OSLER

SIROSIS
HEPATIS
INSAN TAJDID AKBAR
2113020034

Pembimbing : dr.R.Agus Sunaryo, Sp.PD,

FINASIM, FIAS
DISKUSI

1 ANAMNESIS PASIEN
2 PEMERIKSAAN FISIK

3 FOLLOW UP TERAPI
PASIEN 4 TINJAUAN PUSTAKA
ANAMNESI
S PASIEN
ANAMNESIS
FLAMBOYAN
402 A
Nama Ny. J

Usia 66 tahun

Agama Islam

Pekerjaan Ibu Rumah Tangga

Alamat Semowo, RT1/2

Pabelan - Semarang
Tgl Masuk 28 – 10 – 2021
ANAMNESIS

KELUHAN UTAMA
Perut membesar, agak sesak serta terasa mual.

RIWAYAT PENYAKIT SEKARANG

Pasien datang ke Poli Penyakit Dalam dengan keluhan perut membsar, dirasakan sejak 2 hari yang lalu semakin membesar.
Pasien juga mengeluh 2 hari sebelum masuk ke Rumah Sakit lemas, kurang nafsu makan, sesekali mual tetapi tidak
muntah. Pasien tidak demam, tidak ada nyeri ulu hati. Tahun 1978, Ketika melahirkan anaknya pasien terdiagnosis pertama
kali Hepatitis B dan menjalani pengobatan hingga sembuh. Kemudian, 1 bulan yang lalu, pasien mulai merasakan
tubuhnya mengalami bengkak, mulai dari tangan, kemudian, kaki, setelah bengkak di kaki hilang, pindah pembengkakan
pada perut, keluhan lain dirasakan seperti pusing, lemas, kurang nafsu makan ketika bengkak di perut semakin membesar.
1 bulan kemudian, pasien sudah merasa keadaan tubuhnya semakin memburuk, pasien datang ke poli Penyakit Dalam
RSUD Salatiga.
ANAMNESIS

RIWAYAT PENYAKIT DAHULU

Penyakit Jantung : disangkal
Diabetes Mellitus : disangkal
Penyakit Ginjal : disangkal
Hepatitis : Riwayat Hepatitis B (+)

RIWAYAT PENYAKIT KELUARGA

Keluarga pasien tidak memiliki riwayat penyakit serupa atau penyakit lain seperti diabetes mellitus, penyakit jantung,
penyakit ginjal dan penyakit lainnya.

RIWAYAT PERSONAL SOSIAL

Pasien tidak pernah mengkonsumsi alkohol. Pasien tidak pernah merokok. Pasien juga jarang
Berolahraga.
Aktivitas sehari-hari pasien sebagai ibu rumah tangga dan pasien memiliki asuransi BPJS Kesehatan.
PEMERIKSAA
N FISIK
PEMERIKSAAN FISIK
Kesan Umum Tampak lemas
Kesadaran Compos Mentis (GCS : E4V5M6)
Tanda Tanda Vital Tekanan Darah : 78/56 mmhg
Nadi : 64 x/menit.
KELUHAN UTAMA Respirasi : 20x/menit
Perut membesar, agak sesak serta terasaSuhu
mual. : 36,40C
SpO2 : 90%
RIWAYAT PENYAKIT SEKARANG
Pasien datang ke Poli Penyakit Dalam dengan keluhan perut membsar, dirasakan sejak 2 hari yang lalu semakin membesar.
Pasien juga mengeluh 2 hari sebelum masuk ke Rumah Sakit lemas, kurang nafsu makan, sesekali mual tetapi tidak
Inspeksi
muntah. Tahun 1978, Ketika melahirkanConjungtiva anemis (+/+),
anaknya pasien Sklera Ikterik
terdiagnosis (-/-), kali
pertama deviasi trakea (-)B dan menjalani pengobatan
Hepatitis
Palpasi
hingga sembuh. Kemudian, 1 bulan yang Pembesaran Limfonodi
lalu, pasien mulai(-), Trakea teraba
merasakan di garis tengah,
tubuhnya mengalamiJVP 5±1
bengkak, mulai dari tangan,
kemudian, kaki, setelah bengkak di kaki  hilang, pindah pembengkakan pada perut, keluhan lain dirasakan seperti pusing,
Thorax
lemas, kurang nafsu makan ketika bengkak
Pulmo   di perut semakin membesar. 1 bulan kemudian, pasien sudah merasa keadaan
tubuhnya
Inspeksi semakin memburuk, pasien datang
Bentukke poli
dada Penyakit
simetris, tidakDalam
terdapat RSUD
jejas danSalatiga.
kelainan bentuk, ginekomasti (-), spider navi (-)
Palpasi Tidak ada ketertinggalan gerak dan vokal fremitus tidak ada peningkatan maupun
penurunan
Perkusi Redup, terutama dibagian basal paru dextra dan sinistra
Auskultasi Suara vesikular dasar (SDV) : +/+ menurun dikedua lapang paru
Suara ronkhi: -/-
Wheezing : -/-
PEMERIKSAAN FISIK
Cor  

