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7/24/2019 Word Case Anak - Ayu

1/19

CASE PRESENTATION

AMOEBIC DYSENTERY

Preceptor :

dr. Ulynar Marpaung, Sp. A

Presenter :

Ayu Wijayanti (1102009049)

DEPARTMENT OF PEDIATRIC

RADEN SAID SUKANTO POLICE CENTER HOSPITAL

FACULTY OF MEDICINE YARSI UNIERSITY

1


2/19

PATIENT IDENTITY

Name : !"

"irt# $ate : %uly 1&t2012

Age : ' year& ld

ender : Male

Addre&& : %l. * U&man N 2 !+ 1111 -elapa $ua

Natinality : ndne&ian

!eligin : &lam

$ate / admi&&in : April

t#

201

$ate / eaminatin : April t#201 3 April 9t#201

PARENT IDENTITY

HISTORY TAKIN! Allanamne&i& /rm patient& mt#er n t#e date / admi&&in, Mar5# 24t#

201.

6#ie/ 6mplain :

$iarr#ea &in5e 4 day& 7e/re entering t *&pital.

Additinal 5mplain& :

/e8er a& &uddenly #ig# until ',;6

2

F"t#er Mot#er

N"$e Mr% B Mrs% R

A&e '( )e"rs o*+ ', )e"rs o*+

-o. E$p*o)ee Ho/se012e

Re*1&1on Is*"$ Is*"$

E+/c"t1on Sen1or H1 Sc#oo* Sen1or H1 Sc#oo*


3/19

H1stor) O2 P"st I**ness

PRENATAL HISTORY

Antenatal 5are

Antenatal 5#e5< up& per/rmed at t#e pu&a7r : ?u&


4/19

"irt# eig#t : '200 gram&

"dy lengt# : 4 5m

A55rding t t#e mt#er, t#e 7a7y &tarted t 5ry and t#e 7a7y@& &aug#ing : 1D 2 mnt# ld

Slant : 2, mnt# ld

Spee5# nitiatin : mnt# ld

?rne ?&itin : mnt# ld

Bd Sel/ : 3 C mnt# ld

Sitting : C mnt# ld

6raling : mnt# ld

Standing : 12 mnt# ld

Wal


5/19

Fr/1t "n+ 9e&et".*es B"n"n"< sp1n"c#

So*1+ 2oo+s "n+ s1+e +1s#es R1ce< C"rrots< Pot"toes

FAMILY HISTORY

?atient& 7t# parent& ere married #en t#ey ere 24 year& ld and 21 year&

ld, and t#i& i& t#eir /ir&t marriage.

+#ere are nt any &igni/i5ant illne&&e& r 5#rni5 illne&&e& in t#e /amily

de5lared.

H1stor) o2 t#e +1se"se peop*e "ro/n+ t#e p"t1ent

Arund t#e #u&e

?eple # li8ed arund t#e patient& #u&e are in #ealt#y 5nditin

S)ste$"t1c P#)s1c"* E8"$1n"t1on

*ead : Nrm5ep#aly, #air (7la5


6/19

8ein&, n &pider ne8i.

?alpatin : &upple, li8er and &pleen nt palpa7le, /luid a8e (D), a7dminal

ma&& (D).

?er5u&&in : +#e entire /ield / tympani5 a7dmen, i/ting dullne&& (D).

Au&5ultatin : nrmal 7el &und, 7ruit (D).

L".or"tor) In9est1&"t1on He$"to*o&) = Apr1* >t# ,?; @

He$"to*o&) Res/*ts Nor$"* "*/e

*aemgl7in 10,' 1'D1C gd>

>eu ,000 3 10,000G

*emat5rit& '1 H 40 3 4 H

+rm75yte& 24'.000 G> 10,000 3 400,000

ryt#r5yte& ',0 millinG> 4 3 millinG

ma5r&5pi5

5lur 7rn

5n&i&ten5y &/t

mu5u& E

7ld E

mi5r&5pi5

>eu


7/19

He$"to*o&) Res/*ts Nor$"* "*/e

*aemgl7in 12,0 gdl 1'D1C gd>

>eu ,000 3 10,000G>

*emat5rit& 'H 40 3 4 H

+rm75yte& 29.000 u> 10,000 3 400,000G>

D122erent1"* Co/nt = Apr1*

t#

,?; @

D122erent1"* Co/nt

= Apr1* t# ,?; @

B"sop#1* 2 0 3 1

Eos1nop#1* 1 1 3 '

