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HEPATITIS

Suatu proses inflamasi pada hati dengan gambaran klinis dan histologis
yang spesifik yaitu terdapatnya suatu keadaan nekrosis difus atau
sebagian pada lobus hepatikus

Etiologi
Tiga penyebab utama hepatitis adalah virus hepatitis tipe A, tipe B,
alkohol dan obat2an, juga virus C,D dan E
Infeksi yang jarang terjadi oleh karena mononukleosis, yellow fever,
cytomegalovirus, coxsachievirus, leptospirosis
Infeksi parasit, schistosomiasis, amoebiasis, malaria, sasarannya
adalah liver tetapi tidak menyebabkan hepatitis
infeksi piogenic dan abses merupakan masalah juga
tuberkulosis pada liver dan infiltrasi granulomatous lain disebut
granulomatous hepatitis , akan tetapi mempunyai gejala klinis, biokemis
dan histologis yang berbeda
Systemic infection dan penyakit lain dapat menghasilkan nekrosis
pada sebagian lobus liver dan proses peradangan, keadaan ini
sifatnya non spesifik disebut reactive hepatitis, menyebabkan
abnormalitas fungsi liver, biasanya asymptomatik.

ACUTE VIRAL HEPATITIS

Inflamasi difuus hepatoseluler, disebabkan oleh 2 macam agent virus


Terdapat tipe A : serum hepatitis (SH), post transfusion hepatitis
Tipe B : infeksi virus B (long incubation hepatitis)

Etiologi
virusA
Virus B
Epidemiologi

Virus A : terjadi oleh karena kontak fekal-oral , darah dan sekret


lain yang infeksius.
Merupakan food- borne epidemics, terutama di negara
berkembang
Secara sporadis terjadi oleh karena kontak person-to-person
Virus B : transmitted melalui parenteral
Akibat transfusi darah
Pemakaian jarum suntik secara bergantian pada pengguna narkoba
Cuci darah (renal dialisis)
Non parenteral juga dapat terjadi misalnya ok sex intercourse
Inkubasi virus A : 2-6 minggu
virus b : 6-25 minggu
Dapat mengenai semua umur
Hepatitis A lebih sering terjadi pada anak2 dan orang muda
Patologi

Semua lobus pada liver dpt mengalami patchy nekrosis dan infiltrat
mononuklear inflamasi
Gambaran regresi histologik sering dijumpai, meskipun pada awal
penyakit

Symptom dan sign


Bervariasi dari yang ringan seperti gejala flu s/d gejala fulminant yang
sangat berat, sampai fatal
Phase prodromal :
- dimulai awal dengan gejala nausea, anorexia, malaise, panas.
- dapat terjadi urticaria (gatal), arthralgia (nyeri sendi), khususnya
pada hepatitis B
- setelah 3-10 hari terjadi fase ikterik, sampai terdapat warna lebih
gelap pada urin
- diikuti dengan jaundice
Gejala klinis (penderita dengan ascites)
Chronic viral hepatitis (cirrhosis hepatis)
Jaundice mencapai puncak/peak dalam 1-2 minggu, kemudian terjadi
fase recovery dalam 2-4 minggu
Terdapat pembesaran hati, kadang2 keras, biasanya teraba lunak dan
halus.
Pembesaran limpa (splenomegali) terjadi pada 15-20% pasien

Laboratorium

Peningkatan transaminase, terjadi pada awal masa prodromal,


puncaknya terjadi sebelum masa peak jaundice kemudian pelan2
turun pada fase recovery
SGOT dan SGPT 1000-3000 u. Tidak terdapat hubungan dengan
gejala klinis
SGPT biasanya lebih meningkat dibanding SGOT
Bilirubin pada urine terjadi sebelum jaundice
Kenaikan alkali fosfatase terjadi apabila terdapat cholelithiasis berat
Tidak terdapat kenaikan protrombine time
Diagnosis
Pada fase prodromal didapatkan gejala seperti influenza dan susah
didiagnose
Apabila jaundice sudah tampak, dapat didiagnosa
Hepatitis ok obat atau toxic dapat diperoleh ketr mell riwayat penyakit
Gejala prodromal sakit tenggorokan, adenopati diffus
Atipical limfositosis
Alkoholik hepatitis ditanyakan melalui riwayat, terdapat spider nevi
Keadaan ekstra hepatik obstruksi dan neoplasma kadang sulit
dibedakan

Prognosis

Hepatitis sembuh spontan pada sebagian besar kasus, selama 6-12 mg


Hepatitis B lebih jelek dibanding hepatitis A, khususnya pada orang2 tua,
mortalitas sebesar 10-15%
Prophilactie
Personal hygiene
Isolasi faeces, urine dan darah dari penderita2 hepatitis A,
hendaknya diperlakukan sbg bahan infeksius
Isolasi dari penderita hanya dapat menghindari pyebaran hepatitis B
Mma 0globulin 0,02 ml/kg BB
Transfusi darah - hati2 terhadap kontaminasi hepatitis B
vaksinasi
What can you do to prevent hepatitis A?

