RESUME

JURNA KEPERAWATAN PADA PASIEN HEPATITIS

Dosen pengampu : NS.lalu M.pannji Azali,M.Kep.

Disusun Oleh :

Anisa indiyana

S18166

S18-D

PROGRAM SARJANA KEPERAWATAN FAKULTAS ILMU KESEHATAN

UNIVERSITAS KUSUMA HUSADA SURAKARTA

TAHUN AJARAN 2019/2020

PENDAHULUAN
Sehat adalah sesuatu yang diinginkan semua orang. Bebas dari penyakit dan menjalani
kehidupan yang optimal. Kemampuanmanusia untuk melaksanakan kegiatan mereka
sangat tergantung pada kondisi tubuh orang itu sendiri. Seperti diketahui bahwa manusia
berinteraksi langsung dengan lingkungan, itu membuat mereka susah menghindar dari
zat atau bahan dalam bentuk radikal bebas. Umayah (dikutip dalam Agustina, E)
menyatakan bahwa radikal bebas berasal dari asap rokok, debu, bahan kimia, asap
kendaraan, obat-obatan, racun dan polutan lainnya, atau bahkan dapat ditemukan dalam
makanan yang tidak diproses dengan benar. Masyarakat perlu mengetahui faktor-faktor
yang mempengaruhi terjadinya penyakit, setidaknya dari lingkungansekitarnya seperti
hidup kondisi, sekolah dan tempat kerja, dan kemudian dari tempat-tempat umum yang
secara teratur mengunjungi seperti tempat wisata, tapi yang paling penting adalah
untuk mengetahui pentingnya kesehatan pribadi. Ini bisa menjadi tindakan cerdas untuk
melindungipribadi dan keluarga kesehatan.Sebuah peristiwa luar biasa telah terjadi di
Trenggalek, Jawa Timur dan terus menyebar luas. Data yang dinyatakan oleh kepala
departemen kesehatan Jawa Timur sekitar 227 orang menderita hepatitis A, dan banyak
juga yang menderita hepatitis B dan C. Menurut data dari Dinas Kesehatan Jawa Timur
ada sekitar 303 penduduk terdeteksi dengan hepatitis.ini Wabah yang luar biasayang
terjadi di Trenggalek terjadi sekitar Januari-Mei 2019. Kepala Dinas Kesehatan Jawa
Timur akhirnya mengirim tim survei epidemiologi ke Panggul, Trenggalek untuk
mencegah penyebaran cepat dan korban tentu tidak casu lainnya. Berbagai upaya
dilakukan untuk menyembuhkan orang yang terinfeksi dan mengurangi wabahnya
(Puput, 2019) Peringatan Hari Hepatitis Sedunia adalah pada 28 Juli. Masyarakat harus
memperhatikan penyakit hepatitis, Indonesia adalah negara dengan tingkat hepatitis
tertinggi. B infeksi, gejalanya kadang-kadang tidak terlihat tetapi biasanya orang yang
terinfeksi merasa lesu, mual dan muntah, dan nafsu makan berkurang. Penderita juga
mengalami demam ringan, ada beberapa yang mengalami sakit di perut. Kejadian
hepatitis menunjukkan signifikan di Indonesia, tidak sedikit di antaranya terjadi pada bayi,
kemudian mengimbau bayi untuk segera diberikanhepatitis imunisasi(Antara,
2019) Tidak dapat dipungkiri bahwa masih banyak orang yang tinggal di kota dan desa
yang mengandalkan pada obat-obatan kimia yang dibeli berdasarkan resep dokter atau
di tempat-tempat yang menjual obat bebas sesuai dengan kebutuhan dan keluhan
mereka. Orang juga mengenal parasetamol yang sering digunakan ketika ada anggota
keluarga yang mengalami demam, selain itumudah ditemukan parasetamol, dan sering
menjadi andalan masyarakat dalam mengurangi demam dan sakit karena sudah menjadi
kebiasaan untuk mengkonsumsi obat-obatan seperti parasetamol. Parasetamol adalah
pereda nyeri ringan, tetapi jika Anda menggunakannya dalam waktu yang lama dapat
merusakhati fungsi. Anindhita Maharrani (2017) melaporkan bahwa ada banyak peneliti
dari luar negeri yang membahas tentang parasetamol yang merusak hati yaitu dengan
merusakpenting strukturantara sel-sel yang berdekatan dalam organ. Jika ada kerusakan
pada dinding sel, akan ada kerusakan pada struktur jaringan di hati juga. Dan akhirnya,
sel-sel di hati tidak dapat bekerja dengan baik dan mati. Hati adalah organ vital bagi
tubuh Indonesia kaya dengan jenis flora dan fauna yang tersebar luas di seluruh wilayah.
Orang yang tinggal di daerah pedesaan sering menggunakan herbal yang terbuat dari
tumbuhan atau hewan menjadi campurantradisional obat-obatanyang diyakini
berkhasiat. Abednego Bangun (2016) berpendapat bahwa warisan leluhur kita telah
dilestarikan di era globalisasi. Ada banyak daun yang efektif menyembuhkan banyak
penyakit seperti hipertensi, batuk, batu ginjal, diabetes, dan bahkan kanker. Yang luar
biasa adalah bahwa tanaman yang hidup di sekitar dan kita mengkonsumsinya memiliki
banyak manfaat, bahkan beberapa di antaranya adalah obat yang membawa mukjizat
sampai sekarang. Oleh karena itu penelitian ini menggunakan ramuan herbal yang ada
di sekitar masyarakat dan dilakukan dengan tujuan untuk menentukan efektivitas buah
ara (Ficus carica L.), kemerahan periwinkle (Catharanthus roseus), dan rebusan ceri
(Muntingia calabura L.) pada penurunan serum SGOT dan SGPT pada hepatitis akut.
Tumbuhan ini mengandung antioksidan yang sangat berguna untuk menangkal atau
mengatasi radikal bebas. Penelitian ini menggunakan rebusan daun bernutrisi dalam
prosesnya karena mudah diproses oleh masyarakat dan mudah diperoleh. Banyak
jumlah korban hepatitis tersebar di Indonesia, jadi dalam penelitian ini, para peneliti
termotivasi untuk mencari pengobatan alternatif untuk hepatitis dengan menemukan
herbal bergizi. Menurut Undang-Undang Republik Indonesia Nomor 36 Tahun 2009
tentang Kesehatan "Obat tradisional adalah bahan atau bahan dalam bentuk bahan
tumbuhan,hewan bahan, bahan mineral, galenik, atau campuran dari bahan-bahan ini
yang telah turun temurun untuk digunakan sebagai obat, dan dapat diterapkan sesuai
dengan norma yang berlaku di masyarakat ".

