LAPORAN PENDAHULUAN ASUHAN KEPERAWATAN PADA

PASIEN DENGAN HEPATITIS AKUT

A. Kon se p Da s a r P en ya k it
1. P en g er t i an

P en yak it h e p at it is ak u t m eru p ak an p en yak it i nf ek s i ak ut de n ga n gej a la ut am a

ber h u bu n ga n er at d en g an a d an ya n ek ro s is p ad a sel -sel h a ti ( Ka p it a S e lek t a
K ed ok ter a n, 2 0 05) .
Pr ic e ( 1 99 5) , He p a ti t is v ir us ak ut m eru p ak an p e n yak i t i nf ek s i ya n g
pe n ye b ar a nn ya l uas da l am tu bu h , wa la u pu n ef ek ya n g m enc o lo k pad a ha t i. B e nt uk
he p at i tis ya n g p a l in g d ik en a l a da l a h he p at i tis A da n B .
J ad i k es im pu l an n ya , he p at i ti s ak ut m eru p ak an s u at u pe n yak it i nf ek s i at au
per a d an g an ya n g t er j ad i p a d a s e l - s e l h a ti at a u he p at os it ya n g d is eb a bk an o l eh v ir us
he p at i tis .
2. Ins i de ns i

No er , Sj a if o e l la h ( 1 99 6) , Ik ter us e p id em ik te la h d i la p ork an p ert a m a k ali o l eh

Hi p oc r at es . S el a nj u t n ya t e la h d i l ap ork a n b an yak ep i dem ik , t eru t am a s e wak tu per a ng .
Da l am Per a ng d u n ia K e 2 t e l ah d i l ap ork an b erb a ga i e p id em ik ik terus , ter u tam a ya n g
terj ad i di T im ur T e n ga h d an I t al i a. K it a m eng en a l b e ber a pa m ac am he p at i tis v ir al ak ut,
dar i h e pa t it is A s a m pai d en g an h e pa t i tis C. Be rh u bu n ga n d en g an c e p at n ya
perk em ba n ga n tek n o l og i k e dok t era n ter u ta m a di b id a ng m ol ek ul er, d ap a t d i p as t ik an
ba h wa ak i b at h e pa t it is ak a n s eg er a b ert am bah .
He p at it is m enj ad i m as a la h k es e ha ta n m as ya rak at ya n g p en t in g b u k an ha n ya d i
Am erik a te t ap i d is el ur u h d un i a. L e b ih d ar i 60 .0 0 0 k as us d i l ap ork an ke P us at
P en g a was an K es e h at an d i Am er ik a, d a n s et i ap ta h un j um la hn ya s ec ar a b ert a ha p
ber t am bah , wa l a up u n m or ti l it as d ar i h ep at i tis v irus r el a ti v e re n d ah , m orb i d it as d an
k erug i an ek on om i ya n g b es ar d i h ub u n gk a n d en g an pe n yak i t i n i ( P i nc e , 1 99 5) .
Ins i de n h ep a ti t is v ir us ya n g te rus m e ni n gk at s em ak in m enj ad i m as a l ah k es e ha ta n
da l am m as yar ak at . P en yak it t er s eb u t pe n ti n g k ar en a m ud a h d it u lark a n, m em ilik i
m orbi d it as ya n g t i ng g i d an da p at m en ye b abk an p e n der i ta n ya a bs e nt d ar i s ek o la h at a u
dar i t em pa t k er j a da l a m wak t u ya n g c uk u p l a m a.
 Enam puluh s am pai 90% dari k as us hepatit is virus diperk irak an berlang s u n g
ta n pa d il a po r k an. K ea da a n k as us s u bk l in is , k et i dak b erh as i la n un t uk m eng e na l i k as us
ya n g r in g a n d an k es al ah a n d i a g n os is d i perk ir ak an t ur ut m enj ad i p en ye b a b pe l a por a n
ya n g k ura n g d ar i k e a da a n s e be n ar n ya . M e s k ipu n k ura ng l eb i h 5 0% o ra n g d e was a d i
Am erik a te l ah m em ilik i an t ib o d i t er ha d ap v ir us h e p at it is A , b a n ya k oran g ti d ak da p at
m eng in g at k em ba l i e p is o d e a ta u k ej a d ia n s eb e lum n ya ya n g m em per l ih atk a n g ej al a
he p at i tis ( Br un n er , dk k , 20 0 2) .
3. Et i o lo g i

L im a j en is p en ye b a b p en yak it h e pa t it is v ir us ak ut d en g an m e la l u i r ag am pe n ye ra n g an ,
rag am p erm ul aa n d a n m as a i nk ub as i. V irus i n i un tuk j e n is p are n ter a l da n n on p ar e nt er al
s eh u bu n ga n d e ng a n m ek an is m e tr a ns m is i ( p en ye r a ng a n).
J en is n o n - par e nt er a l : H ep a ti t is A da n H ep a ti t is E , p en ye b ar a n v ir us m e la l u i r ut e o ra l -
f ec a l. J e n is p ar e nt er a l : H e pa t it is B, H ep a ti t is C , da n He p at i tis D, p en ye r ab a n n ya
m ela l ui tr a ns f us i d ar a h m el a l u i p em b ul u h d a rah v en a d a n hu b un g a n s ex .
a. H ep at i t is A
Da h ul u d is e b ut juga de n ga n he p at it is i nf ek s ios a . P e n ye b ab ya n g d a p at
m enj an gk it H ep a ti t is A k em un gk in a nn ya a da l a h v irus R N A d ar i f am il i en te ro v ir us .
K arak t eris t ik He p at it is A ad a l ah s am a d e ng a n s if a t k has d ar i s yn dr o m a vir us d an s er i ng
k ali t i d ak d ap at d ik ena l i . P en ye b a ra n H ep at i tis A a da l a h m e la l u i j al ur f ek a l – or a l
ter ut am a l e wa t k o ns u m s i m ak ana n at a u m inum an ya n g terc em ar v ir us h ep a ti t is A , a ir
ya n g t i dak b er s i h m e ng a nd u ng s um ber p e n yak i t at a u i nf ek s i, k era n g - k era n g ya n g
d iam b il d ar i ai r ya n g t er c em ar . Vir us d ap at j ug a ters e ba r m el a lu i a k tiv i tas s ex or a l - a n a l
da n k ad an g - k ad a ng m e la l u i pem b uk aa n pe n ge l ur an f ec a l da l am R um ah S ak it . Da l am
k as us ya n g s am a, He p at i tis A d ap a t j u g a b er tra ns m is i d a lam a l ira n da ra h. P e n yak i t in i
s er in g t erj a d i p a da da er a h ya n g s a n it as in ya k ura ng . M as a i nk ub a s i H ep a ti t is A an tar a
1 h in g ga 7 m in gg u d e ng a n r at a - r at a 3 0 ha ri . Pe rj a l an a n pe n yak it da p at b er l an gs un g
l am a, d ar i 4 s am pa i d en a gn 8 m in gg u . Um um n ya he p at i tis A ber l an gs un g le b i h l am a
da n l e b ih b er at pa d a p en d er it a ya n g ber us i a d ia tas 40 t a hu n (B ru n ner , dk k , 20 0 2).
V ir us h e pa t it is A h an ya t er da p at d a lam wak tu s in gk at d i da l am s eru m . Pa da s a at
terj ad i n ya ik ter us , k em un gk i na n p as ie n s u da h ti d ak i nf ek s ius la g i ( Br un n er, dk k , 2 00 2) .
b. H ep at i t is B
 Brunner , dk k ( 2002) , Hepatitis B dis ebut j uga s ebagai s erum hepatit is . Dim an a
pe n ye b a bn ya a da l a h v ir us he p at it is B (H V B ). J en is p en u l ara n H V B i n i a d a la h s ec ara
per e nt er a l at au k on ta k den g an k ari er at a u p en d er it a i nf ek s i ak ut k o nt ak s e k s ua l ,
pe n u lar a n s ec ar a pe r i na ta l d ar i ib u k ep ad a ba yi n ya , d an m eru p ak an a nc am an
k es eh at a n k er j a ya n g pe n ti n g b a gi pe t ug as k es eh at a n. Se l a in i tu j ug a p e n ye b ar an n ya
m ela l ui m uk os a m em br an de n ga n l e wa t :

