Download - Abses Hati_3
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ABSES HATI
dr.Ira Ramadhani Mked PD SpPD
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Anatomy of liver
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PendahuluanAbses hati: Infeksi pada hati yang disebabkan
ok infeksi bakteri, parasit , jamur yang ditandai dengan adanya proses supurasi dengna pembentukan pus yang terdiri dari jaringan hati nekrotik, sel-sel inflamasi atau sel darah didalam parenkim hati.
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Parasitic Infestations Parasitic infestations are thought to predispose
to pyogenic liver abscesses.
These include: Ascariasis. Schistosomiasis Fascioliasis Trichuris Necator. Ancylostoma. Toxocara.
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Abses hati adalah penimbunan pus didalam parenkim hati yang disebabkan oleh kuman piogenik ataupun amuba. Piogenik (AHP)Etiologi :
Amuba (AHA)Kuman piogenik: Bakteri aerob :E. Coli, Klebsiella pneumoniae, Streptococcus faecalis , Staphylococcus aureus Bakteri anaerob :Bacteroides, Clostridium
Amuba : E. Histolytica
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AHP: - Hepatic abses- Bacterial liver abses- Bacterial abses of the liver- Bacterial hepatic abses
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EPIDEMIOLOGYAHA > AHPAHP tersebar diseluruh dunia, >> didaerah
tropis dgn higiene yang (-)MALE > FEMALEUsia 40 dan insiden puncak 60 tahun.
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Patho physiology of PYOGENIC ABCESSPYOGENIC:
PeritonitisTo liver via portal circulation
Direct Biliary infections (cholingitis)
Hematogenous SeedingBacteremia, septecemia(unusual)
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Gejala klinis :
Demam
Nyeri perut kanan atas
Mual, muntah, anoreksia
Penurunan berat badan
Kelemahan tubuh
Pembesaran hati disertai rasa nyeri
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Kelainan laboratorium
Anemia ringan normokrom normositer
Lekositosis
Tes fungsi hati Tidak banyak memunyai arti diagnostik
Biasanya terjadi peningkatan ringan / normal.
Kista dan tropozoit pada kotoran
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.
Ludwick Sign
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investigationsNON SPECIFIC
TLC :increase leukocytosisPeningkatan LED
SPECIFICUSGDIAGNOSTIC ASPIRATION & CULTURE
SENSITIVITYCT scan
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Gambaran USG :
Abses hati amuba Bentuk bulat atau oval
Tunggal ( 85 % )
Abses hati piogenik Bentuk bulat atau ovalMultipel
Foto Thorax : Dome Diafragma Meninggi
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ULTRASOUND of pyogenic abscess
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CT Scann Hati
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Pemeriksaan cairan aspirasi abses
Bila disebabkan oleh kuman piogenik:
Berbau busuk
Warnanya tidak terlalu khas
Kultur : Bakteri (+)
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Bila penyebabnya kuman amuba:
Berwarna coklat ( anchovy paste atau chocolate syrup )
Tidak berbau
Dapat ditemukan bentuk trofozoit E. Histolytica (pada bahan kerokan dinding abses)
Serologi ( seramuba ) positip
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Serologi Membedakan abses pyogenik dengan abses amuba pada hepar seringkali tidak dapat dilakukan dengan mempergunakan kriteria klinis, pemeriksaan laboratorium rutin, dan pemeriksaan radiologis. Karena itu, pemeriksaan serologi diperlukan untuk memastikan adanya infeksi amuba. Pemeriksaan serologi yang dapat dilakukan meliputi IHA (Indirect Hemagglutination), GDP (Gel Diffusion Precipitin), ELISA (Enzyme-linked Immunosorbent Assay), counterimmunelectrophoresis, indirect immunofluorescence, dan complement fixation.
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OTOPSI
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Diagnosis Banding
Penyakit lain yang gejala kliniknya mirip dengan abses hati antara lain:
Kolesistitis akut Kolangitis Hepatitis virus akut Karsinoma hati primer
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Penatalaksanaan :
Medikamentosa :
Metronidasol per oral 3 x 750 mg (10 hari)
Paromomisin per oral 4 x 500 mg ( 10 hari)
Aspirasi Cairan Abses
Drainase
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TreatmentMEDICAL
BROAD SPECTRUM ANTIBIOTICS triple regime(penicillin , amino glycoside and
Metronidazole) cephalosporin and Metronidazole
SPECIFIC ACCORDING TO CULTURE SENSITIVITY
i/v fluidsANALGESICS & ANTIPYRATICSUrgent drainage
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Role of aspiration Aspiration is indicated in solitary, unilocular
lesions. Multiloculated liver abscesses can be managed with aggressive percutaneous techniques.
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Role of surgery Surgical drainage is for :
(a) Patients with failed percutaneous drainage. (b) Patients who need additional management for
an underlying abdominal problem. (c) Patients with multiple macroscopic abscesses. (e) Patients with ascites.
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Komplikasi Diperkirakan 10% mengalami komplikasi.
Perforasi ke : Rongga Pleura Efusi Pleura
Rongga peritoneum Peritonitis Rongga perikardial Efusi perikardial
AsitesKonsolidasi paruSepsis
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Amoebic abscessEpidemiology M > F 7:1 10 % world population
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ETIOLOGY AND PATHOPHYSIOLOGYEntemoeba histolytica
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SIGN AND SYMPTOMSFeverNyeri perut kanan atasDysentery
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INVESTIGATIONSNON SPECIPIC
Increase TLCIncrease LFT’sMost common biochemical abnormality(alk
phosphate)SPECIFIC
USGCT SCANIMAGE GUIDED ASPIRATION ANCHOVY
SAUCE LIKE CULTURE AND SENSTIVITYFluorescent antibody test for Entamoeba(can be
positive even after clinical cure)If serology is negative , amoebiasis is uncertain
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Comparison
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