Ne/trop#1* Ro+ D 2 D C

Ne/trop#1* Se&$ent 0 0 D 0

L)$p#oc)te 1C 20 D 40

Monoc)te 1 2 D

Er)t#roc)te

Se+1$ent"t1on R"te

10 J1

FOLLO6 UP

April t#201

S : $iarr#ea (E) : 7ld, mu5u&,

A7dminal pain (E)

Be8er (E)=miting and Nau&ea (E)

7


8/19

I : eneral 5nditin: Mild ill.

*eart rate K 111 min

!e&piratry rate K 2Cmin

+emperature K 'C.4L6

6ardi : S1S2, reguler, n murmur, n gallp

?ulmnary : 8e&i5uler EE, r#n5#i DD, #eeFing DD

A : Ame7a5 $y&entery

? : =B$ -AN '" 1200 5524#

nj. 6e/taime 200mg

?ara5etaml &yr '12 5t#

>a5t " '1 &a5#

in


9/19

9


10/19

LITERATURE REIE6

;%;% DEFINITION

D)senter) i& an in/lammatin/ t#e inte&tine 5au&ing diarr#eait# 7ld.12

It#er &ymptm& may in5lude /e8er, a7dminal pain,' and re5tal tene&mu& (a

/eeling / in5mplete de/e5atin).

t i& 5au&ed 7y a num7er / type& / in/e5tin&u5# a& 7a5teria, 8iru&e&, para&iti5

rm&, r prtFa. t i& a type / ga&trenteriti&. +#e me5#ani&m i& an

in/lammatrydi&rder / t#e inte&tine, e&pe5ially / t#e5ln.

;%,% EPIDEMIOLO!Y

Ame7ia&i& 55ur& rldide, 7ut i& m&tly &een in trpi5al and de8elping

5untrie&, #i5# #a8e 7ad &anitary and #ygieni5 pra5ti5e&. +en per5ent / rld&

ppulatin i& e&timated t 7e in/e5ted 7y t#e para&ite (4H in USA) it# an

e&timated annual mrtality / 40,00030,000. *e8er, 90H / t#&e in/e5ted are

a&ymptmati5, 1H may de8elp in8a&i8eetrainte&tinal ame7ia&i&. Spread i&

m&tly t#rug# /e5alDral rute, 7y inge&tin / 5y&t& and al& t#rug#

5ntaminated 8egeta7le& /ertiliFed 7y /e5e& and /d& and ater #andled 7y

un5lean #and&. Bmite& and /lie& al& #a8e a rle in t#e tran&mi&&in.

Autin/e5tin t#rug# imprper 5leaning / #and& i& al& reprted. t i&

un5mmn in 5#ildren 7el t#e age / year&. *= in/e5tin pe5uliarly de&

nt aggra8ate t#e illne&&.

;%'% ETIOLO!Y

Co/ses o2 D)senter)$y&entery 5an #a8e a num7er / 5au&e&. B"cter1"* 1n2ect1ons "re .) 2"r t#e

$ost co$$on c"/ses o2 +)senter)% +#e&e in/e5tin& in5lude Shigella,

Campylobacter, E. coli, and Salmonella&pe5ie& / 7a5teria. +#e /reOuen5y /

ea5# pat#gen 8arie& 5n&idera7ly in di//erent regin& / t#e rld. Br eample,

igell&i& i& m&t 5mmn in >atin Ameri5a #ile Campylobacter i& t#e

dminant 7a5teria in Sut#ea&t A&ia. $y&entery i& rarely 5au&ed 7y 5# emi5al

irritant& r 7y inte&tinal rm&.