1) K o nt ak d en g an c ai r an t u bu h , s e per t i : s e m en, s a l i v a , d an d ar a h.
2) K o nt am in as i d en g a n l uk a ya n g t er b uk a
3) P er a la ta n d a n p er l en gk ap a n ya n g t erj an g k it
Co nt o h wak t u ter j a di n ya tr a ns m is i ( p en ye b a ran ), a nt ar a l a in :
1) J ar um s un t ik ( s ec a r a s e ng aj a at a u k eb e t u la n)
2) T ra ns f us i d ar ah ya ng t er k on t am in as i de n ga n l uk a, g or es an a t a u l ec e t
3) M u lu t a ta u m at a ya ng t er k on t am in as i s e la m a ir ig as i l uk a at a u s u c ti o n
4) Pr os ed ur b e da h m u lu t at a u g ig i
Nu gr oh o ( 2 00 1) , H e pa t it is B d a pa t t ers e bar m e la l u i h u b un g an s ex d an k hus us n ya
par a g a y ( h om os ek s u a l ) . V ir us i n i d ap at j u ga t ers eb ar d e ng a n m ela l ui p e ng g u na a n
per a l at a n ” ta to ” da n pe l u ba n g d au n t el i n g a ; p en g gu n aa n ya n g t erk on tam i nas i n ya
per l e ngk a pa n pem ba g i an ob a t) ; berc i um an ; d an pe rl e ngk a p an la i n n ya . S ep ert i : c a ngk ir ,
pas t a g ig i , da n r ok ok .
P erj a l an a n p en yak it He p at it is B s a ng a t b era g am . H e pa t it is B k em ungk i n an
m em pun ya i s e r a n ga n t i pu a n d e ng a n s in ya l yan g l em ah d a n s ek um pu l a n p e n yak i t a t au
k om pl ik as i ya n g s er i u s . Mas a i nk ub as i v ir us h ep a ti t is B i n i a da l a h 2 8 s am pa i 1 60 h ar i
de n ga n ra ta - r a t a 70 s am pa i 80 har i ( Bru n n er, 2 0 02 ). V ir us H V B i ni da p at m e n yer a ng
s em ua um ur d e ng a n m or t a l it as s ed ik i t le b i h t i ng g i dar i p ad a h ep at i t i s A . ( Pr ic e ,
19 9 5).
c. H e pa t it is C
He p at it is C j u ga s er in g d is e bu t d e ng a n h e pa t i tis no n A n o n B . Pe n ye ba b h e p a t it is
i ni a d a la h V ir us He p at it is C ( HC V) . V ir us i ni da p at m enu l ar m e la l u i tr ans f us i d ar ah d a n
pro d uk d ar a h ya n g ter k ont am in as i le wa t p er a la ta n a ta u p er a la ta n ob a t. M as a i nk ub as i
dar i v irus he p at i tis C i ni ad a la h 1 5 0 h ar i s a m pai d e ng a n 1 60 h ar i d e ng a n r at a - r at a 50
 hari. Pada HVC ini s er ing ter j adi s tatus k rier yang k ronis pada penderita dan penya k i t
ha t i ya n g k r on is d a pa t m eni n gk atk an r es ik o k ank er h at i ( Br un n er, 20 0 2).
d. H e pa t it is D
He p at it is D d is e b abk a n k ar e n a t er i nf ek s i H DV , v ir us R N A ya n g ti dak s em pur n a
m em but uhk a n f u ngs i pem ba n tu H B V. P e nu l ara n da ri H VD i n i a da l a h s am a de n ga n
pe n u lar a n H V B , d e n g an m as a ink u bas i 2 1 s am pa i 1 4 0 har i d en g an ra ta - ra ta 3 5 ha ri .
Has i l ak h ir d ar i HV D a d al a h s er up a d e ng an H B V t et a p i k em un gk in a s t at us k ar i er,
he p at i tis ak tif ya n g k r on is d a n s ir os is h ep at i tis le b i h bes ar ( Bru n n er, dk k , 2 00 2) .
e. H ep at i t is E
Br un n er , dk k ( 200 2) , He p at it is E d is eb a bk an o l eh v ir us h ep at i t is E (H E V) . Ca ra
pe n u lar a n H E V a d a la h m e la l u i j a l ur f ek al - ora l da n k on tak a nt ar a m a nus i a m es k ipu n
res ik on ya r e nd a h. Mas a i nk ub as i d ar i H E V a d a la h s e l am a 15 har i s a m pai 6 5 h ar i d e ng a n
m as a r at a - r at a 4 2 h ar i. Has i l ak h ir ya n g d a pa t d i tim b ulk a n o l eh HE V s er up a d e ng a n
HA V k ec u a l i s an g at b e r at p a da wa n it a h am il .

4. P at of is i o lo g i

L i ver m em buk a s ej um l ah a ge n s e p ert i v ir us m as uk k eda l am h at i/ l i v er s e h i ng g a

terj ad i p er ad a ng a n p ad a s e l - s el h at i / li v er / l i v er m enj a d i m em bes ar d a n m en des ak
de n ga n m er a da n gn ya s e l - s e l h a ti da n b er ta m bahn ya c a ir a n, s eh i ng g a d a lam k ua dra n
k ana n a tas t er as a s ak it , t i dak n yam an m ua l , d a n a n orek s i a. K em aj ua n d a n k el anj ut a n
dar i pr os es p e n yak i t h ep a ti t is in i a da l a h pe m bel ah a n s el - s e l h at i ya n g n orm al be ru b ah
m enj ad i p er a d an g an ya n g m el u as , n ek ros e d a n re g e ner as i s el - s e l h e par t ers e b ut
m en ye b a bk an t er j ad i n ya k e ga g a la n h at i un tu k m el ak uk an d et ok s if ik as i s e h i n gg a t erj ad i
pe l e pas a n t ok s in da r i ha t i ya n g r us ak da n p en i n gk ata n k ad ar SG P T da n SG O T . Ak ib a t
k ej ad ia n te r s e b ut , t er j ad i p u la p er ub a ha n pa da s is t em s irk ul as i s e l he p ar ya i t u m as uk
da n b erc am pur n ya s ir k u las i d ar a h k e da l am p em be la h an j ar in g an he par s eh i n gg a t erj ad i
pe n i ngk at a n t ek an an da l am l i nt as an s irk ul a s i s e l h e p ar ya n g k em ud i a n m en ye b a bk a n
ud em ter ut am a pa d a s a lu r a n - s a lur a n em pe d u ha t i in tr ah e pa t i k ak iba tn ya te rj a d i
k oles tas is k r o n ik ya n g m en im bu lk an b il ir u b in to t al d a n b i l ir ub i n d ir ec t m en in gk at
m ele b ih i ba t as n or m a ya n g m en im bu lk an m an if es t as i ik ter ik , pr ur it us , ur i ne b er war na
ge l a p da n f es es puc a t.
 G angguan m etabolis m e zat gizi j uga terj adi terutam a pada m etabolis m e pr ot e i n
da n l em ak s eh i n gg a p en d er it a h ep a ti t is b ias an ya t erj a d i k e l em aha n at a u m ud a h l e la h.
P ad a k as us ya n g t a np a t er j ad i n ya k om plik as i, f as e a ta u ta h ap p e n yem buh a n dar i
he p at i tis s u da h m ul a i pa d a 1 at a u 2 m in gg u dar i tim b ul n ya ik t erus da n ak an b er l an gs un g
s e lam a 2 s am pa i 6 m i ng g u. Ya n g m an a h a l i n i d i ta n da i d e n ga n ak tif i t as f a g os it os is ,
ak tif i t as en zim - en zim pa d a ha t i ya n g n om ral s ert a p er ba ik an s e l - s e l he p ar ( UN AI R,
20 0 2).

WOC
 5. K las if ik as i

a. H ep at i t is v ir us
1) H ep at i t is A
Dis e ba bk an ol e h v ir u s H ep a ti t is A . P en u la ran n ya ak ib a t k on t ak de n ga n or a ng ya n g
ter i nf ek s i m e la l u i k o nt am in as i f ec es , pa d a m ak an an , m as a i nk ub as i n ya 1 5 - 4 5 har i .
2) H ep at i t is B
Dis e ba bk an ol e h v ir us H ep a ti t is B .
He p at it is B t er j a d i p ad a s em ua k e lom pok um ur, k e l om pok or an g ter te nt u d an or a ng ya n g
m em il ik i c ar a h id u p te r te nt u ya n g b eres ik o t i ng g i k e l om p ok ters e b u t m enc ak up :
- Im igr a n da r i da er a h e nd om is HB V
- P e ng g un a o b at i n t r a ve n a ya n g s eri n g b e rtuk ar j ar um da n a l at s un t ik
- P e lak u h u bu n ga n s ek s ua l d en g a n ba n ya k ora ng a t au de n ga n o ran g t er inf ek s i
- Pr i a h om os ek s ua l ya n g s ec ar a s ek s ua l a k tif
- P as ie n rum a h s ak i t j i wa
- N ara p i da n a pr ia
- P as ie n h em odi a l i s is da n pe n der i ta h e m of ili a ya n g m en er im a pr o duk t ert e nt u d a ri
p las m a
- K o nt ak s er um ah d en g an k ar ier H B V
- P ek erj a s os i a l d i bi da n g k es eh at a n te ru ta m a ya n g b a n yak k on tr ak d en g an d ar a h
- B a yi b aru la h ir d ar i i b u ter i nf ek s i
Mas a i nk u bas i n ya 30 - 18 0 h ar i.
3) H ep at i t is C
Dis e ba bk an o l eh vir u s He p at it is C. M e n yer an g k e lom pok or a ng ya n g b erpr i l ak u s ex
be b as ( ber g an t i p as an ga n) , tr a ns f us i d ar ah a ta u pe n gg u na a n o b at I V m as a i nk ub as in ya
15- 1 5 0 har i .
4) H ep at i t is D
Dis e ba bk an o l eh vir us h e p at it is D m en ye ra n g k el om pok p e c an d u ob at . Mas a
i nk ub as i n ya 3 0 - 1 8 0 h a r i.
5) H ep at i t is E
 Dis ebabk an oleh vir us hepatit is E daerah k um uh m as a ink ubas i 15 - 60 hari.
6) H ep at i t is F & G
In i j ar an g t er j a d i.
b. H ep at i t is tok s ik um /t ok s ik
T erj ad i s et e l ah t er p a p ar s ua tu s u bs t a ns i ( ob at - o ba ta n) d ap a t t erj a d i n ek ros is 2 - 3 h ar i
s ej ak p em ap ar an t er h ad a p s u bs t ans i t ok s ik . G ej a la n ya m unc u l 2 - 3 m ing g u.
c. H e pa t it is ak tif k r o n is
Me n ye b a bk an i nf l am as i he p at ik , n ek ros is h ep a tik d an f ib ros is ya ng pr o gres if . B an yak
terj ad i p a d a wa n it a d a n a nak - a nak m ud a.
d. H e pa t it is a lk oh o l ik
Me ru p ak an i nf l am as i li v er ak ut d a n k ro nik .