TINJAUAN PUSTAKA
Hati adalah kelenjar terbesar di tubuh manusia. Organ ini sangat bermakna dalam
kehidupan karena hati memiliki beragam fungsi mulai dari fungsi biokimia atau
metabolisme. Hati memiliki fungsi utama dalam membentuk dan mengeluarkan empedu,
berguna dalam proses metabolisme nutrisi dan vitamin, inaktivasi berbagai zat seperti
racun dan hormon lainnya, pembentukan protein plasma dan juga sebagai bagian dari
pertahanan tubuh atau sistem kekebalan tubuh (Kim, Susan, Scott, Heddwen, 2017). Jika
hati terlalu banyak bekerja dan selalu terpapar patogen, hepatitis akan terjadi. Hepatitis
adalah peradangan hati yang dapat disebabkan oleh obat-obatan, terlalu banyak
mengonsumsi alkohol, dapat juga disebabkan oleh virus, zat beracun, atau patogen lain
dan mekanisme lain yang akan merusak sel-sel di hati dan bahkan mengganggu hati
untuk melakukan fungsinya. fungsi. (Priscilla, Karen, Gerene, 2017). Hepatitis ditandai
dengan peningkatan dalam kadar SGOT dan serum SGPT di hati. Istilah "hepatitis"
digunakan untuk semua jenis peradangan di hati. Tanda dan gejala yang ditemukan pada
pasien dengan hepatitis akut sering tidak terlihat, tetapi tanda dan gejala yang sering
muncul adalah penyakit kuning pada sklera, kulit atau selaput lendir.
Pruritusdapat jugaterjadi pada orang dengan hepatitis. Saat buang air besar, tinja
berwarna coklat muda dan abu-abu. Proses inflamasi dapat mengganggu aliran empedu
melalui canaliculi empedu dan ke dalamempedu sistemyang kemudian menyebabkan
penyakit kuning. Metabolisme nutrisi, obat-obatan, proses eliminasi empedu, atau racun
terganggu karena peradangan hepatitis (Kim, Susan, Scott, Heddwen, 2017). Menurut
Riset Kesehatan Dasar (RISKESDAS 2018) prevalensi hepatitis berdasarkan diagnosis
dokter (dokter spesialis dan dokter umum) menurut provinsi pada 2013-2018 adalah
serangan tertinggi adalah di Aceh (0,7%) pada 2003 dan Papua (0,7%) ) pada tahun2018
dan yang paling tidak menyerang wilayah Kepulauan Bangka Belitung dan Kepulauan
Riau pada tahun 2018. Pengukuran SGOT (Serum Glutamic Oxaloacetic Transaminase)
dan SGPT (Serum Glutamic Piruvic Transaminase) dilakukan untuk mendeteksi
peradangan pada tubuh dan digunakan untuk mengindikasikan peradangan di hati dan
ditemukan lebih banyak SGPT serum daripada SGOT di hati. Indikator yang dapat
menunjukkan peradangan pada hati merujuk pada nilai SGOT karena lebih spesifik.
Sementara peningkatan kadar SGPT dapat terjadi pada penyakit yang menyerang organ
lain seperti gagal ginjal akut, pankreatitis akut, anemia hemolitik akut, infark
miokard, trauma, luka bakar, atau penyakit yang menyerang sistem muskuloskeletal
(Ahmad, Banundari, 2017). Paracetamol adalah obat yang paling populer dalam
mengatasi menghilangkan rasa sakit dan demam. Fitri, Asep dan Waluyo (2019)
menyatakan bahwa parasetamol saat ini merupakan rekomendasi terapi
farmakologis dalam pengelolaan nyeri akut dan kronis yang ditetapkan oleh WHO (World
Health Organization). Konsumsi parasetamol yang berlebihan akan menyebabkan
kerusakan hati, kerusakan ini disebut hepatotoksisitas. Dilaporkan di Amerika Serikat
sekitar 65-75% menggunakan parasetamol dan juga Eropa, sekitar 50% lebih banyak
mengonsumsi parasetamol, ini mendukung laporan kasushati akut gagalakibat
penggunaan parasetamol. Hepatotoksik terjadi karena terlalu sering baik dalam dosis
dan dalam periode waktu dan berulang, itu terjadi sebagai reaksi dari metabolit NAPQI
(N-acetyl-p-benxoquinoneimine).NAPQI Produksiakan terus tumbuh, sehingga tidak
sebanding dengan kadar gluthathione di hati yang pada akhirnya akan menyebabkan
nekrosis sel-sel hati. (Yusri et al., 2015) Senyawa aktif dalam bentuk flavonoid dapat
mencegah kerusakan hati karenaantioksidannya efekyang manjur, semakin tinggi
kandungan flavonoid pada tanaman, semakin baik sel terlindungi. di hati. Antioksidan
bekerja untuk menghambat radikal bebas dengan menghambat berbagai reaksi
oksidasi di hati dan kemudian menghindari kerusakan (Fitri et al., 2019; Soeksmanto et
al., 2007). Masyarakat Indonesia telah lama menggunakan tanaman sebagai bahan
bergizi atau obat tradisional Ada juga berbagai cara untuk mengkonsumsinya
