Hepatitis a Case Anak Ayu

8/10/2019 Hepatitis a Case Anak Ayu

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HEPATITIS AOLEHAYU RAHAYU

NIM: 0608120857

Supervisor:dr. Muhammad Nur, SpA


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Definition

Hepatitisviral infection at hepar

Hepatitis A hepatitis caused by HAV (RNA

viral -FamilyPicornavirus.)


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CLINICAL MANIFESTATION

>90% asimptomatik

preicterik phase : prodromal (fever, malaise,

nausea, vomit, anoreksia, abdominal pain,

diarre)

icterik (30%)10 days after that patient had

abdominal pain at upper right quadran,

hepatomegali, yellow urine, stool feces, yellow

skin and sclera, anoreksia, nausea, vomit.


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Patophysiologi

HAV enter to hepar and GIT through blood,

and replication at hepatosit

From hepar HAV eliminated at sinusoid ,

kanalikuli and go to the intestine after clinical

manifestation and laboratorium result

appearance


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IgM anti-HAV examination can stay in body 3-6

month

IgG anti-HAV can detection in 5-6 weeks after

infection

Polymerace Chain Reaction(PCR)

Protrombin Time(PT)

elevate urinalisis ; bilirubin urin dan urobilinogen,

bilirubin serum, alkalifosfatase.

Support examination


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Management

Bed rest

Avoid hepatotoksik material

vaksination


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CASE ILUSTRATION

Identity: An. S, perempuan, 13 years old,

Admitted to hospital : 7 -04-2014

Alloanamnesis: mother Chief complain: eye becoming yellow since 1

week


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Present Historical Disease

10 days, fever, nausea, vomit 2x contains food

Decrease of apetite, headache, abdominalpain at umbilical, brown feces, normal urine

1 week yellow eye, then skin become yellow,

fever (-), abdominal pain at umbilical, yellowfeces


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Past historical disease and family :

Same complain (-)

Imunitation : completeHome and environment :

Living in semipermanent house, clean

environment,


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Physical examination

General condition : mild

Counciusness : compomentis

Vital sign

Blood pressure: 120/80 mmHg

temperatured : 36,5 C

Heart rate : 98

Respiration 20 x/i


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nutrition:

height : 157 cm

weight : 50 kg Arm sircum: 25,5 cm

Head sircum : 54 cm


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Nutrition status : normal

Head : normocephali

Hair : black Eye : Konjungtiva anemis (-/-),

Sklera ikterik (+/+) bright

yellow,isokhor,diameter 3mm/ 3mm, lamp

Reflek : direct +/+, undirect +/+

Nose, mouth : normal


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Neck : enlargement limf(-), Kaku kuduk (-)

Paru : normal

Jantung : normal Abdomen :supel, hepatomegali 1/3

1/3,licin, press pain(+) at regio hipokondrium

dextra


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Genitalia :normal

Ekstremity : warm, CRT < 2 detik, edem (-

),ekstremitas jaundice (-)

Sistem neurologis : Reflek fisiologis (+/+)

normal, Reflek patologis (-/-)


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PEMERIKSAAN PENUNJANG

07 April 2014 :

Darah rutin

Hb : 12.7 g/dl, Ht : 32.3 %, Leu : 9700/

mm, Trom : 308.000/ mm Kimia darah

Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88

mg/dl, AST : 180 IU/L, ALT : 807 IU, Ureum : 15mg/dl, Creatinin : 0,40 mg/dl, BUN : 7,0 mg/dl,Albumin : 4, 31 gr/dl


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Pemeriksaan Koagulasi Darah :

FIB (PT PLUS) : 2, 761 g/L

PT HS Plus : 13,9

APTT : 34,0

Pemeriksaan Imunoserologi :

Anti HAV IgM : Reaktif 3,05

HbsAg kualitatif : Non Reakif


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10 April 2014

Urin :

Makroskopis : Warna kuning pekat

Mikroskopis :

Eritrosit 3-4 /LPB, Leukosit : 5-6 /LPB, Epitel +,Hialin +, Epitel lilin +, Bilirubin urin +


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Important thing in anamnesis

High fever, countinious

Decrease of appetite, nausea(+), vomit(+)

Headache, Yellow urine

Yellow eye


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Important thing in physical

examination

Nutrition statusnormal

eye: sklera ikterik +/+ bright yellow

Palpation of abdomen : hepatomegali


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Important thing in supporting

examination

Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88

mg/dl, AST : 180 IU/L, ALT : 807 IU

FIB (PT PLUS) : 2, 761 g/L, PT : 13,9. APTT :

34,0, Anti HAV IgM : Reaktif 3,05, HbsAg

kualitatif : Non Reakif


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Urinalisis

Makroskopis : yellow

Mikroskopis : Eritrosit 3-4 / LPB, Leukosit urin :1-2 / LPB, Epitel : +

Kimia Urin

Bilirubin urin : +


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DIAGNOSIS : Hepatitis virus A

NUTRITION DIAGNOSIS :Normoweight

THERAPY Medikamentosa : IVFD D5 NS 20 tpm (makro)

Domperidon syrup 3x 1cth

Curcuma 2x 1 tab

Nutrition: 1840 kkal


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PROGNOSIS

Quo ad vitam : bonam

Quo ad fungsionam : bonam


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FOLLOW UP & PEMBAHASAN

7/4/2014.

nausea, fever(-), vomit(-), epigastric pain (+).

BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:

hepatomegali, yellow skin of all body.

Urinalisis: deep yellow urine, Bilirubin urin : +


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Lab: leu 9.700/mm; Hb 12,7 mg/dl; Ht 35,4 %;

platelet 308.000/mm, Bil D : 6,12 mg/dl, Bil T :

8 mg/dl, Bil I : 1,88 mg/dl, AST : 180 IU/L, ALT :

807 IU, Anti HAV IgM : Reaktif 3,05.

Assessment: Hepatits A. IVFD D5 NS 20 tpm

(makro), Domperidon syrup 3x 1cth, Curcuma

2x 1 tab.


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This patien had been diagnosed with hepatitis A,

because :

Have prodromal sign like : fever, nausea, vomit,

headache, epigastric pain, decrease of appetitude

Icteric phase : deep yellow urine because of

problem at transportation, konjugation and

ekscretion of bilirubin. Icteric sklera +/+, kadar bilirubin direk (6,12

mg/dl) and bilirubin indirek up to (1,88 mg/dl).


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Icterus happen because obstruction of bile

flow and damaged of hepatosit

Sklera become ikterik if blood bilirubin2-

2.5 mg/dl or more.

Hepatomegali happen because compensation

damaged of hepatosit


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9/4/2014.

nausea, fever(-), vomit(-), epigastric pain (+).

BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:

hepatomegali, yellow skin of all body

Assessment: Hepatits A. IVFD D5 NS 20 tpm

(makro), Curcuma 2x 1 tab.

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Hepatitis a Case Anak Ayu