VennDiag Lola (3)

7/27/2019 VennDiag Lola (3)

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PATIENT IDENTITY

Name : Mrs. ER

Age : 39 years old

Marital state : married

Admission date : May 2nd, 2013


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10 STEPS VENNDIAG

1. Define a Chief Complaint

2. Draw a VennDiag & Fill It With Possible Disease

3. Literature Review

4. Scan on Patient Signs & Symptoms

5. Make a Working Diagnosis

6. Define Initial Treatment

7. Further Investigation

8. Make a Definitive Diagnosis

9. Define Causative Treatment10. Show a Clinical Course of the Disease


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STEP VENNDIAG

STEP 1 : Define the Chief Complaint

Step 2 : Draw a Venndiag and Fill it with Possible Diseases

Step 3 : Make a Brief Literature Review of Each Disease

Step 4 : Scan on Patients Sign & Symptoms

STEP 5 : Make a Working Diagnosis


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STEP 1 : DEFINE THE CHIEF COMPLAINT

Female 39 years old, came with acute

diarrhea


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STEP VENNDIAG





STEP 5 : Make a working diagnosis


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INFECTIOUSNON INFECTIOUS

Protozoa : Giardia, Cryptospora

Bacterial : Vibrio cholera

Viral : Rotavirus, Norwalk

Bacterial: Shigella, Campylobacter, Salmonella,

Escherchia coli, Aeruginosa

Protozoa: Entamoeba hystoliytica

Drugs

Toxins

Dietary: Intoleransi lactosa

Irritable Bowel SyndrommeThyroid Storm

Acute appendicitis

Drugs: NSAIDs

Inflammatory Bowel

Disease

1. Ferri, FF. 2006. Ferris Differential Diagnosis : A Medical Guide to the Differential Diagnosis of Symptoms, Signs, and Clinical Disorders. 2nd eds. Philadelphia : Mosby Elsevier.

2. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17 th eds.

ACUTE DIARRHEA

Acute Bloody

Acute Watery


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STEP VENNDIAG







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Acute Watery


Bacterial : Vibrio choleraViral : Rotavirus, Norwalk

Acute Bloody




Drugs

Toxins


Irritable Bowel Syndromme

Thyroid Storm

Acute appendicitis

Drugs: NSAIDs

Inflammatory Bowel

Disease



ACUTE DIARRHEA


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COMMON IN INFECTIOUS

ACUTE WATERRY DIARRHEA

Waterry diarrhea

Blood (-)

Abdominal pain Nausea and vomit

Fever


11/72INFECTIOUS

Protozoa : Giardia lamblia

Symptom :Sulfurous

bleaching

Flatus

Loose stools withmucus (-)

Diagnose :

Antigens in the feces

Cysts in the feces

Trophozoites in the

feces or small intestine


Physical :Bloating abdominal

Extra intestinal :

Urticaria Anterior uveitis

Artritis


12/72INFECTIOUS

Protozoa : Cryptosporidium

Symptom :Immunocompetent

host

Anorexia

Weight loss

Diagnose : Small oocyts , cyst,

trophozoites in feces

Direct immunofluorescent

stains

Enzyme immunoassay

Biopsy specimen of thesmall bowel


Physical : Low fever

Dehydration


13/72INFECTIOUS

Bacterial : Vibrio cholera

Diagnosed by

Dark field microscopy on wet mount of freshstool : V. Cholera

Antiserum specific: serotype

Isolation with thiosulfate-citrate-bile salts-sucrose

(TCBS) agar : flat yellow colony .

