Tinjauan Pustaka

DIAGNOSTIK DAN PENATALAKSANAAN KOLESTASIS

Oleh :
ARIF PUGUH S

Dr.M TANTORO H, SpPD. KGEH., FINASIM

Pembimbing

BAGIAN / SMF ILMU PENYAKIT DALAM

FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET
RUMAH SAKIT UMUM DAERAH DR. MOEWARDI
SURAKARTA
2014
LEMBAR PENGESAHAN

DIAGNOSTIK DAN PENATALAKSANAAN KOLESTASIS

Oleh :
ARIF PUGUH S

Referat ini telah diajukan dan direvisi

pada tanggal : 2014

Dr.M TANTORO H, SpPD. KGEH., FINASIM

Pembimbing

BAGIAN / SMF ILMU PENYAKIT DALAM

FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET
RUMAH SAKIT UMUM DAERAH DR. MOEWARDI
SURAKARTA
2014

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 DAFTAR ISI

LEMBAR PENGESAHAN ................................................................................................ ii

DAFTAR ISI ........................................................................................................................ iii
DAFTAR GAMBAR.......................................................................................................... iv
DAFTAR TABEL .............................................................................................................. v
BAB 1 PENDAHULUAN ................................................................................................... 1
BAB 2 PEMBAHASAN ....................................................................................................... 3
2.1. Kolestasis.............................................................................................................. 3
2.2. Definisi Kolestasis................................................................................................ 3
2.3. Epidemiologi ........................................................................................................ 3
2.4. Etiopatogenesis Kolestasis .................................................................................. 4
2.5. Manifestasi Klinis ................................................................................................ 15
2.6. Diagnosis .............................................................................................................. 19
2.7. Penatalaksanaan .................................................................................................. 31
2.8. Prognosis ............................................................................................................. 36
BAB III RINGKASAN ........................................................................................................ 37
DAFTAR PUSTAKA...........................................................................................................38

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 DAFTAR GAMBAR

Gambar 1. Metabolisme Bilirubin ................................................................................ 5

Gambar 2. Gambaran hepateosit normal dan hepatosit pada kolestasis ....................... 6
Gambar 3. Etiologi Kolestasis ...................................................................................... 7
Gambar 4. Prinsip mekanisme kolestasis...................................................................... 8
Gambar 5. Patogenesis kolestasis akibat primary biliary cirrhosis .................................... 9
Gambar 6. Patogenesis kolestasis akibat Primary sclerosing cholangitis .......................... 11
Gambar 7. Patogenesis kolestasis akibat infeksi bakteri ekstrahepatik ........................ 11
Gambar 8. Mekanisme obat hepatotoksik ..................................................................... 14
Gambar 9. Mekanisme Pruritus .................................................................................... 18
Gambar 10. Kulit Xanthoma ........................................................................................... 19
Gambar 11. Algoritma pendekatan diagnostik untuk pasien dengan kolestasis ............. 23
Gambar 12. Patologi anatomi kolestasis ........................................................................ 26
Gambar 13. Patologi anatomi pada Primer Bilier Cirhosis............................................. 26
Gambar 14. Patologi anatomi pada Primary Sclerosing Cholangitis ..................................... 27
Gambar 15. ERCP sebagai alat diagnostik ..................................................................... 30
Gambar 16. Penatalaksanaan Pruritus pada primary biliary cirrhosis ............................ 32
Gambar 17. Efek Asam Ursodeoxycolic ........................................................................ 36
Gambar 18. ERCP sebagai alat terapeutik spingterektomi dan stent............................. 36

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 DAFTAR TABEL

Tabel 1. Klasifikasi Kolestasis intrahepatik.................................................................... 9

Tabel 2. Obat yang berefek kolestasis ............................................................................ 12
Tabel 3. Perbedaan ikterus prehepatik, hepatik & posthepatik ........................................... 15
Tabel 4. Manifestasi klinik kolestasis ............................................................................. 16

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 DAFTAR SINGKATAN

AFP ....................................... Alfafetoprotein

AIH ....................................... Autoimmune hepatitis
AIP ........................................ Aautoimmune pancreatitis
AMA .................................... Antimitochondrial antibodies
AP ......................................... Alkaline phosphatase in serum
ASMA ................................... Anti-smooth muscle antibodies
BRIC ..................................... Benign recurrent intrahepatic cholestasis
CCA ...................................... Cholangiocarcinoma
CF.......................................... Cystic fibrosis
CFALD ................................. Cystic fibrosis-associated liver disease
CPG ....................................... Clinical Practice Guidelines
CT ........................................ Computed tomography
DILI...................................... Drug-induced liver injury
EASL..................................... European Association for the Study of the Liver
ERCP..................................... Endoscopic retrograde cholangiopancreatography
EUS ....................................... Endoscopic ultrasound
FDG-PET .............................. Fluoro-deoxy-D-glucose positron emission tomography
FXR ....................................... Farnesoid X receptor
HCC ...................................... Hepatocellular carcinoma
IAC ........................................ Immunoglobulin G4-associated cholangitis
IAIHG .................................. International Autoimmune Hepatitis Group
IBD ....................................... Inflammatory bowel disease
IgG ....................................... Immunoglobulin G in serum
MRCP ................................... Magnetic resonance cholangiopancreatography
NASH................................... Non-alcoholic steatohepatitis
PBC ...................................... Primary biliary cirrhosis
PDC-E2 ................................ E2 subunit of the pyruvate dehydrogenase complex
PSC ...................................... Primary sclerosing cholangitis
PIIINP ................................. Procollagen-3-aminoterminal propeptide
UC ........................................ Ulcerative colitis
ULN ..................................... Upper limit of normal

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