Inspeksi Pulsasi tidak terlihat

Palpasi Ictus cordis teraba di SIC V midclavicularis sinistra

Jantung tidak membesar, batas paru-jantung:

 Kanan atas: SIC II Linea Para Sternalis Dextra
Perkusi  Kanan bawah: SIC IV Linea Para Sternalis Dextra
 Kiri atas: SIC II Linea Para Sternalis Sinistra
 Kiri bawah: SIC IV Linea Medio Clavicularis Sinistra

Auskultasi Suara S1 dan S2 terdengar regular dan tidak ada bising ataupun suara tambahan jantung

Abdomen  
Inspeksi Tampak membesar, asites (+), caput medusa (-), striae (-), sikatriks (-)

Auskultasi Bising usus (+) menurun

Palpasi Nyeri tekan (-), hepar dan lien tidak dapat diraba karena terdapat cairan yang banyak di dalam perut,
shifting dullness (+), undulasi (+)

Perkusi Redup (+), batas paru-hepar dan paru-lien tidak dapat dinilai
PEMERIKSAAN FISIK

Ekstremitas  

Ekstremitas atas (+/+)

Inspeksi
Ekstremitas bawah (+/+)

Palpasi Pitting edema (-), akral hangat, WPK <2 detik

Genitalia  

Inspeksi Tidak dilakukan pemeriksaan

PEMERIKSAAN PENUNJANG
Pemeriksaan Hasil Nilai Rujukan Satuan
Hematologi
Leukosit 5,16 4,5 – 11 ribu/ul
Eritrosit 2,80 3,8 – 5,8 juta/ul
Hemoglobin 9,5 11,5 – 16,5 gr/dL
Hematokrit 27,0 37 – 47 vol%
MCV 96,4 85 – 100 Fl
MCH 33,9 28 – 31 Pg
MCHC 35,2 30 – 35 gr/dL
Trombosit 64 150 – 450 ribu/ul
Golongan darah A    
Hitung Jenis
Eosinophil 1,7 1–6 %
Basophil 0,2 0–1 %
Limfosit 17,3 20 – 45 %
Monosit 5,0 2–8 %
Neutrofil 75,8 40 – 75 %
NLR 4,4 <3,13 mg/dl
FOLLOW UP
TERAPI
PASIEN
FOLLOW UP
TINJAUAN
PUSTAKA
TINJAUAN PUSTAKA

DEFINISI
Sirosis hepatis adalah suatu keadaan
patologis yang menggambarkan stadium
akhir fibrosis hepatik yang berlangsung
progresif yang ditandai dengan distorsi
dari arsitektur hepar dan pembentukan
nodulus regeneratif. Gambaran ini
terjadi akibat adanya nekrosis hepatoselular.

Sumber : Sudoyo et al. 2010. Buku Ajar

Ilmu Penyakit Dalam
TINJAUAN PUSTAKA

Global burden of cirrhosis mortality. The age-adjusted risk of mortality (per 100,000 persons)
attributed to cirrhosis is shown. Legend (mortality per 100,000 persons): dark to light blue (0–
40), yellow (40–50), yellow-orange (50–60), orange-red (60–70), and red (>70). Adapted from the
Global Burden of Disease Study.
TINJAUAN PUSTAKA

KLASIFIKASI

Sirosis mikronodular, yaitu nodul-nodul

yang berdiameter kurang dari 3 mm.
Penyebabnya meliputi alkohol,
hemokromatosis, obstruksi biliaris,
obstruksi aliran vena hepatik, jejunoileal
bypass.
Sirosis makronodular, yaitu nodul-
nodul yang berdiameter lebih dari
3 mm. Penyebabnya meliputi
hepatis C kronis, hepatitis B kronis,
defisiensi alfa-1 antitripsin, dan
sirosis biliaris primer.

