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8/12/2019 Hepatologi Anak [Compatibility Mode]
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HEPATOLOGI ANAK
HEPATITIS IKTERUS OBSTRUKTIF
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HEPATITIS PADA ANAK
HEPATITIS :
INFLAMASI PARENKIM HATI
DENGAN ATAU TANPA NEKROSIS
SEL-SEL HATI (HEPATOSIT)
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ETIOLOGI
INFEKSI :
BAKTERI
PARASIT
JAMUR
VIRUS :
VHA
VHB VHC
DLL
NON - INFEKSI :
ALERGI
AUTOIMUN
INTOKSIKASI
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FAKTOR PREDISPOSISI
SANITASI
SARANA KESEHATAN YANG KURANG
KEPADATAN PENDUDUKPENDIDIKAN
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PENULARAN
ORAL
PARENTERAL :
JARUM SUNTIKTRANSFUSI DARAH
SENGATAN (?)
PHS
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PERJALANAN PENYAKIT
AKUT
KRONIK
SIROSIS KEGANASAN HATI
PRIMER
SEMBUH
FULMINANTVHA
VHB
VHC
VHB
VHC
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GEJALA GEJALA PENYAKIT
SIMPTOMATIS ASIMPTOMATIS>>
TIDAK DITANGANI
DENGAN BAIK
SUMBER PENULARAN
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SIMPTOMATIS
MASA INKUBASI :
VHA : beberapa hari 30 hari
VHB : 30 hari 180 hariVHC : antara VHA & VHB
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MASA PRE IKTERUS (PRODROMAL) :
KELUHAN TIDAK SPESIFIK
KELUHAN KELUHAN INFEKSI VIRUS
PADA UMUMNYA Demam, pusing, mual-muntah, lemas,
anoreksia, nyeri otot-sendi dll
Limfadenopati, hepatosplenomegali (tidakselalu)
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MASA IKTERUS :
Anak kecil gejala prodromal menghilang
Anak besar/dewasa gejala masih ada
tetapi sudah berkurang Ikterus konjunctiva, mukosa, kulit
Urine warna gelap mendahului timbulnya
ikterus Hepatosplenomegali/nyeri tekan
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MASA PENYEMBUHAN :
Keluhan menghilang
Ikterus berkurang/menghilang
Laboratorium normal
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Fase prodromal jelas ikterus tidak jelas
Fase prodromal samar-samar ikterus (+)
Kronik :Keluhan menetap
Kelainan laboratorium menetap
Konfirmasi : BIOPSI
> 6 bulan
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LABORATORIUM
1. Darah : Pemeriksaan rutin
Pemeriksaan enzymatik hati :
SGOT/SGPT
Akut : SGPT > SGOT Kronik : SGOT > SGPT
Alkaline fosfatase
Pemeriksaan fungsi hati :
Bilirubin I & II meningkat Albumin
PT, PTT
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2. Urine :
Warna gelap atau seperti teh tua
Bilirubin >>>
Urobilin
3. Marker (petanda) virus penyebab
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PENANGANAN/TERAPI
Tidak ada terapi kausal
Pengobatan suportif makanan bergizi,
sesuai selera penderita
Lemak kadar tinggi ??
Hepatitis kronik aktif (VHB/VHC) :
Interferon dan Lamivudin
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PENCEGAHAN
Atasi faktor resiko
Imunisasi :
VHA :> 2 tahun
dasar 2 x (interval 5 bulan)
ulangan (booster) setiap 10 tahun
VHB :segera setelah lahir
ulangan setiap 5 10 tahun
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IKTERUS OBSTRUKTIF (IO) PADA BAYI
Hambatan aliran empedu :
Hiperbilirubinemia konyugasi
Penimbunan bilirubin, asam empedu dankolesterol
Keadaan PATOLOGIS
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Hiperbilirubinemia konyugasi
Selalu patologis
IO
Klinis : - ikterus berkepanjangan- tinja pucat/dempul
- urin berwarna gelap
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IKTERUS OBSTRUKTIF
Ikterus > 2 minggu pada bayi baru lahir
Perlu diagnosis/tindakan dini prognosis
Etiologi ?? -intrahepatik-ekstrahepatik
atresia biliaris
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Diagnosis/terapi dini atresia biliaris prognosis
< 8 minggu keberhasilan 80%
> 12 minggu keberhasilan 20%
R/ bertahan 2 tahun
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PENYEBAB :
1. EKSTRAHEPATIK
Atresia biliaris
Stenosis duktus biliaris
Hipoplasia biliaris
Massa (batu, neoplasma)
Perforasi spontan duktus biliaris
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2. INTRAHEPATIK Idiopatik :
Hepatitis neonatal idiopatik
Kolestasis intrahepatik persisten
Anatomis
Gangguan metabolisme
defisiensi alfa-1 antitripsin
Hepatitis infeksi & toksik Gangguan genetik & kromosom
Lain-lain
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ANGKA KEJADIAN :
1/2500 kelahiran hidup
68% intrahepatik
32%
ekstrahepatik
72-86% : - hepatitis neonatal
- atresia biliaris
- defisiensi 1-antitripsin
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GAMBARAN KLINIS :
Pe bilirubin II (20% dari total bilirubin)
Pe asam empedu ( >10 mmol/l)
Tinja akolik Urine warna gelap
Hepatomegali
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Berlangsung kronik :
malnutrisi & retardasi pertumbuhan
defisiensi vitamin larut lemak
kelainan kulit, rabun senja, kelainan tulang
neuromuskuler, anemia kelainan hati progresif sirosis bilier
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GAMBARAN KLINIS & HISTOPATOLOGI
Gambaran Kolestasis
Ekstrahepatik
Kolestasis
Intrahepatik
Berat badan lahir (gram)
Warna tinja (% akol ik)
Usia saat tinja akolik (hari)
Ukuran abnormal atau
konsistensi hepar (%)
Biopsi
Fibrosis portal (% positif)
Proliferasi duktus biliaris (% positif)Trombus biliaris intraportal (% positif)
3.200
79
16
87
94
8663
2.700
26
30
53
47
301
P < 0,001
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Tinja 3 (tiga) porsi : jam 06.00
- 14.00
, jam14.00 - 22.00 & jam 22.00 06.00
Akalis pada semua porsi atresia bilier
Warna tinja befluktuasi intrahepatal
Saringan pertama
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LABORATORIUM
Uji Fungsi Hati Kolestasis
Ekstrahepatik
Kolestasis Intrahepatik
Bilirubin total (mg/dl)
Bili rubin direk (mg/dl)
SGOT
SGPT
-GT
10.2 4,5
6,2 2,6
< 5 x normal
< 5 x normal
> 5 x normal/ > 600 U/L
12,1 9,6
8.0 6,8
>10 x normal/ >800 U/L
>10 x normal/ >800 U/L
< 5 x normal atau
normal
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ASPIRASI DUODENUM :
Ada tidaknya bilirubin dalam cairan
duodenum
Cairan duodenum
tablet ICTOTEST Biru (+) empedu (+) aliran (+)
Biru (-) empedu (-) aliran (-)
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PEMERIKSAAN PENUNJANG
USG
Kolangiografi
Skintigrafi
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PENANGANAN
1. Atresia biliaris operasi
2. Hepatitis neonatal R/ medis
3. Vitamin larut air4. Pemberian formula dengan lemak MTC
5. Obat-obat untuk hindari kerusakan sel
hati/memperlancar aliran empedu6. Kalau sudah terjadi disfungsi hati
transplantasi hati
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TERIMA
KASIH
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