6. T and a d a n G ej a l a

Me n ur ut B r u n ner , dk k ( 20 0 2)
a. H ep at i t is A
He p at it is A d ap at t er j a d i de n ga n a ta u t an p a gej a la , s ak it m iri p d e n ga n f l u.
1) P a da f as e Pr e ik ht e r ik ya i t u Sak i t k ep a l a, m ala is e, f at i qu e , an or ek s ia d a n f e br is .
2) P a da f as e ik hte r ik ya i t u ur i ne b er war na g e la p s e p ert i t e h, gej a l a ik ht er us p a da s k l er a
da n k ul it , n ye r i tek a n pa d a h at i.
b. H ep at i t is B
Da p at t erj a d i t an p a ge j al a . Nam un da p at j u g a terj a di art a lg i a d a n r uam p a da k ul i t.
c. H e pa t it is C
S eru p a d en g an H B V , t i dak b e g it u b ea t d an a n ik hter ik .
d. H e pa t it is D
T and a d an g ej a l a ya n g di t im bu lk an o l eh H D V a da l ah s er u pa d e ng an t an d a da n g ej a l a
HB V .
e. H ep at i t is E
S eru p a d e ng a n t an d a da n gej a la H AV n am un ak an s a n ga t b er at j ik a t erj ad i pa d a wan i ta
ya n g s e d an g h am il .
Me n ur ut S e lek t a Ka p it a ( 20 0 5) , m a nif es t as i k lin ik ya n g d i tim b ulk a n ol e h v ir us h e pa t it is
ad a l ah
1) Stadium pr eik hter ik ber langs u ng s elam a 4 s am pai 7 hari. Pas ien m engeluh s ak it k epal a ,
l em ah, an o ek s ia , m ua l, m un ta h , s u b f e bris , n yer i ot ot , d a n n ye r i d ip er ut k an a n a tas .
Uri n e m enj a d i l eb i h c o k lat .
2) S ta d i um i nk ter ik yan g ber l a ngs u ng s e la m a 3 s am p ai 6 m in g gu . Ik ht er us m ul a - m ul a
ter l i ha t p ad a s k ler a , k e m udi an pa d a k u l it d a n s e lur u h tu b u h. Ke l uh a n - k el u ha n b erk ur an g
nam un k l ie n m as ih l e m a, a nor ek s i a, d a n m un t ah . T i nj a m un gk in ber wa rn a k e l ab u a ta u
k uni n g m ud a. H a ti m em bes ar d an n yer i t ek a n
3) S ta d i um pas c ak ht e r ik ( r ek o n va l es e ns i) . I k terus m er ed a, war n a ur in e d an t i nj a m enj ad i
norm a l k em ba li . P e n ye m buha n p ad a a nak - a n ak le b i h c ep at d ar i pa d a ora n g de wa s a ya i t u
pa d a ak hi r bu l a n k ed u a k ar en a p e n ye b ab ya ng bi as an ya b er be d a.
G am bar an k li n is pa d a he p at it is v ir us b ia s an ya b er var i as i, m u l ai d ar i ya n g t id ak
m eras ak an a pa - a pa a t au h an ya m em pun ya i k e lu h an s e dik i t s am pai k ead aa n ya n g b era t,
ba hk an k om a d a n k em at i an da l am be b er ap a har i s aj a .
P ad a h ep at i t is an ik te r ik , k el u ha n s a ng at r i ng a n d a n s am ar - s am a, um um n ya
an or ek s ia da n g an g g u an pa d a pe nc er na a n. Uri n e s ec ara m ak ros k op is b er war n a s e pe rt i
te h t ua d a n a pa b i la di k oc ok ak an m em per l ih atk a n bus a b er war n a k un i n g k eh ij a ua n.
P ad a h e pa t it is ak u t i k hter ik , pa l i ng s er in g d i tem uk an da l am k li n is . Bi as a n ya
perj a l an a n j in ak d a n a k an s em buh da l am wa k tu k ira - k ir a 8 m in gg u.
7. P em er ik s aa n f is ik

Me l a l ui pem er ik s aa n f i s ik d i da p atk a n j au n d ic e, eri t em a, s k l er a tam pak k un i n g ( ik ter us ) ,

as it es , ter d ap a t b e ber ap a s p id er v as k ul er di pu n gg u ng . Lim p a d a p at ter a ba p ad a pe ru t
k uadr a n k an a n at as t er d a p at n ye r i tek a n, he p at om eg a li , s p l en o m ega l i. P erk us i pa d a
tu l an g i g a k a na n b a wa h s e be l ah be l ak an g ak an m en im bu lk an n ye r i ber t am bah .
8. P em er ik s aa n p e nu nj a n g/ d ia g nos t ik

a. P em erik s a an la b or at or ium
- T es f u ngs i h at i : a bn or m al
- SG O T /SG PT m en i ngk a t
- D ara h l e ngk a p : s e l dar a h m er ah m en ur un
- L euk o pe n i a: tr om bos it op e n ia m un gk in a d a (s p le n om eg a li)
- A l bum i n s er um : m en ur u n
- B i l ir ub i n s er um : m eni ngk a t
- A nt i H A V I g M : po s it if p ad a t ip e A
- Hbs AG : Dapa t pos itif ( tipe B) atau negatif (T ipe A)
- P a da p em er ik s aa n f es es : war na t a n ah li at , s te at or e a.
- Ur in a l is a : pe n i ng k ata n k ad ar b i l ir ub i n, pro t ei n /h em at ur ia d a p at t erj a d i
b. R ad i o lo g i
X - Ra y d a pa t d it em uk an p em bes ar a n l i v er d a pa t d i at as b ag i an ab d om in a l.
9. Di a gn os is

P ad a s ta d ium pr a ik te r ik , h e pa t it is da p at d ik ac a uk an d e ng a n p e n yak it i nf ek s i ak u t la i n
s ep er ti ap p en d ik s it is a k ut/g as tr o e nt er it is ak u t.
10. P en at a l ak s an aa n

a. T i ra h b ar in g ( b e d r es t)
T ira h ba r i n g m er up ak an pe n at a lak s a na a n ya n g di rek o m e ndas ik a n ta n pa
m em perh i tu n gk an b e n tuk t er ap i ya n g l a in s am pa i g ej a l a h ep at i tis s ud a h m ere d a.
S el a nj u t n ya ak t i vi t as b ar u d i b at as i s am pa i g ej a l a pem b es ar a n ha t i d an k en a ik an k a dar
b il ir u b in s er t a e n zim - en zim ha t i d a l am s erum s uda h k em ba l i n o rm al (Br u n ner , dk k ,
20 0 2).
b. D ie t
J ik a p as i e n m ua l , t id a k na ps u m ak an, at au m unta h - m un ta h , s e ba i k n ya d ib er ik an inf us .
J ik a s ud a h t i d ak m ual l ag i , di b er ik an m ak an an ya n g c uk up k al or i ya i t u 30 - 3 5 k a lo ri /k g
B B. Pas i e n he p at i t is d ap a t d ib er ik an d i et ha t i II - II I ( K a p it a S e l ek t a, 2 0 05) .
Me n ur ut Es t er ( 2 00 2) s ec ar a um um , pas ie n de n ga n he p at i t is d i anj urk an d ie t s eim ba n g
ti n gg i k arb o hi dr at da n r e n da h l em ak . M ak an an har us d i ber i ak n d a l am pors i k ec i l d a n
d ib er ik an 4 s am pa i 6 k a li s eh ar i.
c. M e d ik am ent os a
1) K or tik os ter o i d t i d a k dib er ik an b i l a u nt u k m em perc e p at p en u run a n bi l ir u bi n d ara h .
K ort ik os t er o id da p at d ig u nak a n a p ab i l a k ol es t as is t erj a d i b erk e pa nj an g an , d im an a
tra ns m in as e s er um s u da h k em bal i n orm al t e ta p i b i li ru b in m as i h t i ng g i. P ad a k e a da a n
i ni da p at d i be r ik a n pr e dn is o n 3 x 1 0 m g s e l a m a 7 ha ri .
2) B er ik an o b at - o ba t ya n g m el in d un g i h at i
3) B er ik an k rim l ip i d da n em o li e n u nt uk p en at a lak s a na a n pr ur it us
4) A nt i em et ik u nt uk m engo n tr o l m ua l d a n m unt a h, t et a p i g o lo ng a n f en ot i a zi d ti d ak
d ig u nak a n k ar en a a ge ns i n i d ib i otr a n s f orm as ik an d i h ep ar s e h in g g a b erp ot e ns i u nt uk
m enj ad i t ok s ik .
5) Vitam in K par enter al dapat diber ik an pada pas ien dengan m as a protrom bin m em anj ang .

