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Penyakit Pada Hepar Flashcards

1
Q

Penyakit Pada Hepar (7)

A

Abses Hepar
Sirosis Hepatis
Hepatitis A
Hepatitis B
Hepatitis C
Non Alcoholic Fatty Liver Disease (NAFLD)
Non Alcoholic Steatohepatitis (NASH)

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2
Q

Etio Abses Hepar

A

E. coli, streptococcus
Entamoeba histolytica

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3
Q

Klasifikasi Abses Hepar (2)

A

Abses hepar pyogenic → 80% kasus riw. apendisitis
Abses hepar amoebic → 80% kasus riw. disentri

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4
Q

Dx Abses Hepar

A

Demam
Nyeri perut kanan atas
Riw. disentri amoeba → berdarah + lendir
Ludwig sign (+) → nyeri tekan di ICS V/VI kanan
Hepatomegali

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5
Q

PP Abses Hepar

A
  • X-Ray
    Dome diafragma
  • USG
    Lesi hipoekoik/anekoik, internal echoes
  • Kultur Abses
    Gold Standard
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6
Q

Tx Tepat Abses Hepar

A
  • Abses hepar pyogenic
    Cefotaxim 2g/8 jam IV ATAU
    Ceftriaxone 2g/24 jam IV + Metronidazole 500 mg/8 jam IV
  • Abses hepar amoebic
    Metronidzaole 3x750 mg IV/PO 7-10 hari
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7
Q

Tx Definitif Abses Hepar

A

Rujuk → Percutaneous aspirasi/insisi drainase

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8
Q

Indikasi percutaneous aspirasi/insisi drainase abses hepar

A

1 dari:

Usia >55 tahun
Ukuran >5 cm
Mengenai 2 lobus/lobus kiri saja
Gagal tx setelah 7 hari

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9
Q

Etio Sirosis Hepatis

A

Hep B, hep C, alkoholik, obs bilier

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10
Q

Dx Sirosis Hepatis

A

SEKASIH
S plenomegali
E ritema palmar
K olateral vein
A sites
S pider nevi
I nverted alb:globin
Hematemesis melena

1 dari 3 bold = sirosis hepar

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11
Q

PP Sirosis Hepatis

A
  • Fungsi hati
    SGPT ↑, SGOT ↑ (Kronik: SGOT>SGPT)
    Bilirubin ↓
    PT ↑
    Trombosit ↓
  • USG Abdomen (Awal)
    Hepar mengecil irreguler, asites
  • Biopsi Hepar (Gold Standard)
    Fibrosis hepar
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12
Q

Komplikasi Sirosis Hepatis (5)

A

PSMBA ec variceal bleeding
Hepatocellular carcinoma (HCC)/Hepatoma
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Hepatic encephalopathy

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13
Q

PSMBA ec variceal bleeding

A

Pecahnya varises esofagus

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14
Q

Hepatocellular carcinoma (HCC)/Hepatoma

A

+ Alarm symptom (massa keras berdungkul, anemia, BB ↓)
+ Alpha Fetoprotein (AFP) >100 ng/L

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15
Q

Hepatorenal syndrome

A

Asites + Cr >1,5

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16
Q

Spontaneous bacterial peritonitis

A

PMN >2500 sel/mm3

  • Tx: Cefotaxime 2 g/8 jam
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17
Q

Hepatic encephalopathy

A

Penkes + bau napas pesing (amonia ↑)

  • Tx
    Rujuk → laktulosa → amonia ↓
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18
Q

Etio Hepatitis A

A

Virus Hep. A

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19
Q

Transmisi Hepatitis A

A

Fecal, oral → makanan → banyak orang

20
Q

Dx Hepatitis A

A
  • Gejala prodomal
    Demam, mual, muntah
  • Fase ikterik
    Ikterik hepatomegali
  • Fase resolusi
    Gejala membaik
21
Q

PF Hepatitis A

A

Hepatomegali + nyeri tekan (+)

22
Q

PP Hepatitis A

A
  • Fungsi hati
    SGOT ↑, SGPT ↑
  • Serologi
    • IgM anti HAV
      Akut
    • IgG anti HAV
      Sembuh/vaksin
23
Q

Tx Hepatitis A

A

Self limited disease
Bed rest + diet TKTP + tx cairan
Simtomatik → Ibuprofen, domperidon
Hepatoprotektor → Curcuma

