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PEMICU 2 HEPATOBILIER
“ URINE ATAU TEH?”
ALMIRA NABILA VALMAI
405130193
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LO
1. Hepatt! "#a$
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HEPATITIS VIRAL(A,B,C,D,E)
LO 1
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HEPATITI% AA. DEFINISI Penyakit infeksi sistemik yang dominan menyerang hati akibat
masuknya virus hepatitis A (HAV) melalui transmisi fekal-oraldari makanan atau minuman yang telah terkontaminasi.
B. ETIOLOGI Virus RNA yang tergolong dalam famili pikornaviradae yang
berukuran !-" mm dan tidak mempunyai selubung serta tahan
terhadap panas dan asam. #itemukan oleh Peinstone pada tahun
$%!& dalam tin'a penderita.
C.EPIDEMIOLOG
I
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D. GEJALA Te#a!a &'#a() !e*at+ #a!a !a&t+ ,e-a-+ -'a$+&'#a() (a!' -a&a(+ pe#'t te#a!a &'#a() e(a&+ a#!e( /e#a#(a pe&at+ t(a p'at ,a( pe(a&t&'(() -ata ,a( &'$t -e(a, &'(().
E. RESIKOPENULARAN
O#a() a() /e$'- -e(,e#ta *epatt! A ,a( /e$'-
,"a&!(a! *epatt! A+ !a(ta! /'#'&+ ,ae#a*
pa,at+ pe())'(a 6/at+ *'/'()a( !e&!'a$ ,e()a(
6#a() te#(e&!.
F.PATOFISIOLOGI
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G. DIAGNOSA • Be#,a!a#&a( )ea$a pa!e(
• Te! ,a#a* a() -e('('&&a( a(t/6, I)M
te#*a,ap *epatt! A.
H.PEMERIKSAANLABORATORIUM
•g anti-HAV* infeksi akut+
•g, anti-HAV* infeksi lama+ imun terhadap HAV
•HAV-RNA* mendeteksi infektivitas
I.TATALAKSANA
• Te#ap !-pt6-at&•H,#a! a() a,e&'at•Be,#e!t
J.PENCEGAHAN
•Va&!( HAV•Pe-/e#a( I-'(6)$6/'$( !e/e$'-7!ete$a*
paa(a(•%e$a$' -e(' ta()a( ,e()a( /a& ,e()a( !a/'(,a( a# -e()a$#•Hygiene perorangan yang baik
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Hepatt! B
• I(e&! "#'! *epatt! B -e#'pa&a( -a!a$a*&e!e*ata( ,'(a. %e/a(a& 2 'ta 6#a() ,!e$'#'* ,'(a te#(e&! "#'! (+ ,e()a( 450 'ta -e()a$a- (e&! (&.
• %e/a(a& 500 'ta *())a 1 'ta pa!e(,e()a( *epatt! B -e(())a$ !etap ta*'((a.
• Hepatt! B -e('-/a() 80 pe(e/a/
te#a,(a &a#!(6-a *epat6!e$'$e# p#-e# ,a(-e(,','& pe#()&at &e,'a !ete$a* #6&6&!e/a)a pe(e/a/ &a(&e#.
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• V#'! *epatt! B -e#'pa&a( "#'! :NA a()te#-a!'& )6$6()a( Hepa,(a"#,ae+ a()
-e-p'(a e-pat /'a* 6pe( #ea,() #a-e ;(t+ &ap!'$+ p6$-e#a!e+ ,a( <.
• =e( (t -e()&6,e p#6te( ('&$e6&ap!, a()pe(t() ,a$a- -e-/'()&'! "#'! ,a( HBeA).
=e( pe#-'&aa( -e()&6,e p#6te( p#e>%1+ p#e>%2+ ,a( p#6te( %. =e( < -e()&6,e p#6te( <a() /e#pe#a( pe(t() ,a$a- p#6!e!&a#!(6)e(e!!.
• %a-pa !aat ( te#,apat ,e$apa( )e(6tpe "#'!*epatt! B ; )e(6tpe A+B+C+:+E++=+H. =e(6tpeB ,a( C pa$() /a(a& ,te-'&a( , a!a.