B. Ko ns ep D a sa r As ke p He pat it i s Ak ut
1. P en gk aj i a n

P en gk aj i a n m er u pak a n pem ik ir an d as ar d ar i pros es k e per a wa ta n yan g be rt uj u a n

un t uk m eng um pu lk an da ta t en ta n g k li e n ag ar da p at m en g i d en t if ik as i, m en g en a l i
m as al ah , k e bu tu h a n k es e h at a n da n k e pe ra wa ta n k l i e n ba ik f is ik , m ent a l, s os i al da n
l in gk un g an .
P en gk aj i a n ya n g s is t e m atis d a l am k eper a wa ta n d i b ag i da l am 4 k e g ia ta n , ya i t u :
pe n gum u la n d at a , an a lis a d at a , s is t em at ik a da t a da n p e ne nt u a n m as a l ah ( Ef f en d y,
19 9 5).
P en gk aj i a n ya n g m un c u l pa d a k l ie n d en g a n he p at i tis ak u t m en uru t Do e ng es
(20 0 0) a da l a h :
a. D as ar D at a Pe n gk aj i a n P as ie n
Da ta t er ga n tu n g p ad a pe n ye b a b d an ber at n ya k er us ak a n/ g a ng g ua n h at i.
b. Ak t i vi t as / Is t ir ah a t
G ej a l a : K e l em aha n, k e le l ah a n, m al a is e um u m
c. Si rk ul as i
T and a :
- Br a d ik ard i a ( h ip er b il ir u b in em ia b er at)
- Ik ter ik p ad a s k ler a , k u li t, m em br an m uk os a
d. E lim i nas i
G ej a l a :
- Ur in e g e l ap
- D iar e /k ons ti p as i, f es es war n a t a n ah li a t
- A d an ya / b er ul a n gn ya h em od ia l is a
e. M ak an a n/ Ca ir a n
G ej a l a :
- H i la n g naf s u m ak an ( a nor ek s i a) , p e nu ru n an ber at ba d an at au m en i n gk at ( e dem a).
- M ua l /m unt a h
T and a : As i tes
f. Ne ur os e ns or i
 G ej ala :
- Kr am a bd om en , n yer i tek a n p ad a k u ad ra n k a na n a tas
- M i al g i a, ar tr a lg i a, s ak it k ep al a
- G a ta l (p rur i tus )
T and a : O t ot t e ga n g, g e lis a h
g. P er na p as a n
G ej a l a : T i d ak m ina t/ e ng g an m er ok ok (p er ok ok )
h. K e am ana n
G ej a l a : A d an ya tr ans f us i dar a h/ pr od uk d ar a h
T and a :
- D em am
- Urt ik ar i a, l es i m ak u lo p ap u la r , er i tem a ta k ber at ur an
- Ek s as erb as i j er a wat
- A n gi om a j ar i ng - j a r i ng , e r i t em a pa lm ar , g i nek om as t i a (k ad an g - k a da n g ada pada
pe n yak it h e par ak ib at A lk oh o l ik )
i. S ek s ua l it as
G ej a l a : Po l a h id u p/ p er il ak u m en i ngk a tk an ris ik o t er paj an (c o n to h hom os ek s u a l ak t if
b is ek s u al wa n it a) .
A da n ya i nf ek s i s e per t i f l u pa d a p ern a pas a n at as
j. P em erik s aa n D i ag nos t ik
T es f un gs i h a ti : A b no r m al ( 4 - 1 0 k a li d ar i no rm al). Ca t at an : M er u pak a n ba tas a n n il a i
un t uk m em bed ak an he pa t it is vir us - n on v irus .
A ST ( SG O T ) / ALT ( SG PT ) : A wa l m en in gk a t. D ap a t m en i n gk at 1 - 2 m i ng g u s e be l um
ik ter ik .
Da l am dar a h l en gk ap : S D M m en ur un s e h ub u ng a n d en g an p e n uru n a n hi d u p SD M
(ga n g gu a n en zim h at i) a ta u m eng ak i ba t p erd ara h a n.
Le uk op e n ia : T r om bos i to p en i a m un gk i n ad a ( s p le n om ega l i)
Dif ere ns i al d ar ah l e n gk ap : Le uk os i t os is , m onos it os is , l im f os it a nt i pik a l. D an s e l
p las m a.
A lk al i f os t at as e; Ag ak m eni ngk a t (k ec u a l i a d a k o les t as is ber a t)
Fes e : W ar na t a na h l i a t, s t ea to r e a (p e nur u na n f u n gs i ha t i).
A lb um in s er um : M e nu r un
 G ula darah : Hiper glik em ia tr ans ien/h i po g l ik em ia (ganggua n f ungs i hati).
A nt i- HA V I g M : P os it if pa d a t ip e A
Hbs AG : Da p at pos i t i f ( t ip e B) a ta u n e g at i f (t ip e A). C at a t : m erup ak a n d ia g n os t ik
s eb e l um ter j ad i g ej al a k li n ik .
Mas a pr o tr om b in : Mu ngk i n m em anj a n g ( d is f un gs i h at i)
B i li ru b in s er um : D i at a s 2 ,5 m g/1 0 0 m l ( bi l a d i at as 20 0 m g/m l, pro g n os is bur uk m ungk i n
ber h u bu n ga n d en g a n pe n i ngk at a n n ek ros is s e lu l er.
T es ek s k res i B S P : K a dar dar a h m en i n gk at
B io ps i h at i : m enu nj uk k an di a gn os is d a n l ua s n ya nek ros is
Sk an h a ti : Mem b an tu per k ir a an , b er at n ya k e rus ak a n p are nk im
Uri n a l is a : Pe n in g g ia n k ad ar b i lir u b in ; pr ot e i n/ h em atur i a d ap at t erj ad i
Me n ur ut Br u nn er , dk k ( 20 0 2) pe n gk aj i a n p a d a k l ie n de n ga n h ep at i t i s ak ut a da l ah
:
a. P e ngk aj ia n p a da k l ie n d e ng a n h ep at i t is A
B an yak k li e n t i dak t a m pak ik ter ik g e ga l a. K et ik a g ej a l a m unc u l , b e nt uk n ya ber u p a
i nf ek s i s a l ur an p er n af as a n ak ut r in g a n s e p ert i f l u da n dem am s ub f e br is , a n orek s i a,
war n a ur in e g e l ap d a n ik t er us .
G ej a l a d is p e ps i a d ap at te r j a d i d a l am ber b ag a i der aj at ya n g d it an d a i d e ng a n n yer i
ep i g atr i um , m ual , d an f la tu e ns i , d an pem bes ara n h at i .
b. P e ngk aj ia n p a da k l ie n d e ng a n h ep at i t is B
G ej a l a d an t a nd a h ep at i tis B da p at s am ar d a n b er v ar i as i . G ej a la ya n g m u nc u l b er up a
dem am d an d is p n ea , a r tr a l g ia , r u am /pr ur it us , p e n uru n an na ps u m ak an , d is p eps i a, n yer i
ab d om en, ti d ak e n ak b ad a n d an l em ah. G ej a l a ik te rus , wa rn a f es es c er a h, war n a ur i ne
ge l a p, p em bes ar an li e n d an h e pa r . N ye r i tek an p a d a ha t i.

