CRITICAL ANALYSIS OF PROBLEMS IN SCENARIO ACCORDING TO

REFERENCES.

Mrs. M comes with epigastric pain , nausea, and vomitting since yesterday. But after we

do some anamnesis we know that it is not the first time she experiences the pain. Based on our

evidence based study there are two kinds of pain based on the onset: acute pain and chronic pain

. We assume that Mrs. M experiences acute pain because temporary and recurrent. Based on the

characteristic Mrs. M experiences visceral pain because she has no trauma history, difuse, and

blunt.

From anatomical view, epigastric pain is often associated with foregut disease. Organs

that contained in forgut is esophagus, gaster, duodenum (up to ampulla vatery), liver, gall

bladder, and pancreas (Rice university, 2017). We pulled out midgut and hindgut disease because

midgut pain is colicky and usually periumbilically, while hindgut pain is colicky and located in

the below of the umbilicus (Davey, 2014). But, in appendicitis, pain could be located in the

epigastrium, hipochondrium, periumbilical, and then localized in right illac fossa (Gleadle,

2012).

From the anamnesis data Mrs. M frequently consumed some pain medication, but the

type or class of the drugs is not clear yet. So we add this to our additional question and we got

the data that Mrs. M consumed Diclofenac sodium, sometimes piroxicam, and “Jamu”. Whereas,

diclofenac sodium and piroxicam is a non selective Non Steroidal Anti Inflamation Drugs that

has effect on GI tract. This drugs has aspirin-like effect but the incidence lower than aspirin.

Some of aspirin effect is gastric ulceratioun and upper GI bleeding (Trevor et al, 2013). In a
previous study, Acetaminophen, dexamethasone, prednisone, mefenamic acid, and piroxicam

was found in “Jamu pegal linu” contents (Wisnuwardhani et al, 2013)

From the endoschopy we found erosive gastritis in anthrum and corpus, this finding

supports our asumption before that Mrs. M has something wrong on her foregut organ, which by

the endoschopy result is specified to the gaster. The pain medications that Mrs. M frequently

consumed could be one of some etiologies of the disease that Mrs. M suffered. But we still need

some information that we will look for in learning issue 2 to determine exactly what the disease

and the management and therapy.

DAFPUS TAMBAHAN:

Wisnuwardhani, H.A., Fidrianny, I., Ibrahim, S., 2013. METHOD DEVELOPMENT FOR

SIMULTANEOUS ANALYSIS OF STEROID AND NON STEROID ANTIINFLAMATORY

SUBSTANCES IN JAMU PEGAL LINU USING TLCSPECTROPHOTODENSITOMETRY.

International Journal of Pharmacy and Pharmaceutical Sciences. Vol 5, Issue 4, 2013