kuliah hepato
DESCRIPTION
InternaTRANSCRIPT
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HEPATITIS
FRANS WANTANIA
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SASARAN PEMBELAJARAN
Dapat menjelaskan :1.Etiologi Hepatitis2.Patogenesis Hepatitis3.Manifestasi Klinis Hepatitis4.Diagnosis Hepatitis5.Pengobatan dan Pencegahan Hepatitis
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HEPATITIS VIRUS AKUT
HEPATITIS A
HEPATITIS B
HEPATITIS C
HEPATITIS D
HEPATITIS E
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CARA PENULARAN HEPATITIS VIRUS
1.TRANSMISI ENTERIK - Hepatitis A dan E
2.TRANSMISI MELALUI DARAH- Hepatitis B, C, dan D
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PATOFISIOLOGI
1.Mekanisme sistem imun
2.Efek sitopatik langsung dari virus hepatitis
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MANIFESTASI KLINIS
- Fase Inkubasi
- Fase Prodromal
- Fase Ikterus
- Fase konvalesen
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MANIFESTASI KLINIS
- GAGAL HATI AKUT
- HEPATITIS DENGAN KOLESTASIS
- HEPATITIS RELAPS
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GAGAL HATI AKUT
- Perubahan status mental
- Edema serebral
- Koagulopati
- Gagal Organ Multipel
- Asites anasarka
- Lekositosis, hiponatremia, dan hipokalemia
- Hipoglikemia
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HEPATITIS DENGAN KOLESTASIS
- Kuning sangat menonjol
- Pruritus
- Konsentrasi bilirubin serum dapat melebihi 20
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HEPATITIS RELAPS
- Kemunculan kembali gejala dan abnormalitas
tes hati beberapa minggu/ bulan kemudian
- Artritis, vaskulitis
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FAKTOR RESIKO HEPATITIS A DAN E
Penggunaan fasilitas air minum bersama
Pusat perawatan sehari untuk bayi atau balita
Institusi untuk Developmentally Disadvantage
Perilaku seks oral-anal
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FAKTOR RESIKO HEPATITIS B, C, D
- Transmisi seksual
- IVDU
- Homoseksual atau biseksual
- Resipien donor darah
- Tatto
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DIAGNOSIS
1. MANIFESTASI KLINIS
2. FAKTOR RESIKO
3. SEROLOGIS (IgM)
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PENATALAKSANAAN
Mempertahankan asupan kalori dan cairan yang
adekuat
Menghindari aktivitas fisik yang berlebihan
Obat-obat yang tidak perlu harus dihentikan
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GAGAL HATI AKUT
TRANSPLANTASI HATI
TERAPI SUPORTIF
TERAPI TERHADAP KOMPLIKASI
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HEPATITIS KOLESTASIS
Pemberian jangka pendek prednison
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PROFILAKSIS
• IMUNOPROFILAKSIS SEBELUM PAPARAN\
- Vaksin yang dilemahkan
• IMUNOPROFILAKSIS PASCA PAPARAN
- Imunoglobulin
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DOSIS DAN JADWAL VAKSIN HAV
• > 19 tahun : 2 dosis HAVRIX 1440 unit interval
6-12 bln
• Anak > 2 tahun :
- 3 dosis HAVRIX 360 unit
- bulan ke 0, 1, dan 6-12
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INDIKASI VAKSINASI
• Pengunjung ke daerah resiko tinggi
• Homoseksual dan Biseksual
• IVDU
• Anak dan dewasa muda di daerah KLB
• Pramusaji
• Petugas laboratorium
• Pekerja pada bagian pembuangan air
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HEPATITIS B KRONIK
• Persistensi virus hepatitis B lebih dari 6 bulan
• Melalui proses imunologis bukan sitopatik
langsung oleh virus hepatitis
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PERJALANAN PENYAKIT
1.FASE IMUNOTOLERANSI
2.FASE IMMUNE CLEARANCE
