Dr.WAN NEDRA Sp.AChild Health Dept.School of MedicineUniversity of YARSI

• organ paling besar

• Fungsi utama:1. Regulasi Metabolite dalam dara2.Detoxikasi

• RegenerateRegenerate jk terjadi jk terjadi kerusakankerusakan

Old Old ErythrocytesErythrocytesSpleen

Urobi-Urobi-linogelinogenn

Small amount –entero-hepatic circulation

StercobiliStercobilinene

HEPATITISHEPATITIS• Inflammasi & Inflammasi & necrosisnecrosis• Infeksi & non InfInfeksi & non Inf

Conj. Conj. bilirubibilirubinn

Unconj Unconj bilirubinbilirubin

Morbidity - mortality Epidemiology – endemic area

carrier rate - transmission rate Therapeutics ? Quality of life?

Prevention - !!!

Epidemiology, virology, patophysiology: Diagnosis DINI Supportive & monitoring Detection dini:

fulminant, chronicity Prevention of spreading Pengobatan Antivirus

HAVHAV HBVHBV HCVHCV HGVHGVVirusVirus PicornaPicorna HepadnHepadn

aaFlaviFlavi FlaviFlavi

InkubasiInkubasi 15-40 hr15-40 hr 50-50-160hr160hr

1-5 bln1-5 bln ? 2 mg? 2 mg

OnsetOnset AkutAkut SubklinikSubklinik SubkliniSubklinikk

Akut/subAkut/sub

Oral-fekalOral-fekalParenteraParenterall

(++)(++)JarangJarang

(-)(-)(++)(++)

(-)(-)(++)(++)

(-)(-)(++)(++)

KronisitaKronisitass

(-)(-) (+)(+) (+)(+) (+)(+)

Endemic - young children – reservoir Morbidity – mortality at older age

Complication in chronic liver Complication in chronic liver disease – 8xdisease – 8xSelf Self

limiting limiting diseasedisease

Single Single exposurexposuree

Long Long life life immuniimmunityty

HAV PathogenesisHAV Pathogenesis

CTL HepatocyteReceptor

Excretion in stool Excretion in bile

OUTCOMEOUTCOMEHAV infectionHAV infection

DeathDeath

Asymptomatic

Non icteric

IctericIcteric

Complication -

Relapsing

Cholestatic

Liver Liver failurefailure

ResolvedResolved

TransplantatioTransplantationn

HAV infectionHAV infection

Anti HAV total

IgM-Anti HVAIgM-Anti HVAHVAstool

Heat stable virus Endemic - reservoir Fecal-oral, kontak erat High risk: children, CLD cases, etc

Susceptible: High sosio-economic population  

Hygiene - sanitation Proper cooking, hand washing, septic

tank,diapers, etc Isolate index case

Immunization Pre-post exposure (active–passive)

IgM anti HAV (+)IgM anti HAV (+)

PT/INRPT/INR

INR < 2INR < 2

RepeatRepeat LFTs 5–7 LFTs 5–7 dd

ImprovedImproved

Repeat LFT 6wk

Normal – No follow up

AbnormalAbnormal

Not improvedNot improved(clinic-

laboratory)

INR > 2INR > 2 ReferRefer

Long immunity Simultaneous -

other vaccine Interchangeable Serologic test:

pre- likely exposed post- vaccination: (-)

Individual risk: Children, CLD cases, IVDU, homosexuals multitransfused, household contact, traveler - low endemic

Professional risk: food sector, health, sewage, waste water, in contact with children, lab-military staff

PENCEGAHAN PENCEGAHAN VAKSIN VAKSIN HVA HVA

Inactivated, safeInactivated, safe

AgeAgeysys

Routine Routine immunization immunization

Individual Individual Community Community protectionprotection

Post-Post-exposureexposure

immunizationimmunization< 2< 2 Vaccine (-)Vaccine (-) NHIGNHIG –– household household

contactcontact2 – 2 – 1818

HavrixHavrix 720 EU, 720 EU, AvaximAvaxim 160 AU/ml, 2x (0, 6 – 12)160 AU/ml, 2x (0, 6 – 12)

VaccineVaccine or or Vaccine & NHIG#Vaccine & NHIG#

> 18> 18 HavrixHavrix 1440 EU, 1440 EU, AvaximAvaxim 160 AU/ml, 2x (0, 6 – 12)160 AU/ml, 2x (0, 6 – 12)

None None or or VaccineVaccine or or Vaccine & NHIG#Vaccine & NHIG#

Protective – anti HAV Protective – anti HAV 20 mIU/ml 20 mIU/ml

AGEAGE(ys)(ys)

DURATION DURATION protectionprotection

RECOMMENDATIONRECOMMENDATION

< 2< 2 < 3 months< 3 months3-5 months3-5 monthsLong termLong term

NHIG 0.02 ml/kg, 1xNHIG 0.02 ml/kg, 1xNHIG 0.02 ml/kg, 1xNHIG 0.02 ml/kg, 1xNHIG 0.06 ml/kg, repeat NHIG 0.06 ml/kg, repeat 5/125/12

2 2 < 3 months< 3 months3-5 months3-5 monthsLong termLong term

Vaccine or NHIG (0.02 Vaccine or NHIG (0.02 ml/kg)ml/kg)Vaccine or NHIG (0.06 Vaccine or NHIG (0.06 ml/kg)ml/kg)VaccineVaccine

ReferRefer

ReferRefer

IgM HAVIgM HAV(+)(+)

IgM HAV (–)

Treat as HAV

ReferReferBilirubin Bilirubin > 6 mg/dl> 6 mg/dl

GGT – cholestatic or GGT – cholestatic or obstructionobstruction

Bilirubin Bilirubin > 6 mg/dl> 6 mg/dl

Alanine transaminaseAlanine transaminase

Initial consultationInitial consultation: - LFTs- LFTs - Anti HAV-IgM- Anti HAV-IgM - HBsAg- HBsAg