TUTORIAL REPORT OF SCENARIO A

BLOCK XI : DIGESTIVE SYSTEM

GROUP 8

Lecturer : dr. Iskandar Z A, DTM&H, M.Kes, Sp.ParK

Clarisa Lucia Valerina (702013076)

Nanik Wardani Muslikah (702016007)
Ahmad Nanda Maulana (702016014)
Muhammad Abidinsyah (702016020)
Ria Adiba (702016039)
Yanisah Afuah Defriva (702016070)
Erika Alviyanti (702016072)
Alifah Dimar Ramadhina (702016078)
M. Arif Qobidhurahmat (702016083)
Anita Febrianti (702016086)
Muhammad Rizky Febriyadi (702016085)

FACULTY OF MEDICINE
MUHAMMADIYAH PALEMBANG UNIVERSITY
2018
 CHAPTER II
DISCUSSION

2.1 Tutorial Data

Tutor : dr. Iskandar Z A, DTM&H, M.Kes, Sp.ParK
Moderator : M. Arif Qobidhurahmat
Desk Secretary : Ria Adiba
Bord Secretary : Muhammad Rizky Febriyadi
Time : Monday, March 19th 2018
(13.00 – 15.30 p.m)
Wednesday, March 21st 2018
(13.00 – 15.30 p.m)

The Rule of Tutorial : 1. Deactivate the phone or condition the phone in

silence.
2. Raise your hand when going to argument.
3. Get permission when going out of the room.
4. It is prohibited to bring food or eat in the room
during the discussion process is in progress.

2.2 Scenario A
“When Feces in Trouble”

Diwan, A 2 years old, is bought by his mother to puskesmas with chief

complaints of fluid defecating since 4 days ago. Frequency of defecation are 3-4
times a day, consistency of feces more liquid than pulp, as much as 1/4 cup,
yellowish color, nblood and mucus in the feces. He had experienced fever. He
also sufferes nausea and vomitting with frequency 1-2 times a day, as much as
1/4 cup, contain what his consumed, and not explusion. He began lethargic but
still want to drink. Last urinate was 4 hours ago.
Physical Examination :

General condition : moderate illness, weight 11 kg, height 84 kg

Vital signs : composmentis; PR : 140 times per minute, regular ; RR : 32 times

per minute ; temp : 36, 4°c

Specific condition :

Head : close forehead, sunken eyes, no tears, wet mouth mucous

Thorax : symmetrical, retraction : (-)

Cor : SI - SII normal, no heart noisy

Lung : vesicular, wheezing (-), ronki (-)

Abdomen : flat, increased bowel sounds, liver and lien are not palpable, decrease
turgor pressure

Extremitas : palms and soles are warm

Laboratory Examination :

Hb 12,6 g/dl, WBC 6.000/mm, differential count 0/1/2/45/48/4

Routine Examination of the Feces :

Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-), yellowish
color

Leukocyte Feces : 1-2/hpf, erythrocytes : 0-1/hpf, bacteria (-), hyfa (-)

2.3 Terms of Clarfication

No Clarifications Meaning
 11 Turgor condition become swallen or congesti
is high pitch white whistly sound made when
2 Wheezzing
you breath
a normal condition which there’s no
3 Wet mouth mucous
dehidration
The appearence of the person that have a
sign a hollowing under the eyes, dark
4 Sunken eyes
shadow over the lower eyelid, dark circles
underness be eyes
5 Palpable the act of feeling with the hand
bursts of gastric content that come out by
6 Vomiting
force through the mouth
State of tiredness wearingness fatigue or leck
7 Lethargic it can be compained by depretion decrease
motivation or apthy
8 feces Excretion that come out through the intestine

2.4 Problems Identification

1. Diwan, A 2 years old, is bought by his mother to puskesmas with chief
complaints of fluid defecating since 4 days ago. Frequency of defecation
are 3-4 times a day, consistency of feces more liquid than pulp, as much as
1/4 cup, yellowish color, no blood and mucus in the feces.
2. He had experienced fever. He also sufferes nausea and vomitting with
frequency 1-2 times a day, as much as 1/4 cup, contain what his
consumed, and not explusion. He began lethargic but still want to drink.
Last urinate was 4 hours ago.