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I(e&! "#'! *epatt! B
• %e$a( t#a(!-! "e#t&a$+ "#'! *epatt! B ,apat,t#a(!-!&a( ,e()a( ee&t -e$a$' a#a(t'/'*+ pe#&'ta(+ ,a( -e$a$' -e-/#a( -'&6!a.
• V#'! *epatt! B 100 &a$ $e/* (e&!'! pa,apa!e( ,e()a( (e&! HIV ,a( 10 &a$ $e/*(e&!'! pa,a pa!e( *epatt! C.
• Pat6)e(e!! (e&! "#'! -e$/at&a( #e!p6(! -'(*'-6#a$ ,a( !e$'$a#. V#'! /e#ep$&a! , ,a$a-
*epat6!t+ ,-a(a "#'! te#!e/'t t,a& /e#!at!t6pat&. Re!p6( a(t/6, te#*a,ap a(t)e(pe#-'&aa( /e#pe#a( ,a$a- e$-(a! "#'!.
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=a-/a#a( &$(! (e&! "#'!
*epatt! B
• Ma!a (&'/a! "#'! *epatt! B a,a$a* 1>4 /'$a(.%ete$a* -a!a (&'/a!+ pa!e( -a!'& &e ,a$a- pe#6,ep#6,#6-a$+ ,e()a( )ea$a &6(!tt'!6(a$+ /e#'pa-a$a!e+ a(6#e&!a+ -'a$+ -'(ta)+ -a$)a+ ,a( -',a*
$e$a*.• Pa!e( ,apat -e()a$a- pe#'/a*a( #a!a pa,a (,#a
pe()eap ,a( pe#'/a*a( !e(!a! /a'>/a'a(. %e/a)a(pa!e( ,apat -e()a$a- (e# a/,6-e( &'a,#a( &a(a(ata! ata' (e# ep)a!t#'- (te#-te( a() #()a(
!a-pa -6,e#at.• :e-a- $e/* a#a() te#a, pa,a pa!e( ,e()a( (e&!
*epatt! B ,a( :+ /$a ,/a(,()a&a( ,e()a( (e&!*epatt! A ,a( .
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=a-/a#a( &$(! ,a( pe('(a()(e&! "#'! *epatt! B a&'t
• Pa,a *epatt! B a&'t+ HB!A) -'('$ , !e#'-,a$a- a&t' 2>10 -())' !ete$a* papa#a("#'!. Pa,a !e/a)a( pa!e( ,ea!a+ HB!A)*$a() ,a$a- a&t' 4>@ /'$a(.
• A,a(a HB!A) a() pe#!!te( $e/* ,a# @ /'$a(-e('('&&a( /a*a pa!e( -e(,e#ta (e&!*epatt! B (&.
• I)M a(t>HB -e#'pa&a( pe(a(,a !e#6$6)!pa$() pe(t() pa,a *epatt! B a&'t ,a(pe(a(,a !at'>!at'(a a() p6!t. Ba!a(a/e#ta*a( 4>@ /'$a( !e$a-a *epatt! a&'t.
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Tata$a&!a(a (e&! *epatt!B a&'t
• I(e&! "#'! *epatt! B a&'t t,a& -e-/'t'*&a( a(t"#a$. Te#ap a() ,/e#&a( *a(a te#ap !'p6#t ,a( !-pt6-at&&a#e(a !e/a)a( /e!a# ,apat !e-/'* !p6(ta(.
• Pe(e)a*a( (e&! ,$a&'&a( -e$a$' "a&!(a!.
Pe(e)a*a( -e())'(a&a( -'(6)$6/'$( t,a& -e(e)a*(e&!+ -e$a(&a( -e()'#a() #e&'e(! pe(a&t &$(!.
• Va&!(a! *epatt! B te#,# ata! pa#t&e$ H/!A) a() t,a&te#)$&6!$a!+ (a-'( tetap t,a& ,apat ,/e,a&a( 6$e*t'/'* ,a# H/!A) (at'#a$.
• Pe-/e#a( ,$a&'&a( !ea#a (t#a-'!&'&a# , ,ae#a*,e$t6, !e/a(a& 3 &a$+ pa,a 0+ 1+ ,a( @ /'$a(. Pa!e(,e()a( &e*a-$a( t,a& -e(a,&6(t#a(,&a! '(t'&"a&!(a! (.