berdasarkan kebiasaan dan budaya masing-masing daerah. Kehidupan masyarakat
pedesaan di Indonesia masih sangat tradisional, tetapi tidak menutup kemungkinan
banyak orang yang melirik tanaman hanya digunakan untuk menghiasi halaman, atau
hanya tumbuh di sisi jalan sebagai tanaman liar, atau hanya hidup untuk
menyeimbangkan ekosistem. Kebanyakan orang tidak tahu manfaat tanaman yang
diciptakan oleh Yang Mahakuasa di sekitarnya.Metode pengobatan yang efektif dan
cukup aman adalah dengan menggunakan obat herbal, yaitu mencampur bahan
tanaman dan sering disebut pengobatan botani. Ada unsur kimia pada tanaman yang
mempengaruhi tubuh. Pengobatan herbal ini menjadi andalan bagi masyarakat, terutama
mereka yang tinggal di daerah pedesaan atau mereka yang menderita kekebalan
terhadap obat-obatan kimia yang ditawarkan oleh layanan kesehatan. Banyak
masyarakat menyediakan tanah mereka untuk digunakan sebagai tanaman obat. Obat
herbal akan memulihkan mekanisme tubuh, terutama masyarakat primitif yang sangat
bergantung pada alam yang menyediakan obat, makanan, tempat tinggal, atau pakaian.
(Abednego, 2016, p.16) Di Amerika Serikat ada setidaknya satu bahan herbal alami yang
diekstraksi menjadi bahan dalam setiap produksi obat, sisanya adalah bahan sintetis
yang dibentuk berdasarkan bagaimana komponen asli dari tanaman bekerja. (Abednego,
2016, p.17) Menurut Eva (2017) salah satu senyawa yang sangat efektif melawan radikal
bebas yang menyerang tubuh adalah antioksidan. Senyawa ini memblokir reaksi
oksidasi. Tumbuhan yang digunakan dalam sudeys ini adalah buah ara (Ficus carica L.),
periwinkle merah (Catharanthus roseus), dan ceri (Muntingia calabura L.). Ficus carica L
atau yang biasa disebut tanaman ara adalah tanaman dengan potensi antioksidan yang
tinggi, ditemukan dalam daun, buah, kulit buahnya. Joseph dan Raj (dikutip dari Agustina,
E) menulis bahwa selain antioksidan ara (Ficus carica L.) juga mengandung fenolat,
flavonoid, β-karoten, beberapa senyawa bioaktif seperti arabinosa, dan juga glikosida.
Apalagi buah ara (Ficus carica L.) juga mengandung serat, vitamin A dan C, kalium,
kalsium dan juga magnesium yang bermanfaat bagi tubuh. Buah ara kering memiliki
sumber karbohidrat dan mineral. Senada dengan Fadillah (dikutip dari Amin et al.,), Ia
menyatakan bahwa ada kandungan flavonoid dalamtimah daunyang berfungsi sebagai
antioksidan. Klasifikasi Gambar menurut penelitian Medika (dikutip dari Anggraeni)
Kingdom: Plantae
subkingdom: Tracheobionta
super divisi: Spermatophyta
Divisi: Magnoliophyta
Kelas: Magnoliopsida
Subkelas: Dilleniidae
Ordo: Rosales
Famili: Moraceae
Genus:Ficus
Spesies: Ficus carica
Rosy periwinkle (Catharanthus roseus) sering ditemukan di halaman belakang rumah
dan digunakan sebagai hiasan atau pinggir jalan dan tumbuh sebagai tanaman liar.
Tanaman ini mudah tumbuh di berbagai iklim, ia memiliki daun yang cukup tebal.
Tanaman ini tersebar luas di daerah-daerah di Indonesia dengan berbagai nama.
Dikatakan bahwa tanaman tapak mengandung 70 jenis alkaloid di bagian-bagian
seperti daun, biji, batang dan akar. Alkaloid yang terkandung dalam periwinkle merah
digunakan sebagai anti kanker. Bahan lainnya adalah flavonoid, saponin, dan tanin.
Telah ditemukan bahwa- sifatsifat periwnkle merah seperti menghancurkan batu ginjal,
mengobati DM dan sebagainya (Abednego, 2016, p. 336-339). Klasifikasi rosy
periwinkle menurut Kardinan 2003:
Kerajaan: Plantae
Divisi: Magnoliophyta
Kelas: Magnoliopsida
Urutan: Gentianales
Keluarga: Apocynacaeae
Genus: Catharanthus
 Spesies: Catharanthus roseus
Cherry (Muntingia calabura L.) adalah salah satu tanaman yang mengandung
antioksidan dan berguna untuk meningkatkan asupan dari luar untuk kebutuhan
antioksidan tubuh (Lily, Novi, 2014). Cherry (Muntingia calabura L.) juga sering
digunakan untuk menurunkan kadar gula darah karena mengandung flavonoid, selain
itu ada juga bahan-bahan bergizi lainnya seperti saponin dan tanin (Brechkerts et al.,
2018) Dalam penelitian Sari (dikutip dari Zahara, M. Dan Suryady), Cherry
diklasifikasikan ke dalam:
Kerajaan: Plantae
Divisi: Spermatophyta
Anak divisi: Angiospermae
Kelas: Dicotyledoneae
Anak Kelas: Dialypetalae
Keluarga: Malvales / Columniferae
Ordo: Elaeocarpaceae

