Liver Cirrhosis

Oleh: Difa Kartika (20190420072)

Pembimbing: dr. Andi Purnomo, Sp.PD,KHOM,FINASIM
  Kondisi terjadinya pembentukan fibrosis (fibrogenesis)
akibat chronic injury
Definisi  Ditandai dengan Regenerasi nodular yang diffuse
dikelilingi dense fibrotic septa
  Penyebab kematian ke 12 di US. 32,000 kematian/tahun
 Di Indonesia, 3.5% pasien penyakit dalam yang dirawat
adalah pasien SH
Epidemiologi  Rata-rata 47.4% dari seluruh pasien penyakit hati yang
dirawat
 Prevalensi perempuan:laki-laki adalah 2.1:1
  Viral hepatitis (most common hepatitis B & C)
 Alcoholic liver disease
 Nonalcoholic steatohepatitis (NASH)
 Other causes: autoimmune hepatitis, primary biliary
Etiologi cholangitis, primary sclerosing cholangitis,
hemochromatosis, Wilson disease, alpha-1 antitrypsin
deficiency, Budd-Chiari syndrome, drug-induced liver
cirrhosis, RHF.
 Cryptogenic
Patofisiologi
 KLASIFIKASI MORFOLOGI
 Micronodular

 Macronodular

 Mixed

Classification
ETIOLOGY CLASSIFICATION
 Viral – hepatitis B, C, dan D

 Toxins – alcohol, drugs

 Autoimmune – autoimmune hepatitis

 Cholestatic – primary biliary cholangitis, primary sclerosing cholangitis

 Vascular – Budd-Chiari syndrome, sinusoidal obstruction syndrome, cardiac cirrhosis

 Metabolic – hemochromasitosis, NASH, Wilson disease, alpha-1 antitrypsin deficiency, cryptogenic cirrhosis
  GI: ascites, hepatosplenomegaly, caput medusa,
esophageal varices
 Hematologi: anemia
 Renal: hepatorenal syndrome
 Pulmonary: hepatopulmonary syndrome,
portopulmonary hypertension, hepatic hydrothorax,
Manifestasi ventilation-perfusion mismatch, hyperventilation

klinis  Kulit: spider nevi, eritema palmaris, jaundice

 Endocrine: hypogonadism, gynecomastia, amenorrhea,
irregular menstruation, infertility
 Kuku: clubbing, Dupuytren contracture
 Others: fetor hepaticus, asterixis
  Aminotrasnferases: peningkatan SGOT & SGPT
 Prothrombin time ↑
Diagnosis – lab
 Bilirubin ↑
findings  Albumin ↓
  USG
 CT scan w/
Diagnosis - contrast Liver nodularity/signs of portal
hypertension
Imaging  MRI
  Gold standard
 Pemeriksaan histologis dengan pewarnaan hematoxylin
Diagnosis – eosin

biopsy  Pemeriksaan kuantitatif collagen proportionate area

dengan pewarnaan picro-Sirius red stain
  Congenital hepatic fibrosis
Diagnosis  Nodular regenerative hyperplasia
banding  Budd-Chiari syndrome
  Ascites
 Varices esophagus
 SBP
 Hepatic encephalopathy
Komplikasi
 Hepatorenal syndrome
 Hepatopulmonary syndrome
 HCC
  Simptomatis
Tatalaksana  Kausatif
  Endoscopic variceal ligation

Tatalaksana –  Non-selective beta-blocker – carvedilol

 Statin – simvastatin
perdarahan
 Vasopresin – somatostatin, octreotide
varices
  Pembatasan diet natrium (4.0-6.9 g/hari)
 Spironolactone 100 mg +/- furosemide 40 mg
Ascites  Paracentesis
 Transfusi albumin (8 g/L)
Spontaneous  Primary prophylaxix – norfloxacin
bacterial  Cefotaxime IV selama 5 hari
peritonitis
  Lactulose
Encephalopathy  Rifaximin
Transplantasi
hepar
Prognosis