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Hepatt! #6(&
• Hepatt! (& te#,# ata! ; 1. Hepatt! (&pe#!!te(+ 2. Hepatt! (& a&t+ 3. %#6!!*at
• Pa,a &e$a(a( *epatt! (& pe#!!te(/a!a(a *a(a ,,apat&a( pe(())a( %=OT,a( %=PT a() t,a& te#$a$' *e/at.Ba!a(a%=OT ,a( %=PT -e(()&at 2>3 &a$ (6#-a$+
!e,a()&a( )a--a =T /a!a(a $e/* &e$ ,a#%=OT. 6!ata!e a$&a$+ =L:H+ CHE ,a( e(-&6a)'$a!-a!* ,a$a- /ata!>/ata! (6#-a$.P#6)(6!! pe(a&t ( /a!a(a /a&.
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• Pa,a *epatt! (& a&t &e#'!a&a(*epat6!e$'$e#(a $e/* /e#at. %=OT ,a( %=PT ,apat-e(()&at !a-pa 5 &a$ ata' 10 &a$ , ata! a()&a(6#-a$. =a--a =T /a!a(a ,,apat&a( $e/*#e(,a* ,a# %=OT. Apa/$a &e#'!a&a( !e$ $e/* /e#at,apat p'$a ,te-'&a( pe(())a( =L:H.
• Pa,a !#6!! *at a&a( ,te-'&a( pe(())a( %=OT,a( %=PT a() !a()at /e#"a#a!. U-'-(a a&a(,,apat&a( =a--a =T $e/* t()) ,a# %=OT.Pe#/a(,()a( a(ta#a %=OT ,a( %=PT ata' #a!6 ,eRt! /a!a(a , ata! 1. 6$(e!te#a!e a&a(-e('#'( apa/$a &e#'!a&a( *at -a&( /e#at. E(-'(t'& pe-/e&'a( ,a#a* ')a a&a( -e('#'(.
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Hepatt! B (&
• A,a(a pe#!!te(! "#'! *epatt! B $e/* ,a#@ /'$a(.
• Hepatt! B (& -e#'pa&a( -a!a$a*
&e!e*ata( /e!a# te'ta-a , A!a+ ,-a(ate#,apat !e,,&t(a 5 ,a# !e$'#'*(a 300 'ta (,",' HB!A) p6!t -e(etap , !e$'#'*,'(a.
• %e/a(a& 15>25 pa!e( ,e()a( (e&! (&*epatt! B -e(())a$ a&/at pe(a&t *at(& a() ,!e/a/&a( 6$e* "#'! *epatt! B.
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• A,a 3 a!e pe(t() ,a$a- pe#a$a(a(
pe(a&t Hepatt! B (& at' a!e-'(6t6$e#a(!+ a!e -'(6a&t ata'a!e --'(e$ea#a(e+ ,a( a!e
(6(#ep$&at ata' a!e #e!,'a$.
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Pat6)e(e!! pe#!!te(! VHB
• VHB -a!'& &e ,a$a- t'/'* !ea#a pa#e(te#a$. :a#pe#e,a#a( ,a#a* pa#t&e$ :a(e -a!'& &e ,a$a- *at,a( te#a, p#6!e! #ep$&a! "#'!.
• %e$a('t(a !e$ *at a&a( -e-p#6,'&! ,a(
-e(!e&#e! pa#t&e$ :a(e 't'*.• VHB -e#a()!a() #e!p6(! -'( t'/'*+ a() pe#ta-a
,#a()!a() a,a$a* #e!p6(! -'( (6(!pe!D&. P#6!e!e$-(a! (6(!pe!D& ( te#a, ,e()a(
-e-a(aat&a( !e$>!e$ N ,a( N>T.• U(t'& p#6!e! e#a,&a! VHB $e/* $a('t ,pe#$'&a(
#e!p6(! -'( !pe!D&+ at' ,e()a( -e()a&t"a! !e$$-6!t T ,a( !e$ $-6!t B.
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=a-/a#a( &$(!
