PPT Case Dr.anggun

7/23/2019 PPT Case Dr.anggun

http://slidepdf.com/reader/full/ppt-case-dranggun 1/36

LAPORAN KASUSSIROSIS HEPATIS

PEMBIMBING : DR. ANGGUN SANGGUNA, SP.PD

PENYUSUN : ANASTASIA WIDHA SYLVIANI



BAB I. PENDAHULUAN

● Sirosis adaa! s"a#" $%adaa& 'a#oo(i )a&( *%&((a*+ar$a& s#a

+rosis !%'a#i$ )a&( +%ra&(s"&( 'ro(r%si- )a&( di#a&dai d%&(a& d

arsi#%$#"r !%'ar da& '%*+%&#"$a& &od""s r%(%&%ra#i-.

● Saa! sa#" *%&i-%s#asi !i'%r#%&si 'or#a adaa! aris%s %so'!a("s.

201 'asi%& sirosis d%&(a& aris%s %so'!a("s '%3a! )a&( *%&i*+"$a&

!i&((a $%*a#ia&.

● K%s%"r"!a& i&sid%&si sirosis di A*%ri$a di'%r$ira$a& 450 '%r 600.000

Di N%(ara +ara# )a&( #%rs%ri&( a$i+a# a$o!oi$ s%da&($a& di I&do&%sia #%r"

i&-%$si ir"s !%'a#i#is B *a"'"& 7.



STATUS PASIEN

IDENTITAS PASIEN

Na*a : T&. B

8%&is K%a*i& : La$i9a$i

Usia : 4 #a!"&

A(a*a : Isa*

Aa*a# : 8. Ma$a* RT 6;5, 7i'"ir , K%+a)ora& Bar", 8a$s%

P%$%r<aa& : Kar)a=a& S=as#a

P%&didi$a& : Sar<a&a S6

S#a#"s P%r$a=i&a& : M%&i$a!

S"$" Ba&(sa : 8a=a

No. RM : 66666



ANAMNESISDia$"$a& s%3ara a"#oa&a*&%sis 'ada #a&((a 4 No%*+%r /06 di r"a&( ra=a# P"

AL TNI Dr, Mi&#o!ard<o.

K%"!a& U#a*a : M"&#a! dara!K%"!a& Ta*+a!a& : BAB +%r=ar&a !i#a*, $%d"a *a#a +%r=ar&a $%$"&i&(a&, *"a

%*as, &a-s" *a$a& *%&"r"&

RPS :

M"&#a! dara!

*%ra! s%(ar s%<a$

6 !ari SMRS

s%+a&)a$ 6 $ai ,

s%+a&)a$ / sd*

da& #%rasa (%#ir

<a* $%*"dia&BAB !i#a* '%$a#s%'%r#i #%r, a(a$%*+%$, %&($%#,da& +%r+a" a(a$+"s"$. BAB !i#a*

dirasa$a&s%+a&)a$ 4>

K%d"a *a#a&)

+%r=ar&a

$%$"&i&(a& 4 +"

SMRS. P%r&a!

*%&(aa*i

$%"!a& s%r"'a

'ada 6 #a!"& )



D%*a*, s%sa$, '%r"#

*%*+"&3i#, +%&($a$

'ada $a$i, +%r3a$

$%*%ra!a& +%r3a+a&(

s%'%r#i $a$i a+a 9 a+a

'ada '%r"# a#a" dada,

'%*+%sara& +"a!

dada, BAK (%a' s%'%r#i

#%!, disa&($a

Pasi%& *%&(a$"

s%<a$ 4 +"a& )a&

*%&d%ri#a H%'a

da& s%da&( da

*asa '%&(o+a

!i&((a s%$ara

M"a,

'%r"# #%rasa +%(a!,

sa$i# $%'aa )a&(

+%rd%&)"#,%*as,

&a-s" *a$a&

+%r$"ra&( ?@

RPD :

● Ri=a)a# Sirosis H%'a#is d%&(a& as3i#%s 6 #a!"& )a&( a"

● Ri=a)a# %&dos$o'i da& dia$"$a& i(asi %&a 6 #a!"& )a&( a".

● Ri=a)a# DM ?@

● Ri=a)a# dara! #i&((i, a%r(i, as*a, '%&)a$i# <a&#"&(, '%&)a$i# (i&<a

disa&($a o%! 'asi%&.