2. Di a gn os a K e per a wa ta n

a. I n to l er an ak ti v i ta s be r h u bu n ga n de n g an k e l em aha n um um , p e nur u na n k ek ua ta n,
m ala is e da n l a ter g i
b. Pe ru b ah a n n utr is i k ur a ng dar i k eb ut u ha n t u bu h b er hu b un g an de n ga n k eg a ga l a n
m as uk an un t uk m em enu h i k e bu t uh a n m et ab o l ik , a no rek s i a, m ua l/ m unta h.
c. K er us ak a n i nt e gr i tas k ul i t ber h u bu n ga n de n ga n ik t erus da n e d em a
d. Ris ik o tinggi ter hadap k ek ur angan volum e c airan berhubung a n dengan k ehila n g a n
ber l e b ih a n m el a l ui di a r e, as i tes , g an g g ua n p ros es pem bek u an .
e. H ar g a d ir i r en da h s it u as i o n al b e rhu b u ng a n d en g a n gej a la j en gk e l/m a rah ,
terk ur un g /is o l as i , s ak i t ya n g l am /p er io d e p e n yem bu h a n.
f. R es ik o t er ha d ap i n f ek s i b er h u bu n ga n d en ga n p ert a ha n pr im er t i dak a d ek uat , l ek op en i a,
pe n ek an an r es p o n i nf l am as i, da n d e pres i im u n .
g. N ye r i ak ut ber h ub un g an de n ga n r ef lek s s pas m e ot o t s ek un d er ter h ad a p h ep ar.
h. R is ik o t er ha d ap per u b ah a n s u h u t u bu h be rh u bu n ga n de ng a n t i dak ef ek t if n ya :
term ore g u las i s ek u nd e r t er ha d ap inf ek s i .
i. Kur a ng p e ng e ta h ua n ( k e bu t uh a n be l aj a r) t en ta n g k o nd is i, pr og n os is , d an k eb ut u h an
pe n go b at a n b er h u bu na g n d en g an k ura n g ter p aj a /m en g in g at , s a l ah i nt erp re tas i
i nt erp re tas i inf o r m as i, ti d ak m eng en a l s um be r i nf orm as i.
3. Re nc an a t in d ak an k ep era wa t a n