Sumber : Sudoyo et al. 2010. Buku Ajar

Ilmu Penyakit Dalam
TINJAUAN PUSTAKA

KLASIFIKASI

Sumber : Konsensus Baveno IV. 2008

TINJAUAN PUSTAKA

ETIOLOGI
• Konsumsi alkohol
• Hepatitis B dan
• Hepatitis C
• Obstruksi aliran vena
• Autoimun
• Malnutrisi
• Galaktosemia
• Kelainan metabolik berupa hemakromatosis (kelebihan zat besi)

Sumber : Sudoyo et al. 2010. Buku Ajar

Ilmu Penyakit Dalam
TINJAUAN PUSTAKA

MANIFESTASI KLINIS
Sirosis Hepatis Dekompensata
 Kerontokan rambut badan
 Gangguan tidur dan demam yang tidak begitu tinggi
 Gangguan pembekuan darah
 Perdarahan gusi
 Epistaksis
 Gangguan siklus haid
 Ikterus dengan air kemih berwarna seperti teh pekat
 Hematemesis
 Melena

Sumber : Sudoyo et al. 2010. Buku Ajar

Ilmu Penyakit Dalam
TINJAUAN PUSTAKA

PATOFISIOLOGI

Sumber : Sudoyo et al. 2010. Buku Ajar

Ilmu Penyakit Dalam
INTRODUCTION
Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a bit
larger than the Moon. The planet’s name has
nothing to do with the liquid metal, since it was
named after the Roman messenger god, Mercury.
 AWESOME
WORDS
Mercury is the closest planet to the Sun and the smallest one in the Solar System—it’s
only a bit larger than the Moon.
ABOUT THE DISEASE

JUPITER MARS JUPITER

Saturn is composed mostly Mars is full of iron oxide It’s a gas giant and the
of hydrogen and also helium. dust, which gives the planet biggest planet in the Solar
its reddish cast. System.
ABOUT THE DISEASE

Jupiter is a gas Mars is a planet is

giant and the full of iron oxide
biggest. dust.

01 02 03 04
It’s composed of
Earth is the planet
hydrogen and
where we live on.
helium.
YOU COULD USE TABLES

DISEASES PATIENTS TREATMENT

MERCURY 267 187 65%

MARS 669 224 10%

CONCEPTS AND TYPOLOGY

TYPE A TYPE B GESTATIONAL

Saturn is composed mostly It’s a gas giant and the Mars is full of iron oxide
of hydrogen and also helium. biggest planet in the Solar dust, which gives the planet
System. its reddish cast.
PATHOLOGY

The planet is full of Despite being red,

iron oxide dust. Mars is a cold place.

Saturn is the ringed Jupiter is a gas giant

one. It’s a gas giant. and the biggest planet.
SYMPTOMS OF THE DISEASE

SYMPTOM 1
Despite being red, Mars is a
cold place. It’s full of iron
oxide dust.

SYMPTOM 2
Jupiter is a gas giant and the
biggest planet in the Solar
System.
RISK FACTORS

20%
JUPITER
SATURN
40%
MERCURY 15%
VENUS

25%
Despite being red, Mars is a
cold place. The planet is full of To modify this graph, click on them, follow the link,
iron oxide dust. change the data and paste the new graph here.
50,000
Mercury is the closest planet.

20,000
Patients in the hospital.
A PICTURE IS
WORTH A
THOUSAND
WORDS
923,857
People have suffered from fatty liver disease.
 “This is a quote, words full of wisdom that
someone important said and can make the reader
get inspired.”

SOMEONE FAMOUS
DIAGNOSIS

Mercury is the closest planet It is the smallest Venus is the second planet
to the Sun. one in the Solar System. from the Sun.

Despite being red, Mars is a The planet is full It’s a gas giant and the
cold place. of iron oxide dust. biggest planet.
PREVENTION
It is the smallest one in the
Solar System.

Jupiter is the biggest of Venus is the second planet

them all. from the Sun.

The planet is full

of iron oxide dust.
TREATMENT

TREATMENT 1
Despite being red, Mars is a
cold place. It’s full of iron
oxide dust.

TREATMENT 2
Jupiter is a gas giant and the
biggest planet in the Solar
System.
RECOMMENDATIONS

● Here you can describe ● Here you can describe

what the patient should what the patient
do shouldn’t do
● Here you can describe ● Here you can describe
what the patient should what the patient
do shouldn’t do
● Here you can describe ● Here you can describe
what the patient should what the patient
do shouldn’t do
PREVALENCE

25% - JUPITER
20% - SATURN
40% - MERCURY
15% - VENUS
CONCLUSIONS
Mercury is the closest planet to the Sun
and the smallest one in the Solar System—it’s only
a bit larger than the Moon. The planet’s name has
nothing to do with the liquid metal, since it was
named after the Roman messenger god, Mercury.
OUR TEAM

JENNA DOE JOHN DOE

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