24
Q

Komplikasi Hepatitis A

A

Hepatitis Fulminans/Gagal Hepar Akut

25
Q

Etio Hepatitis B

A

Virus Hep. B

26
Q

Transmisi Hepatitis B

A

Cairan tubuh

27
Q

Dx Hepatitis B

A

Ikterik + nafsu makan ↓ + demam + hepatomegali + nyeri tekan

28
Q

PF Hepatitis B

A

Hepatomegali + nyeri tekan (+)

29
Q

PP Hepatitis B

A
  • Fungsi hati
    SGOT ↑, SGPT ↑
  • Serologi
    • HbsAg (+)
      Akut
      (+) >6 bulan → kronik
    • IgM anti HBc (+)
      Akut/window period
    • IgG anti HBc (+)
      Kronis/sembuh
    • Anti HBs (+)/HBs Ab
      Kronis/riw. vaksin
    • HBeAg (+)
      Infeksius, bereplikasi
    • Anti HBe/HBeAb (+)
      Kronis/tidak bereplikasi
30
Q

Tx Hepatitis B

A

Tenofovir 1x300 mg

31
Q

Etio Hepatitis C

A

Virus Hep. C

32
Q

Transmisi Hepatitis C

A

Cairan tubuh

33
Q

Dx Hepatitis C

34
Q

PF Hepatitis C

35
Q

PP Hepatitis C

A
  • Fungsi hati
    SGPT ↑, SGOT ↑
  • Serologi
    • HCV RNA (+) → virus (+)
      • <6 bulan
        Hep. C akut
      • > 6 bulan
        Hep. C kronis
    • HCV RNA (-) → virus (-)
      • Anti HCV (+)
        Riw. infeksi
      • Anti HCV (-)
        Tidak pernah Hep. C
36
Q

Non Alcoholic Fatty Liver Disease (NAFLD) & Non Alcoholic Steatohepatitis (NASH)

A

Perlemakan hepar bukan karena konsumsi alkohol

37
Q

NAFLD vs NASH

A

NAFLD → Steatosis tanpa tanda inflamasi
NASH → Steatosis dengan tanda inflamasi

38
Q

FR NAFLD & NASH

A

Obesitas
Dislipidemia
DM
Riwayat kolesistektomi

39
Q

Dx NAFLD & NASH

A

Biasanya tidak bergejala
RUQ pain (+)
Hepatomegali
Malaise

40
Q

PP NAFLD & NASH

A
  • Peningkatan AST dan ALT
    ↑ 2-5x rasio AST/ALT <1 (pada alcoholic fatty liver → >2)
  • Peningkatan ALP
    ↑ 2-3x normal
  • USG
    Hipoekoik (bright liver) akibat infiltrasi lemak difus
  • Biopsi Hepar
    >5% hepatosit steatotik
    NASH → degenerasi hepatosit + inflamasi lobus hepar
41
Q

Tx NAFLD & NASH

A
  • Non Farmakologi
    BB ↓
  • Farmakologi
    • Anti hiperlipidemia
      Gemfibrozil, atorvastatin
    • Hiperglikemia oral
      Metformin, pioglitazone
    • Antioksidan
      Vitamin C, vitamin E
42
Q

PSMBA (2)

A

Varises (SEKASIH +)
Non Varises (SEKASIH -)

43
Q

Varises (SEKASIH +)

A

Varises esofagus

44
Q

Non Varises (SEKASIH -)

A
  • Gaster, duodenum
  • Pecahnya ulkus peptikum
  • Gastritis erosiva
45
Q

Tx PSMBA

A

ABC
→
Stabilkan hemodinamik: rehidrasi, NGT, bilas lambung
→
Tx empiris
Varises → Inj. Vit. K
Non-varises → Inj. omeprazole
→

  • Perdarahan berhenti
    Endoskopi elektif
  • Perdarahan tak berhenti
    + Obat vasoaktif (somatostatin)
    Endoskopi cito (emergency)
    • Varises esofagus
      Ligasi varises
    • Ulkus
      Inj. NE di ulkus
46
Q

Tx Sederhana PSMBA

A
  • Varises
    • Awal
      ABCD
    • Tepat
      Somatostatin/octreotide
    • Definitif
      Ligasi
    • Profilaksis
      Propanolol
  • Non Varises
    • Awal
      ABCD
    • Tepat
      PPI
    • Definitif
      Inj. NE
    • Profilaksis
      -

GEH (9 decks)

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