s1 kuliah hepatologi ipdiii
TRANSCRIPT
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HEPATOLOGIHEPATOLOGINASRUL ZUBIRNASRUL ZUBIR
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PENYAKIT HATIPENYAKIT HATI
1.1.
HEPATITIS ( Akut & Kronik )HEPATITIS ( Akut & Kronik )
2.2. SIROSIS HATISIROSIS HATI
3.3. KARSINOMA HATIKARSINOMA HATI
4.4. ASES HATIASES HATI
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HEPATITIS AK!THEPATITIS AK!T
"I# $"I# $ PERA"ANGAN HATI YANGPERA"ANGAN HATI YANGERLANGS!NG SE%ARA AK!T KARENAERLANGS!NG SE%ARA AK!T KARENA
EERAPA SEAEERAPA SEA Trn'i'i $ ori*ont+ & ,-rtik+Trn'i'i $ ori*ont+ & ,-rtik+Etio+oi $ 1. /iru' 0 A00%0"0E0#0G0TTEtio+oi $ 1. /iru' 0 A00%0"0E0#0G0TT
2. Ototn2. Ototn 3. kt-ri3. kt-ri 4. r'it4. r'it
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Grn K+inikGrn K+inik
1.1. St r-ikt-rikSt r-ikt-rik
G-5+ uu in6-k'i ,iru'G-5+ uu in6-k'i ,iru'
- 0nor-k'i0 tr+i0+-'u - 0nor-k'i0 tr+i0+-'u i+i0 u+0unt 'i+i0 u+0unt '
2. St Ikt-rik2. St Ikt-rik
ikt-ru'0 -to-+i0-noti ikt-ru'0 -to-+i0-noti 3.3.St r-ko,+-'-n'iSt r-ko,+-'-n'i
't. -n7-un 't. -n7-un
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P-tn -titi' ( -titi'P-tn -titi' ( -titi'
rk-r )rk-r )H-titi' AH-titi' A $ AntiHA/$ AntiHA/
H-titi' H-titi' $$
H'A0ntiH'0H-A0AntiH-0H'A0ntiH'0H-A0AntiH-0
H8A 0nti H80"NA H/H8A 0nti H80"NA H/
H-titi' %H-titi' %$ Anti H%/ 0 RNAH%/$ Anti H%/ 0 RNAH%/
H-titi' "H-titi' "$ Anti H"/$ Anti H"/
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Lortoriu $Lortoriu $
#un'i Hti $
SGOT( AST) 0
SGPT (ALT)
i+iruin
A+uin 0 +ou+in
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P-r5+nn H-titi' ,iru'P-r5+nn H-titi' ,iru'
Sembuh (90%)
B Kronik (10%)
Hepatitis kronik
Hepatitis Sirosis hati
Akut Kanker hati
C Kronik (90%)
Sembuh (10 % )
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P-n8-n9 Pr-,-nti6P-n8-n9 Pr-,-nti6
1. /k'in'i -titi'1. /k'in'i -titi'
H-titi' A H-titi' A
H-titi' H-titi'
2. Iuno+ou+in2. Iuno+ou+in
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P-notn H-titi' kutP-notn H-titi' kut
1. I'tirt
2. "i-t $ "H1 "H4
3. Ototn $
-torot-ktor
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H-titi' KronikH-titi' Kronik
"i6 $ H-titi' -nn -r5+nn"i6 $ H-titi' -nn -r5+nn
-n7kit +-i ri : u+n-n7kit +-i ri : u+n
T-riri $T-riri $
1. H-titi' kronik -r'i't-n1. H-titi' kronik -r'i't-n2. H-titi' kronik +ou+-r2. H-titi' kronik +ou+-r
3. H-titi' kronik kti63. H-titi' kronik kti6
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G.K+inik H-titi'G.K+inik H-titi'
kronikkronikGrn k+inik tik k' 0+-'uGrn k+inik tik k' 0+-'u
0ikt-rik 0-to-+i0ikt-rik 0-to-+i
P-r5+nn -titi' +-i : u+nP-r5+nn -titi' +-i : u+n0itni -nn H'A (;) tu Anti0itni -nn H'A (;) tu AntiH%/ (;)H%/ (;)
