EDUCATION
CALEDUCAEDUCATIONTION
Akreditasi PB IDI3 SKP
ABSTRAK
Jejas hati imbas obat (drug-induced liver injury, DILI), atau hepatotoksisitas imbas obat, merupakan jejas hati yang disebabkan oleh pajanan
terhadap obat atau agen non-infeksius. Jejas yang ditimbulkan oleh obat bervariasi, mulai dari tidak bergejala, ringan, hingga gagal hati akut
yang mengancam nyawa. Insidens hepatotoksisitas imbas obat terbilang rendah, yaitu antara 1 dari 10.000 sampai 1 dari 100.000 pasien,
tampaknya karena sulitnya diagnosis dan angka pelaporan yang masih rendah. Kunci penting diagnosis DILI adalah pajanan obat harus terjadi
sebelum onset jejas hati dan penyakit lain yang dapat menyebabkan jejas hati harus disingkirkan. Selain itu, jejas hati akan membaik bila
penggunaan obat tertentu dihentikan dan jejas hati dapat terjadi lebih cepat dan lebih berat pada pajanan berikutnya, khususnya bila jejas
hati tersebut terjadi akibat proses imunologis.
Kata kunci: Drug-induced liver injury, diagnosis, obat
ABSTRACT
Drug-induced liver injury or drug-related hepatotoxicity is injury to the liver caused by exposure to a drug or another noninfectious agent. The
clinical signs could vary from very mild condition without any clinical symptoms to severe and life-threatening acute liver failure. Drug-related
hepatotoxicity has a low reported incidence, ranging from 1 in 10.000 and 1 in 100.000 patients, but its true incidence may be higher
because of difficulties in detection or diagnosis and underreporting. Key elements in assessing cause in the diagnosis of drug-related
hepatotoxicity were: Exposure to a drug must precede the onset of liver injury. Other disease should be ruled out. Condition may improve
when the drug is stopped and may recur more rapidly and severely on repeated exposure, especially if immunological process is involved.
Imelda Maria Loho, Irsan Hasan. Drug-Induced Liver Injury Diagnostic Challenges.
Key words: Drug-induced liver injury, diagnosis, drug
PENDAHULUAN
Jejas hati imbas obat (drug-induced liver
injury, DILI) merupakan salah satu masalah
kesehatan yang memiliki tantangan diagnosis
tersendiri. Luputnya diagnosis DILI sering
terjadi karena DILI memiliki spektrum yang
luas, mulai dari tidak bergejala sama sekali
sampai gagal hati akut yang mengancam
nyawa. Karena itu, pendekatan diagnosis
yang tepat merupakan hal yang sangat
penting. Dalam artikel ini, akan dibahas
secara singkat mengenai epidemiologi,
klasifikasi, mekanisme, diagnosis, dan tata
laksana DILI.
EPIDEMIOLOGI
Perkembangan dunia kedokteran, yang antara
lain diwarnai dengan makin banyaknya jenis
Alamat korespondensi
email: melda.loho@gmail.com
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Campuran
(Peningkatan ALP dan ALT)
Amitriptilin
Azatioprin
Kaptopril
Karbamazepin
Klindamisin
Siproheptadin
Enalapril
Flutamid
Nitrofurantoin
Fenobarbital
Fenitoin
Sulfonamid
Trazodon
Trimetoprim-sulfametoksazol
Verapamil
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Jika sebuah obat digunakan dalam jangka panjang, dapat timbul hepatotoksisitas
yang gejalanya bervariasi, mulai dari mual, anoreksia, malaise, lemah, nyeri
abdomen kanan atas, sampai ikterus. Lakukan pemeriksaan jejas dan gangguan
fungsi hati.
Perhatikan hukum Hy
Ikterus yang muncul setelah DILI merupakan kondisi serius yang berpotensi fatal.
Segera konsultasikan dengan spesialis.
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SIMPULAN
Jejas hati imbas obat (drug-induced liver injury,
DILI) merupakan masalah kesehatan yang
sering luput terdiagnosis oleh dokter. Tidak
adanya alat diagnostik spesifik mengharuskan
seorang klinisi benar-benar cermat dalam
mendiagnosis DILI.
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