METODE
Percobaan laboratorium adalah metode yang digunakan dalam penelitian ini, dengan
30 tikus galur Wistar jantan sebagai percobaan yang telah disesuaikan selama 7 hari,
tikus-tikus itu 2- Berusia 3 bulan dengan
berat badan 180-200 gr, Setelah mengadaptasi perubahan berat badan tikus galur
Wistar jantan adalah ± 10%, maka 30 galur Wistar jantan yang memenuhi kriteria
tersebut dikelompokkan menjadi 3 (tiga). Kelompok pertama adalah kelompok kontrol
negatif, kelompok kedua adalah kelompok kontrol positif, sedangkan
 E-ISSN: 2476-9606
Abstract Proceedings International Scholars Conference
Volume 7 Issue 1, October 2019, pp. 744-755

https://doi.org/10.35974/isc.v7i1.2078

Effectiveness of Figs (Ficus carica L.), Rosy Periwinkle

(Catharanthus roseus) and Cherry (Muntingia Calabura
L.) Decoction on Decreasing SGOT and SGPT Serum in
Male Wistar Strain Rats with Acute Hepatitis Model
Grace Arni Yunita Hutajulu1, Untung Sudharmono2
Faculty of Nursing, Adeventist University of Indonesia gracearniyunita@gmail.com

ABSTRACT
Acute hepatitis is inflammation of the liver. This disorder is usually caused by a virus or exposure to
alcohol, drugs, toxic, or other pathogens. The purpose of this study was to determine the effectiveness
of figs leaves (Ficus carica L.), Rosy Periwinkle (Catharanthus roseus), and cherry (Muntingia Calabura L.)
decoction on decreasing serum levels of SGOT and SGPT. The objects in this study were 30 male Wistar
strain rats aged 2-3 months with a weight of 180-200 grams. Rats were randomly divided into 3 groups:
the treatment group, positive control and negative control. The treatment group and positive control
group were induced paracetamol 120 mg / day orally for 7 days. Boiled water of 0.3 grams Figs (Ficus
carica L.), 3.5 grams of rosy Periwinkle (Catharanthus roseus), and 3.5 grams of cherry (Muntingia
Calabura L.) was given as much as 3.6 cc orally for 7 days to treatment group. Data were analyzed with
SPSS version 24, One Way ANOVA test was performed to compare SGOT and SGPT levels. The results
showed a significant difference in SGOT levels between the treatment group, positive control group, and
negative control group (p < 0.05) and there were significant differences in SGPT levels between the
treatment group and positive control group (p <0.05). The conclusions of this study were mixed boiled
of Figs (Ficus carica L.), rosy Periwinkle (Catharanthus roseus), and Cherry (Muntingia Calabura L.) had an
effect in decreasing serum SGOT and SGPT in male rats with acute hepatitis model.