Get vaccinated against hepatitis A if your travel


plans, job, health, or lifestyle puts you at risk.
Make sure your children get vaccinated. The U.S.
Centers for Disease Control and Prevention
recommends the vaccine for all children starting at
age 1 year. It's also important for children adopted
from other countries to get the vaccine.
Talk to your doctor if you've been around someone
who you know has hepatitis A. The hepatitis A
vaccine or an injection of immunoglobulin (IG) within
2 weeks of exposure may prevent you from getting
sick.1
Practice good hygiene habits.

Wash your hands well after using the


toilet, after changing a diaper, and
before you prepare or eat food.
Wash dishes in hot, soapy water or in
a dishwasher.
Discourage children from putting
objects in their mouths.
Don't eat or drink anything that you
think may have been prepared in
unclean conditions.
Don't eat raw or undercooked shellfish.
If you plan to travel to a part of the world where
sanitation is poor or where hepatitis A is a known
problem:

Ask your doctor about getting the hepatitis A vaccine,


a shot of immunoglobulin (IG), or the combination
hepatitis A and B vaccine.
Always drink bottled water or boil water before
drinking it. Avoid drinks with ice cubes.
Don't eat raw foods, such as unpeeled fruits or
vegetable
People with jaundice
Alcoholic hepatitis
Key facts about Hepatitis B
Hepatitis B is a viral infection that attacks the liver and can cause both
acute and chronic disease.

The virus is transmitted through contact with the blood or other body
fluids of an infected person.

An estimated 240 million people are chronically infected with hepatitis B


(defined as hepatitis B surface antigen positive for at least 6 months).

Approximately 780 000 persons die each year from hepatitis B infection
-- 650 000 from cirrhosis and liver cancer due to chronic hepatitis B
infection and another 130 000 from acute hepatitis B.1

Hepatitis B is an important occupational hazard for health workers.

However, it can be prevented by currently available safe and effective


vaccine.
Geographical distribution

Hepatitis B prevalence is highest in sub-Saharan Africa and


East Asia, where between 510% of the adult population is
chronically infected.

High rates of chronic infections are also found in the


Amazon and the southern parts of eastern and central
Europe.

In the Middle East and the Indian subcontinent, an estimated


25% of the general population is chronically infected.

Less than 1% of the population in western Europe and North


America is chronically infected.
Transmission

The hepatitis B virus can survive outside the


body for at least 7 days.
During this time, the virus can still cause
infection if it enters the body of a person who is
not protected by the vaccine.
The incubation period of the hepatitis B virus is
75 days on average, but can vary from 30 to 180
days.
The virus may be detected within 30 to 60 days
after infection and can persist and develop into
chronic hepatitis B.
In highly endemic areas, hepatitis B is most
commonly spread from mother to child at birth
(perinatal transmission), or through horizontal
transmission (exposure to infected blood),
especially from an infected child to an uninfected
child during the first 5 years of life.

The development of chronic infection is very


common in infants infected from their mothers or
before the age of 5 years.
Hepatitis B is also spread by percutaneous or mucosal
exposure to infected blood and various body fluids, as
well as through saliva, menstrual, vaginal, and seminal
fluids. Sexual transmission of hepatitis B may occur,
particularly in unvaccinated men who have sex with men
and heterosexual persons with multiple sex partners or
contact with sex workers. Infection in adulthood leads to
chronic hepatitis in less than 5% of cases. Transmission
of the virus may also occur through the reuse of needles
and syringes either in health-care settings or among
persons who inject drugs. In addition, infection can occur
during medical, surgical and dental procedures, tattooing,
or through the use of razors and similar objects that are
contaminated with infected blood.
All children and adolescents younger than 18
years old and not previously vaccinated should
receive the vaccine if they live in countries
where there is low or intermediate endemicity.

In those settings it is possible that more people


in high risk groups may acquire the infection
and they should also be vaccinated.

They include:
people who frequently require blood or blood products,
dialysis patients, recipients of solid organ transplantations;

people interned in prisons;

people who inject drugs;

household and sexual contacts of people with chronic HBV


infection;

people with multiple sexual partners;

health-care workers and others who may be exposed to


blood and blood products through their work; and

travellers who have not completed their hepatitis B


vaccination series, who should be offered the vaccine
before leaving for endemic areas.
Good luck