Download pdf - Wan Hesti Case Report Pediatric

8/17/2019 Wan Hesti Case Report Pediatric

1/27

AUTHOR : Wan HestiNIM : I11109088LECTURE : DR. HILMI KURNIAWAN RISKAWA, Sp.A, M.KesDATE DA! : "# 1$ Ma"%& $01'

NON D!SENTRI(ORM ACUTE )ASTROENTERITIS*A09+ MILD-MODERATE DEH!DRATION *E8'+

ANEMIA CERERAL /ALS!

Case Rep"t


2/27

Identitiy

A, boys, 1 years 8 month, was care inDahlia Room, no medic : 092122, KartikaHsada Hos!ital, "or 10 days, "rom date 2th

to #anary 11th 201$


3/27

%hie" %om!lainDe"ecate a watery stool


4/27

&atient come de"ecate a watery stool within morethan 10'(days, a yellowish color, "eces !resence o"mcs, dre)s ,no blood, and "e*er+ !atient naseaand *omited 2 time, *omitin) o" "ood and water+&atient looks thirsty and still want to drink water,bt dont want to eat,+ -rinate as sal normal+De"ecation in !atients also no sym!toms o" co)h,colds, con*lsions and loss o" consciosness+mather !atients were then )i*en !aracetamol syr!medications, "e*er had decreased, bt de"ecate the!atients condition does not im!ro*ed+

1 day be"orehos!itali.ed

1 day be"orehos!itali.ed


5/27

&re*ios !atient had s/ered "rom the samecom!laints and im!ro*ed withot a )i*en

treatment or treated in a hos!ital+Ha*e history o" sei.re time+

ha*e no history o" aler)y , thy!oid "e*er,asthma+

o "amily members with a similarcom!laints+

&atient ha*e a )et com!lete *aksin+

&atient nly )et A3I ntil now +

&arents !atient lower4class economyHistory o" )rowth and de*elo!ment is no

a!!ro!riate with any normal children

&atient ha*e a Delay de*elo!ment


6/27

/&si%a2 E3a4inatin

5eneral a!!earance : moderate sick, "ssyAwareness : %om!os mentis

Antro!ometry, 6%53, 2007

6ei)ht : 7,8 k)

len)th : 8 cm

6ei)ht(a)e : 4 3D

Hei)ht( a)e : 0 3D s+d 42 3D

6ei)ht(hei)ht : 4 3Dtrition state : alntrisi


7/27

ital 3i)nHeart rate : 110 '(s, re)ler, stron) in

!al!ableRes!+ Rate : 0'(s, re)ler in rythm,

thoracoabdominal ty!e

;em!eratre : 7,$o %


8/27

5eneralist 3tats

Head : normoche!al

(>?, sclera icteric =4(4?,snken eye =>(>?, tears =4(4?

?, eck : enlar)ement o" lym!h nodes =4?+


9/27

• @n) : *esiclar =>(>?, whee.in) =4(4?, rhonki =4(4?• Heart : 31, 32, re)ler, mrmr =4?, )allo! =4?• Abdomen

• Ins!ection : dome4sha!ed, mass =4?• Askltation : bowel sond =>? increased

• &al!asi : he!ar and lym!h are not !al!able• &erksi : tym!ani in all Bled

• Ans C 5enitalia : no abnormality•


10/27

Status Neurologis

Refleks Fisiologis : Right exstremitas (+)

normal, left ekstremitas (+) incresest

Refleks Patologis : Babinski (+)

Meningeal sign : Kaku kuuk (!),

Bru"inski # an $ (!)


11/27

Elood ;est = 2 Febrari 201$?

ormal

6E% 10+200 ( mm G+000412+000 (mm

RE% G,9#ta ,0 ,0 #ta

Hemo)lobin 8,8 )(dl 11,41G, )(dl

H%; 28,8 J 4J

&@; 29+000(mm 10+0004G00+000

(mm

MCV 65,7 fl 7, 04 100+0

MCH 20,2 fl 2, 04 +0

MCHC 30,7 fl 1, 04 8+0


12/27

Di/erential Dia)nose

Gastroeneteritis Acut ec non disentriform , disentriform, parasit, amoeba

+ mild-moderate dehdration + Anemia ec defisiensi !e, infe"si, +

Cere#ral $als


13/27

6orkin) Dia)nose

on dysentri"orm acte )astroenteritis >mild4moderate dehydration > Anemia ecdeBsiensi "e > %erebral &alsy


14/27

;reatment

• IFD Rin)er laktat $0 =t!m? micro• In#ection am!hicillin G ' G00 m)• in#ection &aracetamol ' 100 m)

• In#eksi ndansetron ' 1, m)• In#eksi Ranitidine 2 ' 10 m)• Linc sir! 1 ' 1 cth !er oral•Asam *al!roat 2 ' 1,G cc dro! !er oral• &robiotik1'1 sachet !er oral


15/27

$0$1' 60$1'

Fo@@6-!

