Ppt Case Misun

7/26/2019 Ppt Case Misun

1/61

Department of Pediatric

Dr. Mohammad Hoesin General Hospital

Sriwijaya University Faculty of Medicine

2!"

Case Presentation

Presented by:

Mentari Indah Sari

Erniyanti Puspita Sari

Advisor:Dr. Achirul Bakri, SpA!"


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I. INTRODUCTION

#


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# Diarrhoea remains one of the major causes of mor$idityand mortality of children in developin% countries .

# Most of acute diarrhea caused $y infection. Many of theimpacts that occur due to infection of the %astrointestinaltract includin% to&in that can cause impaired secretion andrea$sorption of 'uid and electrolyte due to dehydration(electrolyte $alance disorders and acid#$ase $alancedisorder. )he invasion and destruction of epithelial cells (

penetrate into the lamina propria and dama%e the microvillimay constitute a maldi%est and mala$sorption .

# )o carry out the treatment of diarrhea in a comprehensive (e*cient and e+ective way( it must $e done rationally. )heuse of oral rehydration solutions are %enerally e+ective in

correctin% dehydration. ,ntravenous 'uid administration isneeded if there is a failure $ecause of the hi%h fre-uency ofdiarrhea( uncontrolla$le vomitin% and oral input todisruption due to infection. Some ways of prevention $yvaccination and the use of pro$iotics has $een widelydisclosed and treatment with specic anti$iotics and

antiparasitic.


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II. PATIENT STATUS

$


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,D/0),F,1),30

0ame 4 0%e 5 6irth date 4 !! months5 March( !7th2!7Se& 4 Female8ei%ht 4 9 :%Hei%ht 4 "; cmenten ?aut )l.

>elapa


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0M0/S,S

Blloanamnesis4 patientCs mother( !! March 2!7(!".

1hief 1omplain 4 8atery stoolSecondary 1omplain 4 Eomit and fever


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History


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)here was no previous illness with similar symptoms)here was no aler%ic history of mil:( food( and dru%s

History in familial illness with the same complaintin the family denied


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Pre%nant duration 4 term

Parturition 4 SpontaneousHelped $y 4 MidwifeDate 4 March( !7th2!"6irth wei%ht 4 2A %ram6irth len%th 4 A cm6irth condition 4 spontaneous cryin%

BirthHistor

y


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Feeding History6reast mil: 4 #" months

Formula mil: 4 " months# present


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?yin% down on stomach 4 @ monthsSittin% 4 " monthsStandin% 4 ! months8al:in% 4!! months

)al:in% Bmama papa 4 ; months


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1onclusion4 6asic immuni=ation complete

,mmuni=ation

B#si$ I""%nition

! 6ln @ $ln ; $ln

BCG J

DPT ( J DP) 2 J DP) @ J

HEPATITIS B(

J H/P),),S62

J H/P),),S6@

J

Hi) ( J Hi$ 2 J Hi$ @ J

PO*IO ( J P3?,3 2 J P3?,3 @ J

+e#ses J


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Physical /&aminationB!! March 2!"

General condition4 mild illness 1onsciousness 4 1ompos Mentis

/dema B# 5#( sianosis B#5#(dyspnue B#5#( anemia

B#5#( icteric B# 5#(dismorc B#5#

)emp 4 @9 31


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8ei%ht 4 9 >%?en%th 4 "; cm

8ei%ht5%e 4 SD #2 SD?en%th5%e 4 SD #2 SD8ei%ht5?en%th 4 #! SD #2 SD

1onclusion 4 0ormowei%ht

N%trition St#te


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Specic /&amination

Shape 4 0ormocephaly( symmetrical(dysmorphic B#

Hair 4 6lac:( strai%ht( not easilypulled o+

/yes 4 Sun:en eyes B5( tears B(pupils4 round( isocoric( L @mm(li%ht re'e&es 5( paleconjunctiva B#( icteric sclera B#0ose 4 Secretion B#( nasal 'arin% B#./ars 4 Secretion B#.

Mouth 4 Dry oral mucosa and lipsB(cyanosis B#

)hroat 4 Hyperemic pharyn& B#( )onsil)!#)!Ne$, 4 ?ymph node enlar%ement B#

He#d


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, 4 Static5dynamic4 symmetrical( retraction#5#P 4 Stem fremitus left ri%htP 4 Sonorous in $oth hemithora& 4 0ormal vesicular sound( rhonchi B#(whee=in% B#.