RPK :

Ri=a)a# DM ?@ 'ada i+", ri=a)a# !i'%r#%&si as*a, da& a%r(i 'ada $%"ar(a

Ri=a)a# P%&(o+a#a& :

Pasi%& *%&(a$" #%a! +%ro+a# $% RS Sari Asi! d%&(a& $%"!a& %*as, *a#a $

BAB !i#a* !ari SMRS &a*"& +%"* *%&(aa*i '%r+ai$a&.

Ri=a)a# K%+iasaa&

● M%ro$o$ 6 +"&($"s;!ari +%r!%&#i s%<a$ 6 #a!"& )a&( a" da&

● S%ri&( *%&($o&s"*si *i&"*a& +%ra$o!o +%r!%&#i s%<a$ 6 #a!"& )a&( a

● Pasi%& *%&)a&($a *%*ii$i $%+iasaa& *%*i&"* o+a# 9 o+a#a& da& <a*".

● Pasi%& *%&(a$" <ara&( +%roa! ra(a da& *%&)"$ai *a$a& *a$a&a& )a&(

'%das.



PEMERIKSAAN ISIK

STATUS GENERALIS :

K%adaa& U*"* : Ta*'a$ sa$i# s%da&(

K%sadara& : 7o*'os M%&#is

S#a#"s GiCi : BB 5 $(, TB 6 <(, IMT /6./, K%sa& : Nor*a

TANDA VITAL

T%$a&a& dara! : 660;50 **H(

Nadi : F0 >;*%&i#, r%("ar, $"a#, isi 3"$"', %$"a

P%r&a'asa& : 6F >;*%&i#, r%("%r

S"!" : 45, o7



MataI&s'%$si :

Ko&<"&(#ia a&%*is ?@;?@, s$%ra i$#%ri$ ?@;?@, s%$r%# ?9;?9, '"'i iso$orR7TL ?@;?@THT : Daa* +a#as Nor*a

Rongga Mulut : Daa* +a#as Nor*aLeher : Daa* +a#as Nor*a

Thorax : 8a&#"&( da& Par" daa* +a#as Nor*aAbdomen :

I&s'%$si : B%&#"$ a+do*%& &or*a, *%&da#ar da& si*%#ris,=ar&a $"i# sa=o *a

(%ra$ di&di&( '%r"# 'ada '%r&a'asa& si*%#ris, sa((i&( o- #!% a&$s ?9, s'id%r

"*+ii$"s ?9

A"s$"#asi : BU ?@ 4>;*%&i#, ar#%ria +r"i# ?9, %&o"s !"*' ?9

Pa'asi : s"'%, *assa ?9, d%-%&s% *"s$"ar ?9, &)%ri #%$a& ?9, !%'ar da& i%& #

Bao#%*%& (i&<a ?9, T%s "&d"asi ?9

P%r$"si : #i*'a&i, s!i-#i&( d"&%ss ?9, "&d"asi ?9, &)%ri $%#o$ 7VA ?9

E!trem"ta! : A$ra #%ra+a !a&(a#, sia&osis ?9;9, 'a*ar %ri#%* ?9;9, 7RT

?9;?9, d%-or*i#as ?9;9, $o&#ra$#"r D"'")#r%& ?9



OLLOW UP ?/;66;/06

S # A

BAB !i#a* 6>, a(a$ 'ada#

M"a

M"&#a! ?9P"si&(

L%*as

Na-s" *a$a& +%r$"ra&(

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

TD: 6/0;0 **H(,N: F0>;*%&i#,

RR: 6F>;*%&i#.

S"!" : 45,0 7

Ma#a : 7A @;@, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,

Par": S"ara &a'as %si$"%r ?@;@,

ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9

E$s#r%*i#as: a$ra !a&(a#, o%d%*

?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @

A&%*ia %.3 S"s' Sirosis

H%'a#is

9H%'a#i#is 7 $ro&is a$#i-

9 I&-"s D : a

9 E')so& S)

9 I&< Ra&i#idi9 HP 'ro 4>6

9Tra&s-"si PR

9Di%# DH/ 3a



OLLOW UP ?4;66;/06

S # A

BAB !i#a* 6>, a(a$ 'ada#

M"a

M"&#a! ?9P"si&(

L%*as

Na-s" *a$a& *%&i&($a#

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

TD: 6/0;F0 **H(,N: F0>;*%&i#,

RR: 6F>;*%&i#.