• =a-/a#a( &$(! *epatt! B (! !a()at /e#"a#a!.A,a a() ta(pa &e$'*a( ,a( !e/a)a( $a) ,,apat&a(*epat6-e)a$ ata' /a*&a( !p$e(6-e)a$. U-'-(a,,apat&a( &6(!e(t#a! /$#'/( a() (6#-a$.
• Hepatt! B (& a() -a!* a&t ; HB!A) p6!t,e()a( :NA VHB $e/* ,a# 105 &6p7-$ ,,apat&a(&e$a(a( ALT a() -e(etap ata' (te#-te(. Pa,a /6p!*at+ ,,apat&a( )a-/a#a( pe#a,a()a( a() a&t.
• Ca##e# VHB (a&t ; HB!A) p6!t ,e()a( tte# :NA VHB
a() #e(,a* at' &'#a() ,a# 105 &6p7-$. 6(!e(t#a!ALT (6#-a$ ,a( pa,a pe-e#&!aa( *!t6$6)& te#,apat&e$a(a( a#()a( a() -(-a$.
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=a-/a#a( *!t6pat6$6)& *epatt! B
(&
• Pa,a pa!e( *epatt! B (& a#a() ,,apat&a()a-/a#a( &6$e!ta!!.
• =a-/a#a( *!t6pat6$6)& *epatt! B (& ,/a) -e(a,3 &e$6-p6& ;
- Hepatt! (& pe#!!te( a,a$a* (D$t#a! !e$>!e$-6(6('&$# pa,a ,ae#a* p6#ta$ ,e()a( !e,&t D/#6!!+$-t() p$ate -a!* 't'*+ t,a& a,a pee-ea$ (e!!.=a-/a#a( !e#() ,,apat&a( pa,a a##e# a!-t6-at&.
- Hepatt! (& a&t a,a$a* a,a(a (D$t#at #a,a() a()
-e(6(6$+ a() te#'ta-a te#,## ,a# $-6!t ,a( !e$p$a!-a a() te#,apat , ,ae#a* p6#ta$. Me(-/'$&a( e#6!$-t() p$ate ,a( ,!e#ta pee-ea$ (e!!. =a-/a#a(( !e#() ta-pa& pa,a a##e# a() !a&t !-t6-at&.
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> Hepatt! (& $6/'$a# !e#()
,(a-a&a( *epatt! a&'t/e#&epa(a()a(. :,apat&a()a-/a#a( pe#a,a()a( ,a( (e!!
(t#a$6/'$a#+ t,a& te#,apatpee-ea$ (e!! ,a( /#,)()(e!!.
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Tata$a&!a(a
• :&e(a$ 2 &e$6-p6& te#ap '(t'&*epatt! B (& at' ;
- e$6-p6& -'(6-6,'$a! ;(te#e#6(+ t-6!( a$a 1+ "a&!(a!te#ap
- e$6-p6& te#ap a(t"#'! ;
$a-"',(+ a,e6"# ,p"6&!$
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Hepatt! C
• Me#'pa&a( (e&! (& te#!e#() a()-e('$a# -e$a$' ,a#a* , A-e#&a %e#&at!e&ta# 3.2 'ta
• a$a'p'( t,a& -e('$a# !ea#a !e&!'a$+!e!e6#a() a() #e!&6 (e&! -e$a$'(e&! (a#&6/a -'()&( -e-e#$'&a(pe#$a&'a( -e,! '(t'& pe(a&t -e('$a#
!e&!
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HEPATITI% C
• A!a- ('&$eat ; !!RNA
• a-$; $a""#,ae
• =e('! ; Hepa"#'!
• :!e/'t *epatt! (6( A ,a( (6( B• E("e$6pe
• T,a& ta*a( a!a- ,a( e-pe,'
• T,a& ,te-'&a( ,a$a- t(a
• 80 p#6)#e! -e('' (&
• Ma!a (&'/a! ; – >8 -)
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• Ep,e-6$6) ;
– T#a(!-! te#/a(a& /e#*'/'()a( ,e()a(
t#a('! ,a#a* te#'ta-a !e/e$'-,$a&'&a( pe(ap!a( ,6(6# ,a#a*
• T#a(!-! ;
– :a#a*
– Mate#(a$ (e6(ata$
– Pe())'(aa( a#'- !'(t& /e#!a-a
– %e&!