Keywords: Paracetamol, SGOT, SGPT, Ficus carica L., Catharanthus Roseus, Muntingia Calabura L.

INTRODUCTION
Healthy is something that everyone desires. Free from illness and live an optimal life. The ability of
humans to carry out their activities is very dependent on the condition of the body of the person
himself. As known that humans interact directly with the environment, it makes them hard avoid
substances or materials in the form of free radical. Umayah (cited in Agustina,
E) states that free radicals comes from cigarette smoke, dust, chemicals, vehicle fumes, drugs, poisons
and other pollutants, or even can be found in food that are not processed properly. Society needs to
know the factors that influence the occurrence of a disease, at least from the surrounding environment
such as living conditions, schools and workplaces, and then from public places that regularly visited such
as tourist attractions, but the most important is to know the importance of personal health. This can be
a smart action to protect personal and family health.

An extraordinary event has occurred in the Trenggalek, East Java and continues to spread widely. The
data stated by the head of the East Java health department approximately 227 people suffer for
hepatitis A, and many also have hepatitis B and C. According to data from the East Java Health Office
there are around 303 residents detected with hepatitis. This extraordinary outbreak that occurred in the
Trenggalek occurred around January to May 2019. The head of the East Java Health Office finally sent an
epidemiological survey team to the Panggul, Trenggalek to prevent the rapid spread and certainly not
casu other casualties. Various effort is made to cure the infected people and to decrease the outbreak
(Puput, 2019) The commemoration of World Hepatitis Day is in July 28. The public must pay attention to
the hepatitis disease, Indonesia is a country with the highest rate of hepatitis B infection, the symptoms
are sometimes not visible but usually infected people feel lethargic, nausea and vomiting, and decreased
appetite. Patients also experience mild fever, there are some who experience pain in the abdomen. The
incidence of hepatitis show a significant in Indonesia, not a few of which occurred in infants, then
appealed for infants to be immediately given hepatitis immunization (Antara, 2019)

It is undeniable that there are still many people living in cities and villages who rely on chemical drugs
bought based on a doctor's prescription or in places that sell drugs freely according to their needs and
complaints. People are also familiar with paracetamol which is often used when there are family
members who experience fever, in addition it is easy to find paracetamol, and it is often a mainstay of
the community in reducing fever and pain because it has become a habit to consume drugs such as
paracetamol.

Paracetamol is a mild pain reliever, but if you use it for a long time it can damage the liver function.
Anindhita Maharrani (2017) reports that there have been many researchers from abroad bringing up
about paracetamol which damages the liver that is by damaging important structur between adjacent
cells in the organ. If there is damage to the wall of the cell, there will be damage to the tissue structure
in the liver as well. And finally, the cells in the liver are unable to work properly and die. The liver is a
vital organ for the body
 Indonesia is rich with kind of flora and fauna that is widespread throughout the region. People living
in rural areas often use herbal made from plants or animals into a mixture of traditional medicines
that are believed to be efficacious.

Abednego Bangun (2016) argues that the legacy of our ancestors has been preserved in the era of
globalization. There are many leaves that are effective in healing many diseases such as hypertension,
coughing, kidney stones, diabetes, and even cancer. What amazing is that the plants that live around
and we consume it has many benefits, even some of them are medicines that carry miracles until now.
Therefore the research uses herbal ingredients that are around the community and is carried out with
the aim to determine the effectiveness of figs (Ficus carica L.), rosy periwinkle (Catharanthus roseus),
and cherries (Muntingia calabura L.) decoction on decreasing serum SGOT and SGPT in acute hepatitis.
These plants contain antioxidants which are very useful for counteracting or overcoming free radicals.

This research utilizes a decoction of nutritious leaves in the process because it is easily processed by the
community and easily obtained. Many numbers of hepatitis victims are spread in Indonesia, so in this
study, researchers are motivated to look for alternative treatments for hepatitis by finding nutritious
herbal.

According to the Law of the Republic of Indonesia Number 36 Year 2009 about healthy "Traditional
medicine is an ingredient or ingredient in the form of plant material, animal material, mineral material,
galenic, or mixtures of these materials which have been hereditary for use as a medicine, and it can be
applied in accordance with the norms prevailing in society".

LITERATURE REVIEW
The liver is the largest gland in the human body. This organ is very meaningful in life because the liver
has a variety of functions ranging from biochemical or metabolic functions. Liver has the main function
in forming and secreting bile, useful in the process of metabolism of nutrients and vitamins, inactivation
of various substances such as toxins and other hormones, the formation of plasma proteins and also as a
part of the body's defense or immune system (Kim, Susan, Scott, Heddwen, 2017). If the liver is
overworked and always exposed to pathogens, hepatitis will occur. Hepatitis is inflammation of the liver
that can be caused by drugs, consuming too much alcohol, can also caused by a virus, toxic substances,
or other pathogens and other mechanisms that will damage cells in the liver and even interfere with the
liver to perform its function. (Priscilla, Karen, Gerene, 2017). Hepatitis is characterized by an increase in
levels of SGOT and SGPT serum in the liver. The term "hepatitis" is used for all types of inflammation in
the liver.