S"!" : 45,0 7

Ma#a : 7A @;@, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9


?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is


9 I&-"s D : a

9 E')so& S)

9 I&< Ra&i#idi9 HP 'ro 4>6

9Tra&s-"si PR

9Di%# DH/ 3a



OLLOW UP ?2;66;/06S # A

BAB *"ai $%$"&i&(a&,

a(a$ 'ada#

M"a ?9

M"&#a! ?9

P"si&( ?9

L%*as ?9

Na-s" *a$a& *%&i&($a#

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

TD: 660;0 **H(,

N: 5/>;*%&i#,

RR: 65>;*%&i#.

S"!" : 45,0 7

Ma#a : 7A @;@, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9


?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is


9 I&-"s D :

9 E')so& S)

9 I&< Ra&i#id

9 HP 'ro 4>6

9 La3#"a> 4



OLLOW UP ?5;66;/06S # A

BAB Hi#a* ?@ 3air / >

M"a ?@

M"&#a! ?9

P"si&( ?@

L%*as ?@

N)%ri P%r"# ?@

Na-s" *a$a& +%r$"ra&(

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

NGT $%!i#a*a&

TD: 620;0 **H(,

N: />;*%&i#,

RR: 65>;*%&i#.

S"!" : 40 7

Ma#a : 7A @;@, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9

E$s#r%*i#as: a$ra !a&(a#, o%d%*?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is

9 Varis%s Eso-a("s

Grad% IV


9 I&-"s Na3

9 S#%a*i& 4

9 I&< 7%-#ria>

9 I&< Vi# K 4>

9 Tra&s-"si P

9 Bias a*+



OLLOW UP ?;66;/06

S # A

BAB Hi#a* +%r$"ra&(, 3air

2 >

M"a ?@

M"&#a! ?9

P"si&( ?@

L%*as ?@

N)%ri P%r"# ?@

Na-s" *a$a& +%r$"ra&(

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

NGT $%*%ra!a&

TD: 640;F0 **0H(,

N: />;*%&i#,

RR: 6F>;*%&i#.

S"!" : 45.0 7

Ma#a : 7A 9;9, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9

E$s#r%*i#as: a$ra !a&(a#, o%d%*?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is

9 Varis%s Eso-a("s

Grad% IV


9 I&-"s RL 6

9 I&< 7%-#ria>

9 I&< Vi# K 4>

- I&< OM 4>

- I&< Tra&sa*

- E'isa& S)r

9 A NGT



OLLOW UP ?;66;/06S # A

BAB $%$"&i&(a&,

*%*ada# />

M"a ?9

M"&#a! ?9

P"si&( ?9

L%*as ?9

N)%ri P%r"# ?9

Na-s" *a$a& *%&i&($a#

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

TD: 660;0 **0H(,

N: FF>;*%&i#,

RR: 6F>;*%&i#.

S"!" : 45.F0 7

Ma#a : 7A 9;9, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9


?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is

9 Varis%s Eso-a("s

Grad% IV


9 I&-"s RL 6

9 I&< 7%-#ria>

9 I&< Vi# K 4>

- I&< OM 4>

- I&< Tra&sa*

- E'isa& S)r

9 HP Pro 4>6



OLLOW UP ?60;66;/06S # A

BAB $%$"&i&(a&,

*%*ada# 6>

M"a ?9

M"&#a! ?9

P"si&( ?9

L%*as ?9

N)%ri P%r"# ?9

Na-s" *a$a& *%&i&($a#

7o*'os M%&#is

Ta*'a$ sa$i# s%da&(

TD: 660;F0 **0H(,

N: 5>;*%&i#,

RR: 6F>;*%&i#.

S"!" : 45.60 7

Ma#a : 7A 9;9, SI@;@

8a&#"&(: S6 S/ r%("%r, *"r*"r ?9,

(ao' ?9,


ro&$!i ?9;9, =!%%Ci&( ?9;9.