3.FASE RESIDUAL
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MANIFESTASI KLINIS
• Tergantung fase penyakit
• Sirosis
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PENATALAKSANAAN HEPATITIS B KRONIK
• IMUNOMODULASI
- Interferon
• TERAPI ANTIVIRUS
- Lamivudin
- Adefovir Dipivoksil
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PENATALAKSANAAN HEPATITIS B KRONIK
• IMUNOMODULASI
- Interferon 5-10 mU 3 kali seminggu (16-24
mingg)
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PENATALAKSANAAN HEPATITIS B KRONIK
• TERAPI ANTIVIRUS
- Lamivudin 100 mg/ hari
- Adefovir Dipivoksil 10 mg/ hari
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HEPATITIS C KRONIK
- Umumnya tidak memberikan gejala
- Faktor Resiko
* Homoseksual/ biseksual
* IVDU
* Tatto
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DIAGNOSIS HEPATITIS C KRONIK
• Faktor Resiko
• Anti HCV
• HCV RNA
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PENATALAKSANAAN
• INTERFERlON
• 2-3 kali seminggu 3 juta unit SC
• PEG Interferon 1,5 ug/kgBB/ kali setiap minggu
• RIBAVIRIN
• 1000 mg per hari (BB 50-70kg) dibagi dalam 2 dosis
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DISPEPSIA
• Pain or discomfort centered in the upper
abdomen
• DISPEPSIA ORGANIK
• DISPEPSIA FUNGSIONAL
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DISPEPSIA ORGANIK
• ESOFAGO-GASTRO-DUODENAL
• OBAT-OBATAN
• HEPATOBILIER
• PANKREAS
• PENYAKIT SISTEMIK LAINNYA
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ESOFAGO-GASTRO-DUODENAL
• Tukak Peptik
• Gastritis
• Keganasan
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OBAT-OBATAN
• NSAID
• Teofilin
• Digitalis
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HEPATOBILIER
• Hepatitis
• Kolesistitis
• Kolelitiasis
• Keganasan
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PANKREAS
• Pankreatitis
• Keganasan
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PENYAKIT SISTEMIK LAINNYA
• Diabetes Melitus
• Tiroid
• Gagal Ginjal
• Penyakit Jantung Koroner
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DISPEPSIA FUNGSIONAL
1. Adanya satu atau lebih keluhan rasa penuh
setelah makan, cepat kenyang, nyeri ulu hati,
heartburn
2. Tidak ada bukti kelainan struktural
3. Terjadi selama 3 bulan dalam waktu 6 bulan
terakhir sebelum diagnosis ditegakkan
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GAMBARAN KLINIS
• ULCER LIKE DYSPEPSIA
• DISMOTILITY LIKE DYSPEPSIA
• DISPEPSIA NON-SPESIFIK
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PENATALAKSANAAN
• NON FARMAKOLOGIS
• FARMAKOLOGIS
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NON FARMAKOLOGIS
• EDUKASI
• DIET
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FARMAKOLOGIS
• ANTASIDA
• PPI
• SITOPROTEKSI
• PROKINETIK
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SIROSIS HEPATIS
• STADIUM AKHIR FIBROSIS HEPATIK
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MANIFESTASI KLINIS
• AKIBAT GAGAL HATI
• AKIBAT HIPERTENSI PORTAL
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AKIBAT GAGAL HATI
• HIPOALBUMINEMIA
• HIPERESTROGEN
• ENSEFALOPATI
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AKIBAT HIPERTENSI PORTAL
• ASITES
• SPLENOMEGALI
• KAPUT MEDUSA
• VARISES ESOFAGUS
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KOMPLIKASI
• RUPTUR VARISES ESOFAGUS
• SPONTANEUS BACTERIAL PERITONITIS
• KOMA HEPATIKUM
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PENATALAKSANAAN
ATASI :
• ASITES
• PERITONITIS BAKTERIAL SPONTAN
• HIPERTENSI PORTAL
• VARISES ESOFAGUS BERDARAH
• ENSEFALOPATI HEPATIKUM
