Anda di halaman 1dari 31

Mata kuning

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Skenario
Pasien wanita 20 tahun datang ke dokter dengan
keluhan mata dan kulit berwarna kekuning-kuningan.
Pasien mngalami demam beberapa hari sebelumnya
disertai rasa mual dan nyeri pada perut kanan atas.
Penderita sekitar seminggu yang lalu baru pulan dari
KKN terpadu di Kab. Mamuju, sebuah daerah
endemis malaria. Di tempat KKN, pasien sempat
mengalami diare berlendir. Ketika ditanyakan riwayat
imunisasinya, pasien tidak pasti imunisasi apa saja
yang pernah diterimanya.

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Kata Kunci
Wanita, 20 tahun
Pernah ke daerah endemis malaria
Imunisasi tidak jelas

1 minggu

?
Diare Kembali dari Demam Jaundice
berlendir KKN
Mual
Nyeri
hipochondriac

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Metabolisme Bilirubin
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Sirkulasi Portal
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Lobulus Hepatik
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Ekskresi Empedu

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Jaundice
Jaundice (i.e., icterus), which results from an abnormally high
accumulation of bilirubin in the blood, is a yellowish
discoloration to the skin and deep tissues. Jaundice becomes
evident when the serum bilirubin levels rise above 2.0 to 2.5
mg/dL. (Essentials of Pathophysiology, p.498)
Jaundice refers to a yellowish tint to the body tissues,
including a yellowness of the skin as well as the deep
tissues.The usual cause of jaundice is large quantities of
bilirubin in the extracellular fluids, either free bilirubin or
conjugated bilirubin. (Guyton Textbook of Medical Physiology,
p.863)

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Penyebab Jaundice
Pre-Hepatik:
- Hemolisis RBC : malaria, sickle cell anemia, spherocytosis
- Transport bilirubin : sindrom nefrotik, sirosis
Intra-Hepatik:
- Ggn uptake: obat2an (novobiocin, flavaspidic acid), Gilberts
syndrome
- Ggn konjugasi: obat2an (pregnanediol, novobiocin,
chloramphenicol, gentamicin) Crigler-Najjars Syndrome,
Gilberts syndrome
- Ggn sekresi: Cholecystitis
Post-Hepatik:
- Obtruksi duktus choledocus: Cholelithiasis

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Differential Diagnosis
Malaria
Hepatitis
Cholelithiasis

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Riw. Daerah
endemik
Malaria
Tes Tetesan
Darah

JAUNDICE Kemungkinan
+ Riw. Demam, Hepatitis Penularan
Nyeri RUQ, mual, Tes Serologi
diare berlendir

Nyeri Kolik
USG

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
MALARIA

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Gejala
Keluhan Prodormal: kelesuan, malaise, sakit kepala, sakit
belakang, merasa dingin dipunggung, nyeri sendi dan
tulang, demam ringan, anoreksia, perut tak enak, diare
ringan dan kadang-kadang dingin.
Demam Periodik
Splenomegali

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Pemeriksaan
Tetesan preparat darah tebal
Tetesan preparat darah tebal.
Tetesan darah tipis.
Tes antigen
Tes serologi.
Pemeriksaan pCR

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
HEPATITIS VIRUS AKUT

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Tipe
Tipe DNA:
HAV HBV (dsDNA)
HDV (ssDNA)

HEV HBV Tipe RNA:


HAV
Hepatitis HCV
HEV

HDV HCV

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Patomekanisme
Efek sitopatik
Virus
Sistem Imun:
sel T CD8+ &
CD4, Sitokin

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Perjalanan Penyakit

1 Fase
Inkubasi 2 Fase Pro
dormal 3 Fase Ikterik
4 Fase
Konvalesen

A: 15-45 hari
B: 30-80 hari
C: 15-160 hari
D: 30-180 hari
E: 14-60 hari

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
GK
Spektrum: Asimtomatik Fatal
Fase prodormal:Gejala GI (Malaise, anorexia, mual,
muntah), Gejala flu (faringitis, batuk,mialgia), Demam
(pada HAV), serum sickness (arthralgia, skin rash dan
lymphadenopathy.)

Fase Ikterik: Muncul ikterus, gejala prodormal menghilang


(kecuali malaise, anorexia), ikterus didahului urin warna
gelap, pruritus. Pemfis ditemukan pembesaran dan
sedikit nyeri tekan hati.

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Diagnosis
Anamnesis dan Pemfis non spesifik
Pastikan dengan pemeriksaan serologi

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Pemeriksaan

Ada kerusakan hati?


Tes Fungsi Hati: *Kemampuan Ekskresi (Bilirubin)
*Kemampuan sintesis protein ( PT
ALT,AST,-GT memanjang, albumin)

Apa penyebabnya?
Mendeteksi Antibodi terhadap virus Mendeteksi antigen

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Tes Serologi
HAV: IgM anti HAV, anti HAV
HBV: IgM anti HBc, anti HBsAg, HBeAg, HBV DNA, IgG anti
HBc, Anti HBs
HCV: anti HCV, IgM anti HCV, HCV RNA
HDV: Anti HDV, HDV RNA, IgM anti HDV, dapat koinfeksi
dengan HBV
HEV:IgG dan IgM anti HEV

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Fase akut: IgM anti HAV
Infeksi lampau: anti HAV (+) tanpa IgM anti HAV

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Antibodi terhadap core antigen: IgM anti HBc
HBsAg
HBV DNA dalam serum dan HBeAg
IgG anti HBc dan anti HBs

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Terapi
HAV: Non spesifik
HBV: Alfa-Interferon, Lamivudine
HCV: Alfa Interferon, Ribavirin
HDV: Non spesifik
HEV: Non spesifik

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
KOLELITIASIS

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Patomekanisme
Kolelitiasis

Kolesistitis &
Kolangitis

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Anamnesis Pemfis PP
4F Nyeri RUQ LFT: Bilirubin
Kolik Jaundice dan Alkali
Phosphatase
Nausea, Muntah demam
Urin gelap
USG
Steatorrhea
Anorexia ERCP

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Pengobatan
Analgetik dan Antibiotik
Bedah: Cholecystectomy (open/laparoscopic), ERCP
Dissolution treatment: Chenodeoxylate, Ursodeoxycolic
acid (jarang)

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)