Biochemical confirmation : oxidase +

Monoclonal Ab in PCR : V. Cholerae O1 and O 139


Symptom :

- Incubation 24 - 48 hour- Fever (-)

- Sudden painless quickly become

voluminous

- The stool: nonbilious, gray, slightly

cloudy fluid with fleck s of mucus =

rice water stool

- Odor sweet

Physical :

- Muscle cramps electrolyte

imbalance


14/72INFECTIOUS

Virus : Rotavirus and Norwalk

Diagnosed

EIAs (Enzyme immunoassay) PCR

WBC normal, rarely leucocytosis with

relative lymphopenia


Symptom :

- Incubation 1-3 day, abrupt onset- Mostly in children

- Chill and myalgia

- Mucus (-)

- Self limiting

Physical :

- High fever > 39 c


15/72INFECTIOUS

Virus : Rotavirus and Norwalk

Diagnosed

EIAs (Enzyme immunoassay) PCR

WBC normal, rarely leucocytosis with

relative lymphopenia


Symptom :

- Incubation 1-3 day, abrupt onset- Mostly in children

- Chill and myalgia

- Mucus (-)

- Self limiting

Physical :

- High fever > 39 c


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Bacterial: Shigella, Campylobacter,

Salmonella, Escherchia coli, AeruginosaProtozoa: Entamoeba hystoliytica

Drugs

Toxins



Thyroid Storm

Acute appendicitis

Drugs: NSAIDs

Inflammatory Bowel

Disease



ACUTE DIARRHEA

Acute Bloody

Acute Watery


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COMMON IN INFECTIOUS

ACUTE BLOODY DIARRHEA

Bloody diarrhea

Blood (+)

Mucus (+/-)

Abdominal pain Nausea and vomit

Fever

Malaise

Diagnosed with oocyst/trophozoit in feces, high PMN in feces Leucocytosis peripher


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INFECTIOUS

Protozoa : Entamoeba hystolitica

Symptom

Incubation : 2-6 weeks

May pass 10-12 stools per day

The stool: little fecal material, consist

mainly blood and mucus

Diagnosed by

- Culture of stool forE. Hystolytica

tropozoites

- PCR assay for DNA in stool

- ELISA ag E. hystolytica


PhysicalWeight loss

Diffuse lower abdomen or back pain,

cramping


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Bacterial : Shigella

INFECTIOUS

Symptom : 4 stages

Incubation Period

- Lasts 1-4 days- Transient fever (40-41c)

Watery Diarhhea

Mild abdominal discomfort severe cramps,

tenesmus

Dysentry

Follow hours or days. Uninterupted excretion

of small volume ofbloody mucopurulent

stool diarrhea with increased tenesmus and

abdominal cramps

Post infection


Diagnosed

- Isolation pathogen from fecal material

Medium: agar mac conkey:nonlactose fermeting colonies: 0,5-1mm in

diameter, convex, translucent, smooth

surface


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Bacterial : Campylobacter

INFECTIOUS

Symptom

Prodorme 12-48 hour before onset ofdiarrheal

- Degree of diarrhea varies from several

loose stool to grossly blood stool,

> 10 bowel movement

- Abdominal pain: cramping, general/local

Diagnosed

- Direct microscopy: vibroid morphology- Isolate from culture of stool, blood


Physical

- Abdominal pain: cramping, general/local


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Bacterial : Salmonella

INFECTIOUS

Symptom

Incubation 10-14 days (3-21 days)- High fever characteristic

- Coated tongue, splenomegaly,

abdominal tenderness

Diagnosed by

- Leukopenia, neutropenia- Elevated liver function test and muscle

enzyme level

- Isolation of S. Typhi or S. Paratyphi from

blood, bone marrow

- Widal test

- PCR and DNA assay : S.typhi in blood

1. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th

eds.

Physical

- Coated tongue, splenomegaly,abdominal tenderness


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INFECTIOUS

Symptom

Incubation 24 - 72 hours. Other symptoms may include:

Distension abdominal

Bacterial : Escherchia.coli

Diagnosed by

- E. coli strains O157, is the most

common method currently used to

detect STEC/EHEC

- Testing forShiga toxins or toxin genes

is more sensitive, specific, and rapid. It

detects both non- O157 STEC/EHEC

and sorbitol-fermenting strains ofO157:H7difficult to identify.

