Mata kuning A1 [Compatibility Mode].pdf
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Mata kuning
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Skenario
Pasien wanita 20 tahun datang ke dokter dengankeluhan mata dan kulit berwarna kekuning-kuningan.Pasien mngalami demam beberapa hari sebelumnyadisertai rasa mual dan nyeri pada perut kanan atas.
Penderita sekitar seminggu yang lalu baru pulan dariKKN terpadu di Kab. Mamuju, sebuah daerahendemis malaria. Di tempat KKN, pasien sempatmengalami diare berlendir. Ketika ditanyakan riwayatimunisasinya, pasien tidak pasti imunisasi apa saja
yang pernah diterimanya.
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Kata Kunci Wanita, 20 tahun
Pernah ke daerah endemis malaria
Imunisasi tidak jelas
Diare
berlendir
Demam
Mual
Nyeri
hipochondriac
Kembali dari
KKNJaundice
?
1 minggu
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MetabolismeBilirubin
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Sir
kulasiP
ortal
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Lob
ulusHep
atik
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Ekskresi Empedu
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Jaundice
Jaundice (i.e., icterus), which results from an abnormally highaccumulation of bilirubin in the blood, is a yellowishdiscoloration to the skin and deep tissues. Jaundice becomesevident when the serum bilirubin levels rise above 2.0 to 2.5mg/dL. (Essentials of Pathophysiology, p.498)
Jaundice refers to a yellowish tint to the body tissues,including a yellowness of the skin as well as the deeptissues.The usual cause of jaundice is large quantities ofbilirubin in the extracellular fluids, either free bilirubin orconjugated bilirubin. (Guyton Textbook of Medical Physiology,
p.863)
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Penyebab Jaundice
Pre-Hepatik:- Hemolisis RBC : malaria, sickle cell anemia, spherocytosis
- Transport bilirubin : sindrom nefrotik, sirosis
Intra-Hepatik:
- Ggn uptake: obat2an (novobiocin, flavaspidic acid), Gilberts
syndrome- Ggn konjugasi: obat2an (pregnanediol, novobiocin,chloramphenicol, gentamicin) Crigler-Najjars Syndrome,Gilberts syndrome
- Ggn sekresi: Cholecystitis
Post-Hepatik:- Obtruksi duktus choledocus: Cholelithiasis
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Differential Diagnosis
Malaria
Hepatitis
Cholelithiasis
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Malaria
Riw. Daerahendemik
Tes TetesanDarah
Hepatitis
KemungkinanPenularan
Tes Serologi
Nyeri Kolik
USG
JAUNDICE+ Riw. Demam,
Nyeri RUQ, mual,
diare berlendir
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MALARIA
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Gejala
Keluhan Prodormal: kelesuan, malaise, sakit kepala, sakit
belakang, merasa dingin dipunggung, nyeri sendi dan
tulang, demam ringan, anoreksia, perut tak enak, diare
ringan dan kadang-kadang dingin.
Demam Periodik Splenomegali
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Pemeriksaan
Tetesan preparat darah tebal
Tetesan preparat darah tebal.
Tetesan darah tipis.
Tes antigen
Tes serologi.
Pemeriksaan pCR
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HEPATITIS VIRUS AKUT
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Tipe
Hepatitis
HAV
HBV
HCVHDV
HEV
Tipe DNA:
HBV (dsDNA)
HDV (ssDNA)
Tipe RNA:
HAV
HCV
HEV
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Efek sitopatik
Virus
Sistem Imun:
sel T CD8+ &
CD4, Sitokin
Patomekanisme
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Perjalanan Penyakit
Fase
Inkubasi
1Fase Pro
dormal
2Fase Ikterik
3Fase
Konvalesen
4
A: 15-45 hari
B: 30-80 hari
C: 15-160 hari
D: 30-180 hari
E: 14-60 hari
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GK
Spektrum: Asimtomatik Fatal
Fase prodormal:Gejala GI (Malaise, anorexia, mual,
muntah), Gejala flu (faringitis, batuk,mialgia), Demam
(pada HAV), serum sickness (arthralgia, skin rash dan
lymphadenopathy.)
Fase Ikterik: Muncul ikterus, gejala prodormal menghilang
(kecuali malaise, anorexia), ikterus didahului urin warna
gelap, pruritus. Pemfis ditemukan pembesaran dansedikit nyeri tekan hati.
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Diagnosis
Anamnesis dan Pemfis non spesifik
Pastikan dengan pemeriksaan serologi
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Pemeriksaan
Apa penyebabnya?Mendeteksi Antibodi terhadap virus Mendeteksi antigen
Ada kerusakan hati?
Tes Fungsi Hati:
ALT,AST,-GT
*Kemampuan Ekskresi (Bilirubin)*Kemampuan sintesis protein ( PT
memanjang, albumin)
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Tes Serologi
HAV: IgM anti HAV, anti HAV
HBV: IgM anti HBc, anti HBsAg, HBeAg, HBV DNA, IgG anti
HBc, Anti HBs
HCV: anti HCV, IgM anti HCV, HCV RNA
HDV: Anti HDV, HDV RNA, IgM anti HDV, dapat koinfeksi
dengan HBV
HEV:IgG dan IgM anti HEV
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Fase akut: IgM anti HAV
Infeksi lampau: anti HAV (+) tanpa IgM anti HAV
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Antibodi terhadap core antigen: IgM anti HBc
HBsAg
HBV DNA dalam serum dan HBeAg
IgG anti HBc dan anti HBs
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Terapi
HAV: Non spesifik
HBV: Alfa-Interferon, Lamivudine
HCV: Alfa Interferon, Ribavirin
HDV: Non spesifik
HEV: Non spesifik
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KOLELITIASIS
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Pengobatan
Analgetik dan Antibiotik
Bedah: Cholecystectomy (open/laparoscopic), ERCP
Dissolution treatment: Chenodeoxylate, Ursodeoxycolic
acid (jarang)