a. I n to l er an ak ti v i ta s be r h u bu n ga n de n g an k e l em aha n um um , p e nur u na n k ek ua ta n,
m ala is e da n l a ter g i.
T uj ua n :
- S et e l ah d i l ak uk an t in d ak an k ep er a wa ta n, k l i en m en ya t ak an pem ah am an s i tu as i d an
pro gr am p en g ob at a n
- K l i en m en unj uk k an pr i lak u ya n g m am pu m elak uk an ak t i vi t as k e m bal i
- K l i en m el ap or k a n k em am pua n m el ak uak n p en i ngk a ta n t ol e a ns i ak t i vi t as .
Re nc an a :
Ma n d ir i :
1) T i n gk atk an t ir a h b ar is / du d uk . B er ik an l i ngk u ng a n t e na n g; ba t as i p en g u nj u ng s es ua i
k eper l ua n .
Ras i on a l : M e n in gk atk an is t ir a h at d an k ete n a ng a n. M en ye d i ak a n en erg i ya n g d i gu n ak an
un t uk p en yem b u h an a k tiv i tas da n pos is i d u d uk t eg ak d i yak in i m en uru nk a n a l ira n dar a h
k ek ak i, ya n g m enc eg a h s ir k u las i o p ti o na l k e ha t i.
2) U ba h p os is i de n ga n s er in g . B er ik an p er a wa ta n k ul it ya n g b a ik
Ras i on a l : Me n i ngk at k an f un gs i p ern a pas a n da n m em in im alk an tek a na n pa d a ar ea
ter te n tu u n tuk m en ur u nk an r is ik o k erus ak an j ari n g an .
3) L ak uk an tu g as d en ga n c e p at d a n s es u a i t o ler a ns i
Ras i on a l : M em un gk in k an per i o de t am ba ha n is t ira h at t a np a g a ng g ua n
4) T ingk atk an ak tivitas s es uai toler ans i, bantu m ela k uk an latihan rentang gerak s en d i
pas if / ak tif
Ras i on a l : T i r a h bar i ng l am a d ap a t m enu runk a n k em am puan d ap a t t erj a d i k are n a
k eter ba tas a n ak ti v i tas ya n g m eng a ng g u p er io de is t ir a ha t.
5) D oro n g p e ng g u na a n t ek nik m anaj em en s tres , c o n to h r e lak s as i pro gr es if , v is u as l is as i ,
b im bi ng a n im aj i nas i . B er ik an ak ti v i tas hi b ur an ya n g t ep at c on to h m enon t on T V, r ad i o,
m em bac a .
Ras i on a l : M en i ngk a t k an r e lak s as i da n p e ng h em ata n en er g i, m em us atk a n k em ba l i
per h at i a n, d a n da p at m eni ngk a tk an k o p in g.
6) A wa s i t er u la n gn ya an or ek s ia da n n ye r i te k an pem bes ar an ha t i.
Ras i on a l : Me n unj uk k an k ur a n gn ya r es o lus i /e k s as erb as i pe n yak it m em erl uk an is t ira h at
l anj ut , m en g ga n ti pr o g r am ter c a pa i .
K ol a b oras i
1) B er ik an an t id o t at au ba n tu da l am pr os e dur s es ua i in d ik as i (c on t oh la v as e, k at ars is ,
h ip er v en t i las i) t er ga nt un g p a da p em aj a na n .
Ras i on a l : M em bu a ng a g en pe n ye b a b p ad a h ep at i t is tok s ik da n m em batas i d er aj a t
k erus ak a n j ar i n g an .
2) B er ik an ob at s es u a i i nd ik as i : s e da t if , a ge n a nt i a ns ie tas , c o nt oh di a ze p am (V a l i um ),
l ara ze p am ( At i v an)
Ras i on a l : M em ban t u da l am m anaj em en k ebu tu h an ti d ur, c at at a n : Pe n gg u ba a n
bar b it ur at da n tr an q u il i ze r s e p ert i C om pa .. . da n T hor a zi n e , d ik on tr ai n d ik as ik a n
s eh u bu n ga n d e ng a n ef ek h ep at o tok s ik .
3) A wa s i k ad ar e n zim h at i
Ras i on a l : Mem b an tu m enen t uk an k ad a r ak t i v it as t e pa t, s eb a b p e n in gk at an pr em atur
pa d a p ot ens i a l r is ik o b er u l a ng .
b. Pe ru b ah a n n utr is i k ur a ng dar i k eb ut u ha n t u bu h b er hu b un g an de n ga n k eg a ga l a n
m as uk an un t uk m em enu h i k e bu t uh a n m et ab o lik , a no rek s i a, m ua l/ m unta h.
T uj ua n :
- M en u nj uk k an pe r i l ak u p er ub a ha n p o la h i du p u nt uk m eni ng k atk an/m em pert a ha nk an
ber a t ba d a n ya n g s es u a i
- M en u nj uk k an pe n i ngk a ta n b er a t b ad a n m enc a pa i t uj u a n de ng a n n il a i l ab or at or i um
norm a l d an b e b as t a n da m al n utr is i
 Renc ana :
Ma n d ir i
1) A wa s i p em as uk an d ie t/j um la h k al or i. B er i k an m ak an s e d ik it da l am f rek uens i s er i n g d a n
ta wark a n m ak an p a g i pa l i ng bes ar .
Ras i on a l : M ak an ba n yak s u l it u nt uk m en ga t u r b il a pas i e n a n orek s i . A nor ek s i j u g a p a l in g
bur uk s e l am a s ia n g h a r i, m em bua t m as uk a n m ak ana n ya n g s u l it p a da s ore h ar i .
2) B er ik an p er a wa ta n m ulu t s e be l um m ak an
Ras i on a l : M e ng h i la n g k an r as a t ak e n ak da p at m en in gk atk a n naf s u m ak an
3) A nj urk an m ak an p ad a p os is i du d uk t eg a k
Ras i on a l : M en ur unk a n r as a pe n uh p ad a a b dom en d an d ap a t m e ni ngk a tk an p em as uk a n
4) D oro n g p em as uk an s ar i j er uk , m in um an k arbo n at d a n perm e n ber a t s ep a nj a n g h ar i.
Ras i on a l : ba h a n i n i m er u p ak an ek s tra k al or i da n da p at le b i h m uda h dic er n a/t o l era n b il a
m ak ana n la i n t id ak .
K ol a b oras i
1) K o ns u l p a da ah l i d ie t, d uk un g an t im b u tris i u n tuk m em berik a n d ie t s es ua i k eb ut uh an
pas i e n, d e ng a n m as uk an lem ak d an pro te i n s es u a i t ol er a ns i .
Ras i on a l : Ber g un a d a l am m em bua t pr ogr am d i et un tt uk m em enuh i k eb ut uh a n i n d i vi d u.
Me t ab o l is m e lem ak b e r v ar ias i t er ga n tu n g p a da pro d uk s i d an p e ng e lu ar an em ped u d a n
per l u n ya pem ba t as a n m as uk an l em ak bi l a t erj a d i d i are . Bi l a t o ler an , m as uk an n orm al
at a u l eb i h pr ot e in ak an m em ban t u r eg e n era s i h at i . P em bat as an p rot e in di i n d ik as ik an
pa d a p en yak it ber at ( c o nt o h h ep a ti t is k ronis ) k are n a ak um u las i pr o duk ak hir
m etab o l is m e pr o te i n d ap a t m enc et us k an he p at ik /e ns ef a lo p at i.
2) A wa s i gl uk os a da r ah
Ras i on a l : H i per g l i k em ia/ h i po g l ik em ia da p at t erj ad i , m em er luk a n p eru b ah a n
d ie t/ p em ber ia n i ns u li n .
3) B er ik an ob at s es u a i i nd ik as i:
a) A nt i em etik , c o nt o h m et a lo pr am id e ( R eg l an) ; tr im eto b e n zam id ( T iga n)
Ras i on a l : D ib er ik an ½ j am s eb e lum m ak an, da p at m e nru nk an m ua l da n m en i n gk atk an
to l era ns i p a da m ak ana n. C at a ta n : C om pa zi n e d ik on tra i n dik as ik an pa d a p en yak it h a ti .
b) A nt as id a, c on to h M yl a nt a , T i tr a l a e
Ras i on a l : K er j a p ad a as am g as t er , d ap at m en ur u nk an ir i tas i /r is ik o p erd ar ah a n.
c) V i tam in c on t oh B k om pl ek , C , tam ba h an d ie t l a in s es u a i i nd ik as i
 Ras ional : Mem per baik i k ek ur angan dan m em bantu pros es penyem buh a n.
d) T er a p i s t er o i d , c o n to h Pr e d n is o n ( De l tas o ne) t un g ga l at a u k om binas i d en g an a za t i opr i n
(Im uran )
Ras i on a l : St er oi d d ik on tr ai n d ik as ik a n k are n a m en in gk atk a n r is ik o be ru l an g /t erj a d i n ya
he p at i tis k r on is pa d a p as ie n de n ga n h ep at i t is k ronis p a da p as ie n d e ng a n he p at it is v ir us .
Nam un , ef ek a nt i inf l am as i m un gk in ber g u na p ad a h e pa t it is ak ti f k ron is (k h us us n ya
i di o pa t ik ) u nt uk m en ur u nk an m ua l /m un ta h d an m em am pu k an pas i en un tuk
m engk ons um s i m ak an an da n c a ir a n. S t ero i d da p at m en uru nk an am ino tr ans f e ras e s er um
da n k a dar b i l ir ub i n, t et ap i t id ak m em peng ar u h i n ek ros is ha t i a t au re ge n er as i . K o m bi nas i
ter a pi m em pun ya i ef ek s am pi n g l e bi h s e d ik it .
4) B er ik an t am ba h an m ak ana n/ n utr is i d uk ung a n to t al bi l a d i bu t uh k an
Ras i on a l : M u ngk i n p er lu u nt uk m em enu h i k ebu tu h an k a l or i b i l a t a nd a k ek rua n ga n
terj ad i /g ej a la m em anj a ng .
c. K er us ak a n i nt e gr i tas k ul i t ber h u bu n ga n de n ag n ik t erus da n e d em a
T uj ua n :
- M en u nj uk k an p er b a ik an j ar i ng a n/k u li t, b eb as ek s k ori as i
- M e la p ork an p e nur un a n pr ur it us / l ec e t
Re nc an a :
Ma n d ir i
1) G u n ak an a ir m an d i d in g i n da n s o da k u e at a u m an d i k anj i d ar i s a bu n a lk al i . B er ik an
m in yak k e l am in s es u ai i n d ik as i .
Ras i on a l : M e nc e g ah k u li t k er i ng ber l e bi h an . Mem b er ik an p en g h il a n ga n g at a l.
2) A nj urk an m en gg u n ak an buk u - b uk u j ar i u nt uk m engg ar uk ti d ak terk o ntr o l. P ert a ha nk a n
k uk u j ar i t er po r o n g p a da p as ie n k om a at a u s e lam a j am t i d ur. A nj urk an l ep as pak a i an
k etat . B er ik an s pr e i k atu n l em but .
Ras i on a l : M e nur u nk an p ot ens i a l c e der a k ul i t
3) B er ik an m as as e pa da wak tu t i du r
Ras i on a l : B er m anf a a t d a lam m en in gk atk a n t i dur d e n ga n m e nur u nk an ir it as i k u l it .
4) H in d ar i k om en tar t en t an g p en am pi l a n pa s i en
Ras i on a l : M em in im alk an s tr es ps ik o lo g is s e hu b un g an de n ga n p er ub a ha n k ul it .
K ol a b oras i
1) B er ik an o b at s es u a i i nd ik as i :
a) Antihis t am in, c ontoh m etdilazi n ( T ac aryl) ; dif enhidram i n (Benadr yl)
Ras i on a l : Me n gh i l an gk an g a ta l . Ca t at a n : G un ak an t er us m en erus pa d a p e n yak i t
he p at ik b er at
b) A nt i l ip em ik , c o nt o h k o le tr am in ( Q u es tra n)
Ras i on a l : Mu n gk in d i gu n ak an u nt uk a s am em ped u p ad a us us dan m enc e ga h
abs or ps in ya . Ca ta t an : Ef ek s am pi ng m ua l d a n k o ns t i pas i .
d. R is ik o t in g g i t er h ad a p k ek ur a ng a n v o l um e c a ir an b er hu b un ga n d en g an k eh i la n g an
ber l e b ih a n m el a l ui di a r e, as i tes , g an g g ua n p ros es pem bek u an .
T uj ua n :
Mem p ert a ha nk an h i dr as i ad ek ua t d i buk t ik an o le h t a nd a v i ta l s t a b il , t urg or k ul i t ba ik ,
pe n g is i a n k e p il er , na d i p er if er k uat , d an ha l u ara n ur i n e i nd i v i du s e s ua i .
Re nc an a :
Ma n d ir i
1) A wa s i m as uk an da n h al u ar an , b an d in gk a n d en g an b er at ba d an har i a n.
Ca ta t k e h il a ng a n m e la l ui us us , c o nt oh m un ta h d an d i ar e
Ras i on a l : M em ber ik an i nf or m as i t en t an g k ebu t uh a n p en g g an t ia n/ ef ek t er ap i . C at at a n :
Di ar e da p at be r h u bu n g an d en g an res p ons t er ha d ap i nf ek s i da n m un gk in terj a d i s e b ag a i
m as al ah ya n g le b i h s e r i us d ar i o bs tr uk s i a l ir an da ra h p or ta l d e n ga n k o ng es ti v as k ul er
pa d a tr ak tus G I a ta u s e b ag a i h as il pe n g gu n aa n o b at (n e om ic i n) l ak tu los a u nt uk
m enur unk a n k ad ar am on i a s er um pa d a a da n ya e ns e l of a lo p at i h e pa tik .
2) K aj i ta n da v it a l, n a d i per if e r , p e ng is i an k ap i l er, t ur go r k u li t, da n m em bra n m uk os a
Ras i on a l : I nd ik at or vo l um e s ir k u l as i / perf us i
3) P er ik s a as it es at a u p em ben t uk an e dem a . Uk ur li n gk ar ab d om en s es ua i i n d ik as i
Ras i on a l : M e nur u nk an k em un gk ink a n pe rd a rah a n k e d a lam j ar i ng an
4) B i ark an p as i en m eng g un ak an la p k at un /s po n d a n pem b ers ih m ul ut u nt uk s ik a t g ig i
Ras i on a l : M e ng h in d ar i tr aum a d an p er d ara h an gus i
5) O bs er v as i ta n da p er d ar a ha n, c on to h h e m atur ia /m el en a , ek im os is , p er dar a ha n t er u s
m ener us da r i gus i /b ek as i nj ek s i
Ras i on a l : K a dar pr ot r om bi n m enu ru n da n wak tu k o ag u l as i m em anj a ng b i la a bs or ps i
v it am in K t er g an g gu pa d a tr ak tus Gi d an s i nt es is pr o trom b i n m e nru n k are n a
m em pen g ar u h i h at i
K ol a b oras i
1) Awas i nilai labor ator i um , c ontoh Hb/Ht, Na + album in, dan wak tu pem bek uan
Ras i on a l : m en unj uk k an h i dr as i d a n m en gi de n ti d ik as i re t ens i n a tri um k adar pr ot e in
ya n g d a p at m en im bu l k an p em be nt uk an e d em a. D ef is i t p a da p e m bek uan p ot ens i a l
ber is ik o p er d ar a ha n.
2) B er ik an c a ir a n I V b ias a n ya g l uk os a) , e l e k trol it :
Ras i on a l : M em ber ik a n c a ir a n d a n p en g ga nt i an e l ek tro l it
3) Pr o te i n h id r o l is at
