SIROSIS

HEPATIS
Pembimbing:
Dr. Yulia Rachmawati, Sp.Rad(K)

Sekar Nabila Ramadhani

2110221085
 Definisi
• Sirosis hepatis didefinisikan sebagai perkembangan
histologis dari nodul-nodul regeneratif yang dikelilingi
oleh jaringan fibrosis pada hepar yang merupakan
respon dari penyakit hati kronis.
• “The end stage of chronic liver disease.”
• Perkembangan dari kelainan hepar sampai menjadi
sirosis  rapidly (years) atau more slowly (decades)
• Kelainan hepar yang mendasari sirosis menentukan
kecepatan perkembangan dan tata laksana.
 Etiologi
• Toxin  alcohol, drugs o Non Alcohol Fatty Liver Disease
• Viral  hepatitis B, hepatitis C o Hemochromatosis
• Autoimmune hepatitis o Wilson disease
• Cholestatic o Alpha-1-antitrypsin deficiency
o Primary biliary cirrhosis o Cryptogenic Cirrhosis
o Primary sclerosing cholangiitis
• Cardiovascular
o Recurrent bacterial cholangitis o Budd-Chiari syndrome
o Bile duct stenosis o Right-heart failure
• Metabolik
o Alcoholic Liver Disease
 Epidemiologi
• Peringkat ke-14 penyebab kematian terbanyak di dunia.\
• Peringkat ke-4 penyebab kematian terbanyak di Eropa.
• US  35.000 kematian/tahun  peringkat ke-9 kematian terbanyak
• Indonesia  data masih terbatas  sirosis yang disebabkan konsumsi alkohol
jarang terjadi
• Konsumsi alkohol
• Overweight
• Pasien Diabetes
• Merokok
 Manifestasi Klinis
Manifestasi klinis merupakan hasil dari perubahan patologis dan menggambarkan
keparahan kelainan hepar pasien  compensated (asimptomatis) dan decompensated.
• Ikterus
• Ascites
• Hepatomegali
• Splenomegali
• Spider angioma
• Palmar eritema
• Kaput medusa
• Gynecomastia
• Anorexia, weight loss, fatigue, muscle wasting
• Kontraktur dupuytren
• Clubbing finger
Patofosiologi
 Klasifikasi
Child Pugh Turcotte (CPT)
 Diagnosis
1. Anamnesis  riw. penyakit liver kronis, konsumsi alkohol, gx klinis
2. Px Fisik
• Kesadaran: menurun (hepatic encephalopathy)
• Kepala: sklera ikterus
• Thorax: gynecomastia
• Abdomen: hepatomegali, splenomegali, ascites, kaput medusa, Cruveilhier-
Baumgarten sign
• Ekstremitas: palmar eritema, clubbing finger, kontraktur dupuytren
3. Px Penunjang
• Px Darah: eritrosit, leukosit, trombosit
SGOT SGPT PT bilirubin albumin Kolestatik: ALP GGT
• Px Radiologi  ultrasound, CT, MRI
• Px Histopatologi  px definitif, jarang digunakan.
 Imaging
ULTRASOUND
● Memiliki sensitivitas 80% untuk
deteksi perubahan pada sirosis
● Early: enlarged  shrinkage
● Surface nodularity, increased
parenchymal echogenicity, a coarse
heterogeneous texture, and surface
indentations.
● Segmental hypertrophy/atrophy 
hipertrofi lobus kaudata dan lobus
kiri, atrofi lobus kanan dan lobus
quadratus
● Ascites
● Reversal portal venous flow
CT Scan
● Insensitif pada early stage
● Early cirrhosis: Fatty infiltration 
hypodense enlarged liver
● Shrunken liver
● Lobus kaudata dan lobus kiri
hipertrofi
● Splenomegali

Sirosis dengan hipertensi portal

Diffuse fatty infiltration

 • Surface and parenchymal nodularity

Recanalized paraumbilical vein

Widening porta hepatis

Regenerative nodule

Contrast enhanced computed tomography portal phase images

● Ascites
● Irregular surface and margin
MRI
● Tidak sensitif pada early phase cirrhosis
 screening Hepatocellular Carcinoma
(HCC)
● Histological changes and altered hepatic
morphology  fibrosis, and cirrhotic
nodules
● Nodul: regenerative nodules, low-grade
dysplastic nodules (low malignant
poential), high-grade dysplastic nodules
(high malignant potential), and neoplastic
nodules.
● Regenerating nodules  low signal
intensity on T1W and T2W sequences
(iron deposits)  dark
● Dysplastic nodules  isointensity in
relation to the background liver tissue on
T1-weighted images. Low-intermediate
signal intensity on T2-weighted images
● Neoplastic nodules  variable on T1W
and hyperintense on T2W images
● Early HCC  isointense or mildly
hyperintense
 Siderotic nodules

Axial SSFSE T2-weighted image, with fat suppression  Axial in-phase 3D-GRE T1-weighted image
 Low grade dysplastic nodules

A. Axial SSFSE T2-weighted image,

with fat suppression
B. Axial pre-contrast 3DGRE T1-
weighted image, with fat
suppression

Small HCC

Axial SSFSE T2-weighted image, with fat suppression

 Tata Laksana
• Tata Laksana Underlying Causes
o
Alcoholism: Stop konsumsi alkohol
o
Viral: vaksin, interferon-based antiviral treatment, lamivudine (HBV)
o
Autoimmune: immunosupresan, prednisone, azathioprine
o
NASH: Menurunkan BB, diet sehat
o
Hemochromatosis: phlebotomy
o
Primary biliary cholangitis: Ursodeoxycholic acid, obeticholic acid
o
Wilson disease: Trientine, zinc
• Tata Laksana Symptoms
o
Ascites: diuresis  spironolactone 100 mg dan furosemide 40 mg per hari, salt restriction
(2000 mg/hari)
o
Peritonitis: antibiotik
• Transplantasi Hati
 Komplikasi
• Hepatocellular carcinoma
• Ensefalopati
• Hepatorenal failure
• Varises esofageal
• Bacterial peritonitis