– 6(ta& ,e()a( pe(,e#ta
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• =ea$a ; – A&'t ; -#p ,e()a( *epatt! "#'!
$a((a – #6(! ; )ea$a -(-a$ $e$a*+ -'a$+
-a$)a+ #a!a t,a& e(a& pa,a pe#'t&a(a( ata!+ )ata$>)ata$+ pe('#'(a( /e#at
/a,a(. :apat t-/'$ )ea$ae&!t#a*epat&
• :a)(6!! ;
– A(t HCV F – HCV RNA F
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Hepatt! C
P t # $ H tt
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Pat"#!"$"% Hepatt!C Awalnya virus melekatkan diri pada reseptor spesifik di
membran sel hepar.
Virus berpenetrasi dan memasuki sitoplasma sel hepar.
Virus melepaskan kapsulnya dan terbentuk nukleokapsid.
Selanjutnya nukleokapsid menembus dinding sel hati danmemasuki inti sel.
Asam nukleat virus akan keluar dari nukleokapsid dan
menempel pada DA.
DA akan merangsang hepar untuk membentuk protein dan
asam nukleat bagi virus.
!erbentuk virus baru dan akibat nekrosis sel-sel hati" maka
virus baru akan dilemparkan ke dalam peredaran darah.
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Fa&t"' '!&"
• :a#a* p#e,6-(a( ; IV:U ,a(pe(et#a! a#()a(+ #e!epe( p#6,'&,a#a*
• T#a(!-! !e&!'a$ ; eD!e(! ,a#a*+#e&'e(! #e(,a*
• Mate#(a$>(e6(ata$ ; eD!e(! #e(,a*+
#e&'e(! #e(,a*• Ta& te#,apat /'&t t#a(!-! e&a$>6#a$
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Pee'&!aa Pe*+a%
A. AST (SGOT) ALT(SGPT)Aa$(a -e(()&at. :apat-e(()&at 1>2 -())'!e/e$'- &te#& &e-',a(ta-pa& -e('#'(.
B. Da'a- Le%&ap (DL)
C. De'e!a Da'a-Le%&ap
D. A$&a$ p-"!ata!eE.Fe!e!
F. A$/* Se'*
G. G*$a Da'a-
H. Ma!a P'"t'"/
I. B$'*/ !e'*
J. Te! E&!'e! BSP(B'"!*$"pta$e)
K. B"p! Hat
L. S0a Hat
M.U'a$!a
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Ha$ a% t2a& /"$e- 2$a&*&a pa2ape2e'ta a% e%a$a Hep3C
1. Ga()a( -e(,6(6#&a( ,a#a*+ a#()a( ata' 6#)a( t'/'*
2. H(,a# a$&6*6$ '(t'& -e$(,'() *at ,a# &e#'!a&a($e/* $a('t
3. La&'&a( te! $a/6#at6#'- !e!e#() a()
,#e&6-e(,a!&a( 6$e* ,6&te# '(t'& -e()'&'# &a,a#e(- *at ,a( '(t'& -e(,ete&! "#'! a() a&t ,a$a-,a#a*.
4. H(,a# -e-('- 6/at apap'( ta(pa /e#&6(!'$ta! pa,a,6&te# a(,a
5. :apat&a( "a&!( "#'! Hep>A ,a( Hep>B &a#e(a (e&!"#'! Hep>C t,a& /e#a!a$ ,a# /e(t'& *epatt! $a((a.
(e&! ,a# "#'! *epatt! $a((a ,apat -e-pe#/'#'&&e#'!a&a( *at
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• I!t'a-at
• Det
• Me,&a-e(t6!a a() ,)'(a&a( ,a$a- pe()6/ata(Hepatt! C a,a$a*;• Interferon alfa
p#6te( a() ,/'at a$a- 6$e* t'/'* -a('!a '(t'&-e(()&at&a( !!te- ,aa ta*a( t'/'*7-'(ta! ,a( -e()at'#'()! !e$ $a((a.