A+do*%&: da#ar, s"'%, BU?@ &or*a,

NT?9, s!i-#i&( d"&%s ?9,

S'id%r &a) ?9


?9,'a*ar %ri#%* ?9

9H%*a#%*%sis M%%&a @


H%'a#is

9 Varis%s Eso-a("s

Grad% IV


9 I&-"s RL 6

9 I&< 7%-#ria>

9 I&< Vi# K 4>

- I&< OM 4>

- I&< Tra&sa*

- E'isa& S)r

9 HP Pro 4>6



PEMERIKSAAN PENUN8ANG

La+ora#ori"* Dara! ?/;66;/06

Pemer"!aan Ha!"l Satuan N"la" normal

HEMAT#L#GIH+H#L%"$osi#

Tro*+osi#Eri#rosi#

$%&'(5000$)&%*$

(;dL1Ri+";"LRi+";"L

8"#a;"L

629652/92F.0960.0609202.095./0

+IMIA +LINI+

G"$osa Dara!

626 *(;dL /00

,ung!" Hat"SGOTSGPT

40/

U;IU;I

4




HEMAT#L#GIH+H#

L%"$osi# Tro*+osi#Eri#rosi#

-%&'$

(.//$$&%-'

(;dL1

Ri+";"LRi+";"L

8"#a;"L

629652/92F

.0960.0609202.095./0

La+ora#ori"* Dara! ?4;66;/06

La+ora#ori"* Dara! ?;66;/06



Tro*+osi#Eri#rosi#

$%-'$('//0/*&%$.

(;dL1Ri+";"LRi+";"L

8"#a;"L

629652/92F.0960.0609202.095./0

HEMOSTASISPTAPTT

62.4&-%'

d%#i$d%#i$

629/6/694



La+ora#ori"* Dara! ?5;66;/06



Tro*+osi#Eri#rosi#

-%)')5000

(-&%)0

(;dL1Ri+";"L

Ri+";"L 8"#a;"L

629652/92F.0960.0

609202.095./0



HEMAT#L#GI

H+H#L%"$osi#

Tro*+osi#Eri#rosi#

)%)&'00.$(%0)

(;dL1Ri+";"LRi+";"L

8"#a;"L

629652/92F.0960.0609202.095./0






Tro*+osi#Eri#rosi#

0/&&000

$)(%&'

(;dL1Ri+";"L

Ri+";"L 8"#a;"L

629652/92F.0960.0

609202.095./0

P%*%ri$saa& E&dos$o'i

K%sa& : Varis%s Eso-a("s Grad%

IV <a* /...60 d%&(a&

'%rdara!a&



DIAGN#SIS

9 H%*a#%*%sis M%%&a @ A&%*ia %.3 S"s' Sirosis

H%'a#is

9 Varis%s Eso-a("s (rad% IV

9 H%'a#i#is 7 $ro&is a$#i-

DIAGN#SIS 1ANDING

9 Hi'%r#%&si Por#a I&#ra!%'a#i$: "*i&a&# !%'a#i3 -ai"r%, V%&o9o33"si%

dis%as%

9 Hi'%r#%&si Por#a E$s#ra!%'a#i$: H%'a#i3 %i& o+s#r"3#io& ?B"dd9 7!iari s)&



TATALAKSANA

Non med"amento!a:

Tira! +ari&(

Tra&s-"si PR7 00 33 !i&((a H+ 60

Med"amento!a:

9 I&-"s RL 62#'*

9 I&< 7%-#ria>o&% />6 (r

9 I&< Vi# K 4>/ a*'

9 I&< OM 4>6 a*'

9 I&< Tra&sa*i& />6 a*'

9 E'iso& s)r 4>76

9 HP 'ro 4>6



PROGNOSIS

Ad i#a* : ad +o&a*

Ad -"&(sio&a* : d"+ia ad *aa*

Ad sa&a#io&a* : d"+ia ad *aa*



PEMBAHASAN KASUS

Pada (a(a !%'ar sirosis $ro&is, $%*a#ia& s% daa* !%'ar*%&(a$i+a#$a& '%&i&($a#a& #%$a&a& %&a 'or#a. S%+a(a#%r+%&#"$ sa"ra& $oa#%ra daa* s"+*"$osa %so'!a("s

*%&i&($a#&)a #%$a&a& daa* %&a i&i, *a$a %&a #%rs%+"*%&(%*+a&( da& *%*+%sar ?dia#asi o%! dara! dis%+"#Varis%s da'a# '%3a!, *%&(a$i+a#$a& '%rdara!a& d%&(a&s%'%r#i *"&#a! dara! s%(ar )a&( di$%"!$a& 'asi%&.