3. Physical Examination :

General condition : moderate illness, weight 11 kg, height 84 kg

Vital signs : composmentis; PR : 140 times per minute, regular ; RR : 32

times per minute ; temp : 36, 4°c
 Specific condition :

Head : close forehead, sunken eyes, no tears, wet mouth mucous

Thorax : symmetrical, retraction : (-)

Cor : SI - SII normal, no heart noisy

Lung : vesicular, wheezing (-), ronki (-)

Abdomen : flat, increased bowel sounds, liver and lien are not palpable,
decrease turgor pressure

Extremitas : palms and soles are warm.

4. Laboratory Examination :

Hb 12,6 g/dl, WBC 6.000/mm, differential count 0/1/2/45/48/4

5. Routine Examination of the Feces :

Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-),
yellowish color

Leukocyte Feces : 1-2/hpf, erythrocytes : 0-1/hpf, bacteria (-), hyfa (-)

2.5 Priority Issue

Number 1.

2.6 Problems Analysis

1. Diwan, A 2 years old, is bought by his mother to puskesmas with chief
complaints of fluid defecating since 4 days ago. Frequency of defecation are 3-
4 times a day, consistency of feces more liquid than pulp, as much as
1/4 cup, yellowish color, nblood and mucus in the feces.
a. How is the anatomy, physiology, histology in this case?
b. what is the etiology of the case?
c. how is the phatophysiology?
 d. what is classification of diarrhae?
e. What is the meaning of fluid defecation are 3-4 times a day, consistency
of feces more liquid than pulp, as much as 1/4 cup, yellowish color, no
blood and mucus in the feces?

2. He had experienced fever. He also sufferes nausea and vomitting with

frequency 1-2 times a day, as much as 1/4 cup, contain what his consumed, and
not explusion. He began lethargic but still want to drink. Last urinate was 4
hours ago.

a. what is the meaning of the experienced fever?

b. What is the patophysiology of fever, nausea, vomiting?
c. What is the meaning from nausea and vomiting with frequency 1-2
times a day, as much as 1/4 cup, contain what his consumed, and not
expulsion?
d. what is the meaning of began lethergic but still want to drink?
e. What is the classification dehidration?
f. What is the meaning of last urinate was 4 hours ago?

3. Physical Examination :

General condition : moderate illness, weight 11 kg, height 84 kg

Vital signs : compos mentis; PR : 140 times per minute, regular ; RR : 32 times
per minute ; temp : 36, 4°c

Specific condition :

Head : close forehead, sunken eyes, no tears, wet mouth mucous

Thorax : symmetrical, retraction : (-)

Cor : SI - SII normal, no heart noisy

Lung : vesicular, wheezing (-), ronki (-)

 Abdomen : flat, increased bowel sounds, liver and lien are not palpable,
decrease turgor pressure

Extremitas : palms and soles are warm.

a. What is the interpretation of physical examination?

b. What is the abnormal mechanism abnormal physical examination?

4. Laboratory Examination :

Hb 12,6 g/dl, WBC 6.000/mm, differential count 0/1/2/45/48/4

a. What is the interpretation of laboratory examination?

b. What is the abnormal mechanism abnormal laboratory examination?

5. Routine Examination of the Feces :

Macroscopic : more liquid than pulp, blood (-), pus (-), mucous (-), yellowish
color

Leukocyte Feces : 1-2/hpf, erythrocytes : 0-1/hpf, bacteria (-), hyfa (-)

a. What is the interpretation of routine examination?

b. What is the abnormal mechanism abnormal routine examination?

6. How to diagnose?
7. What are the differential diagnostic in this case?
8. What are the supporting examination to diagnose in this case?
9. What is the complication?
10. How the prognostic in this case?
11. What is the general practitioner’s competence in this case?
12. What is islamic view in this case?
2.6 Hyphotesis

2.7 Framework