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    PBL Tutor - (Student) Guide

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    A 24-year-old female student presented with chronic diarrhea for 1 month, with 3-4 loose and sometimes bloody stools daily. She reported decreased appetite and weight loss of 8 kg. On examination, increased bowel sounds and tenderness in the left lower abdomen were found. She was advised to undergo blood tests and stool examination to evaluate for the cause of her chronic diarrhea.

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    PBL Tutor - (Student) Guide

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    94 views6 pages
    A 24-year-old female student presented with chronic diarrhea for 1 month, with 3-4 loose and sometimes bloody stools daily. She reported decreased appetite and weight loss of 8 kg. On examination, increased bowel sounds and tenderness in the left lower abdomen were found. She was advised to undergo blood tests and stool examination to evaluate for the cause of her chronic diarrhea.

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    A 24-year-old female student presented with chronic diarrhea for 1 month, with 3-4 loose and sometimes bloody stools daily. She reported decreased appetite and weight loss of 8 kg. On examination, increased bowel sounds and tenderness in the left lower abdomen were found. She was advised to undergo blood tests and stool examination to evaluate for the cause of her chronic diarrhea.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    94 views6 pages

    PBL Tutor - (Student) Guide

    Uploaded by

    dellangela
    A 24-year-old female student presented with chronic diarrhea for 1 month, with 3-4 loose and sometimes bloody stools daily. She reported decreased appetite and weight loss of 8 kg. On examination, increased bowel sounds and tenderness in the left lower abdomen were found. She was advised to undergo blood tests and stool examination to evaluate for the cause of her chronic diarrhea.

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    of 6

    KASUS 2

    Tema : nyeri perut kanan bawah

    Seorang gadis berusia 19 tahun datang ke ugd rsud kanjuruhan dengan keluhan
    nyeri perut. Nyeri perut dirasakan sejak kemarin pagi . awalnya nyeri dirasakan di ulu
    hati, dan kini nyeri terutama dirasakan di bagian perut kanan bawah. keluhan lain
    terkait keluhan utama penderita juga merasakan mual sampai muntah , perut terasa
    kembung, melilit, dan seperti ditusuk-tusuk sejak 6 jam yang lalu, dan kehilangan
    nafsu makan, sehingga hanya makan bubur 1-2 sendok saja dan minum sedikit air
    putih. Pasien mengeluhkan sedikit demam , sejak kemarin sulit buang air besar,
    sedangkan buang air kecil tidak ada kelainan. kondisi yang memperburuk keluhan
    bila ia bergerak, pasien harus menekuk perutnya supaya nyerinya berkurang .
    pasien merasakan penyakitnya nyeri sangat parah dan seperti mau mati
    T : 90/60 mmhg, n : 110x/m, rr 20x/m , t : 37,9 c , nyeri tekan perut kanan bawah + ,
    RT ; nyeri jam 11

    Lab : L : 12.000 u/ml , hb 11 gr/dl , Tr : 230.000 u/ml


    Riwayat penyakit dahulu :
    - Penyakit kronis : -
    - Riwayat pengobatan penyakit dahulu : -
    - Riwayat penyakit keluarga : -
    - Riwayat menstruasi : HPHT 2 minggu yang lalu
    Riwayat kebiasaan :
    - diet suka makan makanan pedas dan jarang mengkonsumsi sayuran
    - sering mengalami susah buang air besar

    Modul PBL GASTRO For Student TA 2017/2018 Page 13


    Kepustakaan :

    Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW. Clinical
    policy: Critical issues in the evaluation and management of emergency department
    patients with suspected appendicitis. Ann Emerg Med. 2010 Jan. 55(1):71-116.
    [Medline].

    [Guideline] National Guideline Clearinghouse (NGC). Guideline summary: Clinical


    policy: critical issues in the evaluation and management of emergency department
    patients with suspected appendicitis. National Guideline Clearinghouse (NGC),
    Rockville (MD). Available at http://guideline.gov/content.aspx?id=15598. Accessed:
    November 18, 2013.

    Repplinger MD, Levy JF, Peethumnongsin E, et al. Systematic review and meta-
    analysis of the accuracy of MRI to diagnose appendicitis in the general population. J
    Magn Reson Imaging. 2015 Dec 22. [Medline].

    Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs Appendectomy for


    Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical
    Trial. JAMA. 2015 Jun 16. 313 (23):2340-8. [Medline].

    Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in
    appendicitis. J Am Coll Surg. 2006 Mar. 202(3):401-6. [Medline].

    Fair BA, Kubasiak JC, Janssen I, et al. The impact of operative timing on outcomes
    of appendicitis: a National Surgical Quality Improvement Project analysis. Am J Surg.
    2015 Mar. 209 (3):498-502. [Medline].