M"&#a!

dara! *%ra!

s%(ar

BAB !i#a*

P%&i&($a#a& #%$a&a& %&a 'or#a 'ada sirosis !%'a#is <"(a

*%&)%+a+$a& #%r+%&#"$&)a sa"ra& $oa#%ra daa* s"+*%so'!a("s, a*+"&( da& r%3#"*. Varis%s da'a# '%3a!, *'%rdara!a& (as#roi&#%s#i&a *asi-. Pada *%%&a daa* '%*%a"i "s"s, dara! *%&<adi +%r=ar&a *%ra! (%a' +a!$aP%r"+a!a& =ar&a dis%+a+$a& o%! H7L a*+"&(, '%'si&, d!i#a* i&i did"(a $ar%&a ada&)a 'i(*%& 'orri&.



K%d"a *a#a

+%r=ar&a

$"&i&(

K%"!a& $%d"a *a#a +%r=ar&a $"&i&( )a&( dirasa$a& 'asa$i+a# ada&)a !i'%r+iir"+i&%*ia, )ai#" $%adaa& di*a&a +iir"+i& daa* dara! sa&(a# #i&((i . Hi'%r+iir"+i&%*ia d#i*+" s%+a(ai a$i+a# dari *%&"r"&&)a $%*a*'"a& s% !*%&(o&<"(asi da& *%&(%$sr%si$a& +iir"+i& 'ada sirosis !

M"a, '%r"#

#%rasa +%(a!

Pada o+s#r"$si sir$"asi 'or#a. S%*"a dara! dari or(a&9oa$a& +%r$"*'" daa* %&a 'or#a da& di+a=a $% !a#i. Kasiro#i$ #ida$ *%*"&($i&$a& '%i&#asa& dara! )a&( +%+asdara! #%rs%+"# a$a& $%*+ai $% daa* i*'a da& #ra$#"s d%&(a& $o&s%$"%&si +a!=a or(a&9or(a& i&i *%&<adi #%*''asi- )a&( $ro&is d%&(a& $a#a ai&, $%d"a or(a& #%rs%+"#o%! dara! da& d%&(a& d%*i$ia& #ida$ da'a# +%$%r<a d%&

A&%*ia,

sa$i#

$%'aa,%*as

Varis%s )a&( '%3a! da'a# *%&(a$i+a#$a& $%!ia&(a& dara

'%&"r"&a& ar"s +ai$ %&a $% <a&#"&(, da& '%&"r"&a& '%



BAB II. TIN8AUAN PUSTAKA

DEINISI

Is#ia! Sirosis !a#i di+%ri$a& o%! La%&3% #a!"& 6F6, )a&( +%rasa dari $a#a K!irros

$"&i&( ora&(% ?ora&(% )%o=, $ar%&a '%r"+a!a& =ar&a 'ada &od"9&od")a&( #%r+%

!a#i adaa! K%*"&d"ra& -"&(si i%r )a&( '%r*a&%& )a&( di#a&dai d%&(a& '%r"+a!a& !

Yai#" $%r"sa$a& 'ada s%9s% !a#i )a&( *%ra&(sa&( 'ros%s '%rada&(a& da& '%r+ai$a

)a&( *a#i s%!i&((a *%&)%+a+$a& #%r+%&#"$&)a <ari&(a& 'ar"#.

ANATOMI HEPAR



ISIOLOGI HEPAR

● "&(si !a#i s%+a(ai *%#a+ois*% $ar+o!idra#, %*a$, 'ro#%i&, da& i#a*i&

● "&(si !a#i s%!"+"&(a& d%&(a& '%*+%$"a& dara!

