HEPATITIS VIRUS AKUT

Amie Vidyani

DIVISI GASTROENTERO-HEPATOLOGIDEPARTEMEN ILMU PENYAKIT DALAM

FK UNAIR – RUMAH SAKIT DOKTER SOETOMOSURABAYA

DEFINISI

Keradangan difus pada jaringan hati < 6 bulan akibat virus hepatitis

Penyebab: Virus hepatotropik: A,B,C,D,EVirus Non-Hepatotropik:Epstein Barr, cytomegalovirus, herpes simplex, rubella dll

Causes:Hepatitis AHepatitis A

HAVHAV

Infective Infective hepatitishepatitis

Hepatitis BHepatitis B

HBVHBV

serum serum hepatitishepatitis

HepatitisHepatitis

DD

HDVHDV

Hepatitis CHepatitis C

HCVHCV

Post Post transfusion transfusion

hepatitishepatitis

Hepatitis EHepatitis E

HEVHEV

Epidemic/ Epidemic/ EntralEntral

virusvirus 27 nm RNA27 nm RNA 42 nm DNA42 nm DNA

Hepa virusHepa virus

35 nm 35 nm

IncompleteIncomplete

RNA+HBsAgRNA+HBsAg

30 – 60 nm30 – 60 nm

RNA flavi firusRNA flavi firus

32 nm RNA32 nm RNA

transmissiontransmission Feco-oral Feco-oral Paraentral and post transfusionParaentral and post transfusion

Sexual low risk 1-5 %Sexual low risk 1-5 %

Intrauterine low risk <5%Intrauterine low risk <5%

Feco-oralFeco-oral

Incubation p.Incubation p. 2 – 6 weeks2 – 6 weeks 2 – 6 months2 – 6 months 2 – 6 months2 – 6 months 2 – 6 months2 – 6 months 2 – 6 weeks2 – 6 weeks

ChronicityChronicity

&liver cancer &liver cancer

nono Yes Yes YesYes YesYes NoNo

ImmunizationImmunization

-passive-passive

Non specificNon specific

Ig Ig

Specific Ig Specific Ig IgMIgM Non specificNon specific

IgIg

-active-active HAV vaccine HAV vaccine

dangerdanger

Heptavax Heptavax HBV vaccineHBV vaccine

Heptavax Heptavax HBV vaccineHBV vaccine

GAMBARAN KLINIS• Fase 1 - Viral replication/Masa inkubasi;

asimtomatik.• Fase 2 – Prodromal /Pre-ikterik: Flu like syndrome

(lemah,lesu, panas, artralgia), mual,muntah,anoreksia,nyeri perut kanan

• Fase 3 – Ikterik : urine coklat, ikterus, hepatomegali, • Fase 4 – Convalescent/Penyembuhan; Ikterus

berkurang dan hilang (2-6 minggu).Penyembuhan sempurna 3-4 bulan.

Pemeriksaan Penunjang• ↑ serum bilirubin : total, direct and indirect

• ↑ ALT – AST : 500 – 2000 IU/L ALT > AST

• ↑Alkaline phosphatase – 5’nucleotidase – GGT

• Leucopenia with relative lymphocytosis, ESR

• Urine :• Bilirubin +

• SerologiHepatitis A: Ig M anti HAVHepatitis B: HBs Ag,Ig M anti HBcHepatitis C: Anti HCV,HCV RNAHepatitis D: Ig M anti HDV,HBs Ag,HDV RNAHepatitis E: Ig M anti HEV

Hepatitis B marker:antigenantigen SignificanceSignificance Corresponding Corresponding

AbAbsignificancesignificance

HBsAgHBsAg(surface)(surface)

Appear after 6 weekAppear after 6 weekAcute infection, remain Acute infection, remain

for 3 msfor 3 msChronic infection if >6 Chronic infection if >6

msms

Anti HBsAnti HBs Appear after 3 mAppear after 3 mReflecting recovery & Reflecting recovery &

immunityimmunity

HBcAgHBcAg(core)(core)

Detected on Liver Detected on Liver Biopsy only (not serum)Biopsy only (not serum)

Anti HBcAnti HBc Appear after 2 mAppear after 2 mReflecting sever Reflecting sever

acute & chronic formacute & chronic form

HBeAgHBeAg(envolop)(envolop)

Reflect ongoing viral Reflect ongoing viral replication (chronicity) replication (chronicity)

Anti HBeAnti HBe Appear after 2.5 mAppear after 2.5 mNon replicating virusNon replicating virus

HBV DNAHBV DNA Most sensitive indication for viral replication & chronicity (Dan Most sensitive indication for viral replication & chronicity (Dan particle)particle)

It is detected by PCRIt is detected by PCR

Penatalaksanaan• Tirah baring• Simtomatik

Diagnosis Banding• Hepatitis akibat virus non hepatotropik• Hepatitis akibat obat• Alkoholik hepatitis• Penyakit saluran empedu• Gagal jantung

Komplikasi• Gagal hati fulminan, gagal hati akut• Hepatitis kronik (B,C,D)• Kolestasis• Hepatitis-aplastic anemia syndrome

“ Karena Sesungguhnya sesudah Kesulitan itu ada Kemudahan.....

Sesungguhnya Sesudah Kesulitan itu ada Kemudahan “ (QS 94: 5-6)