• Pegylated interferon alfa:/'at ,) -e())a/'()&a( -6$e&'$ a() $a#'t a# ,!e/'t"polyethylene glycol (PEG)" ,) -6$e&'$ interferon alfa. $e/*
ee&t ,/a(,()&a( interferon alfa /a!a.• Ribavirin
6/at a() ,)'(a&a( /e#!a-a interferon alfa '(t'& pe()6/ata(Hepatt! C (!. Ribavirin &a$a' ,pa&a t'())a$ t,a& ee&t+tetap ,) &6-/(a! interferon alfa+ $e/* ee&t inteferon alfa !e(,#.
Pe(ata$a&!a(aa(
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Ep,e-6$6) (e&! "#'! *epatt!
:
• :pe#&#a&a( te#,apat -(-a$ 15 'ta 6#a()te#(e&! H:V , !e$'#'* ,'(a ,e()a( a!'-! 5pe(),ap HBV te#(e&! 6$e* H:V.
• I(e&! H:V te#a, , !e$'#'* ,'(a ,e()a(
p#e"a$e(! t()) , A-e#&a %e$ata(+ A#&a Ba#at+ T-'# te()a*+ ,a( -e,te#a(a.
• #e&'e(! a() $e/* t()) te#a, pa,a a#ea t#6p!,a( !'/t#6p! a() -e-p'(a p#e"a$e(! (e&!
"#'! *epatt! B.• a#e(a ,a$a- 20 ta*'( te#a&*# (e&! "#'!
*epatt! B -'$a ,apat ,ta())'$a()+ -a&a (e&!*epatt! : ')a -e('#'( !ea#a !)(D&a(.
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%t#'&t'# "#'! *epatt! :
• V#'! *epatt! : -e#'pa&a( "#'! te#&e$+t,a& ,apat -e(e/a/&a( (e&! /$a t,a&,/a(t' ,e()a( (e&! HBV.
• H:V a,a$a* "#' /$66, /6#( !e*())ape('$a#a( te#a, !ea#a pa#e(te#a$.
• H:V a,a$a* "#'! RNA /e#,a-ete# 3@ --.Lap!a( $'a#(a a,a$a* HB!A) a()
-e-/'()&'a )e(6- RNA ,a( a(t)e(,e$ta. =e(6- ( te#,# ,a# 100('&$e6t,a #a(ta t'())a$ !#&'$a#+
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Pat6)e(e!!
• O$e* &a#e(a ,/'()&'! HB!A) -a&aa#a -a!'&(a H:V &e ,a$a- !e$*at &e-'()&(a( /e!a# ')a
-e())'(a&a( #e!ept6# '(t'& HBV.• Pa,a pe(,e#ta ,e()a( (e&! H:V
(! te#a, #ep$&a! (t#a!e$'$e#
a() *e/at ,-a(a pa,a &6(,! (/e/a( #ep$&a! "#'! a() t()),apat -e-/e# ee& $a()!'()
/e#'pa &e#'!a&a( !e$ *at !t6pat&.
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=a-/a#a( &$(!
• I&te#'! a() ,&'t ,e()a( pa(a!-e(,a,a&
• He-ate-e!!
• =ea$a )a)a$ *at '$-(a(
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Pe()6/ata( ,a(pe(e)a*a(
• Pe())'(aa( (te#e#6( a$a pa,ape(,e#ta H:V (! -(-a$,$a&'&a( !e$a-a !at' ta*'(.
• Be$'- ,te-'&a( "a&!( H:V+(a-'( &a#e(a #ep$&a! H:V t,a&,apat te#a, ta(pa a,a(a (e&!
HBV -a&a -'(!a! te#*a,ap HBV ')a -e(e)a* te#a,(a (e&!H:V.
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HEPATITI% EA. DEFINISI Penyakit infeksi sistemik yang dominan menyerang hati akibat
masuknya virus hepatitis A (HAV) melalui transmisi fekal-oraldari makanan atau minuman yang telah terkontaminasi.
B. ETIOLOGI Virus RNA untai tunggal keil dengan diameter &-&nm dan
tidak berkapsul. #itularkan seara fekal-oral.
C.EPIDEMIOLOGI
Pa$() !e#() -e(e#a() '!a ,ea!a -',a>pe#te()a*a( ,e()a( a()&a -6#ta$ta! 1>2 ,a(20 pa,a a(ta *a-$.
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D. GEJALA K*'a% a!* a&a, *a$, *ta-,&e$e$a-a, e' pe'*t, 2ea, *' /e'4a'ape&at, t+a p*0at, e' !e2, +a*20e.