P%"o

, 4 ,ctus cordis not visi$le

P 4 0o palpa$le thrillP 4 0ormal heart line 4 H< !!A $pm( re%ular rhythm( heartsound ,#,, normal( additional sounds B#

He#rt


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, 4 Stomach raised 4 ,ncreased $owel sound BA &5minP 4 Supple( liver and spleen not palpa$le(s:in tur%or decreased BN2O( tenderness B#P 4 )ympanic( shiftin% dullness B#

A)do"en

,n%uinal 4 ?ar%e lymphnode B#(eritema perianal B#( prolaps ani B#

/&tremity 4 cold acral B#( cyanosis B#( edema

B#

Genitalia 4 0ormal.

0eurolo%ic e&amination is normal


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cute diarrhoea e.c susp. Eiral infection with mild moderatedehydration Failure of oral rehydration

cute diarrhoea e.c susp. 6acterial infection with mild moderatedehydration Failure of oral rehydration


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cute diarrhoea e.c susp.


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)herapy

dditional /&amination?a$oratory of 6lood analysis and electrolit

?a$oratory of Faeces analysis

)herapy B Supportive Simptomatic#1ausative0on Pharmacolo%ist

,nform patientCs condition

/ducate oralit usa%e


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)herapy

Pharmacolo%ist% ,EFD


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Pro%nosis

6onam

6onam


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FO**O-UP


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& 6lood analysis B /mer%ency Unit !!#@#2!" on !74"

& H$ 4 !!(A %5dl B!!(!#!( %5dl

& Ht 4 @7 volR B@7#! volR

& /ritrosit 4 ("" &! mm@5jam B@(9!#(27 &! mm@5jam

& ?eu:osit 4 ;.A5mm@ B".#!9.7 5mm@

& )rom$osit 4 2;.5mm@ B2!9.#;9.5mm@

& Hitun% jenis 4 5!5@;5A5!2 B#!5!#"57#952#52#Amm@

& ?/D 4 !"mm5jam BN2 mm5jam

Tanggal Keterangan !@#@# S >eluhan 4 66 cair B 2&( darah B#(


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!2#@#2!"

S >eluhan 4 66 cair B @&( cair ampas( darah B#( lendir B#( muntah Btiap ha$is ma:an( isi apa yan%dima:an $anya:nya T %elas$elim$in%( demam B#.O Sense 4 1M; 0 4 !A&5menit ulit 4 tur%or normal

>epala 4 UU6 ce:un% B#( matace:un% B#( air mata 5( mu:osa$i$ir :erin% B#

)hora:s 4 simetris( retra:si B#Pulmo 4 vesi:uler B normal(ron:hi B#(

whee=in% B#1or 4 H< !A&5menit( 6 ,dan ,,

normal( murmur B#(%allop B#$domen $domen 4 datar(lemas( 6U B menin%:at( hepar5lientida: tera$a( cu$itan :ulit perut:em$ali cepat/:stremitas 4 a:ral din%intida: ada( 1onsistensi4 ?em$e:moe$a4 ne%atif/ritrosit4 0e%atif?eu:osit4 !#25lp6a:teri4 ne%atif

amur4 0e%atif)elur cacin%4 ne%atifSisa ma:anan B:ar$ohidrat( protein(

lema:4 ne%atifDarah samar4 ne%atif

@ @2!"

e u a ca B ( da a B (lendir B#( muntah B#O Sense 4 1M0 4 ;A&5menit


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14-3-2016 S >eluhan 4 66 cair B# dan muntah B#O Sense 4 1M; 0 4 ;A&5menit


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III. *ITERATURE RE0IE-

#'