● "&(si !a#i s%+a(ai d%#o$si$asi

● "&(si !a#i s%+a(ai -a(osi#osis da& i*"&i#as

● "&(si !%*odi&a*i$

ETIOLOGI

● A$o!o

● Sirosis Kri'#o(%&i$,

● H%'a#i#is Vir"s Ya&( Kro&is

● K%ai&a&9K%ai&a& G%&%#i$ Ya&( Di#"r"&$a&;Di=aris$a&

● Pri*ar) +iiar) 3irr!osis ?PB7

● Pri*ar) S3%rosi&( 7!oa&(i#is ?PS7

EPIDEMIOLOGI



EPIDEMIOLOGI

Di &%(ara *a<", sirosis !a#i *%r"'a$a& '%&)%+a+ $%*a#ia& #%r+%sar $%#i(a 'ada

+%r"sia 2 25 #a!"&. K%s%"r"!a& i&sid%&si sirosis di A*%ri$a di'%r$ira$a& 450

'%&d"d"$. P%&)%+a+&)a s%+a(ia& +%sar a$i+a# '%&)a$i# !a#i a$o!oi$ *a"'"& i&-%$s

P%&d%ri#a sirosis !a#i %+i! +a&)a$ di<"*'ai 'ada $a"* a$i9a$i <i$a di+a&di&($a& d

=a&i#a s%$i#ar 6,5 : 6, d%&(a& "*"r ra#a9ra#a #%r+a&)a$ a&#ara (oo&(a& "*"r 40 '"&3a$&)a s%$i#ar 20 2 #a!"&.

PATOISIOLOGI

KLASIIKASI



B%rdasar$a& *or-oo(i S!%ro3$ *%*+a(i Sirosis !a#i a#as 4 <%&is, )ai#" :

● Mi$ro&od"ar

Di#a&dai d%&(a& #%r+%&#"$&)a s%'#a #%+a #%ra#"r, di daa* s%'#a 'ar%&$i* !a#i *%&(a&d

da& $%3i )a&( *%ra#a. Sirosis *i$ro&od"ar +%sar &od"&)a sa*'ai 4 **

● Ma$ro&od"arsirosis *a$ro&od"ar di#a&dai d%&(a& #%r+%&#"$&)a s%'#a d%&(a& $%#%+aa& +%rarias

&od" )a&( +%sar&)a <"(a +%rariasi ada &od" +%sar didaa*&)a ada da%ra! "as d%&(a&

*asi! +ai$ a#a" #%r<adi r%(%&%rasi 'ar%&$i*.

● 7a*'"ra& ?)a&( *%*'%ri!a#$a& (a*+ara& *i$ro9da& *a$ro&od"ar

B. S%3ara "&(sio&a Sirosis #%r+a(i a#as :● Sirosis !a#i $o*'%&sa#a.

S%ri&( dis%+"# d%&(a& La#%& Sirosis !a#i. Pada s#adi"* $o*'%&sa#a i&i +%"* #%ri!a# (%

&)a#a. Biasa&)a s#adi"* i&i di#%*"$a& 'ada saa# '%*%ri$saa& s3r%%&i&(.

● Sirosis !a#i D%$o*'%&sa#a

Di$%&a d%&(a& A3#i% Sirosis !a#i, da& s#adi"* i&i. Biasa&)a (%<aa9(%<aa s"da! <%as, *i

%d%*a da& i$#%r"s.

MANIESTASI KLINIS



MANIESTASI KLINIS

6. Kegagalan Hepatoselular

Ma&i-%s#asi $%(a(aa& !%'a#os%"ar 'ada sirosis adaa! s%*"a !a )a&( +%r$ai#a& d%&

!a#i )a&( #%rsisa "&#"$ *a$"$a& -"&(si &or*a&)a )a&( *%&3a$"':

9 I$#%r"s

9 Ga&(("a& %&do$ri&, s%'%r#i a&(io*a a+a9a+a, %ri#%*a 'a*aris, (i&%$

'%$#orais, da& a#ro #%s#is

9 Ga&(("a& !%*a#oo(i , s%'%r#i #ro*+osi#o'%&ia, %"$o'%&ia, a&%*ia ?a$i+a# !

da& $%3%&d%r"&(a& '%rdara!a& ?a$i+a# *%&"r"&&)a 'rod"$si -a$#or '%*+%$"a&

9 Ed%*a '%ri-%r #%r$ai# !i'oa+"*i&%*ia

9 %#or !%'a#i$"*

9 Ga&(("a& *%#a+ois*% s%'%r#i !i'o$a%*ia, Hi'o&a#r%*ia, !i'oa+"*i&%*ia, da

9 E&s%-ao'a#i !%'a#i$"* a#a" $o*a !%'a#i$"* ?s"a#" si&dro* &%"ro 'si$ia#ri )

d%&(a& $adar NH4 s%r"* )a&( #i&((i s%ri&( *%r"'a$a& $%adaa& #%r*i&a.



