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DAFTAR ISI

HALAMAN JUDUL ......................................................................................... i


KATA PENGANTAR ....................................................................................... ii
DAFTAR ISI ...................................................................................................... iii
BAB I STATUS PENDERITA ..................................................................... 1
A. Pendahuluan ................................................................................... 1
B. Identitas Pasien ............................................................................... 1
C. Anamnesis ...................................................................................... 2
D. Anamnesis Sistem .......................................................................... 3
E. Pemeriksaan Fisik ........................................................................... 4
F. Status Lokalis .................................................................................. 7
G. Resume ............................................................................................ 8
H. Diagnosa Holistik ............................................................................ 8
I. Penatalaksanaan ................................................................................ 8
J. Prognosa ........................................................................................... 9
K. Follow Up ....................................................................................... 9
L. Flow Sheet ....................................................................................... 13
M. Diagnostik holistik ......................................................................... 16
BAB II IDENTIFIKASI FUNGSI-FUNGSI DALAM KELUARGA ......... 18
A. Karakteristik Demografi Keluarga ................................................. 18
B. Fungsi Holistik ............................................................................... 18
C. Fungsi Fisiologis ............................................................................ 19
D. Fungsi Patologis dangan Alat SCREEM ........................................ 20
E. Genogram ....................................................................................... 21
F. Informasi Pola Interaksi Keluarga .................................................. 21

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BAB III IDENTIFIKASI FAKTOR YANG MEMPENGARUHI


KESEHATAN .................................................................................... 22
A. Identifikasi Faktor Perilaku dan Non-Perilaku Keluarga ............... 22
B. Identifikasi Lingkungan Rumah ...................................................... 23
BAB IV DAFTAR MASALAH ....................................................................... 25
A. Masalah Medis ............................................................................... 25
B. Masalah Non Medis ........................................................................ 25
C. Diagram Permasalahan Pasien ....................................................... 25
BAB II TINJAUAN PUSTAKA ..................................................................... 5
2.1. Sirsak (Annona muricata Linn.) .................................................. 5
2.1.1. Taksonomi ......................................................................... 5
2.1.2. Kandungan dan Manfaat Sirsak ......................................... 6
2.1.3. Daun Sirsak ......................................................................... 7
2.2. Hepar ............................................................................................ 9
2.2.1. Anatomi Hepar ................................................................... 9
2.2.2. Fisiologi Hepar .................................................................. 10
2.3. Rifampisin Drug-induced Hepatotoxicity ..................................... 11
2.3.1. Metabolisme Obat ............................................................... 11
2.3.2. Hepatotoksin ....................................................................... 14
2.3.3. Radikal Bebas ..................................................................... 17
2.3.4. Rifampisin ........................................................................... 18
2.3.5. Farmakokinetik Rifampisin ................................................ 19
2.3.6. Efek Samping Rifampisin ................................................... 19
2.3.7. Hepatotoksik Akibat Rifampisin ........................................ 20
2.4. Inflamasi ...................................................................................... 21
2.4.1. Mekanisme Inflamasi .......................................................... 21
2.4.2. Mediator Inflamasi .............................................................. 22
2.5. Tumor Necrosis Factor-alpha (TNF-) ....................................... 22
2.5.1. Definisi ............................................................................... 22
2.5.2. Peranan TNF- dalam Mekanisme Inflamasi .................... 23

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2.5.3. Peranan TNF- & Radikal Bebas dalam Inflamasi Hepar 25


BAB III KERANGKA KONSEP PENELITIAN ........................................... 27
3.1. Kerangka Konsep Penelitian ........................................................ 27
3.2. Hipotesis ...................................................................................... 29
3.2.1. Hipotesis Penelitian ........................................................... 29
3.3. Definisi Operasional Variabel Penelitian ..................................... 29
3.3.1. Variabel Penelitian ............................................................. 29
3.3.2. Definisi Operasional .......................................................... 29
BAB IV METODE PENELITIAN .................................................................. 31
4.1. Pendekatan Penelitian .................................................................. 31
4.2. Tempat dan Waktu Penelitian ...................................................... 31
4.3. Metode Pengambilan Sampel ...................................................... 32
4.4. Bahan dan Alat ............................................................................ 33
4.4.1. Hewan Coba ....................................................................... 33
4.4.2. Alat dan Bahan .................................................................. 34
4.5. Prosedur Penelitian ...................................................................... 35
4.5.1. Pengelompokan Hewan Coba ............................................ 35
4.5.2. Induksi Rifampisin ............................................................. 35
4.5.3. Pembuatan dan Pemberian Perasan Buah Sirsak ............... 36
4.5.4. Pembuatan dan Pemberian Rebusan Daun Sirsak ............. 36
4.5.5. Pembunuhan Hewan Coba ................................................. 37
4.5.6. Teknik Analisa Data .......................................................... 37
4.5.7. Diagram Alur Penelitian .................................................... 38
BAB V HASIL PENELITIAN DAN ANALISA DATA ............................... 39
5.1. Karakteristik Populasi ................................................................... 39
5.2. Efek Pemberian Perasan Buah Sirsak dan Rebusan Daun Sirsak
(Anonna muricata L.) Terhadap Kadar TNF- Serum Tikus yang
Diinduksi Rifampisin .................................................................... 40

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BAB VI PEMBAHASAN ................................................................................. 42


6.1. Karakteristik Populasi ................................................................... 42
6.2. Efek Pemberian Perasan Buah Sirsak dan Rebusan Daun Sirsak
(Anonna muricata L.) Terhadap Kadar TNF- Serum Tikus yang
Diinduksi Rifampisin .................................................................... 44
BAB VII SIMPULAN DAN SARAN .............................................................. 49
7.1. Simpulan ....................................................................................... 49
7.2. Saran ............................................................................................. 49
DAFTAR PUSTAKA ....................................................................................... 51
LAMPIRAN

DAFTAR GAMBAR

Gambar 2.1. Buah Sirsak ................................................................................... 5


Gambar 2.2. Daun Sirsak ................................................................................... 8
Gambar 2.3. Struktur Senyawa Flavanoid ......................................................... 9
Gambar 2.4. Penampang Anterior dan Posterior Hepar ..................................... 9
Gambar 2.5. Metabolisme Obat ......................................................................... 13
Gambar 2.6. Mekanisme Hepatotoksisitas ......................................................... 16

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Gambar 2.7. Struktur Kimia Rifampisin ............................................................ 18


Gambar 2.8. Mekanisme Kerja Rifampisin ....................................................... 18
Gambar 2.9. Mekanisme Respon Inflamasi oleh Celullar Stress ...................... 25
Gambar 5.1. Rerata Kadar TNF- Serum tikus pada Kelompok Kontrol dan
Perlakuan yang Diinduksi Rifampisin .......................................... 41

DAFTAR TABEL

Tabel 2.1. Kandungan Gizi per 100 gram Buah Sirsak ...................................... 6
Tabel 2.2. Obat yang Menginduksi dan Menghambat Enzim Sitokrom P-450 .. 13
Tabel 2.3. Perbedaan Efek Sistemik dari Paparan TNF- ................................. 24
Tabel 5.1. Karakteristik Populasi ....................................................................... 39
Tabel 5.2. Rerata Kadar TNF- Serum Tikus Kelompok Kontrol dan Perlakuan
yang Diinduksi Rifampisin ................................................................ 40

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