Vorvick LJ. E.coli Enteritis. US National Library of Medicine NIH. Medline. 2011

Physical

Gas in abdominal

Bruises that happen easily

Pale skin

Red or bloody, reduced amount

urine


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Bacterial : Aeruginosa

- Immunocompromised

host- Antibiotic associated

- Profuse diarrhea, mucus

+, blood +

- Low-grade fever

Diagnosed

- Innoculation on blood agar platesand Mac Conkey agar plates, then

incubated at 370c for 18-24 hours

InfectiousPorco EV, Visconte EB. Pseudomonas Aeruginosa as a Cause of Infectious Diarrhea Successfully Treated With Oral Ciprofloxacin. Department of Internal

Medicine. Pubmed. USA. 1995 Nov;29(11):1122-3

Brad GF et al. Pseudomonas Aeruginosa and Antibiotic Associated Diarrhea In Children. Department of Pediatric, Victor Babes University Medicine andPharmacy. Timisora. Jan 2011.


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Drugs

Toxins

Dietary: Intoleransi lactosaIrritable Bowel Syndromme

Thyroid Storm

Acute appendicitis

Drugs: NSAIDs

Inflammatory Bowel

Disease



ACUTE DIARRHEA

Acute Bloody

Acute Watery


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COMMON IN NON INFECTIOUS

WATERY DIARRHEA

Fever (-)

Watery diarrhea

Abdominal pain

Nausea and vomit

Hematology routine : normal

Feses routine :

Erytrocyte (-)

Leucocyte (-)


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NON INFECTIOUS

Drugs and Toxin

- Antibiotics: cephalosporin,

amynoglicoside, amoxillin clavulanate,

clarithomycin

- Cardiac antidysrhthmics,

antihypertensive

- certain depressant, chemotherapeutic

agent

- Brochodilator- Antacid

- Laxatives

Toxin caused acute watery diarrhea

- Organophospate inseticides

- Amanita and other mushroom- Arsenic

- Preformed in seafood

Physical History of consumption/ingest


Diagnose Hematology routine : normal Feses routine :

- Erytrocyte (-)- Leucocyte (-)


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NON INFECTIOUS

Lactose Intolerance

Symptom

- Flatus

- History of ingest carbohydrates that

contain actively transported

monosaccharide (ec: glucose, galactose)

Diagnosed by Stool fat/steatorrhea quantitative Test- Sudan III stain Blood breath and isotopic test Blood routine: depletion iron, folate,

cobalamin, vitamins D and K Schilling test, D-xylose test, duodenal

mucosal biopsy, small intestinal RO, test ofpancreatic exocrine function


- Flatus

- History of ingest carbohydrates thatcontain actively transported

monosaccharide (ec: glucose, galactose)



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Abdominal pain/discomfort (25%hypogastrium, 20% right side, 10%epigastrium. Episodic and crampy, can be

constant, nocturnal pain, exacerbate byeating, emotional stress, improved bypassage of flatus/stools

Constipation > diarrhea. Diarrhea in smallvolume 200-300 ml/d


Th id St


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Agitation

Tachycardia

Sweating

Fever

Seizure

History of hypertiroidism

*Non Infectious

Thyroid Storm

T1 dan T4


A t di iti


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Anorexia

Pain in periumbilical goes to rightupper quadrant

*Non Infectious

Acute appendicitis


Pain in mc burney area

Rebounf tenderness

Fever 37,2 - 38

USG

Ct scan: thickened appendix with

periappendical


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Bacterial : Vibrio choleraViral : Rotavirus,

Norwalk

Bacterial: Shigella, Campylobacter,

Salmonella, Escherchia coli, Aeruginosa


Drugs

ToxinsDietary: Intoleransi lactosa


Thyroid Storm

Acute Appendicitis

Drugs: NSAIDs

Inflammatory Bowel

Disease



ACUTE DIARRHEA

Acute Bloody

Acute Watery


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COMMON IN NON INFECTIOUS

BLOODY DIARRHEA

Fever (-)

Bloody diarrhea

Abdominal pain

Nausea and vomit

Hematology routine : normal

Feses routine :

Erytrocyte (-)