Signs and symptoms found in patients with acute hepatitis are often not seen, but the signs and
symptoms that often arise are jaundice on the sclera, skin or mucous membrane. Pruritus can also occur
in people with hepatitis. When defecating, the stools are light brown and gray. The inflammatory
process can disrupt the flow of bile through the bile canaliculi and into the bile system which then
causes jaundice. Nutrient metabolism, drugs, bile elimination processes, or toxins are disturbed due to
hepatitis inflammation (Kim, Susan, Scott, Heddwen, 2017). According to Basic Health Research
(RISKESDAS 2018) the prevalence of hepatitis based on the diagnosis of doctors (specialist doctors and
general practitioners) by province in 2013-2018 was the highest attack is in Aceh (0.7%) in 2003 and
Papua (0.7%) in 2018 and which least attacked the Bangka Belitung and Riau Islands regions in 2018.

Measurement of SGOT (Serum Glutamic Oxaloacetic Transaminase) and SGPT (Serum Glutamic Piruvic
Transaminase) levels was carried out to detect the inflammation in the body and used to indicate
inflammation in the liver and found more serum SGPT than SGOT in the liver. Indicators that can
indicate inflammation in the liver refer to the SGOT value since it is more specific. While an increase in
SGPT levels can occur in diseases that attack other organs such as acute kidney failure, acute
pancreatitis, acute hemolytic anemia, myocardial infarction, trauma, burns, or diseases that attack the
musculoskeletal system (Ahmad, Banundari, 2017). Paracetamol is the most popular drug in dealing with
relieving pain and fever. Fitri, Asep and Waluyo (2019) stated that paracetamol is currently a
pharmacological therapy recommendation in the management of acute and chronic pain established by
WHO (World Health Organization). Excessive consumption of paracetamol will cause liver damage, the
damage is called hepatotoxicity. Reported in the United States about 65-75% use paracetamol as well as
Europe, about 50% more consume paracetamol, this supports reports of cases of acute liver failure due
to paracetamol use.

Hepatotoxics occur due to overuse of both in dose and in period of time dose and repeated, it hapen as
the reaction of the metabolite NAPQI (N-acetyl-p-benxoquinoneimine). NAPQI production will continue
to grow, making it not comparable to the levels of gluthathione in the liver which will eventually cause
necrosis of liver cells. (Yusri et al., 2015)

The active compound in the form of flavonoids can prevent liver damage due to its antioxidant effect
which is efficacious, the higher the flavonoid content in plants the better it protects cells in the liver.
Antioxidants work to inhibit free radicals by inhibiting various oxidation reactions in the liver and then
avoiding damage (Fitri et al., 2019; Soeksmanto et al., 2007).

Indonesian society has been used plants as nutritious ingredients or traditional medicines for a long
time. There also has a various way to consume it based in the customs and culture of each region. The
life of rural communities in Indonesia is still very traditional, but it does not rule out the possibility of
many people who glance at the plants are only used to decorate the yard, or only grow on the side of
the road as a wild plant, or just live to balance the ecosystem. Most people do not know the benefits of
plants created by the Almighty around them.

An effective and fairly safe treatment method is by using herbal medicine, which is to mix plant
ingredients and is often called botanical treatment. There is a chemical elements in plants that affect the
body. This herbal treatment is a mainstay for people, especially those living in rural areas or those who
sufferers immunity to the chemical drugs offered by health services. Many communities provide their
land to be used as place to medicinal plants. Herbal medicine will restore the body's mechanisms,
especially primitive societies that highly depend on nature which provide them medicine, food, shelter,
or clothing. (Abednego, 2016, p.16)

In the United States of America there is at least one natural herbal ingredient which is extracted to be an
ingredient in every medicine production, the rest is synthetic material which is formed based on how
the original components of plants work. (Abednego, 2016, p.17)

According to Eva (2017) one of the compounds that is very effective against free radicals that attack the
body is antioxidants. This compound block the oxidation reaction. Plants that is used in this sudeys is figs
(Ficus carica L.), rosy periwinkle (Catharanthus roseus), and cherry (Muntingia calabura L.).

Ficus carica L or commonly called fig plant is a plant with a high potential for antioxidant, it found in its
leaves, fruit, fruit peels. Joseph and Raj (quoted from Agustina, E) wrote that besides antioxidants figs
(Ficus carica L.) also contained phenolics, flavonoids, β-carotene, several bioactive compounds such as
arabinose, and also glycosides. Moreover, Figs (Ficus carica L.) also contained fiber, vitamins A and C,
potassium, calcium and also magnesium which are useful for the body. Dried figs have a source of
carbohydrates and minerals. In line with Fadillah (quoted from Amin et al.,), she states that there are
flavonoid contents in tin leaves that function as antioxidants.