HK P-r'i't-n 0+ou+-r tik it-uHK P-r'i't-n 0+ou+-r tik it-ukn k-+inn k+ini' 0 !SG(;) 0PA (;)kn k-+inn k+ini' 0 !SG(;) 0PA (;)HK Akti6 0 -ninktn SGOT9SGPTHK Akti6 0 -ninktn SGOT9SGPT
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P-nt+k'nn HKP-nt+k'nn HK
I'tirt 6'- kti6 (HKA)I'tirt 6'- kti6 (HKA)
Ot
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E,+u'i H-titi' KronikE,+u'i H-titi' Kronik
1. H'A ti3 u+n2. H/"NA ti : u+n
3. !SG ti : u+n
4. SGOT n SGPT ti 3 u+n=. K-+un k-+un
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ERIMA KASIH
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SIROSIS HATISIROSIS HATINASRUL ZUBIRNASRUL ZUBIR
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"i6ini'i $"i6ini'i $
P-n7kit ti kroni' 7n itniP-n7kit ti kroni' 7n itni
-nn rn $-nn rn $
--n-rti6--n-rti6
N-kro'i'N-kro'i'
-'truk'i 'truktur ti-'truk'i 'truktur ti
'-uo+ou+u''-uo+ou+u'
'-rt 6iro'i' i6u''-rt 6iro'i' i6u'
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In'i-nIn'i-n
%in n Ini 4>?%in n Ini 4>?
A6rik tiur :.>?A6rik tiur :.>?
A-rik S-rikt 24?A-rik S-rikt 24?
Inon-'i 3 > ?Inon-'i 3 > ?
RS.M."5i+ =:?RS.M."5i+ =:?!ur $ 3@=@ tun ( Inon-'i)!ur $ 3@=@ tun ( Inon-'i)
:@ tun ( LN):@ tun ( LN)
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Etio+oiEtio+oi
Yn 'ti $ BYn 'ti $ B
#ktor -tio+oi $#ktor -tio+oi $
H-titi' ,iru' H-titi' ,iru'
A+koo+ A+koo+
Nutri'i Nutri'i r'it ( '8i'to'oi'i' ) r'it ( '8i'to'oi'i' )
Krito-nik Krito-nik
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K+'i6ik'iK+'i6ik'i
Mor6o+oi $Mor6o+oi $ 1. Mkronou+-r1. Mkronou+-r
2. Mikronou+-r2. Mikronou+-r 3. Koin'i3. Koin'i
K+ini'9-tio+oi $K+ini'9-tio+oi $
1. Po'tn-krotik 9o't-titi'1. Po'tn-krotik 9o't-titi' 2. Port+ 9+koo+ik9nutri'ion+9L-n-82. Port+ 9+koo+ik9nutri'ion+9L-n-8 3. i+i-r3. i+i-r
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Grn k+inikGrn k+inik
StiuStiu$$
1. Ko-n't1. Ko-n't
2. "-ko-n't2. "-ko-n't
Grn k+ini' kit $Grn k+ini' kit $
1. K-+n '-+ ti1. K-+n '-+ ti2. Hi-rt-n'i ort+2. Hi-rt-n'i ort+
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Akit k-+n '-+ tiAkit k-+n '-+ ti
Ikt-ru'Ikt-ru'
Si-r n-,iSi-r n-,i
P+r -rit-P+r -rit-
G7n-8o'tiG7n-8o'ti
Atro6i t-'ti'Atro6i t-'ti'
Rut '-k'u+ -rkurnRut '-k'u+ -rkurn
E-9'it-'E-9'it-'
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Akit i-rt-n'i ort+Akit i-rt-n'i ort+
Ko+t-r+Ko+t-r+
%ut -u8-%ut -u8-
H--t--'i' -+-nH--t--'i' -+-n
S+-no-+iS+-no-+i
/ri'-' -'o6u'/ri'-' -'o6u'-oroi-oroi
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In8i-n8- o6 H%% in8r-'-' Cit ror-'' o6 % t7-8roni8 -titi'
nor+ %H L% H%%
Annu+ in8i-n8- o6 H%%
@
nor+
@.=
#1
1.=
#2
%H
3.@
#3
>.@
L%
3@?