Intest1n"* "$oe.1"s1s 1s c"/se+ .) " protoo"n p"r"s1te< Entamoeba

histolytica%+#e ame7a 5an ei&t /r lng perid& / time in t#e large 7el

10
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Rectal_tenesmushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Rectal_tenesmushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Inflammation


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(5ln). n t#e 8a&t majrity / 5a&e&, ame7ia&i& 5au&e& n &ymptm& D nly 10H

/ in/e5ted indi8idual& 7e5me ill. t i& un5mmn e5ept in t#e rld@& trpi5al

Fne&, #ere it i& 8ery pre8alent. ?eple 5an 7e5me in/e5ted a/ter inge&ting

/e5e& t#at 5ntain &me7dy@& e5reted para&ite&. ?eple are at #ig# ri&< /

a5Ouiring t#e para&ite t#rug# /d and ater i/ t#e ater /r #u&e#ld u&e i&n@t

&eparated /rm a&te ater. +#e para&ite& 5an al& enter t#rug# t#e mut# #en

#and& are aed in 5ntaminated ater. / peple negle5t t a prperly

7e/re preparing /d, t#e /d may 7e5me 5ntaminated. Bruit& and 8egeta7le&

5an 7e 5ntaminated i/ aed in plluted ater r grn in &il /ertiliFed 7y

#uman a&te.

+#e Shigellaand Campylobacter7a5teria t#at 5au&e 7a5illary dy&entery are /und

all 8er t#e rld. +#ey penetrate t#e lining / t#e inte&tine, 5au&ing &elling,

ul5eratin&, and &e8ere diarr#ea 5ntaining 7ld and pu&. "t# in/e5tin& are

&pread 7y inge&tin / /e5e& it#in 5ntaminated /d and ater. / peple li8e r

tra8el in an area #ere p8erty r 8er5rding may inter/ere it# gd #ygiene

and &anitatin, t#ey are at ri&< / 7eing ep&ed t in8a&i8e 7a5teria. Pung

5#ildren (age& 1 t 4) li8ing in p8erty are m&t li


12/19

/lra / t#e inte&tine, and #&t innate and a5Ouired immune re&pn&e&.

+rp#Fite& are alay& pre&ent in t#e gut in patient& it# ame7i5 diarr#ea and

dy&entery (diarr#ea it# 7ld r mu5u&), and diagn&i& uld 5n5entrate n

identi/ying t#e para&ite in &tl 7y antigen dete5tin and t#e &erum anti7dy

re&pn&e again&t t#e in8a&i8e para&ite.

n8a&in / t#e trp#Fite& t#rug# t#e inte&tinal epit#elium lead& t ame7i5

diarr#ea and 5liti&. =ie image=ie imagen8a&in in8l8e& a uniOue ni77ling

pr5e&& 7y t#e para&ite n t#e inte&tinal lining, termed ame7i5 trg5yt&i&.

*aematgenu& di&&eminatin 8ia t#e prtal 8enu& &y&tem re&ult& in ame7i5

li8er a7&5e&&=ie imageand in/e5tin in t#er &ite& &u5# a& t#e 7rain,=ie image

alt#ug# t#i& i& rare.

;%@% CLINICAL MANIFESTATIONS

T#e $"1n s)$pto$ o2 +)senter) 1s 2re/ent ne"r4*1/1+ +1"rr#e" 2*ec7e+

01t# .*oo+< $/c/s< or p/s%It#er &ymptm& in5lude:

Q &udden n&et / #ig# /e8er and 5#ill&

Q a7dminal pain

Q 5ramp& and 7lating

12
http://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/3.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/6.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/6.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/4.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/5.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/3.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/6.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/4.htmlhttp://bestpractice.bmj.com/best-practice/monograph/553/resources/images/print/5.html


13/19

Q /latulen5e (pa&&ing ga&)

Q urgen5y t pa&& &tl

Q /eeling / in5mplete emptying

Q l&& / appetite

Q eig#t l&&

Q #eada5#e

Q /atigue

Q 8miting

Q de#ydratin

It#er &ymptm& may 7e intermittent and may in5lude re5urring l /e8er&,

a7dminal 5ramp&, in5rea&ed ga&, and milder and /irmer diarr#ea. Pu may /eel ea


14/19

Stoo* "n+ .*oo+ test

6ulture& / &tl &ample& are eamined in rder t identi/y t#e rgani&m 5au&ing

dy&entery. U&ually, &e8eral &ample& mu&t 7e 7tained due t t#e 5#anging num7er /

ame7a, #i5# 5#ange& daily.

"ld te&t&5an 7e u&ed t mea&ure a7nrmalitie& in t#e le8el& / e&&ential mineral&

and &alt&.

*ig# degree / &u&pi5in in endemi5 area& i& a prereOui&ite. Bre liOuid &tl

eaminatin ing #ematp#agu& trp#Fite& it# 6#ar5tD>eyden 5ry&tal& i&

5#ara5teri&ti5. Stl eaminatin, pre/era7ly /r t#ree 5n&e5uti8e day& i& ad85ated.