De"ecate a watery stool 9' =>?,mcs=>?,blood =4?, dre)s=>?,ase =4? omitin) waterand "ood =>? ' time , "e*er =>?at ni)ht , drink =>?, eatdecreased =>?, -rinate=>? )ood+HR :100'(m, RR 2G'(m, t: 8,EE: 7,8 k)

De"ecate a watery stool ' =>?,dre)s =>?, mcs =4?, blood =4?, ase=4?, omitin) =4?, "e*er =4? , drink =>?,-rinate=>? )ood, eat salHR : 108'(m , RR 28'(m t : 8,8EE: 7,9 k)

F@@6 -&

70$1' 0$1'

Fo

@@6-!

De"ecate a watery stool ' =>?,mcs=>?,blood =4?, dre)s

=>?,ase =4? omitin) water and"ood =>? ' time , "e*er =>? atni)ht , drink =>?, eat decreased=>?, -rinate=>? )ood+HR :100'(m, RR 2G'(m, t: 8,GEE : 7,9 k)

De"ecate a watery stool 2' =>?,dre)s =>?, mcs =4?, blood =4?,

ase =4?, omitin) =4?, "e*er =4? ,drink =>?, -rinate=>? )ood, eatsalHR : 98'(m , RR 2$'(m t : 7,9EEM 8,0 k)


16/27

@AERA;-RI- R


17/27

'0$1' 0$1'

F

@@6-!

De"ecate a watery stool G' =>?,

mcs=>?, blood =4?, dre)s=4?,ase =4? omitin) =4? , "e*er=>? , drink =>?, eat decreased=>?, -rinate=>? )ood+HR :98'(m, RR 2$'(m, t: 7,9EE : 8,2 k)

De"ecate a watery stool =4?, ni)ht ',

dre)s =4?, mcs =4?, blood =4?, ase=4?, omitin) =4?, "e*er =4? , drink =>?,-rinate=>? )ood, eat salHR : 98'(m , RR 2$'(m t : 7,9EE : 8,

F@@6 -&

80$1' 90$1'

F

@@6-!

De"ecate a watery stool =4?, ni)ht1', dre)s =4?, mcs =4?, blood =4?,

ase =4?, omitin) =4?, "e*er =>? ,drink =>?, -rinate=>? )ood, eatsalHR : 110'(m , RR 2G'(m t : 8 %EE : 8, k)

De"ecate a watery stool =4?,de"ecate =>? normal, ase =4?,

omitin) =4?, "e*er =>? , drink=>?, -rinate=>? )ood, eat salHR : 98'(m , RR 2$'(m t : 7,9EE : 8, k)


18/27

F@@6 -&

100$1' 110$1'

F@@

6-!

De"ecate a watery stool =4?, ase=4?, omitin) =4?, "e*er =>? , drink=>?, -rinate=>? )ood, eat salHR : 110'(m , RR 2G'(m t : 8 %

EEM 8, k)

De"ecate a watery stool =4?,ase =4? omitin) =4?, "e*er =>?,drink =>?, eat decreased =>?,-rinate=>? )ood+

E@&@A.itromicin syr 2 ' N cth !+oetronida.ole syr ' O cth !+oLink 1 ' 1 cth !+o@4bio 1 ' 1 sach !+o

Asam *al!roat 2 ' 1,G ccDro! "e ' 1 ml !+o


19/27

Discssion


20/27

/"2e4 ; %ase

Dia)nose


21/27

Discssion)ast"enti"itis ;he main sym!toms are

diarrhea, *omitin),nasea and "e*er andacte abdominal !ain+

)ast"enti"itis "A%5te #ia""&ea:

de"ecate more than

times in 2G hors,watery stool, less than 1

week

De&#"atin si


22/27

;y!e o" DiarrheaDisentri"rom Diarrhea watery stool with mcs

and no blood, "e*er, tenesms ani, !ain inabdomen, !rola!ss ani

on4 Disentri"rom Diarrhea Kids nder 2 years

old, watery stool, hi)h "e*er, *omitin),accom!anied by co)h and cold

%holera diarrhea that is watery and abndant,withot !receded by heartbrn and withottenesms, abdominal cram!s+ Diarrhea has

chan)ed =rice water stool?+In &atient watery stool with mcs, and not

blood, *omitin)+


23/27

3ta)e " Dehydration

Dehydration state can be determineob#ecti*ely by com!are the body wei)htbe"ore and a"ter diarrhae+ 3b#ecti*ely can bese 6H criteria+

In this !atient, deBsit o" body wei)ht abot$J, and accordin) to the criteria o" 6H canbe classiBed as mild4moderate dehydration,


24/27

;R


25/27

%om!lication

%om!lication o" diarrhea :Dehydration


26/27

&ro)nose

Recrrence rates de!endin) on the le*el o"hy)iene o" !atients where the !arental rolein o*erseein) and hy)iene o" "ood childrenare *ery inential+

*itam !ro)nosis and "n)sionam is adbonam,

while sanationam ad malam+


27/27

;hank o