CIRRHOSIS
(WHO, 1978) a diffuse process characterized by fibrosis and the conversion of normal liver architectures into structurally abnormal nodules
Bilirubin :- Selalu meningkat selama bertahutahun dan bisa berfluktuasi. - Kebanyakan type unconjugated kalau cirrhosis cholangiolitic type. - Keadaan yang lebih tinggi dan relatif stabil terjadi pada post necrotic cirrhosis.
Transaminase :- AST/SGOT meningkat < 300 U pada 65%-75% kasus. - ALT/SGPT meningkat < 200 U meningkat pada 50% kasus. - Transaminase bervariasi luas dan ini mencerminkan progression penyakit (parenchymal cell necrosis).
kasus
2. Defisiensi faktor koagulasi Fibrinogen: faktor II, V, VII, IX, X, XI, XII, dan XIII. Akibatnya, PT ( Prothrombin time ) memanjang.
Hepatocellular Carcinoma
Aetiology
Viral hepatitis Aflatoxin Cirrhosis Hepatitis B Hepatitis C Alcohol Haemochromatosis Primary biliary cirrhosis
- Pada foetus disintesa yolk sac, hepatosit foetus dan intestine. - Kadarnya meningkat pada kehamilan 12-14 minggu dan mulai menurun setelah 16 minggu. Kadarnya menuju normal selama 1 tahun kehidupan.
- Pada beberapa benigna liver diseases kadarnya juga meningkat. - Kadar > 500 ng/ml dianggap HCC - Selain untuk diagnostik juga dipakai untuk monitoring ( prognostik )
PIVKA-2 - kadarnya meningkat pada 80% kasus HCC - Kadarnya juga meningkat pada vitamin K deficiency - Digunakan untuk diagnostik dan monitoring (prognostik )
Acute Pancreatitis
1. 2. 3. 4. 5. 6. 7. 8. 9.
Gall stone ( biliary microlithiasis ) Alcohol Trauma Post ERCP Ductal obstruction Hypertriglyceridemia ( type I atau IV ) Hypercalcemia Infection (mumps, mycoplasma, coxsackie, salmonellosis ) Drugs (azathioprine, pentamidine, thiazide, sulphonamide, dll)
Diagnosis:
1. Serum Amylase - Derived from pancreatic acinar cells. - Level rise over 2-12 hours after onset pancreatitis, peak 48 hours and return to normal within 3-5 days.
- 3 x upper limit normal. - Normally elevated in macroamylasemia. - Test interference in hypertriglyceridemia. - Elevated from abnormal sources such as salivary gland and/or intra abdominal inflamation (not above 3X)
2. Serum Lipase. - Derived from pancreatic acinar cells. - Level rise 4-8 hours after onset pancreatitis, peaks at 24 hours, return to normal 8-14days. For these reasons, serum lipase is more sensitive and specific than the serum amylase. - Elevated from salivary gland and intra abdominal inflamation
3. Tripsinogen 2. - Urinary dipstick. - still limited use, unclear if superior to amylase lipase.
4. CRP > 150 mg/L 5. PMN Elastase > 300 g/L 6. Interleukin 6 > 400 pg/mL
Etiolgy : 1. AST/ALT - If 3x upper limit of normal, gall stones present is etiology in 95% of cases. - Low sensitivity.
2. Lipase/amylase ratio - If >5x, alcohol acute pancreatitis. - Low sensitivity. 3. Carbohidrat deficient transferrin - Useful in patients who deny alcohohol. - Remains elevated for weeks after binge drinking.
Severity : 1. Trypsinogen activation peptide (TAP) > 200 IU/L > 30 mmol/L in 6 12 hour urine 2. Hematocrite. - > 44 on admission, or rising over initial 24 hours associated with pancreatic necrosis.
3. C-reactive protein. associatd with pancreatic necrosis. - Useful after first 36-48 hours.
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