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TATALAKSANA ASITES
• DIET RENDAH GARAM (5,2 gram/ hari)
• Spironolakton 100 – 200 mg per hari
• Furosemide 20 – 40 mg per hari
• Parasentesis
• Albumin IV
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PERITONITIS BAKTERIAL SPONTAN
• SEFOTAKSIM
• KUINOLON
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HIPERTENSI PORTAL
• ISMO
• PROPRANOLOL
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ENSEFALOPATI HEPATIK
• LAKTULOSA
• NEOMISIN
• DIET PROTEIN 0,5 gram/ kgBB/ hari
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PERDARAHAN SALURAN CERNA ATAS
• VARISES ESOFAGUS BERDARAH
• NON VARISES
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PENATALAKSANAAN
• RESUSITASI
• TERAPI EMPIRIS
• ENDOSKOPI
• TERAPI KAUSATIF
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PERDARAHAN VARISES ESOFAGUS
• RESUSITASI
• LIGASI
• SKLEROTERAPI
• SOMATOSTATIN
• TRANSAMIN
• VIT K
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PERDARAHAN NON VARISES
• RESUSITASI
• TERAPI EMPIRIK
• PPI, Sitoprotektif
• TERAPI KAUSATIF (Ligasi)
• SOMATOSTATIN
• KONSUL BEDAH
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Laki-laki 60 tahun MRS dengan keluhan muntah
coklat sejak tadi pagi. Pada pemeriksaan fisik
didapati TD 100/80 mmHg, Nadi 120 kali per
menit, R 24 kali per menit, toraks dbn,
abomen : splenomegali, Ekstremitas eritema
palmaris (-). Apa tindakan saudara?
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Laki-laki 50 tahun kontrol ke tempat praktek
dengan riwayat muntah coklat 1 minggu lalu.
Pada pemeriksaan fisik didapati TD 110/80
mmHg, Nadi 100 kali per menit, R 24 kali per
menit, toraks dbn, abomen : splenomegali,
Ekstremitas eritema palmaris (-). Apa tindakan
saudara?
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PENYAKIT BATU EMPEDU
• KOLELITIASIS ASIMTOMATIS
• KOLELITIASIS SIMTOMATIS
• KOLELITIASIS DENGAN KOMPLIKASI
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KOLELITIASIS SIMTOMATIS
KOLIK BILIER :
• Nyeri di perut kanan atas
• Lebih dari 30 menit
• Kurang dari 12 jam.
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KOLELITIASIS DENGAN KOMPLIKASI
• KOLESISTITIS AKUT
• KOLANGITIS
• PANKREATITIS
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KOLESISTITIS AKUT
• Murphy Sign
• Lekositosis
• Hiperbilirubinemia ringan
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KOLANGITIS
• TRIAS CHARCOT
(Nyeri kanan atas, ikterus, dan demam)
• KOLANGITIS AKUT SUPURATIF
- Trias Charcot ditambah :
* Hipotensi, Oliguria, dan gangguan
kesadaran
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PENATALAKSANAAN KOLESISTITIS AKUT
• DIET RENDAH LEMAK
• ANALGETIK
• ANTIBIOTIKA
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PENATALAKSANAAN KOLANGITIS
- RESUSITASI
- ANTIBIOTIK IV
- ERCP
- DRAINASE
- KOLESISTEKTOMI LAPAROSKOPIK
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TERIMA KASIH
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IMUNOPROFILAKSIS PASCA PAPARAN HEPATITIS B
- KONTAK SEKSUAL DENGAN INDIVIDU
HEPATITIS
- 0,04-0,07 mL/kgBB HBIg
- Vaksin HBV pada deltoid kontralateral
- NEONATUS DARI IBU HBsAG positif
- 0,5 ml HBIg diberikan dalam 12 jam setelah lahir di
anterolateral otot paha atas
- Vaksin HBV 5-10 ug diberikan dalam 12 jam pada sisi lain
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- RESUSITASI
- ANTIBIOTIK IV
- ERCP
- DRAINASE
- KOLESISTEKTOMI LAPAROSKOPIK
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PENATALAKSANAAN KOLANGITIS
- RESUSITASI
- ANTIBIOTIK IV
- ERCP
- DRAINASE
- KOLESISTEKTOMI LAPAROSKOPIK