Leucocyte (-)


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NON INFECTIOUS

Drugs

- Causes: NSAIDs

- Mild side effects from short-termuse may include diarrhea

- Blood related ulcerbecause

long term use

Diagnosed by

History of consumption Hematology routine : normal Feses routine :

- Erytrocyte (-)- Leucocyte (-)



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NON INFECTIOUS

Inflammatory Bowel Disease

Crohns disease Ulcerative colitis

Clinical Findings Weight loss, low grade fever, perianal

disease, abdominal mass

Rectal bleeding,tenesmus, crampy,

liquid stool containing blood, pus

Laboratory Elevated CRP, ESR, more severe

hypoalbuminemia, anemia, leucocytosis

Rise in CRP, platelet count, ESR,

leucocyte, and decrease Hb

Spesific marker:

- fecal lactoferin intestinal

inflammation

- Fecal calprotectin histologic

inflammation, prognosis,

Endoscopy Patchy involvement, rectal sparing,

aphthous ulcers, ileal ulcers

Rectal involvement with continuous

superficial ulceration.

Radiology Stricture, fistulas, terminal ileal disease

(string sign), skip lesieon

Loss of haustra, continous ulceration,

collar button ulcer

1. Fauci, Anthony S. 2009. Harrisons Manual of Medicine. 17th

eds.


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STEP VENNDIAG






C


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HISTORY TAKING

Characteristic:

- Acute Diarrhea started 12 hours before admissionDiarrhea characteristic :

- Watery - Frequency > 8 times/day

- Mucus (+) - Stool volume > 250 ml

- Blood (+), no gross, no pus

- Bad stink

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora


Bacterial: Shigella,

Campylobacter,

Salmonella, Escherchia

coli, Aeruginosa

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella

2.Campylobacter.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba hystoliytica

Acute Diarrhea

Acute

Bloody7. NSAIDs

8. InflammatoryBowel Disease

Possible : 1, 3, 4,5,6

Less : 2

Not related : 7,8


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HISTORY TAKING

High fever 38c

Continous

No spesific characteristic

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella


4. Escherchia coli

5. Aeruginosa

Protozoa


Acute Diarrhea

Acute

Bloody7. NSAIDs


Possible : 1, 3, 4,5,6

Less : 2, 3, 8

Not related : 7


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HISTORY TAKING

Nausea

Vomit (-)

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella


4. Escherchia coli

5. Aeromonas

Protozoa


Acute Diarrhea

Acute

Bloody7. NSAIDs


Possible : 2,4,5,6

Less : 1, 3, 7, 8

Not related :

W i ht L


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HISTORY TAKING

Weight Loss DrugsToxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli5. Aeruginosa

Protozoa


Acute Diarrhea

Acute

Bloody7. NSAIDs

8. Inflammatory

Bowel Disease

Possible : 6,8

Less : 1,2,3,4,5,7

Not related :


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HISTORY TAKING

History consumption of food

in the street

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella4. Escherchia coli

5. Aeromonas

Protozoa


Acute Diarrhea

Acute

Bloody7. NSAIDs

8. Inflammatory

Bowel Disease

Possible : 1,2,3,4,6

Less : -

Not related : 5, 7,8


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HISTORY TAKING

History of her children was admitted

hospital because of amoeba

diarrhea

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Bacterial

1.Shigella


4. Escherchia coli

5. Aeruginosa

Protozoa


Acute Diarrhea

Acute

Bloody7. NSAIDs


Possible : 6

Less : -

Not related : 1,2,3,4, 5,7,8

f


42/72

HISTORY TAKING

History of consumption drug

induced acute bloody diarrhea

was denided

Drugs

Toxins



Thyroid Storm

Protozoa : Giardia,

Cryptospora



Campylobacter,


coli, Aeromonas

Protozoa: Entamoeba

hystoliytica

Drugs: NSAIDs

Inflammatory Bowel

Disease

ACUTE DIARRHEA

Acute Bloody

Acute Watery

Acute

Bloody

Bacterial

1.Shigella


4. Escherchia coli

5. Aeromonas

Protozoa


Acute Diarrhea

7. NSAIDs


Possible : -

Less : -

Not related : 1,2,3,4, 5,67,8

L t h M h 30th 2013


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HISTORY TAKING

Last menarche March 30th, 2013

History of Diabetes Mellitus

Medication since 3 years ago: glimepirid 1x1 grmetformin 1x500 mg

No history of Hypertension

No history of Alergic


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PHYSICAL EXAMINATION

Vital sign:

- General appearance : moderately ill

- Conciousness : compos mentis

- Blood Pressure : 100/60 mmHg

- Pulse : 96x/min ( reguler rhythm, strong, and full in palpation )

- Respiratory rate : 22x/min

- Axillary temperature : 39,6 C

- H/W : 154 cm / 57 kg

- BMI : 24,1 kg/m2 (overweight)Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.

InflammatoryBowel

Disease


Less : 5

Not related : 7,8

Acute

Bloody

H d h l


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Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeromonas

Protozoa

6.Entamoeba

hystoliytica

AcuteDiarrhea

7. NSAIDs

8.

InflammatoryBowel

Disease

Head : normocephaly

Eye : conjunctiva anemic -/-

Nose : normal

Ear : normal Mouth : dry mucosa lip and oral

Neck : nodul lymph not palpable

Acute

BloodyPossible : 1,2,3,4,5,6

Less : 7, 8

Not related : ----

Lungs ( normal )


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Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

AcuteDiarrhea

7. NSAIDs

8.

InflammatoryBowel

Disease

Acute

Bloody

Lungs ( normal )

Inspection : symetric in both static and dynamic state.

Palpation : fremitus tactile equal on both lungs.

Percussion : sonor

Auscultation : vesicular breath sounds, no additional sound. Heart :

Inspection : ictus cordis visible

Palpation : ictus cordis is palpable in ICS V linea midclavicularis sinistra

Percussion

- upper border : ICS 3 linea parasternalis sinistra

- right border : linea sternalis dextra

- left border : linea midclavicularis sinistra

Auscultation : regular heart sound, no additional sound


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Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

AcuteDiarrhea

7. NSAIDs

8.

InflammatoryBowel

Disease

Acute

Bloody

Abdomen:

Inspection : convex

Palpation : pain (+) lower abdominal

hepatosplenomegaly -

Percussion : timpaniAuscultation : bowel sound 12-13x/minute

Extremities : CRT < 2 second, warm

Skin : turgor normal


Less : 4, 7, 8

Not related : ----

Female 39 years old came with acute diarrhea 12 hours before admission


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RESUME

Female 39 years old, came with acute diarrhea 12 hours before admission.- Diarrhea characteristic : watery+, mucus (+), blood (+) no gross, no pus, frequency >

8 times/day, stool volume >250 ml,high fever 38c =1,3,4,5, 6

- Nausea = 2,4,5,6

- Weight loss = 6, 8

- History of comsumption food in the street = 1,2,3,4, 6

Bacterial

1.Shigella


4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.

Inflammatory

Bowel

Disease

Acute

Bloody


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- History of her children was admitted hospital because of amoeba diarrhea = 6

- History of diabetes mellitus, her medication since 3 years ago : glimepirid 1x1 gr and

metformin 1x500 mg.

RESUME

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.Inflammatory

Bowel

Disease

Acute

Bloody

Possible : 4, 6

Less : 2,3,5

Not related : 8


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Physical examination found

-Axillary temperature 39,6 C =1,2,3,4, 6

- Dry lip and oral mucosa = 1,2,3,4,5, 6

-Abdomen seemed convex, pain in lower abdominal, = 1,2,3,5, 6

tympani, bowel sound 12 -13x/minute

RESUME

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.Inflammatory

Bowel

Disease

Acute

Bloody

Possible : 1,2,3, 6

Less Possible : 4,5


51/72

STEP VENNDIAG




STEP 6 : Define Initial Treatment

Step 7 : Further Investigation


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WORKING DIAGNOSIS

Acute Gastroenteritis et causa Entamoeba hystolytica

Acute Gastroenterit is et causa Shigella

Acute Gastroenterit is et causa Campylobacter

Acute Gastroenterit is et causa Salmonella

Acute Gastroenteritis et causa Escherchia coli

EXCLUDED

Acute Gastroenteritis et causa Aeruginosa

Acute Gastroenteritis et causa NSAIDs Acute Gastroenteritis et causa Inflammatory Bowel Disease