Ras i on a l : Mem per b a i k i k ek ur an ga n a lb um i n/ pr ot e in d a pa t m em ban t u m en gem ba l ik an
c a ira n d ar i j ar in g an k e s is t em s ir k ul as i.
4) V i tam i n K
Ras i on a l : K ar e n a abs or ps i t erg a ng g u, p e n am bah a n d a pa t m enc eg a h m as al a h
k oag u las i , ya n g d a pa t ter j ad i b i l a f ak tor p em bek u an / wak tu p ro trom b in d i tek a n.
5) A nt as i da at au r es e pt or H 2 an to g on is , c o n to h s im et i d ik (T agam e t)
Ras i on a l : Me n etr a l is ir /m en ur u nk an s ek res i g as ter u n tuk m eren da hk an r is ik o
ir it as i/ p erd ar a ha n g as t er .
6) O b at- o b at a nt i d ia r e, m is a l : d if e nok s i l at da n a tr ip i n ( L om ot il )
Ras i on a l : M e ng ur an g i k eh i la n ga n c a ir an / el e k trol it dar i s a l ur an G I
7) P l as m a b ek u s e gar ( f r es h f r o ze n p las m a/ FFP)
Ras i on a l : Mu n gk in d i per l uk an un tuk m en g ga n tik a n f ak tor p em bek ua n p ad a ad a n ya
def ek k oag u las i .
e. H ar g a d ir i r e n da h s i at ua s i o na l b erh u b un g an d en g an gej a la j e ngk e l/m ar ah ,
terk ur un g /is o l as i , s ak i t ya n g l am a/ per i o de p en yem b u h an
T uj ua n :
- M en g i de n tif ik as i p er as a a n da n m eto d e u nt uk k op in g t erh a da p pers e ps i d ir i ne g at if .
- M en ya t ak a n p en er im aa n d ir i, d a n l am an ya p en yem b u ha n / k eb u t uh a n is o las i
- M en g ak ui dir i s eb ag a i or a ng ya n g b erg u na , b ert a ng g un g j a wa b p a da d ir i s e n d ir i
Re nc an a :
Ma n d ir i :
1) K o ntr ak d en g a n pa s i en m en ge n ai wak tu un t uk m end en g ar
Ras i on a l : P e n ye d i aa n wak tu m en i n gk atk an hu b un g an s al i n g p erc a ya .
2) D oro n g d is k us i p er as a a n/m as a l a h
 Ras ional : Kes em patan untuk m engek s pres ik an peras aan m em ungk ink an pas ien untu k
m eras a l e b ih m en go nt r o l s i tu as i. Pe n gu n gk apa n m enu ru nk an c em as d an de pr es i da n
m em uda hk an per i l ak u k opi n g p os i t if . P as ie n m ungk in per l u m eng ek s pres ik a n p eras a an
te nt a ng m enj a d i s ak i t; l am an ya p era wa t an d an b i a ya ; k em ungk i na n inf ek s i p ad a ora n g
l ai n d an ber at n ya p en yak it , t ak ut m ati . Da p at m enj ad i m as a la h te n ta ng s t i gm a p e n yak i t.
3) H in d ar i m em bu at pe n i la i a n m or al te nt a ng po l a h i d up ( pe n g gu n aa n a lk o ho l /pr ak t ik
s ek s ua l)
Ras i on a l : P as ie n m er as a m er ah /k es a l da n m en ya l a hk an d ir i; p en i l ai a n d ar i ora n g la i n
ak an m erus ak har g a d i r i l e bi h la nj u t.
4) D is k us ik a n h ar a p a n p en yem b u ha n
Ras i on a l : P er io d e pe n yem bu h a n m un gk in l am a (l e b ih d ar i 6 b ul an) p o te ns i al s tr e s
k elu ar ga /s it u as i da n m em er l uk an p er enc a na a n, d uk un g an da n e v a lu as i.
5) K aj i ef ek p e n yak i t pa d a f ak t or ek on om i p as ie n/ or a ng t er dek a t
Ras i on a l : Mas a l ah f i n ans i a l da p at t erj a d i k a ren a k e h i la n ga n p era n f un gs i pas i e n pa d a
k elu ar ga / p en yem bu h a n l am a.
6) T a wa rk an ak ti v i t as s e n gg a ng b er d as ark a n t in gk at e n erg i
Ras i on a l : M em am pu k an pas i e n u nt uk m eng g un ak a n wak tu da n e ner g i p a da c ara
k ons tr uk tif ya n g m e ni n gk atk an h ar g a d iri da n m em inim alk a n c em as da n d e pres i .
7) A nj urk an p as i en m engg u n ak an war na m erah t era n g a ta u b ir u/ h it am d ar ip a da k un i ng
at a u h ij a u.
Ras i on a l : Me n i ngk at k an p e nam p i la n, k aren a k u l it k u n in g d i p erj e l as o le h wa rn a
k uni n g/ h ij a u. Ik ter ik b i as n a ya m em unc ak d a l am 1 - 2 m i ng g u k em udi an s ec ar a ber ta h a p
m em baik le b i h d ar i 2 - 4 m in g g u.
K ol a b oras i
- B u at r uj uk an ya n g t e pa t un tuk m em bant u, s es ua i k e bu t uh a n, c o nt oh p er enc a na a n
pu l a ng , p el a ya n a n m a s ya r ak a t, d a n/ at a u l e m baga k om un it as l a in .
Ras i on a l : Da p at m em ud a hk an p em ec a ha n m as al ah d a n m em ban t u m el i ba tk an i n d i v id u
un t uk m eng at as i s it u a s i l e bi h ef ek t if
f. R es ik o t in g g i t er h ad a p inf ek s i b erh u bu ng a n d e na g n per ta h a n pr im er t i d ak ad ek uat ,
l euk o pe n ia , p e nek a na n r es po n i nf l am as i , d a n d epr es i im un
T uj ua n :
- M en ya t ak a n p em aham an pe n ye b a b i nd i v i du /f ak tor r is ik o
- Menunj uk k an tek nik ; m elak uak n perubaha n pola hidup untuk m enghindar i inf ek s i
u la n g/ tras m is i k e or a n g l a in .
Re nc an a :
1) L ak uk an tek n ik is o l as i u n tuk i nf ek s i e nt e rik d an p er na p as a n s es u a i k e bij ak an rum a h
s ak it : t erm as uk c uc i t a ng a n ef ek tif
Ras i on a l : Me nc eg a h t r ans m is i p en yak it vir u s k e or an g l a in . M el a l u i c u c i t an g a n ef ek tif
da l am m enc e g ah tr ans m is i v ir us . T ip e A ( inf e k s i) di tr ans m is ik an m e l al u i ora l - r ek ta l , a ir
terk o nt am in as i, s us u da n m ak an an , k hus us n ya ik a n ya n g d im as a k tak m at an g . T ip e B
(s er um ) d itr a ns m is ik an m el al u i pr o duk da ra h/ dar a h t erk on tam i nas i , tus uk an j ar um , l uk a
ter b uk a d a n k on t ak d en g an s a l i v a, ur i n e, da n s em e n , j ug a d itr ans m is ik an m el al u i
ter p aj a n p a da d ar a h / pr o d u d ar ah . I n di d e n H B V da n H C V t e la h m en in gk at d ia n tar
pe t ug as r um ah s ak it d an p as ie n r is ik o t i n gg i . C at at a n : H ep a t it is t ok s in d an a lk oh o l ik
ti d ak m enu l ar da n t i da k m em er luk an t i n dak a n/ is o l as i.
2) A wa s i / ba tas i p e ng unj u ng s es u a i i nd ik as i
Ras i on a l : Pas i e n ter p aj a n t er h a d ap pros es i nf ek s i (k h us us n ya res p ira to ri us ) po te ns i al
ris ik o k om pl ik as i s ek und er .
3) A wa s i / ba tas i p e ng unj u ng s es u a i i nd ik as i
Ras i on a l : Pas i e n ter p aj a n t er h a d ap pros es i nf ek s i (k h us us n ya r e s pa t ori us ) po te ns i al
ris ik o k om pl ik as i s ek und er .
4) J e l as k an pr os ed ur is ol as i p ad a p as i en /or an g t erd ek at
Ras i on a l : P em ah am an a l as a n un tuk p er li n du n ga n di ri m erek a s en d ir i d a n or a ng l a in
da p at m eng ur a ng i p er as a a n is ol as i d an s t i g m a. Is o l as i d ap at b er a k hir 2 - 3 m in gg u d ar i
tim bu l n ya p en yak it , te r ga n tu n g p ad a t ip e /l a m an ya g ej a l a.
5) B er ik an i nf or m as i te nt a ng a d an ya ga m a gl ob u l in , IS G , H BI G , v ak s in h ep a ti t is B
(rec om bi v ax HB , E n ge r ix - B) m ela l u i d ep ar te m en k es e ha t an a t au d ok ter k e l uar g a
Ras i on a l : Ef ek tif da l a m m enc e ga h h e pa t it is v ir us p ad a or a ng ya n g ter p aj a n, t er ga n tu n g
ti p e h ep at i t is da n p er i od e i nk ub as i.
6) B er ik an o b at s es u a i i nd ik as i :
a) O ba t a nt i v ir us : v id ar a l u n ( V or a - A), as ik l o v ir (Zo v ir ax ) ; i nt erf er o n a lf a - 2b (I n tro n - A)
Ras i on a l : B er gu n a p a da pe n go b at an he p at i t is ak tif k ro n is
b) A nt i b i ot ik te p an u n tuk a ge n p enc e ga h a n (c on t oh , gram n e ga t if , b ak ter i an a ero b) a ta u
pros es s ek u nd er
 Ras ional : Eek tif pada pengoba ta n penyak i t hati s ehubung an dengan HCV
c) A nt i b io t ik t ep at un tuk a g en pe nc eg a h an (c on t oh , gr am b eg at if , b ak ter i a n aer o b) a ta u
pros es s ek u nd er
Ras i on a l : pe n go b at a n he p at it is b ak ter i a l, at a u un t uk m enc eg a h/m em bat as i i nf ek s i
s ek un de r
g. N ye r i ak ut ber h ub un g an de n ga n r ef lek s s pam e ot o t s ek un d er t erh a d ap h e par
T uj ua n :
- M en ya t ak a n n ye r i h il a ng /t er k o ntr o l
- M en g ik ut i pr o gr am t er a p eu t ik
- M en u nj uk k an p en g gu n aa n m eto d e ya n g m engh i l a ngk a n n ye ri
Re nc an a :
1) K aj i s k a la n yer i ( 0 - 10) , s e l i dik i k el u ha n n ye r i
Ras i on a l : M em ud ahk a n k i ta d a l am pem ber i a n t in d ak an
2) P er ta h ank a n t ir a h bar i n g
Ras i on a l : M e nur u nk an r as a m et ab o l ik d an r an gs an g an / s ek res i G I
3) B er ik an p i l i ha n t i n dak a n n yam a n
Dor o ng pe n gg u na a n te k nik r e lak s as i a ta u ak t i v it as h i bur a n
Ras i on a l : M e ni n gk at k an r e l ak s as i d an m em am puk an p as i en u nt uk m em f ok us k an
per h at i a n, d a pa t m en i ngk a tk an k o p in g
4) K o l ab or as i da l am pem be r i a n a na l g et ik
Ras i on a l : M e ng ur an g i r as a n ye r i
h. R is ik o t er ha d ap per u ba h a n suhu t ub u h b er h ub u ng a n de n ga n ti d ak ef ek tif n ya
term ore g u las i s ek u nd e r t er ha d ap inf ek s i .
T uj ua n :
- M en d em ont r as ik a n s u hu d a l am ba tas no rm al.
- B e bas d ar i k ed in g i na n .
- T i d ak m eng a lam i k om pl ik as i ya n g b er hu bu n ga n .
Re nc an a:
1) P a nt a u s uh u p as ie n
Ras i on a l: s u h u m en in gk at m en unj uk k an pr o s es inf ek s i . Po l a dem am da pa t m em bant u
da l am d ia g nos is .
2) P a nt a u s uh u l i n gk ung a n, b a tas i , tam ba hk an l in e n tem pa t t id ur s es u a i i n dik as i.
 Ras ional: s uhu r uangan , j um lah s elim ut harus diubah untuk m em pertahank an s uh u
m endek a t i nor m a l.
3) B er ik an k om pr es m and i h an g at .
Ras i on a l : da p at m em ban t u m en g ura n g i dem am .
4) K o l ab or as i da l am pem be r i a n a nt i p ire t ik .
Ras i on a l : d i gu n ak an u nt uk m eng ura n g i d em am de ng a n ak s i s e ntr a l n ya p a da
h ip ot a l am us .
i. Kur a ng p e ng e ta h ua n ( k e bu t uh a n be l aj a r) t en ta n g k o nd is i, pr og n os is , d an k eb ut u h an
pe n go b at a n be r h u bu ng a n d en g an k ura n g t erp aj an /m en gi n ga t, s a l ah in te rpr e tas i
i nf orm as i , ti d ak m eng e na l s um b er i nf orm as i .
T uj ua n :
- M en ya t ak a n p em aham an pr os es p e n yak i t da n p e ng o ba ta n
- M en g i de n tif ik as i h ub u ng a n ta n da / gej a la pe n yak it d an hu b un g a n gej a la de n ga n f ak t o r
pe n ye b a b
- M e lak uk an per u ba ha n p er i lak u d a n be rp art is i pas i p a da pe n go b at a n
Re nc an a
Ma n d ir i
1) K aj i t in gk at p em a ham an pr os es p e n yak it , h ar ap a n/ pr o gn os i s , k em un gk in an p il i h a n
pe n go b at a n
Ras i on a l : M e ng i de n tif ik as i ar ea k ek ur an ga n pe n ge t ah u an / s a la h inf orm as i da n
m em ber ik an k es em pa ta n un tuk m em ber ik a n inf orm as i t am ba ha n s es u a i k ep er lu a n.
Ca ta t an : T r ans f us i ..m un gk i n d ip er l uk an p a d a a da n ya pe n yak it b er at g a ga l h a ti .
2) B er ik an inf o r m as i k hus us t en t an g p enc e ga h an / pe n ul ar a n pe n yak it , c on t oh k on tak ya ng
m em erl uk an g am a g lo bu l i n, m as a l ah pr ib a d i tak per l u d i ba g i , tek a n k an c uc i t an g an da n
s an i tas i p ak ai a n, c uc i p ir i n g, d an f as i l i tas k am ar m and i bi l a en zi m hati m as ih t i ng g i.
Hi n da ri k ont ak i nt im , s e per t i c ium an , k on tak s ek s ua l d an t er p aj a n pa d a inf ek s i,
k hus us n ya inf ek s i s a lu r an k em ih ( I S K).
Ras i on a l : K eb u tu h an / r ek om end as i ak a n b er v ar ias i k are n a h e pa t it i s ( ag e n p e n ye b ab)
da n s i t uas i i n d i v id u
3) R enc a nak a n m em u la i ak ti v it as s es u a i to l era ns i , d en g a n p er i od e is t ir ah a t a d ek ua t.
Dis k us ik an p em ba tas a n m en g an gk at b er at , l at i ha n k eras /o l ahr a g a
 Ras ional : Ini tak per lu untuk m enunggu s am pai bilirub in s erum k em bali norm a untu k
m em ula i ak ti v i tas ( m em er l uk an wak tu b er bu l a n - b u l an) , t et a p i a k tiv i tas k er as p er l u
d ib at as i s am p ai k em ba li k e uk ur an n orm al . B il a pas i en m u la i m eras a ba ik , i a p er l u
m em aham i t en ta n g p e nt i ng n ya is t il a h a dek u at la nj u t an da l am m enc eg a h k ek am buh a n.
(terj a di pa d a 5% - 2 5% or a nk g d e was a).
Ca ta t an : En er g i m em er luk a n 3 - 6 bu l a n u nt u k k em bal i n orm al .