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Diarrhea

& Diarrhea4 defecation withli-uid5semisolid feces Bmore watercontent for 2 %rams or 2

ml52h& 8H3 denition4 watery defecation

@&5d( with or without mucus or $lood

in feces& A$%te di#rrhe# less than a wee:( N

episodes5month

#(


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/pidemiolo%y

& Mostly in the rst 2 years of life

& Hi%hest incidence4 #ge 1/(( "onths

) Decline in maternal anti$ody and childCs

low active immunity) ,ntroduction of food possi$ly

contaminated

) Direct contact with fecal materialBanimal5human when child startscrawlin%

#*


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Asy"!to"#ti$ In2e$tion

& Proportion increases after the a%e of 2

formation of active immunity& Durin% this phase( fecal material contains

infectious patho%ens Bviral( $acteria( proto=oalcysts

&


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/tiolo%y

& ,nfectious diarrhea types4 non-infammatory andinfammatory) 0on#in'ammatory4 $acterial enteroto&in production(

villi surface destruction $y viral( attachment $yparasites( attachment and5or translocation of$acteria

) ,n'ammatory4 direct $acterial invasion( cytoto&inproduction

& 0on#infectious diarrhea4) Food aller%ies) 0eoplasms

) natomical defects Bmicrovilli atrophy( malrotation(Hirschsprun%

) Mala$sorptions) Food poisonin%) ,mmune deciency

+#


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1ommon /tiolo%y

++


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Spread of ,nfection

& Fecal#oral 4 3 F 4 fnger, ies, uid,feld

) Food5water contamination $y

enteropatho%ens) Hand contact with patient5contaminated

$elon%in%s

) ,ndirectly4 throu%h 'ies

+$


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Pathophysiolo%y

& 3smotic diarrhea4) Material not a$sor$ed BM%( %lucose( sucrose(

lactose( maltose in colon di+erent osmolarity$etween intestinal lumen and $lood water

'ows into lumen

water collection

e&ceedscolonCs a$sorption capacity diarrhea

& Secretory diarrhea4) Stimulation $y enteroto&in 0a a$sorption $y

villi disrupted 1l secretion increases water

and electrolyte are passed out as watery stool& Motility distur$ances& ,n'ammation of the colon and small

intestine

+


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1linical Manifestations

& G, symptoms4 diarrhea( a$dominal cramps(vomitin%

& /lectrolyte and water loss4 dehydration(meta$olic acidosis( hypo:alemia

&


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Rotaviral Shigella Salmonella ETEC EIEC Cholera

Incubation

Fever

Nausea/vomitingAbdominal pain

Headache

Duration

17-72 hrs

+

OftenTenesmus

-

5-7 days

24-48 hrs

++

SeldomTenesmus

!ram"

+

#7 days

6-72 hrs

++

OftenTenesmus !ol$!

+

3-7 days

6-72 hrs

-

+-

-

2-3 days

6-72 hrs

++

-Tenesmus

!ram"

-

%ar$es

48-72 hrs

-

Often&ram"

-

3 days

Feces

!olume

Fre"uenc#

Consistenc#

$lood

SmellColor

%$C

&thers

'ed$um

5-10()d

*atery

-

otten,ello-

green$sh

-

.nore($a

/e

#10()d

*atery

+

-ed-

green$sh

+

&onuls$on

+

/e

Often

Sem$sol$d

Somet$mes

/oulreen$sh

+

Se"s$s +

. lot

Often

*atery

-

-o !hange

-

'eteor$smus

/e

Often

Sem$sol$d

+

-ed-

green$sh

-

System$!

$nfe!t$on +

. lot

&ont$nuous

*atery

-

/$shy$!e ater

-

-

+'


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Dia%nosis

& namnesis4) Duration( volume of feces

) Fecal consistency( color( smell( presence5a$senceof mucus and $lood

),f vomitin% is present4 volume and fre-uency) Urination BnormalV DecreasedV Has not passedurine in "#A hoursV

) Food and drin:s %iven durin% diarrhea

) Fever( other accompanyin% diseases Bcou%h( runny

nose( otitis media( measles) Medication( oralit administration( administered

dru%s

) ,mmuni=ation history

+(


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& Physical /&amination) 6ody wei%ht( vital si%ns

) Si%ns of dehydration

) >ussmaul respiration4 meta$olic acidosis

) 8ea: or a$sent $owel sounds4hypo:alemia

) /&tremity4 1


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MM8< Dehydration1lassication

$

8H3 D h d i


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8H3 Dehydration1lassication

$-


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?a$oratory ,nvesti%ations

& 1omplete la$ wor:up %enerally not re-uiredunless un:nown underlyin% cause or otherconditions Bsepsis( severe dehydration

