Week 2 Flashcards
Liver cirrhotic
kerusakan sel hepatosit krna kerusakan perlahan2 (kronik), scar tissue ganti sel yg rusak, akhirnya ada blockage dari aliran darah ke hepar
etiology liver cirrhotic
chronic liver disease (viral [hep a, hep b], alcohol, non alcohol, cryptogenic)
etiopathogenesis liver cirrhotic
hepatosit injury –> inflamasi –> hepatric stella cell activate –> pembentukan myofibroblast –> fibrosis hati –> cirrhosis
mediator in liver cirrhosis inflamation + myofibroblast activation
igf-1, tgf,… (blm selsai)
Aliran darah akan terganggu di liver cirrhosis karena..?
perisinusoidal space menebal, vena tertekan
Fibrosis progression in liver cells
hepatic stellate activation –> mild fibrosis (f1) –> clinically relevant fibrosis (f2) –> advanced fibrosis (f3) –> cirrhosis (f4
Untuk menilai fibrosis/cirrhosis hepar
fibroscan, apri, fib-4, hepa score, fibro & forns index
compensated vs decompensated fibrosis in hepar
comp/decomp = kriteria klinis
decomp = adanya penimbunan cairan/ascites (bisa responsive –> refractory –> death is likely w/o transplant b4 tipe 2 hrs)
comp = tidak ada ascites
dokternya td jelasin dikit lagi tp jujur g kedengaran sinyanya jelek
liver crihosis criteria untuk parameter, tipe, severity yg umum dipake
child turcotte pugh, MELD score
Clinical presentation of liver cirrhosis/portal hypertension
ascites, splenomegaly, varisces oesophagus, palmar eritem, spider nevi, atrofi m.temporalis, kuku kuning tipis, gynecomastia, liver flap tremor (asterixis)
hepatic steatosis/fatty liver disease
- can be accompanied with cirrhosis
- akumulasi trigliserida & other fats di sel hepar
- non alcoholic, alcoholic, metabolic disfunction
pathogenesis fatty liver disease
- decrease faty acid beta oxidation
- increased endogenous fatty acid sintesis or delivery to hepar
- deficient VLDL…?
Diagnosis/DB
staetosis (non alchohol, alcohol, metabol) –> cubtype of non alcoholic –> steatohepatitis
Bedanya steatohepatitis dngn steatohepatitis lainnya
Dm as risk factor
besar heparnya masih tetap
??
sel digantiin lemak
Hepatitis
peradangan pada hati (hepar) krna ada luka di hati
Etiologi Hepatitis
virus, obat & toksin (parasetamol, amoksisilin, dkk), autoimun, metabolik, herediter
Gejala klinis hepatitis
ringan (flu-like) –> berat (fulminant)
ikterik, hepatomegali, low grade fever, sakit kepala, sakit otot & sendi, keluhan perut, urin gelap
Lab Hepatitis
Fungsi hati : integritas sel (GOT/AST, GPT/ALT) integritas saluran (ALP, y-GT) fungsi sekresi (bilirubin) fungsi sintesis (albumin, ChE) Imunologi : antibodi (hepatitis), antigen (ag), Molekuler (RNA/DNA)
Virus di Hepatitis
Virus Hepatitis A-G tapi F gajelas
yg sering : A,B,C
Other : Mumps, Rubella, CMV, Epstein barr
Hepatitis A virus
4 weeks udah ada IgM/IgG anti-HAV
-poin2 lain ini ga komplit
Hepatitis B virus
penularan melalui darah and cairan biologis
gejala akut mirip HAV tapi perjalanannya kronik
bagi anak sangat kronis
Hepatitis C virus
RNA virus
penularan dari darah
insidensi kronis tinggi, risiko parut hepar –> cirrhosis –> kanker
pengobatan interferon and anti-retroviral (tp blm ad yg spesifik c bngt)
labnya fluktuatif
HDV
mirip B
sth sth
HEV
RNA virus, non envelope, mirip A, enteric
HGV
sangat infeksius, mirip C
Pankreatitis
peradangan pankreas
akut or kronis
gejala pankreatitis
nyeri lambung bagian atas,
nausea dan vomitus
Etiologi pankreatitis akut
Penyebab banyak = batu empedu & alkohol. Lain: trauma, tumor, obat/toksin, infeksi (mumps/ parotitis, Coxsackie virus, CMV, HSV, Varicella-Zoster)
lab test akut pankreatitis
amilase & lipase. Seroimunologi mumps jarang, pemantauan autoimun diabetes (IL-6, anti insulin, anti GAD)
etiologi kronis pankreatitis
kalsifikasi (alkohol, merokok,
malnutrisi), obstruksi (striktur, tumor), autoimun (responsif
terhadap steroid)
lab test kronik pankreatitis
Pemeriksaan Amilase & Lipase terdeteksi rendah, insufisiensi eksokrin pankreas
CFA (coefficient of fat absorption), acid steatocrit, fecal elastase-1, mixed triglyceride breath test, fecal chymotrypsin