    [Guideline] Korndorffer JR Jr, Fellinger E, Reed W. SAGES guideline for


    laparoscopic appendectomy. Surg Endosc. 2010 Apr. 24(4):757-61. [Medline]. [Full
    Text].

    Le J, Kurian J, Cohen HW, Weinberg G, Scheinfeld MH. Do clinical outcomes suffer


    during transition to an ultrasound-first paradigm for the evaluation of acute
    appendicitis in children?. AJR Am J Roentgenol. 2013 Dec. 201(6):1348-52.
    [Medline].

    Modul PBL GASTRO For Student TA 2017/2018 Page 14


    Yeh B. Evidence-based emergency medicine/rational clinical examination abstract.
    Does this adult patient have appendicitis?. Ann Emerg Med. 2008 Sep. 52(3):301-3.
    [Medline].

    Kasus 3.
    Tema :Nyeri Perut Kanan Atas

    Skenario Klinik :

    Seorang laki laki usia 47 tahun datang ke poliklinik penyakit dalam RSSA dengan
    keluhan nyeri perut kanan atas. Nyeri perut dirasakan sejak 1 minggu sebelumnya
    disertai demam tinggi dan mual muntah. Sebulan sebelumnya pasien juga mengeluh
    BAB cair kental dengan frekuensi 3-4 kali/hari dan penurunan nafsu makan. Pasien
    juga sering mengeluh demam hilang timbul namun membaik dengan minum
    parasetamol. Pasien adalah petani yang selama ini masih aktif bekerja hingga 1
    minggu terakhir disaat perut terasa semakin nyeri.
    Dari pemeriksaan fisik didapatkan keadaan umum lemah dengan tekanan darah
    130/80 mmHg, nadi 96 x/menit, frekuensi nafas 24 x/menit, suhu aksilar 39 derajat
    Celcius. Pada pemeriksaan abdomen didapatkan hepatomegali dengan liver span 16
    cm dengan nyeri tekan pada perabaan liver. Pasien telah membawa pemeriksaan
    laboratorium dari puskesmas yang merujuknya dengan hasil Hb=10,2 g/dL, Leukosit
    = 22.300/mm3, trombosit= 459.000/mm3. Selain itu pasien juga membawa hasil
    USG abdomen dari internis yang menunjukkan gambaran massa lobus kanan hepar
    curiga abses hepar.

    Modul PBL GASTRO For Student TA 2017/2018 Page 15


    DAFTAR PUSTAKA

    1. Brailita Daniel. Amebic Hepatic Abscess. Available at


    http://emedicine.medscape.com/article/183920-overview#showall : July 13rd,
    2012.
    2. Perlata Ruben. Liver Abscess. Available at
    http://emedicine.medscape.com/article/188802-overview#showall : July 13rd,
    2012.
    3. Todd A N.Pyogenic Hepatic Abscess. Available at
    http://emedicine.medscape.com/article/193182-overview#showall : July 13rd,
    2012.
    4. Wenas NT, Waleleng BJ (2010) Abses Hati Piogenik. Buku Ajar Ilmu
    Penyakit Dalam, Cetakan Kedua, Interna Publishing, Jakarta, hal. 692-694
    5. Fauci, Braunwald, Kasper, Hauser. Intraabdominal infection and abscess.
    Harrison principle of internal medicine. 17th edition. USA: The Mc Graw Hill
    Company; 2008. Chapter 121.
    6. Haque R, Mollah NU, Ali IK, et all. Diagnosis of amebic liver abscess and
    intestinal infection with the techlab Entamoeba Histolytica II antigen
    detections and antibody test .Journal of Clinical Microbiology. 2000. hal 3235-
    3239
    7. Ayles HM and Cock KD (2004). Hepatic abscess and cysts. In: Handbook of
    liver disease. Friedman LS, Keeffe EB eds.Second edition. Elsevier
    Inc.Philadelphia, pp 349-364
    8. Chung Y F A, Tan Y M, Lui H F, Tay K H, Lo R H G, Kurup A, Tan B H
    (2007). Management of pyogenic liver abscesses – percutaneous or open
    drainage? Singapore Med J 48, 115
    9. Davis J, Mc Donald M (2008). Pyogenic liver abscess. Available at Uptodate
    Desktop 16.1: January 2008
    10. Haque R, Huston CD, Hughes M, Houpt E, Petri Jr.WA (2003).Amebiasis. N
    Engl J Med 348,1565-73
    11. Hughes MA, Petri WA (2000). Amebic liver abscess, Infectious Disease
    Clinics of North America 14 . 92-106
    12. Neuschwander-Tetri BA (2007).Bacterial, parasitic, fungal, and
    granulomatous liver disese. In:Cecil Medicine. Goldman L, Ausiello D eds.
    23rd Edition .Saunders Elsevier. Philadelphia. Available at CD ROM
    13. Sherlock S, Dooley J (2002). The liver in infections. In: Diseases of the liver
    and biliary system. Sherlock S, Dooley J eds. Eleventh Edition. Milan.
    Blackwell Publishing, pp 495-526

