subscapular liver hematoma

7/24/2019 Subscapular Liver Hematoma

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Presentasi Referat

Subcapsular Liver Hematoma

Oleh :

Almirazada Zhes Putri

Pembimbing:

dr. Dean Wahjudy, Sp.OG (K)


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PENDAHULUAN

Sinrom HELLP hemolisis !H"#

pening$atan en%im hati !EL"# an

trombositopenia !LP" merupa$an salah satu

$ompli$asi pree$lamsia&e$lamsia'

Diper$ira$an ()&*) + pasien engan

pree$lamsia,e$lamsia berat a$an mengalami

gangguan paa hati- $ompli$asi sinrom

HELLP


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ANA.O/0 DAN 10S0OLO20

Leta$ :$uaran $anan atas rongga

perut i ba3ah iafragma'


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Hepar ibagi men4ai 5 lobus :lobus e6tra# lobus

cauatus# lobus sinistra an 7uaratus'

/emili$i lapisan 4aringan i$at tipis 8ang isebut $apsula

2lisson#

9agian luarn8a itutupi oleh peritoneum' Daerah tempat eluar masu$ pembuluh arah paa

hepar :hilus atau porta hepatis'


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Tinjaun pustaka


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Subcapsular Liver Hematomaaalah

$ompli$asi ari HELLP sinrom 8ang 4arang

tapi mengancam n8a3a'

Paa sebagian besar $asus ruptur hepar ter4ai

paa lobus bagian $anan

Diahului oleh terbentu$n8a hematoma


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Patofisiologi

un$no3n

erusa$anenotel an

a$tivasi

trombositintravas$uler

;asospasme

AglutinasiPem'arah

Agregasitrombosit

Smterfragmentasi

Depositfibrin $e

sinusoi

Nekrosis

periportal

Perarahan intrahepati$

Hematm su!"apsular hati

Ruptur hati

Hemolisis

trombositopenia

bl l b i di i S d


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Table 1. laboratory Findings in HELLP Syndrome

Hemolysis (at least two

of these) :

Elevated liver

enymes :

Low !latelets

("1##.###$mm%)

Peri!heral smear

(s&histo&ytes' brr&ells)

AST or ALT twice

upper level ornormal

Serm bilirbin (1.*

mg$+l

LDH twice upper

level or normal

Low serm

ha!toglobin

Severe anemia'

nrelated to blood

loss

Ptekie Ekimosis Gusi berra!


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#a!le $. Si%n and Symptms & Su!"apsular 'ier Hematma

Seere epi%astri" pain Seere nausea r mitin%

Shulderne"* pain

+espiratry di&&i"ulty r pain

n inspiratin A"ute nset & hyptensin and

ta"hy"ardia

Relapsing h8potension Disseminate intravascular

coagulopath8

Abrupt elevations in liver

en%8mes /assive ascites or pleural

effusions


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Diapat$an paa trimester $e ua a$hir atau

trimester $etiga $ehamilan'

Saat ruptur ari $apsul Glisson - hipotensi

an s8o$ hipovolemi$ '

Robe$an ari hematom 8ang inta$ apat

spontan atau apat ihubung$an engan

trauma ari luar !e6: palpasi abomen#

$onvulsi ataupun muntah'


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Diagnosis

#a!el . +adil%i"

-ma%in% in Su!"apsular

'ier Hematma

hest/0/ray

Pleural effusion

Elevate right iaphragm

1ltrasund

Hematoma

0ntraperitoneal flui

# s"an

2+-

=&ra8 US2


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ehamilan 8ang memili$i $ompli$asi seperti

subcapsular liver hematoma ihubung$an

engan ang$a $ematian maternal an perinatal

8ang sangat tinggi'

Resi$o paa 4anin biasan8a berhubunganen an rematuritas an hi o$sia'

.ing$at morbiitas bergantung paa:

(' Rupture atau tia$#

*' eterseiaan arah untu$ tranfusi#

>' .ina$an operasi 8ang

irencana$an


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Table ,. maternal and Perinatal -om!li&ations in He!ati& Hematoma

/aternal Perinatal 0eed for large volmes of

blood transfsions

Preterm eliver"

Prolonged hos!italiation in

intensive &are nit

#erebral pals"

Plmonary edema $ental retaration

2+S

%etal&neonatal eat! 2enal failre

He!ati& failre

Potential for liver trans!lant

Se!sis

+3-

3ntra&erebral hemorrhage

+eath


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&Suspecte subcapsularliver hematoma

&$onsul operasi ancross match bloo

unrupture

.ranfusi? perbai$i$oagulopati? serial

monitoring

0ncrease hematome si%e ?maternal conition

eteriorates

ruprute

>) U PR


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Pro'nosis

Ang$a $ehiupan ber$aitan gn :

Penega$an iagnosis ini

Penanganan meis

.ina$an operasi 8ang cepat'

Penelitian : B gn RPD: hematoma subcapsular hat0

prognosa bai$ paa $ehamilan beri$utn8a


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AS# 4 units ' (nrmal 5 64 units')

A'# >@ units, L !normal F G) units,L"

'DH () units, L !normal F *)) units,L"

Platelet "unt *))'))),mm> !normalF())'))),mm>"

Hem%l!in (*> g,Dl !normal () ,Dl

1SG janin : Presbo$# pertumbuhan normal# ica cu$up'

Prtein urin$6 j : *)() mg,hari'

DD : Pree$lamsia# pasien ira3at#erapi : Steroi untu$ pematangan paru 4anin'

5 4am setelah ira3at : tiba&tiba mengeluh$an n8eri epigastrium

berat#muntah#n8eri te$an paa $uaran $anan atas' Dila$u$an

pemeri$saan laboratorium ulang'

Hasil Lab(1)(

AS# 7$ units ' (nrmal 5 64 units')

A'# ()) units, L !normal F G) units,L"

'DH *@) units, L !normal F *)) units,L"

Platelet "unt B)'))),mm> !normalF())'))),mm>"

Hem%l!in > g,Dl !normal () ,L


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D=: Sinrom HELLP

S

subscapular liver hematoma

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