/ Hipertensi Porta

Ma&i-%s#asi !i'%r#%&si 'or#a 'ada sirosis dis%+a+$a& o%! *%&i&($a#&)a r%sis#%&si #%

*%a"i !a#i )a&( sa&(a# +ro#i$ )a&( *%&)%+a+$a& !i'%r#%&si 'or#a d& $%*+ai&)a d

3aa *%a"i <a"r $oa#%ra ?a&as#o*osis 'or#a$aa. Ma&i-%s#asi i&i *%&3a$"':

9 Asi#%s a#a" '%&i*+"&a& 3aira& daa* ro&((a '%ri#o&%"*

9 Varis%s %so-a("s, )a&( da'a# *%&)%+a+$a& '%rdara!a& -a#a

9 S'%%&o*%(ai )a&( dis%+a+$a& o%! $o&(%s#i 'asi- $ro&is

9 Ka'"# *%d"sa ?%&a +%rdia#asi di s%$i#ar "*+ii$"s )a&( dis%+a+$a& o%! a

*%a"i %&a s"'%risia di&di&( a+do*%&

9 H%*oroid )a&( dis%+a+$a& o%! aira& $oa#%ra *%a"i %&a r%$#a )a&(

d%&(a& %&a *%s%&#%ri$a da& %&a 'or#a.



DIAGNOSISPada saa# i&i, '%&%(a$a& dia(&osis sirosis !a#i #%rdiri a#as '%*%ri$saa& sis,a+da& USG. Pada $as"s #%r#%&#" di'%r"$a& '%*%ri$saa& +io'si !a#i a#a" '%ri#o&%s"i# *%*+%da$a& !%'a#i#is $ro&i$ a$#i- )a&( +%ra# d%&(a& sirosis !a#i di&i



PENATALAKSANAAN

Ta#aa$sa&a 'asi%& sirosis $o*'%&sa#a +%r#"<"a& "&#"$ *%&("ra&(i 'ro(r%si $%r"sa$a& T%ra'i 'asi%& di#"<"$a& "&#"$ *%&(!ia&($a& %#ioo(i, dia&#ara&)a:

● A$o!o da& +a!a&9+a!a& ai& )a&( #o$si$ da& da'a# *%&3%d%rai !a#i di!%&#i$a&'%&(("&aa&&)a.

● Pada !%'a#i#is a"#oi*"&, +isa di+%ri$a& s#%roid a#a" i*"&os"'r%si-. ● Pada !%*o$ro*a#osis %+o#o*i s%#ia' *i&((" sa*'ai $o&s%&#rasi +%si *%&<adi &di"a&( s%s"ai $%+"#"!a&. ● Pada '%&)a$i# !a#i &o&a$o!oi$, *%&"r"&$a& +%ra# +ada& a$a& *%&3%(a! #%r<adi&)a ● Pada !%'a#i#is B, IN a-a da& a*i"di& ?a&ao( &"$%osida *%r"'a$a& #%ra'i "#a*a

s%+a(ai #%ra'i i&i '%r#a*a di+%ri$a& 600 *( s%3ara ora s%#ia' !ari s%a*a 6 #a!"&. IN Adi+%ri$a& s%3ara s"&#i$a& s"+$"#a& 4 MIU, 4 $ai s%*i&((" s%a*a 295 +"a&. ● Pada !%'a#i#is 7 $ro&i$, $o*+i&asi i&#%r-%ro& d%&(a& ri+airi& *%r"'a$a& #%ra'i s#a&dI&#%r-%ro& di+%ri$a& s%3ara s"&#i$a& MIU 4 $ai s%*i&((" da& di$o*+i&asi d%&(a& ri+ai6000 *(; !ari s%a*a 5 +"a&.