Bacterial

1.Shigella


4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.Inflammatory

Bowel

Disease

Acute

Bloody


53/72

EXCLUDED

Acute Gastroenteritis et causa NSAIDs

No history of consumption NSAIDs

Acute Gastroenteritis et causa Inflammatory

Bowel Disease

- Chrons disease

Perianal disease, low grade fever, abdominal

mass

- Colitis ulcerativa

Rectal bleeding, tenesmus, liquid stool

containing blood (+) pus (+)

Acute Gastroenteritis et causa

Aeruginosa

No history consumption antibioticNo immunocompromised host

Low grade fever


54/72

STEP VENNDIAG





STEP 8 : Make a Definitive Diagnosis

STEP 9 : Define the Causative Treatment

INITIAL TREATMENT


55/72

INITIAL TREATMENT

Female 39 years old, came with acute diarrhea 12 hours before admission.1. Diarrhea characteristic : watery+, mucus (+), blood (+) no gross, no pus, frequency > 8

times/day, stool volume >250 ml, got dry lip and oral mucosa.For this condition :

REDUCE the diarrhea with

Antispasmodic (Buscopan 10 mg 1 tab)

Antidiarrheal (New Diatabs 2x 600 mg

CORRECT for mild dehydration

Begin IV fluid with isotonic fluid

Fluid theraphy = maintenance + 5% deficit of body weight

= 30 ml/kgBB + 5% BB(kg)

= (30x57) + 5/100 x 57

= 1710 + 162.45

1872.45 cc/24 jam 2000 cc/24 jam

Guillot AP. Fluid and Electrolyte Management Theraphy. University of Vermont Collenge of Medicine

INITIAL TREATMENT


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INITIAL TREATMENT

2. Her past temperature, fever 38c. Now, the temperature was 39,6 C

The theraphy was Antipyretic (Paracetamol 500 mg 3 tab)

3. She felt nausea but no vomit

Antinausea (Domperidone 10 mg 2tab)

4. She felt her weight had some loss but never been scaled

Education for eat more food, but no stimulated the stomach like spicy food


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STEP VENNDIAG






FURTHER INVESTIGATION


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FURTHER INVESTIGATION

HEMATOLOGY

Hemoglobine 13 18 g% 14.4

Leukocyte 4 11 103 /ul 11.9

Erythrocyte 4.5 - 6.5 106 /ul 5.66

Hematocrit 40 54 % 41.0

Platelet 150 450 103 /ul 164

ERYTHROCYTE INDEX

MCV 80 96 fl 82.4

MCH 27 32 pg 27.4

MCHC 32 36 g/dl 35.1

RDW-CV 11.6 - 14.8 % 13.6

Kidney Function

Ureum 10 50 mg/dl 25

Creatinine 0.7 - 1.2 mg/dl 0.84

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. AeruginosaProtozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.

