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