4) B a nt u p as ie n m e n g id e nt if ik as i ak ti v i tas pe n ga l i h
Ras i on a l : ak ti v it as ya ng d a pa t d in ik m ati ak a n m em ban tu m eng h i nd ar i pem us a t an p a da
pe n yem b u ha n p anj a ng .
5) D oro n g k es in am bu ng a n d ie t s e im ba ng
Ras i on a l : M en i n gk atk an k es eh at a n um um d an m en i n gk atk an pe n yem buh a n/r e ge n er as i
j ari n g an .
6) I de nt if ik as i c ar a u nt uk m em pe r t a ha nk an f un gs i us us b ias a n ya , c on t oh m as uk an c a ira n
ad ek ua t/ d i et s er a t, ak t i v it as / l at i h an s e d a ng s es u a i t ol er a ns i
Ras i on a l : P e nur u n an t i n gk at ak ti v it as , p er ub a ha n pa d a p em as u k an m ak an a n/c a ira n
da n m oti l i tas us us d a p at m eng ak i ba tk an k on s ti p as i.
7) D is k us ik an ef ek s am pi ng d a n ba h a ya m inum o ba t ya n g d ij ua l b eb as /d ir es epk a n (c on t oh
as e t am in of en , as p ir i n, s u lf o nam i d, b eb er a p a an es t e tik ) d a n pe rl un ya m e la p ork an k e
pem be ri per a wa ta n t e nt a ng d i a gn os a.
Ras i on a l : B e b er a p a o ba t m er up ak an t ok s ik un t uk ha t i, ba n y ak l a in d im et ab o l is m e o l e h
ha t i d a n h ar us d i hi n da r i p e n yak i t h a ti b era t k are n a m en ye b a bk an ef ek t ok s ik / he p at it is
k ronis
8) D is k us ik a n p em bat as a n d o na tu r dar a h
Ras i on a l : M enc e ga h pe n ye b ar a n p en yak it i nf ek s i. K eb a n yak a n u n da n g - un d an g n e g ara
ba g i an m en er i m a d on o r ya n g m em pun ya i r i w a ya t b erb a g ai t i p e he p at i tis .
9) T ek a nk an p e nt i ng n ya m en g e va l u as i pem er ik s aa n f is ik da n e v a l uas i la b ora t ori um
Ras i on a l : Pr os es p e n yak it da p at m em ak an wak tu b erb u l an - b u la n un t uk m em baik . B i l a
gej a la a d a l eb i h l am a dar i 6 b i ops i h at i d i pe rl uk an u nt uk m em as tik an a d an ya p en yak it
k ronis .
10) Kaj i u la n g p er l un ya m en gh i n dar i a lk oh o l s e l am a 6 - 1 2 b u l an m inim um ata u l eb i h l a m a
s es u a i t ol er a ns i in d i v i du
Ras ional : Meningk atk an ir itas i hepatik dan m em perc epat pem ulihan.

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