f|kas|
ulare secara garls besar dlbagl aLas radang dan non radang ulare
radang dlbagl lagl aLas lnfeksl dan non lnfeksl
Lt|o|og|
LLlologl dlare dapaL dlbagl dalam beberapa fakLor yalLu
akLor lnfeksl
1) lnfeksl enLeral
lnfeksl bakLerl vlbrlo Lcoll Salmonella Shlgella campylobacLer
?erslnla Aeromonas dan sebagalnya
lnfeksl vlrus LnLerovlrus 8oLavlrus Adenovlrus AsLrovlrus dan lalnlaln
lnfeksl paraslL caclng (ascarls Lrlclurlsdll) proLozoa dan [amur
2) lnfeksl parenLeral yalLu lneksl dlbaglan Lubuh laln dlluar alaL
pencernaan seperLl CMA LonsllofarlnglLls bronkopneumonla
ensefallLls dan sebagalnya
akLor malabsorbsl (malabsorbsl karbohldraL malabsorbsl lemak
malabsorbsl proLeln)
akLor makanan makanan basl beracun dan alergl Lerhadap makanan
akLor pslkologls rasa LakuL dan cemas
paLogenesls
A1CIISICLCGI
8akLerl mengaklbaLkan dlare melalul beberapa mekanlsme
yang berbeda 8akLerl non lnvaslve (vlbrlo cholera Lcoll
paLogen) masuk dan dapaL melekaL pada usus berkembang
balk dlslLu dan kemudlan akan mengeluarkan enzlm
muclnase (mencalrkan laplsan lendlr) kemudlan bakLerl akan
masuk ke membran dan mengeluarkan sub unlL A dan 8 lalu
mengeluarkan cAM yang akan merangsang sekresl calran
usus dan menghambaL absorpsl Lanpa menlmbulkan
kerusakan sel eplLel 1ekanan usus akan menlngkaL dlndlng
usus Leregang kemudlan Ler[adllah dlare
Mu|amu|a anak men[ad| cengeng ge||sah
suhu badan mungk|n men|ngkat nafsu makan
berkurang atau t|dak ada kemud|an t|mbu|
d|are
Ge[a|a k||n|s
Deh|dras|
kaLegorl
1anda dan ge[ala
uehldrasl 8eraL
uua aLau leblh Landa berlkuL
LeLargl aLau penurunan kesadaran
MaLa cowong
1ldak blsa mlnum aLau malas mlnum
CublLan peruL kemball dengan sangaL lambaL ( 2 deLlk)
uehldrasl 1ak 8eraL
uua aLau leblh Landa berlkuL
Cellsah
MaLa Cowong
kehausan aLau sangaL haus
CublLan kullL peruL kemball dengan lambaL
1anpa uehldrasl
1ldak ada Landa ge[ala yang cukup unLuk mengelompokkan dalam dehldrasl
beraL aLau Lldak beraL
penaLalaksanaan
lnfus kALn 38 3 Lpm
ln[ Amplsllln 3x230 mg
ln[ CefoLaxlm 3x230
ln[ meLronldazol 3x130 mg
romuba slrup 3x11/3 cLh (3x133mg)
Sanmol slrup cLh (90 mg) kp
Lblo 2x1 sacheL
vomeLa LableL 3 mg kp
uleL 3 x bubur/nasl
Susu 3
1uberkulosls paru pada anak
18 aru adalah suaLu penyaklL lnfeksl yang dapaL mengenal
paruparu manusla dlsebabkan oleh Mycoboctetlom
tobetcolosls dan bukan merupakan penyaklL keLurunan
8asll 18 akan menyebar dengan cepaL melalul salur geLah
benlng menu[u kelen[ar reglonel yang kemudlan akan
mengadakan reaksl eksudasl ocus prlmer llmfanglLls dan
kelen[ar geLah benlng reglonal
yang akan membesar membenLuk kompleks prlmer
kompleks prlmer Ler[adl 210 mlnggu (68 mlnggu) pasca
lnfeksl
ALnAMDULILLAn
1PAnk ?Cu