H%%
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Li,-r 8irro'i'
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"ino'i'"ino'i'
1. Grn k+ini'Grn k+ini'
2. Rio+oi2. Rio+oi
3. Eno'koi3. Eno'koi 4. !SG4. !SG
=. %T'8n=. %T'8n
:. MRI:. MRI >. P-riton-u'koi>. P-riton-u'koi
D. io'i ( i'toto+oi)D. io'i ( i'toto+oi)
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P-nt+k'nnP-nt+k'nn
1. I'tirt1. I'tirt
2. "i-t 0 "H9RG2. "i-t 0 "H9RG
3. Ototn3. Ototn 4. Tinkn ku'u'4. Tinkn ku'u'
1. - int' ('unt)1. - int' ('unt)
2. TIPS ( Trn'5uu+ri' intr2. TIPS ( Trn'5uu+ri' intr -ti8 orto'7't-i8 'unt)-ti8 orto'7't-i8 'unt)
3. Trn'+nt'i ti3. Trn'+nt'i ti
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Prono'i'Prono'i'
T-rntun $T-rntun $
-tio+oi -tio+oi
Tn k+ini' Tn k+ini'
K-+inn +ortoriu K-+inn +ortoriu
H'i+ -notn H'i+ -notn
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KEGANASANKEGANASAN
HEPATOILIERHEPATOILIER
NASRUL UB!R
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T!MOR HATIT!MOR HATI
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Tuor HtiTuor Hti
Tuor ti $ 1. -nin ( ink )Tuor ti $ 1. -nin ( ink )
2. M+in ( n' )2. M+in ( n' )
1. Tuor -nin $1. Tuor -nin $
. Pr-nki $. Pr-nki $
-to-no -to-no
8o+nio-no 8o+nio-no
8urn 8urn
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b. Tumor vaskulerb. Tumor vaskuler
" heman#ioma
" $iman#ioma
&' umor $ain"$ain " ibroma
" $ipoma
" $eimioma
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2. Tuor Gn'2. Tuor Gn'
1. Tuor n' ti ri-r ( H-to ) $1. Tuor n' ti ri-r ( H-to ) $ . '-+ ti $ %-to'-+u+-r. '-+ ti $ %-to'-+u+-r
%8o+nio'-+u+-r%8o+nio'-+u+-r %-to8o+nio%-to8o+nio '-+u+-r'-+u+-r . rinn ikt $. rinn ikt $
6iro'rko 6iro'rko +i6o +in +i6o +in +-oio'rko +-oio'rko
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Knk-r HtiKnk-r Hti(kr'ino -to'-+u+-r )(kr'ino -to'-+u+-r )
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Ei-io+oiEi-io+oi
T-rut A'i06rikT-rut A'i06rik
Lki+ki Cnit 3$1Lki+ki Cnit 3$1
!ur +-i u i A'i n A6rik!ur +-i u i A'i n A6rik
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Etio+oi $ BEtio+oi $ B
1. #ktor r-i'o'i'i#ktor r-i'o'i'i
'iro'i' ti 'iro'i' ti
-titi' -titi'
nutri'i nutri'i
n kr'ino-nik n kr'ino-nik
-r-it-r0 ++ -r-it-r0 ++
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Grn k+inikGrn k+inik
n7-ri -rut knn t' n7-ri -rut knn t'
-n5o+n -rut knn -n5o+n -rut knn
-rut un8it -rut un8it
L- 0+-'u 0 -nurun nor-k L- 0+-'u 0 -nurun nor-k
'i'i
-to-+i 0k-r' 0-n5o+20 tik -to-+i 0k-r' 0-n5o+20 tik
rtrt
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LortoriuLortoriu
T-' 6+ ti T-' 6+ ti
A+6 6-to rot-in (A#P) A+6 6-to rot-in (A#P)
PI/KAII ( rotroin inu8- PI/KAII ( rotroin inu8-
,itK ntoni't
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Beore *L
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Ater *L
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H-to8-++u+r 8r8ino
(+r- 'i*-)
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Ri'k #8tor' o6Ri'k #8tor' o6
H-to8-++u+-r %r8inoH-to8-++u+-r %r8inoH-titi' ,iru' In6-8tion ( H/ )
H-titi' % ,iru' In6-8tion ( H%/ )A+8oo+
%irro'i' o6 +i,-r
A-G-n-r
Mi'8-++n-ou' #8tor'
