AT/M/19yo

Chief Complaint : Can not defecateIt has been suffered since 7 days before admitted to hospital. He also complained of intermittent abdominal pain. Flatus (+). Patient had fever since one week before. Vomiting more than 5 times a day. History of weight loss (+). Cough since a month ago, with greenish sputum without blood. History of night sweat (+). Micturition (+) normal. History of tuberculosis in the family was denied.

Present State :Awareness : AlertBlood pressure : 110/70 mmHgHR : 98 x/iRR : 24 X/iTemp : 38,60C

Generalized StateHead and neck : conj palp inf pale (-) Thorax : I : simetric

P : SF equal on both hemithorax P : sonor on both of hemithorax A : Sound of breath : vesicular on both of hemithorax

Abdomen : Localized stateGenitalia : male, no abnormalityExtremity : no abnormality

Localized state:Abdomen: I : Symmetry, distention (+), visible bowel movement (+) P: Tenderness (+)P: HypertympaniA: peristaltic (+) increase

DRE: perineum usual, tight tonus anal sphincter, pain (-), smooth mucosa, ampulla recti was collaps. Hand gloves : Feces (+), blood (-), mucous (-)

Laboratorium finding:Hb / Hct / WBC / PLT : 13,3/41,7/9,1/331Na / K / Cl : 145/3,9/104Albumin : 3,1Random Blood Sugar Level : 116,0Ur/Cr : 108,45/2,37

Chest X-ray

Working Diagnosis :Partial Mechanical Bowel Obstruction d/t Susp. Peritoneal TB

Management in Emergency Room: • Nil per mouth• Insertion NGT,comeout clear fluid about 100 cc • Insertion urine cateter,came out initial urine output about 110 cc,clear yellow colour• IVFD Crystalloid• Inj. Antibiotics • Inj.Analgetic• Conservative• Plan : CT Scan Abdomen