Sirosis Hepatik Edit

8/16/2019 Sirosis Hepatik Edit

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PI SFARMAKOTERA

IROSIS HEPATIK

Budi Suprapti

Departemen Farmasi Klinis

Fakultas Farmasi UniversitasAirlangga

Suraa!a

1


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EPIDEMIO"O#I

WHO 2011 : Indonesia - 45.000 kasus

Asia tenggara : Kematian 280.000/th

0! - kematian g"o#a"

$irosis He%atik &5! %asien ra'at ina% I()

4*&4! %asien ra'at ina% + %en,akit

"ier

tio"ogi-H 2!

H-H) + 15! 3$ease& 2008

)unia : He%atitis + 2 i",ar 240

He%atitis - 1*0 6uta

kematian 1&5 6uta/tahun

6uta H kronis

Indonesia: He%atitis - 2 6uta

He%atitis + 2 6uta

7iskesdas 200*:

(emeriksaan #iomedis + &4!

(O$I9I( HsAg

3Kemenkes 7I& 2012 2


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SIROSIS HEPATIK

3

. Chirose-warna orange-kuning orange hati / liver

. Kerusakan difuse irreversibel dari liver

dikarakterisasi oleh hilangnya architecture

liver normal secara lengkap

diganti oleh fibrosis yang ekstensif dengan

nodul-2 regenerasi parenchim

!ipiro" 2#11$


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!ipiro" 2#11%

9IOO;I $I7O$I$ H(A9IK

Konsumsi a"koho" kronik

He%atitis ira" kronis 3ti%e & & )

(en,akit meta#o"ik "ier:

(en,akit hemokromatosis

(en,akit Wi"son

)eona"koho"ik steatohe%atitis

3?att, "ier

,sti@ H& meti"do%a& amiodaron& metotreat&

tamoi?en& retino"& (9B& didanosin


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FU$#SI "I%ER & $ORMA"

&anong" 2#1#$'

-(nergi- interkonversi substrat

)etabolisme K*" prot." lipid- +intesis-sekresi prot.plasma"clotting factor

- +olubilisasi" transpor" storage ,

. +irkulasi empedu

. ipoprotein-transpor lipid

. itamin" glycogen

- rotektif 0 klirens. agositosis

. )etabolisme ammonia

. +intesis glutathion

. )etabolisme obat" hormon


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orotora" 2##3$


7/334

orotora" 2##3$


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Features '( )lini*all! imp'rtant +epatitis viruses ,Dipir'-

Hepatocellular Ca No Yes Yes Yes No )chee" 2##$

Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Virus HAV HBV HCV HDV HEV

Genome ssRNA dsDNA ssRNA ssRNA ssRNA

Incubation 14-4 4!-1"! #-"4 4!-1"! 14-$!% da&s '

(ransmission )ecal-oral *arenteral *arenteral *arenteral )ecal-

oral

+e,ual +e,ual +e,ual%'

*erinatal *erinatal *erinatal

.ucous .ucous

membrane membrane

+erolo/ic mar0ers

Anti/ens HAVA/ HBsA/ HCVAA/

HDVA/ NA

HBcA/

HBeA/

Abtibodies Anti-HAV Anti-HBs Anti-HCV Anti-

HDV NA

Anti-HBc

Anti2HBe

Viral mar0ers HAVRNA HBV DNA HCVRNA HDVRNA NADNA pol&meraseHepatocellular Ca No Yes Yes Yes No )chee"


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A*tive

, *'ntinuing

)ellular

)chee" 2##$Deat+

Re*'ver!

, .it+ n'rmal

Appearing/

Regeneratedliver -

Hepat'

*ar*in'ma

)irr+'sis

)+r'ni*

Hepatitis

$e*r'sis -

Fulminant

Hepatitis

, massive

ne*r'sis -

+r'ni*

rsistentHepatitis

, )arrier state -

stati*

Hepatitis

A*ute

Hepatitis

)+'leSu*lini*al

Hepatitis

)

P

e

,

In(e*ti'n

Hepatitis %ruses

& HA%

& HB%

& H)%

& Delta

& HE%

Clincal syndromes associated with viral hepatitis &anong$


10/33SIK"US REP"IKASI %IRUS HEPATITIS B


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RESPO$S IMMU$ SE"U"AR TERHADAP %IRUS HEPATITIS B


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9A>)A )A> ;CAA

HA:

H

sangat #erariasi& tidak

)emam

>,eri sendi. otot

ke"e"ahan

anoreksia

s%esi?ik

ua"& muntah kem#ung

;e6a"a kuning& gata"

AK se%erti teh

A %u@atH : D 0! asim%tomatik

Kemenkes" 2#12

12


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14/331%


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1'


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1


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14


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Tipe dis(ungsi liver

. Dis(ungsi +epat'sit&l'ulus0 Dis(ungsi sirkulasi ,HT p'rtal-

15


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orotora" 2##3$16


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2#

"I%ER FAI"URE & )OMP"I)ATIO$

7*%0 0 *C83-*ypo- 9lbuminemia

ortal*ypertension

Cholestasis

at 9bs.

9scites (:udativeenteropathy

arices itamin Kdeficiency ;rea

*yperaldo

+teronism

Clotting factors

*ypokalemia &< =leeding

9romatic 99

>enal 7*%0

roduction

(nteric 99

=reak down

*yper 9mmonemia alse 7eurotransmiters

9lkalosis *ypervent. (ncephalopathy

+ilbernagi" 2###$


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)chee" 2##$21

)anifestasi klinik sirosis


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Mani(etasi & data la'rat'rium

Hip'alumin

Pr't+r'min time 1

Tr'm'sit'peni

Alkali ('s(atase 1

Pening+katanAST/

A"T/ ##T

!ipiro" 2#11$

22


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anagemen tera%i

23


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PE$DEKATA$ TERAPI

Identi(ikasi&eliminasi pen!ea

sir'sis

Pr'(ilaksis 2 T3 vari*eal leedingAsites 4

T3

SBP

HE

M'nit'r

(armak'l'gi2para*entesis

+epat'renal s!ndr'me

!ipiro" 2#11$


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HT p'rtal&vari*eal leeding

50

60

70

*ega+ perdara+an 4 pr'(ilkasis

T3 a*ute vari*eal +em'rr+age

)ega+ releeding&pr'(ilaksis sekunder

NOTE ,arises ? '@ pasien sirosis 1 th

25@ pasien sirosis 3 tahun 9cute variceal bleeding terAadi pada 2' ? %#@ pasien

dengan tingkat kematian 3#@>ebleeding dalam 1# hari < , '#@

!ipiro" 2#11" 9CC

2#13$


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9d. 1)encegah perdarahan variceal

0!ipiro" 2#11" 9CC

2#13$

0 Me 8 p'rtal in(l'. 9 tekanan p'rtal

0 β

Adrenergik l'*ker4 8HR 6:; ,::&


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Ad060 T? A)UTE %ARI)EA" B"EEDI$#

0 Resusitasi *airan *ukup @ stailisasi +em'dinamika

*airan kristal'id/ FFP/ platelet/ PR)

0 Kendalikan leeding

O*tre'tide := m*g iv 'lus := m*g2am ,7&: +ari-

S'mat'statin 6:= m*g iv 'lus

6:=&:== m*g2+ari

,7&: +ari-

0 Antii'tika

0 Kuin'l'n

0 )e(tria3'n

0 PPI/ H6RA/ Su*ral(at

!ipiro" 2#11" 9CC 2#13$

Hindari peningkatan v'l0intravask0 erlei+an


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Ad07 )ega+ releeding&pr'(ilaksis sekunder

!ipiro" 2#11" 9CC

2#13$

0β Bl'*ker 4 l'ng a*ting

0 Pr'pan'l'l 7 3 6= mg

$ad'l'l 5 3 6= 4 >= mg

"akukan titrasi mingguan di*apai HR ::&


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*(9


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Hepati* en*+ep+al'pat! ,HE-

!ipiro" 2#11" 9CC 2#13$

Terapi pat'genesis

Batasi pr'tein intake 5&5/: g2kg +ari sumer naati 4stl+ HE teratasi

"aktul'sa & Me 8 amm'nia dara+

A.ali 7=& dd 5:&7= ml

angka panang

$e'misin 7&< g2+ari d'sis teragi 7&> 3

Antag'nis resept'r en'diaepin G Flumaenil

Supplemen Jin*

In(us Asam Amin' )aang Falseneur'transmiter

Sirosis Hepatik Edit

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