?re&en5e / nly 5y&t& in a&ymptmati5 indi8idual& i& nt diagn&ti5, &in5e t#e 5y&t&

/ E. dispar, #i5# i& nnin8a&i8e and #armle&& are indi&tinguia7le /rm t#&e /

in8a&i8e E. histolytica. Sigmid&5pi5 &5raping& / ul5er& ing #ematp#agu&

trp#Fite& are diagn&ti5. S al& i& t#e /inding / ame7ae /rm t#e all& /

#epati5 a7&5e&&.

Ultra&und (US) &5an / t#e a7dmen #elp& in t#e delineatin / #epati5 a7&5e&&e&.

RDray / t#e 5#e&t #elp& in t#e dete5tin / &pread t t#e pleura, lung r peri5ardium.

RDray / t#e a7dmen i& u&e/ul /r t#e diagn&i& / peritniti& and ti5 mega5ln.

6mputed tmgrap#ymagneti5 re&nan5e imaging #elp in t#e diagn&i& /

intra5ranial &pread / ame7ia&i&.

6nditin& t 7e


15/19

A&ymptmati5 5y&t redder&, needuld nt 7e treated3W*I guideline&.

6m7inatin t#erapy it# luminal and ti&&ue ame7i5ide& i& #ig#ly re5mmended.

ntrdu5tin / nitrimidaFle deri8ati8e& #a& re8lutiniFed t#e treatment /

ame7ia&i&. U&age / 5arditi5 emetine and t#e relati8ely le&& ti5 de#ydremetine

are n / #i&tri5al intere&t. +#ug# metrnidaFle and t#er deri8ati8e& are #ig#ly

ti5 t t#e 8egetati8e /rm& and t a le&&er etent t#e 5y&t&, a 5ur&e / luminal

ame7i5ide& i& re5mmended /r 5mplete 5ure.

T1ss/e A$oe.1c1+es

Metronidazole: 00 mg = t# #urly. Br 310 day& /r etrainte&tinal

ame7ia&i&. 400 mg t#ri5e daily rally /r 310 day& (403C0 mg


16/19

$odochlorhydroxyqin: 00 mg ti5e daily /r 10 day&

%aromomycin: '0 mg


17/19

POINTS TO REMEMBER

Blie& may a5t a& 8e5tr& in tran&/erring 5y&tDladen /e5e& n t eata7le&.

6y&t& remain 8ia7le /r &e8eral day& t mnt#& depending n t#e temperature

and mi&ture / t#e eternal atm&p#ere.

6y&t& may &ur8i8e up t 4 minute& in t#e /e5al material ldged under t#e

/inger nail&.

6y&t& are


18/19

1. Al7erta *ealt# and Wellne&& (2011). Ame7ia&i&: ?u7li5 #ealt# nti/ia7le di&ea&e

management guideline&. nline. A8aila7le /rm

#ttp:.#ealt#.al7erta.5ad5ument&uideline&DAme7ia&i&D2011.pd/A55e&&ed $e5em7er, 2012.

2. Antia B?, $e&ai *, %eejee7#y -N, et al. (2012). n5iden5e / inte&tinal

ame7ia&i&. nline. A8aila7le /rm #ttp:gut.7mj.5m 5ntentC44./ull.pd/

A55e&&ed $e5em7er, 2012.

'. 6< 6, Alimuddin . Man&in& +rpi5al $i&ea&e&, 22nd editin.

?#iladelp#ia: Saunder& l&e8ierT 2009.

4. $#aan =-. 6urrent diagn&i& and treatment / ame7ia&i&. US n/e5tiu&

$i&ea&e. 200T 4(1):9DC1.

. Bau5i A, "raunald , -a&per $, et al. *arri&n& prin5iple& / nternal

Medi5ine, 1t# editin. Ne PrA. n8a&i8e ame7ia&i&, an update n diagn&i&

and management. pert !e8 Anti n/e5t +#er. 200T():9'D 901.

10. S#arma S-, Munjal P?, Agaral A-. A? +et7< / Medi5ine, 9t# editin.

Ne $el#i: %aypee "rt#er& Medi5al ?u7lier&T 2012.

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