Classification of Figs according to Medika study (quoted from Anggraeni)

Kingdom : Plantae
 Subkingdom : Tracheobionta
Super divisi : Spermatophyta
Divisi : Magnoliophyta
Kelas : Magnoliopsida
Subkelas : Dilleniidae
Ordo : Rosales
Famili : Moraceae
Genus : Ficus
Spesies : Ficus carica
Rosy periwinkle (Catharanthus roseus) is often found in the back yard of the houses and used as
decoration or roadside and grow as wild plants. This plant is easy to grow in various climates, it has a
quite thick leaves. These plants are widely spread in areas in Indonesia with their various names. It is
said that the tread plant contains 70 types of alkaloids in parts such as leaves, seeds, stems and roots.
Alkaloids contained in the rosy periwinkle are used as an anticancer. Other ingredients are flavonoids,
saponins and tannins. It has been found that the properties of rosy periwnkle such as destroying kidney
stones, treating DM and so on (Abednego, 2016, p. 336-339). Classification of rosy periwinkle according
to Kardinan 2003 :

Kingdom : Plantae

Division : Magnoliophyta
Class : Magnoliopsida
Order : Gentianales
Family : Apocynacaeae
Genus : Catharanthus
Species : Catharanthus roseus
Cherry (Muntingia calabura L.) is one of the plants that contains antioxidants and is useful for increasing
intake from the outside for the body's antioxidant needs (Lily, Novi, 2014). Cherry (Muntingia calabura
L.) is also often used for lowering blood sugar level because it contains flavonoids, in addition there are
also other nutritious ingredients such as saponins and tannins (Brechkerts et al., 2018)

In the study of Sari (quoted from Zahara, M. And Suryady) the Cherry is classified into :

Kingdom : Plantae

Divisi : Spermatophyta

Anak divisi : Angiospermae

 Kelas : Dicotyledoneae
Anak Kelas : Dialypetalae
Family : Malvales/Columniferae
Ordo : Elaeocarpaceae
Genus : Muntingia
Spesies : Muntingia calabura L.

METHODS
Laboratory experiments are the method used in this study, with 30 male Wistar strain rats as the
experiment that had been adapted for 7 days, the rats were 2-3 months old with a body weight of 180-
200 gr, After adapting the change in body weight of male Wistar strain rats is ± 10%, then 30 male
Wistar strain rats that meet these criteria are grouped into 3 (three). The first group is the negative
control group, the second group is the positive control group, while the third group is the treatment
group.

The plants used in this study are figs (Ficus carica L.), rosy periwinkle (Catharanthus roseus), and cherry
(Muntingia calabura L.). These plants are grow a lot around the yard of the house and are used as
traditional medicine and also as decoration. Laboratory tests in this study were examination of serum
levels of SGOT and SGPT.

The object of this study are 30 male Wistar strain rats. The procedure in this study was to adapt wistar
strain male rats for 12 hours of light or during the day and 12 hours of dark or at night for 7 days in the
laboratory. Wistar strain male rats then grouped into three; first is negative control group. In this group,
Wistar strain male rats are given normal food and drink without being damaged to its liver or given
therapy. The second group was the positive control group, it is the group of male wistar rats that the
liver is damaged by inducing paracetamol as much as 120 mg orally for 7 consecutive days (days 8 to day
14 in this study), but this group was not given therapy. Next is the third group, this is a that has been
induced paracetamol at a dose of 120 mg orally for 7 days then given therapy of figs (Ficus carica L.),
rosy periwinkle (Catharanthus roseus), and cherry (Muntingia calabura L.) decoction during 7 days.

The fig (Ficus carica L.) plant in this procedure is that the fig leaves that have been dried in the room
light, as well as the rosy periwinkle (Catharanthus roseus), the leaves, stems and even the roots are also
cut into pieces and then dried, rosy periwinkle was taken from the Parongpong area, West Bandung.
Finally, cherry (Muntingia calabura L.) leaves are taken and cut into smaller parts and then dried, the
next step is that cherry is combined into a therapeutic mixture in this study. Cherry plants (Muntingia
calabura L.) in this study is taken from the Parongpong area, West Bandung.

On the 15th day a laboratory examination was carried out by taking blood samples from the tail end of
the male wistar rats that were cut to determine the serum levels of SGOT and SGPT, and on the 15th day
also began to give boiled water treatment of fig (Ficus carica L.), rosy periwinkle (Catharanthus roseus),
and cherry (Muntingia calabura L.) orally every day for 7 days until the 21st day. The therapy consist of
0.3 grams of Figs (Ficus carica L.), 3.5 grams of rosy periwinkle (Catharanthus roseus), and 3.5 grams of
cherry (Muntingia calabura L.) which is boiled in 200 ml water to 100 ml and from all the cooking water
was taken 3.6 ml to be given orally to the male Wistar strain rats for 7 days. Furthermore, on the 22nd
day, serum levels of SGOT and SGPT were examined in male Wistar strain rats to determine the results
after treatment or therapy.