E. RESIKO
PENULARAN
A# -('- te#&6(ta-(a!+ !ataa( te#'ta-a &e
,ae#a* e(,e-! t()) HEV
F.PATOGENESIS
Ma!a (&'/a!+ a!e #ep$&a!+ a!e p#6)e!"ta!pe(a&t.
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Spt"!
ALT I%G at3HEV
I%M at3HEV
V'*! !t""$
5 1 6 7 8 9 : ; < = 15
11
16
17
Hepatt! E V'*!Ie0t"Tp0a$ Se'"$"%0
C"*'!e
Tte'
>ee&! ate'
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G. DIAGNOSA • Be#,a!a#&a( )ea$a pa!e(
• Te! ,a#a* a() -e('('&&a( a(t/6, Ite#*a,ap
*epatt! A.
H.PEMERIKSAANLABORATORIUM
•P/R reverse transription* deteksi RNA H0V dan H0V pada
spesimen tin'a dan hati
•g anti-H0V* titer yang meningkat bersifat simultan dengan
peningkatan serum transaminase
•1iter g, anti-H0V* meningkat setelah resolusi ge'alaI.TATALAKSANA
• Te#ap !-pt6-at&•%'p6#t
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HEPATITIS NON3VIRAL(NAFL, DRUG INDUCE,AUTOIMUN, GENETIK)
LO 6
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Hepatt! A't6-'(
pe(a&t (! ,-a(a !!te--'( t'/'* -e(e#a() &6-p6(e(ata' !e$ (6#-a$ ,a# *at !e*())a-e(e/a/&a( (a-a! ,a(&e#'!a&a( ,a# *epa#.
• L()&'()a(
• P#e,!p6!!)e(et&
*ttp;77.(,,&.(*.)6"7*ea$t*>(6#-at6(7*ea$t*>t6p!7$"e#>,!ea!e7a't6--'(e>
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Ta(,a ,a( =ea$a
• at)'e
• Uppe# a/,6-(a$ ,!6-6#t
• Ma$)a K At*#a$)a!
• :a##*ea
• Na'!ea
• C'!*()6, eat'#e!
• H#!'t!-
• Pa$$6#
• $6!! 6 appette
• pa( 6# ,!6-6#t 6"e# t*e $"e#
• !&( #a!*e!
• ,a#& e$$6 '#(e
• $)*t>6$6#e, !t66$!
• a'(,e+ 6# e$$6() 6 t*e !&( a(, *te! 6 t*e ee!
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Pe-e#&!aa(
• %e#'- a(t('$ea# a(t/6, ANA• A(t!-66t* -'!$e a(t/6, A%MA
• L"e#>&,(e -#6!6-a$ tpe 1 LM>1 a(t/6,
• %e#'- p#6te( e$et#6p*6# e!! %PEP
• 'a(ttat"e --'(6)$6/'$(!• B6p!
Ha!$ Pe-e#&!aa(• E$e"ate, !e#'- a-(6t#a(!e#a!e $e"e$!• E$e"ate, !e#'- --'(6)$6/'$( $e"e$!+ p#-a#$
--'(6)$6/'$( = I)=• %e#6p6!t"e #e!'$t! 6# ANA!+ %MA!+ 6# LM>1 6# a(t$"e#
t6!6$ 1 a(t>LC1 a(t/6,e!
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Ha!$ B6p!
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a#a&te#!t& $(! Hepatt!
A't6-'(
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Tata$a&!a(a
• 6#t&6!te#6, B!a &6-/(a!,e()a( aat6p#(
• T#a(!p$a(ta! *epa#
• :et ; a#a( (t#a"e(a '(t'& (a'!ea,a( "6-t()+ t()) &a$6#+ tetap&6(!'-! p#6te(
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:#')>I(,'e, Hepatt!
• A(a$)e!& a() -e()a(,'()a!eta-(6e(
• N%AI:
• A-6,a#6(e
• %te#6, a(a/6$&
• P$ B
• $6#p#6-a(
• E#t#6-!(
• Ha$6t*a(e
• Met$,6pa
• I!6(a,
• Met*6t#eJat
• %tat(!