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TREATMENTTREATMENT1. NONS!RGI%AL
2. S!RGI%AL
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NONS!RGI%AL (ME"I%AL)NONS!RGI%AL (ME"I%AL)
1. ETHANOL INTRAT!MOR (EIT) 2. EMOLI INTRA ARTERIAL (EIA) 3. %HEMOTERAPHY INTRA T!MOR
( %IT)9TA%I 4. RA"IO #REF!EN%Y ALATION (R#A) =. RA"IOA%TI/E RA"IATION INTRA
T!MOR ( RRIT) :. GEN THERAPY
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"ino'i'"ino'i'
1. Grn k+ini'1. Grn k+ini'
2. Rio+oi2. Rio+oi
3. %TS8n3. %TS8n
4. MRI4. MRI
=. Anior6i=. Anior6i
:. !SG:. !SG
>. io'i>. io'i
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P-nt+k'nnP-nt+k'nn
1. I'tirt1. I'tirt
2. "i-t2. "i-t
3. Ototn (-i8+)3. Ototn (-i8+) -tno+ intr tuor (EIT) -tno+ intr tuor (EIT)
Eo+i intr rt-ri+ ( EIA) Eo+i intr rt-ri+ ( EIA)
Rio 6r-u-n8- +tion Rio 6r-u-n8- +tion 4. Tinkn - $ r-'-k'i4. Tinkn - $ r-'-k'i
=. Trn'+nt'i=. Trn'+nt'i
%n-' o6 !S i- o6 tuor urin R#A
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%n-' o6 !S i- o6 tuor urin R#A
1 2 3
4 =
s s
1 2 3
=4
RA"IO#REF!EN%Y ALATIO
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RA"IO#REF!EN%Y ALATIO
HOOKE" ARRAYS
ELE%TRO"E%ON/ENTIONALMONOPOLARELE%TRO"E
%OOLE"TIP ELE%TRO"E1.: 8
(+tion r-)
Ion ittion i' rou8- Citin t- ti''u-' 'urrounin t- -+-8tro-.Ti' ittion i' 8on,-rt- 7 6ri8tion into -t0 inu8in 8-++u+r -t
,i 8ou+ti,- n-8ro'i'.
Sur-''ion o6 tuor roCt 7 -n-
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3@@@
Sur-''ion o6 tuor roCt 7 -n-t-r7 Cit A-no,iru'Eno'ttin
%ont. Eno'ttin
1>12D
1>>122D
Eno'ttin%ont.
3
2@@@
1@@@
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S!RGI%AL TREATMENTS!RGI%AL TREATMENT
1. RESE%TION2. TRANSPLANTATION
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Prono'i'Prono'i'
T-rntun $T-rntun $
'tiu knk-r 'tiu knk-r
ti- knk-r $ nou+ 0i6u'0 'i6 ti- knk-r $ nou+ 0i6u'0 'i6
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ASES HATIASES HATI
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DIFINISIDIFINISI
S!AT! IN#EKSI HATIS!AT! IN#EKSI HATI
YANG ER!PA ASESYANG ER!PA ASES
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ETIOLOGIETIOLOGI
1. ASES PIOGENIK1. ASES PIOGENIK
STREPTOKOK!S STREPTOKOK!S
STA#ILOKOK!S STA#ILOKOK!S
++ ++
2. ASES AM!IK2. ASES AM!IK
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Grn k+ini'Grn k+ini'
Skit -rut knn t' Skit -rut knn t'
"- "-
H-to-+i H-to-+i
L-ko'ito'i' L-ko'ito'i'
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"ino'i'"ino'i'
1. Grn k+ini'1. Grn k+ini'
2. Rio+oi2. Rio+oi
3. !SG3. !SG
4. %TS8n4. %TS8n
=. A'ir'i '-'=. A'ir'i '-'
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USG Abses hati
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USG Abses hati
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P-nt+k'nnP-nt+k'nn
1. I'tirt1. I'tirt
2. "i-t2. "i-t
3. Ototn $3. Ototn $ Pio-nik $ ntiiotik Pio-nik $ ntiiotik
Auik $ ntiu Auik $ ntiu
M-troni*o+ M-troni*o+4. Tinkn - $ 'ir'i4. Tinkn - $ 'ir'i
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Prono'i'Prono'i'
P uun7 ikP uun7 ik
Ko+ik'i $ 6i'tu+Ko+ik'i $ 6i'tu+
A'-' ru A'-' ru
'-'i' '-'i'
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TERIMA KASIHTERIMA KASIH