Inflammato

ry Bowel

Disease

Acute

Bloody

Possible : 1,2,3,4,5, 6

Exclude : 7,8

HEMATOLOGYA t


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O OG

Eosinophil 1-6 % 0

Basophil 1-2 % 0.1

Neutrophil 40-80 % 88,9

Lymphocyte 20-40 % 6.3

Monocyte 2-10 % 4.7

LED 1 jam 10 -15 mm/jam 90

LED 2 jam 10 - 15 mm/jam 107

Liver Function Test

SGOT 0-38 U/l 13

SGPT 0-41 U/l 13.9

Renal Function Test

Asam Urat 3.4-7 U/l 5.6

Diabetes

Glukosa 70 - 110 mg/dl 285

HbA1c


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Electrolyte

Natrium 136 145 % 130

Kalium 3.3 - 5.1 % 3.0

Chlorida 98-106 g/dl 99

Fat

LDL < 150 g/dl 65

HDL > 40 g/dl 15

TG < 150 g/dl 197

Bacterial

1.Shigella


4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.Inflammato

ry Bowel

Disease

AcuteBloody

Hypertrygliserida

M i


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STOOL TEST

Macroscopic

Consistency liquid

Color brown

Mucus +

Blood 0

Pus 0

Worm 0

Microscopic

Leucocytes 20 - 25Erytrocytes 10 - 15

Worm eggs 0

Amoeba Cyst +

Other parasites 0

Bacterial

1.Shigella

2.Campylobacter

.3.Salmonella

4. Escherchia coli

5. Aeruginosa

Protozoa

6.Entamoeba

hystoliytica

Acute

Diarrhea

7. NSAIDs

8.

Inflammato

ry Bowel

Disease

Acute

Bloody

Possible : 6


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STEP VENNDIAG






STEP 10 : Show Clinical Course of the Disease


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DEFINITE DIAGNOSIS

Definite Diagnosis : Acute gastroenteritis ec amoeba)

(amoeba cyst +)

Milld dehydration

Diabetes mellitus type 2

Excluded:

Acute Gastroenteritis et causa Shigella

Acute Gastroenteritis et causa Campylobacter

Acute Gastroenteritis et causa Salmonella

Acute Gastroenteritis et causa Escherchia coli


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STEP VENNDIAG







Fluid therapy (IVFD asering 2000ml/24hr)


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DEFINE THE CAUSATIVE TREATMENT


Antipyretic (Paracetamol 500 mg 3 tab)


Antidiarrheal (New Diatabs 2x 600 mg)


Additional treatment:

Antibiotic for amoeba (Metronidazol 2 x 500mg/day)

Observation for hyperglicemia

Lowering triglicerida : fibrate 1x300 mg tab at night


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STEP VENNDIAG









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DEFINE THE CAUSATIVE TREATMENT


Antipyretic (Paracetamol 500 mg 3 tab)


Antidiarrheal (New Diatabs 2x 600 mg)


Additional treatment:

Antibiotic for amoeba (Metronidazol 2 x 500mg/day)

Lowering blood glucose with insulin drip 3 IU/hour

Lowering triglicerida : fibrate 1x300 mg tab at night


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SHOW CLINICAL COURSE OF THE DISEASE

eat contaminated/raw food

gastroenteritis

mostly recovered

(self limited)dehydration

shockdeath


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SHOW CLINICAL COURSE OF THE DISEASE

Hyperglicemia

Diabetes Mellitus

Complication chronicacuteDiabetic

Ketoacidosis

Hyperglicemic

hyperosmolar

Eye

SkinCardiovascular

Abdominal

Renal

Genitourinary

Neurophathy

Lower extremity

Dhermatologic

Infection

REFERENCES


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1. Ferri, FF. 2006. Ferris Differential Diagnosis : A MedicalGuide to the Differential Diagnosis of Symptoms,Signs, and Clinical Disorders. 2nd eds. Philadelphia :Mosby Elsevier.

2. Fauci, Anthony S. 2009. Harrisons Manual of Medicine.17th eds.

3. Stern, Scott D. C. 2010. Symptom to Diagnosis: AnEvidence Based Guide. 2nd eds.

4. Guillot AP. Fluid and Electrolyte Management Theraphy.University of Vermont Collenge of Medicine

REFERENCES


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VENNDIAGIS....

Metode yang beguna dalam menegakkan diagnosis

karena dari awal kita diajak memikirkan segala

kemungkinan diagnosa yang mungkin terjadi padapasien sehingga menemukan yang paling tepat dan

bisa memberikan terapi yang terbaik bagi pasien.


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SPECIAL THANKS to

VennDiag Lola (3)

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