Ta#aa$sa&a 'asi%& sirosis d%$o*'%&sa#a



Ta#aa$sa&a 'asi%& sirosis d%$o*'%&sa#a● Asi#%s

Tira! +ari&(Di%# r%&da! (ara*, ,/ (r a#a" 0 **o; !ari.Di"r%#i$ : a=a&)a d%&(a& '%*+%ria& s'iro&oa$#o& d%&(a& dosis/009/00 *( 6>;!adi"r%#i$ +isa di*o&i#or d%&(a& '%&"r"&a&+%ra# +ada& 0, $(;!ari, #a&'a ada&)a %d%6 $!;!ari d%&(a&ada&)a %d%*a $a$i. Bia*a&a '%*+%ria& s'iro&oa$#o& #ida$ ad%$"

di$o*+i&asi d%&(a& -"ros%*id d%&(a& dosis /0920 *(;!ari. Paras%&#%sis dia$"$a& +sa&(a# +%sar. P%&(%"ara& asi#%s +isa !i&((a 295 L da& dii&d"&(i d%&(a& '%*+%ria& ● E&s%-ao'a#i !%'a#i$

La$#"osa *%*+a&#" 'asi%& "&#"$ *%&(%"ar$a& a*o&ia. N%o*isi& +isa di("&a$a&*%&("ra&(i +a$#%ri "s"s '%&(!asi a*o&ia, di%# r%&da! 'ro#%i& di$"ra&(i sa*'ai 0,!ari, #%r"#a*a di+%ri$a& )a&( $a)a asa* a*i&o ra&#ai 3a+a&(.

● Varis%s %so'!a("s

S%+%"* +%rdara! da& s%s"da! +%rdara! +isa di+%ri$a& o+a# '%&)%$a# +%#a ?'rWa$#" '%rdara!a& a$"# +isa di+%ri$a& 'r%'ara# so*a#os#a#i& a#a"o$#r%o#id, di#%r"s$#i&da$a& s$%ro#%ra'i a#a" i(asi %&dos$o'i.

● Si&dro* !%'a#or%&a

M%&(a#asi '%r"+a!a& sir$"asi dara! di !a#i, *%&(a#"r $%s%i*+a&(a& (ara* da ● Tra&s'a&#asi !a#i #%ra'i d%-%&i#i- 'ada 'asi%& sirosis d%$o*'%&sa#a.

KOMPLIKASI



KOMPLIKASI

● S'o&#a&%o"s Ba3#%ria P%ri#o&i#is ?SBP

● P%rdara!a& dari Varis%s9Varis%s K%ro&($o&(a& ?O%so'!a(%a Vari3%s

● H%'a#i3 %&3%'!ao'a#!)

● H%'a#or%&a s)&dro*%

● H%'a#o'"*o&ar) s)&dro*%

● H)'%rs'%%&is*

● Ka&$%r Ha#i ?!%'a#o3%"ar 3ar3i&o*a

Derajat kerusakan Mininal Sedang

Bilirubin serum (mu.mol/dl) < 35 35-50

Albumin serum (gr/dl) >35 30-35

Asites Nihil Mudah dikontrol

!"/ense#alo$ati Nihil Minimal

Nutrisi em$urna Baik

Kasi$asi 7!id9P"(!PROGNOSIS



1A1 IV

+ESIMPULAN

Daa* $as"s i&i dida'a#$a& 'asi%& s%ora&( 'ria ?T&. B d%&(a& $%"!a&

*%ra! s%(ar s%<a$ 6 !ari SMRS. Dari !asi a&a*&%sis, '%*%ri$saa& si$, da

'%&"&<a&(, dida'a#$a& dia(&osis $%r<a 'ada 'asi%& i&i adaa! H%*a#%*%

A&%*ia %.3 S"s' Sirosis H%'a#is , Varis%s Eso-a("s (rad% IV s%r#a H%'a#i#is

S%#%a! dia$"$a& '%ra=a#a& di r"a&( ra=a# i&a' s%a*a F !ari, $%adaa&

*%*+ai$ da& s#a+i s%!i&((a di'%r+o%!$a& "&#"$ ra=a# <aa&. D%&(a& d

'asi%&, *a$a '%r" di%d"$asi $%*+ai 'ada 'asi%& "&#"$ s%a" r"#i& *%&(

o+a#a& dari do$#%r da& $o&#ro s%#ia' +"a&.



PPT Case Dr.anggun

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