    Modul PBL GASTRO For Student TA 2017/2018 Page 16


    Kasus 4.
    Tema : Diare Kronik

    Skenario Klinik

    Seorang wanita usia 24 tahun datang ke poliklinik umum dengan keluhan perut mules
    disertai BAB mencret sejak 1 bulan yang lalu dengan konsistensi feces cair campur len
    dir dan kadang disertai darah. Frekuensi BAB sekitar 3-4 kali per hari sekitar setengah
    gelas setiap kali BAB. Pasien juga mengeluh adanya penurunan nafsu makan dan mua
    l. Dalam 1 bulan ini pasien mengalami penurunan BB hingga 8 kg. Pasien adalah maha
    siswa di sebuah PTN dan sedang mengerjakan tugas akhir. Pada pemeriksaan fisik did
    apatkan peningkatan bising usus dan nyeri tekan pada abdomen kiri bawah.Pasien dis
    arankan untuk dilakukan pemeriksaan laboratorium darah lengkap dan feses lengkap.

    Referensi
    1. Juckett G, Trivedi R. Evaluation of chronic diarrhea. Am Fam Phys.
    2011;84(10):1119-26.
    2. Thielman NM, Guerran RL. Acute infectious diarrhea. N Eng J Med.
    2004;350:38.
    3. American Gastroenterological Association Medical Position Statement:
    Guidelines for the evaluation and management of chronic diarrhea.
    Gastroenterol. 1999;116:1461.
    4. Bonis PAL, LaMont JT, Rutgeerts P. Approach to the patient with chronic
    diarrhea. Uptodate; 2009 [disitasi 10 Juni 2012]. Available online:
    http://www.uptodate.com.
    5. Fenollar F. Chronic diarrhea. In: Cohen J, Opal SM, Powderly WG, eds.
    Cohen & Powderly: infectious diseases. 3rd edition. London: Mosby
    Elvesier; 2010. p. 389-99.
    6. Fan X, Sellin JH. Review article: small intestinal bacterial overgrowth, bile
    acid malabsorption and gluten intolerance as possible causes of chronic
    watery diarrhoea. Aliment Pharmacol Ther. 2009;29:1069–77.
    7. Schiller LR, Sellin JH. Diarrhea. In: Feldman M, Friedman LS, Brandt LJ,
    edis. Feldman: Sleisenger and Fordtran’s gastrointestinal and liver
    disease. 9th edition. Philadelphia: Saunders Elvesier; 2010. p. 211-32.

    Modul PBL GASTRO For Student TA 2017/2018 Page 17


    8. Simadibrata M. Pendekatan dan penatalaksanaan diare kronis. In: Rani A,
    Simadibrata M, Syam AF, eds. Buku ajar gastroenterologi. 1st edition.
    Jakarta: Pusat Penerbitan Ilmu Penyakit Dalam; 2011. p. 188-92.
    9. Kementerian Kesehatan RI. Situasi diare di Indonesia. Jakarta:
    Kementerian Kesehatan RI; 2011.
    10. Thomas PD, Forbes A, Green J, Howdle P, et al. Guidelines for the
    investigation of chronic diarrhea. Gut. 2003;52:1-5.
    11. Abdullah M. Kanker kolon. In: Rani A, Simadibrata M, Syam AF, eds. Buku
    ajar gastroenterologi. 1st edition. Jakarta: Pusat Penerbitan Ilmu Penyakit
    Dalam; 2011. p. 460-74.
    12. Quigley EMM, Shanab AA. Small intestinal bacterial overgrowth. Infect Dis
    Clin N Am. 2010:24:943-59.
    13. Ros E, Zambon D. Postcholecystectomy symptoms. A prospective
    study of gall stone patients before and two years after surgery. Gut.
    1987;28:1500–4.
    14. Valdovinos MA, Camilleri M, Zimmerman BR. Chronic diarrhea in
    diabetes mellitus: mechanisms and an approach to diagnosis and
    treatment [abstrak]. Mayo Clin Proc. 1993;68(7):691-702.
    15. Persson J. Alcohol and the small intestine [abstrak]. Scand J
    Gastroenterol. 1991;26:3–15.

    Modul PBL GASTRO For Student TA 2017/2018 Page 18

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