RESULTS
Table 1. Result

Dependent Variable (I) kelompok (J) kelompok Mean Difference (I-J) Std. Error Sig.
SGOT_Pre 1,00 2,00 -226,92000* 12,75364 ,000
*
3,00 -203,46000 12,75364 ,000
*
2,00 1,00 226,92000 12,75364 ,000
3,00 23,46000 12,75364 ,176
3,00 1,00 203,46000* 12,75364 ,000
2,00 -23,46000 12,75364 ,176
*
SGOT_Post 1,00 2,00 -963,23000 16,30632 ,000
3,00 -82,20000* 16,30632 ,000
*
2,00 1,00 963,23000 16,30632 ,000
*
3,00 881,03000 16,30632 ,000
*
3,00 1,00 82,20000 16,30632 ,000
2,00 -881,03000* 16,30632 ,000
*
SGPT_Pre 1,00 2,00 -83,17000 9,55826 ,000
*
3,00 -113,11000 9,55826 ,000
2,00 1,00 83,17000* 9,55826 ,000
3,00 -29,94000* 9,55826 ,011
*
3,00 1,00 113,11000 9,55826 ,000
*
2,00 29,94000 9,55826 ,011
SGPT_Post 1,00 2,00 -986,37300* 18,02617 ,000
3,00 -32,86300 18,02617 ,181
*
2,00 1,00 986,37300 18,02617 ,000
 3,00 953,51000* 18,02617 ,000
*
3,00 1,00 32,86300 18,02617 ,181 2,00 -953,51000 18,02617 ,000
*. The mean difference is significant at the 0.05 level.

DISCUSSION
This study the data was analyzed and validate using SPSS (Statistical Product and Service Solution)
version 24. The results of pre-laboratory test of SGOT serum level showed that the negative control
group (1st group) with the positive control group (2nd group) had a significant comparison (p ≤ 0.05)
because the liver of the positive control group was destroyed due to inducing 120 mg of paracetamol
and was not get the treatment so SGOT level increase. The negative control group (1st group) was also
significantly different from the treatment group (3rd group), because the liver of the treatment group
was also damaged and had not been treated. The positive control group (2nd group) was not
significantly different from the treatment group (3rd group) because the liver of both groups were
damaged by the. The treatment group had not been treated at the pre test.

Seen from the results of the SGOT post test it was found that the negative control group (1st group) was
significantly proportional to the positive control group (2nd group), because the liver of positive control
group was damaged and the SGOT levels in the blood of the rat increased while the liver of the negative
control group was not damaged and were given eat and drink as usual. The negative control group (1st
group) was significantly different from the treatment group (3rd group) because the treatment group
had received a water treatment from figs (Ficus carica L.), rosy periwinkle (Catharanthus roseus), and
cherry (Muntingia calabura L.) decoction but had not approached normal value. The positive control
group (2 nd group) compared with the treatment group (3rd group) there was a significant comparison
because the liver of both the positive and treatment control group was damaged but then the treatment
group go the therapy and the level of SGOT serum decrease

The pre-test of SGPT showed that the negative control group (1st group) had a significant comparison
compared to the positive control group (2nd group), because the positive control group was induced
120 mg of paracetamol which damaged the liver while the negative control group was not induced by
paracetammol. There was a significant comparison between the negative control group (1st group) and
the treatment group (3rd group), because the liver of treatment group and had not been treated.
Between the positive control group (2nd group) with the treatment group (3rd group) there was an
insignificant comparison, because the liver of male rats in the positive control group and the treatment
group were equally damaged by paraetamol 120 mg orally for 7 days and the treatment group had not
been given therapy during the SGPT pre test.

Laboratory examination results for the SGPT post test group, found a negative control group (1st group)
was significantly different from the positive control group (2nd group) because the liver of positive
control group was damaged, its marked by an increase of SGPT levels in the blood of male Wistar rats
and the liver of negative control group did not damaged. The negative control group (1st group) with the
treatment group (3rd group) did not have a significant comparison because the negative control group
was not induced paracetamol 120 mg orally then the liver of treatment group was damaged but it was
given a therapy so that the SGPT levels in the post-therapy level decreased. The positive control group
(2nd group) with the treatment group (3rd group) there was a significant comparison, because the liver
of both groups were damaged but the treatment group had been given boiled water treatment therapy
of figs (Ficus carica L.), rosy periwinkle (Catharanthus roseus), and cherry (Muntingia calabura L.). This is
in line with the research of Oktavia and Wahyu (2018) which states that fig leaves are used as
hepatoprotectors.

Conclusion
From this study it was found that by inducing paracetamol at a dose of 120 mg orally for 7 days was able
to make male wistar rats experiencing acute hepatitis characterized by increased levels of SGOT and
SGPT serum. The water therapy of figs (Ficus carica L), rosy periwinkle (Catharanthus roseus), and cherry
(Muntingia Calabura) which has been dried is effective in reducing levels of SGOT and SGPT serum and
requires a longer therapy to obtain maximum results in decreasing levels SGOT and SGPT serum in acute
hepatitis.

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