& Sometimes needed4

& 6lood4 1omplete $lood count( serumelectrolyte( $lood %ases analysis( %lucose(culture( resistance test

& Urine4 urinalysis( culture( resistance test

& Feces4 macroscopic Bconsistency( color(presence of $lood5mucus( smell( froth andmicroscopic Bleu:ocyte( stainin%

$#


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Mana%ement

& Principles BWpillarsO4 rehydration(nutritional support( medication asindicated( parent education

& )reatment plans4 accordin% to 8H3dehydration classication) Plan 4 no dehydration

) Plan 64 some dehydration

) Plan 14 severe dehydration

$+


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$$


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$


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$/


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5in$ S%!!e"ent#tion

& 8H35U0,1/F4

) X" months old4 ! m%5day for !#! days) " months old4 2 m%5day for !#! days

Feeding

& 1hildren with diarrhea must still $e fed) 6reastfed $a$ies4 as often as possi$leY on

demand

) 6a$ies( not $reastfed4 mil: at least every @hours

) 1hildren Z months old with soft5solid foods4continue feedin% in small $ut fre-uent servin%sB"&5more

$'


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Medications

& nti$iotics4 %enerally not re-uired in acutediarrhea Bmost are due to


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Medications

& ntidiarrhea4 often used $ut has nopractical $enet not indicated totreat acute diarrhea in children

& Pro$iotics and Pre$iotics promotes$alance of intestinal micro'ora

$*


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1omplications

& /lectrolyte ,m$alances4) Hypernatremia

) Hyponatremia

) Hypo:alemia& Fever& /dema53verhydration

& Meta$olic cidosis& Paralytic ,leus

& 1onvulsions


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Prevention

& Proper $reastfeedin%& Proper preparations and stora%e of food

& Use of su*cient clean water

& Ma:es ha$it of handwashin% with soap afterdefecation and $efore eatin%

& Use of hy%ienic and clean lavatory $y all familymem$ers

& Proper stool disposal

& Host immunity#related4

) 6reastfeedin% until a%e 2) ,ncreasin% nutritional value of foods and ade-uate

feedin% improves nutritional status

) ,mmuni=ation Bmor$illi( rotaviral

-


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Pro%nosis

& +ost 6789: resove in ;< d#ys

& few B7R continue $ut resolve inN! days

& 7R $ecome persistent diarrhea

#


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I0. CASE ANA*=SIS

+


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namnesis

& 8atery stooldefecation !&5daywithout $lood ormucus and volume4 T cup each

defecation and lastfor N! days B! day& Mild fever& 3ften vomittin% &

T cup each vomit

$

&Acute diarrhea

&0iral In1ection


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Physical /&amination


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/

Rotaviral Shigella Salmonella ETEC EIEC Cholera


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Incubation

Fever

Nausea/vomiting

Abdominal pain

Headache

Duration

17-72 hrs

+

Often

Tenesmus

-

5-7 days

24-48 hrs

++

Seldom

Tenesmus!ram"

+

#7 days

6-72 hrs

++

Often

Tenesmus !ol$!

+

3-7 days

6-72 hrs

-

+

-

-

2-3 days

6-72 hrs

++

-

Tenesmus!ram"

-

%ar$es

48-72 hrs

-

Often

&ram"

-

3 days

Feces

!olume

Fre"uenc#

Consistenc#

$lood

Smell

Color

%$C

&thers

'ed$um

5-10()d

*atery

-

otten

,ello-

green$sh

-

.nore($a

/e

#10()d

*atery

+

-

ed-

green$sh

+

&onuls$on

+

/e

Often

Sem$sol$d

Somet$mes

/oul

reen$sh

+

Se"s$s +

. lot

Often

*atery

-

-

o !hange

-

'eteor$smus

/e

Often

Sem$sol$d

+

-

ed-

green$sh

-

System$!

$nfe!t$on +

. lot

&ont$nuous

*atery

-

/$shy

$!e ater

-

-

'


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Mana%ement

&


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Pro%nosis

Kuo ad vitam et functionam4 d%)i# #d)on#"

& Eiral infection e.%


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)han:

you


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