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Pembahasan soal TO-2

2015

No. 16-20

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C. Menghentikan RHZE obse!asiklinis "an tes #$ngsi hati

• %iagnosa &asien' He&atitis imbasobat

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Hepatitis imbas obat

- ("alah kelainan #$ngsi hati akibat

&engg$naan obat-obat he&atotoksik )"$gin"$*e" he&atitis+

- Penatalaksanaan

•

,ila klinis )+ )kteik / geala m$alm$ntah /+

→OAT Stop

• ,ila geala )+ "an 34OT 34PT kali'

O(T sto&• ,ila geal klinis )-+ 7aboatoi$m te"a&at

kelainan'

•

,ili$bin 2 : O(T 3to&•

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Paduan OAT yang dianjurkan :

• 3to& O(T 9ang besi#at he&atotoksik )RHZ+

•

3etelah it$ monito klinis "an laboatoi$m. ,ilaklinis "an laboatoi$m kembali nomal )bili$bin34OT 34PT+ maka tambahkan H )NH+"esensitisasi sam&ai "engan "osis &en$h )00mg+.

• 3elama it$ &ehatikan klinis "an &eiksalaboatoi$m saat NH "osis &en$h bila klinis"an laboatoi$m kembali nomal tambahkani#am&isin "esensitisasi sam&ai "engan "osis&en$h )ses$ai beat ba"an+. 3ehingga &a"$anobat mena"i RHE3

• Pia:inami" ti"ak boleh "ibeikan lagi

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(. He&atitis (

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hg&';;888.*"*.go!;he&ahhs;Reso$*es;Po#essionals;P%<s;(

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,. Rhe$matoi" atitis

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• Rhe$matoi" athitis )R(+ is a *honi*s9stemi* in=ammato9 "isease o#$nkno8n *a$se. (n e>tenal tigge

)eg *igaette smoking in#e*tion ota$ma+ that tigges an a$toimm$neea*tion lea"ing to s9no!ial

h9&eto&h9 an" *honi* ointin=ammation along 8ith the &otential#o e>ta-ati*$la mani#estations

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3igns an" s9m&toms o# he$matoi" athitisma9 in*l$"e the #ollo8ing'

• Pesistent s9mmeti* &ol9athitis )s9no!itis+

o# han"s an" #eet )hallmak #eat$e+• Pogessi!e ati*$la "eteioation

• E>ta-ati*$la in!ol!ement

• %i?*$lt9 &e#oming a*ti!ities o# "ail9 li!ing)(%7s+

• Constit$tional s9m&toms

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%$ing the &h9si*al e>amination it is im&otantto assess the #ollo8ing'

• 3ti@ness

•

 Ten"eness• Pain on motion

• 38elling

• %e#omit9

• 7imitation o# motion

• E>ta-ati*$la mani#estations

• Rhe$matoi" no"$les

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Diagnosis BandingOA RA Gout

(8itan Pelahan Pelahan (k$tPea"angan -A Patologi %egeneasi Pann$s To#$sB$mlah sen"i Poli Poli Mono k"g2 &oliTi&e sen"i e*il ata$ besa e*il e*il ata$ besa7okasi Pinggang l$t$t

!eteba CMC 1%P PP

MCP PP&egelangantangan kaki

&egelangan kaki

MTP kaki&egelangankaki l$t$t

Tem$an sen"ikh$s$s

No"$s,o$*ha"

no"$sHebe"en

%e!iasi $lnaswan neck 

boutonniere

istal $at

Pe$bahan t$lang OsteoDt Osteo&enia eosi Eosi<it$ eksta-Aahk$la

No"$l 3C&$lmonalka"iak

s&lenomegali

 To#$s b$sihsole*anon bat$ginal

7ab Nomal R< )+ (sam $at

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%iagnosis - 4ER%

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(. Ome&a:ole

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 Am J Gastroenterol 2013; 108:308 – 328; doi:10.1038/aj.2012.!!!; "ublis#ed online

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,. (nemia megaloblastik

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Fk$an

• (nemia mikositik ' "eDsiensi <ethalassemia &en9akit konik)gangg$an $tilisasi <e+ anemia

hemolitik.

• (nemia nomositik ' &e"aahanak$t anemia &en9akit konik

anemia a&lastik gagal ginal• (nemia makostik ' "eDsiensi #olat

"eDsiensi ,12