• %'$a ,#')!
• Tet#a$(e!
• A-6J$$(>$a"'$a(ate
• %6-e a(t>!e'#e -e,(e!
I(a-a! *epa# &a#e(a 6/at>6/at te#te(t' ,a$a- a()&apa(a() -a'p'( &a#e(a ,6!!a() /e#$e/*a(
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Ta(,a ,a( =ea$a
• at)'e
• A/,6-(a$ pa(
• :a##*ea
• :a#& U#(e
• e"e#
• Hea,a*e
• Ga'(,e
• Na'!ea a(, "6-t()
• Ra!*
• *te 6# $a>6$6#e, !t66$!
• L6!! 6 Appette
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Pe-e#&!aa(
• E(- *at -e(()&at
• Hepat6-e)a$ *epa# -e-/e!a#
• Ne# te&a( &'a,#a( &a(a( ata!
Tata$a&!a(a K Pe(e)a*a(
• %t6p -e-('- 6/at a() -e(e/a/&a( *epatt!• Ga()a( -e-('- 6/at -e$e/* ,6!! a() ,!a#a(&a(
• Ga()a( -e-('- 6/at !ea#a te#'! -e(e#'! ta(pa /e#&6(!'$ta!,e()a( ,6&te#
• Be#ta*' &epa,a ,6&te# te(ta() 6/at>6/ata( a() a(,a -('-
&*'!'!(a a() -e()a(,'() a!eta-(6e( ,a( ata' p*e(t6(
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NAL:
• NAL: N6(>a$6*6$ att L"e#:!ea!e! a,a$a* &e$a(a( *at -#p,e()a( pe(a&t *at a$&6*6$& a()
te#a, pa,a !e!e6#a() /'&a(pe-('- a$&6*6$+ ,e()a( !pe&t#'-&e$a(a( *at -e$p't pe#$e-a&a( *at
!aa !-p$e !teat6!!+ pe#$e-a&a(,e()a( &e#a,a()a( *at NA%H+!a-pa ,e()a( D/#6!! ,a( !#6!!.
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• Bata!a( ($a ata! ,a# (6( a$&6*6$&a,a$a* '-$a* &6(!'-! a$&6*6$'(t'& a(ta 20 )#a-7*a# ,a( '(t'&
$a&>$a& 30 )#a-7*a#.• NAL: -e#'pa&a( -a(e!ta! *at
,a# !(,#6- -eta/6$& 6/e!ta!+
*pe#te(!+ ,a/ete!+*pe#t#)$!e#,e-a+ ,a( &a,a# H:L#e(,a*
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%(,#6- -eta/6$&
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$a!D&a! NAL:Cate%"
'
Pat-"$"% C$0"pat-"$"%0
C"''e$at"! Tpe 1 %-p$e !teat6!! (6( t6 /e (6(p#6)#e!!"e
Tpe 2 %teat6!! p$'! $6/'$a#(a--at6(
P#6/a/$ /e()( (6t6(!,e#e, t6 /e NA%H
Tpe 3 %teat6!!+ $6/'$a#
(a--at6(+ a(, /a$$66((),e)e(e#at6(
NA%H t*6't D/#6!! -a
p#6)#e!! t6 ##*6!! a(, $"e#a$'#e
Tpe 4 %teat6!!+ /a$$66((),e)e(e#at6(
NA%H t* D/#6!! -ap#6)#e!! t6 ##*6!! a(, $"e#a$'#e
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Pe-e#&!aa(
• La/
- A!pa#tate a-(6t#a(!e#a!e A%T
- A$a((e a-(6t#a(!e#a!e ALT
- =a--a =$'ta-$ T#a(!pept,a!e ==T
- A$/'-(
- B$#'/(
- I(te#(at6(a$ (6#-a$e, #at6 INRPT
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• Pe(t#aa(
- U$t#a!6(6)#aD U%= /#)*t $"e#
- C6-p'te#e, T6-6)#ap* !a( CT!a(
- Ma)(et Re!6(a(e I-a)() MRI.
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:e#aat pe#$e-a&a( *at !ea#a U%=
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Tata$a&!a(a
• N6( a#-a&6
- Me-pe#/a& )aa *,'p&'#a()/e#at /a,a(