Professional Documents
Culture Documents
Mrs. T , 45 Y.O.
MC :
Abdominal enlargement
HI
HPI
DM (-), HT (-)
Physical examinations
Weak, BP : 110/70 mmHg,
RR : 20 x/min ,
Head / Neck : A+/J-/C-/D-
HR: 88 x/min ,
t: 36.9C
LABORATORY RESULT
Hematology Results
CBC
2/2/14
5/2/14
7/2/14
WBC (103/L)
2.57
2.11
2.07
% Neu (%)
66.1
61.71
58.2
% Lym (%)
22.2
17.97
22.5
% Mo
(%)
8.6
13.09
9.94
% Eos
(%)
3.1
3.58
4.08
%Baso (%)
0.1
3.63
1.96
RBC (106/L)
2.64
4.26
4.31
6.5
9.24
9.58
18.0
30.47
31.2
MCV (fl)
68.2
71.50
72.3
MCH (pg)
17.0
21.69
22.2
MCHC (g/dL)
25.0
30.33
30.7
RDW (%)
20.4
21.22
20.9
85
54.49
56.9
Hb
(g/dL)
Hct
(%)
Plt
(103/L)
05/2/14
RBG (mg/dL)
AST (IU/L)
ALT (IU/L)
Albumin (g/dL)
Creatinin (mg/dL)
BUN (mg/dL)
Na (mmol/L)
Cl (mmol/L)
Ca (mg/dL)
70
27
39
3.6
0.7
7
143
113
72
27
22
4.1
0.8
10
134
104
K (mmol/L)
T.Prot (g/dL)
4.2
TIBC (g/dL)
372
SI (g/dL)
14
9.2
4.1
5.7
T.Cholesterol (mg/dL)
205
Trigliserid (mg/dL)
116
HDL (mg/dL)
55
LDL (mg/dL)
118
D.Bilirubin (mg/dl)
0.2
T.Bilirubin (mg/dl)
0.7
Imunology Result
2/2/2014
HBsAg stick
negative
Coagulatio
n Study
2/2/2014
PPT
APTT
Urinalysis
Sedimen :
Color : yellow
Clarity : clear
Glu : neg
Bil : Keton : SG : 1.013
Bld : pH : 7.0
Prot : Uro :Nitrit :Leu: -
Ery : 0-2
Leu : 0 - 2
Epith : few
10
11
BSE :
E : Hypochromic,anisopoikilocytosis
(normocytes,macrocytes,microcytes, ovalocytes,
helmet cell), polychromatophilic cell -, normoblast L : seems to be decrease in number,
dominated by segmented neutrophils,
no immature cells.
T : seems to be decrease in number,
giant platelet (-)
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THANK YOU
14
15
Hipertensi portal
varices
oesophagus
splenomegali
caput meduse
asites
collateral -vein
anemia, leukopeni
dan
trombocytopenia
17
DIAGNOSA
Pembesaran limpa biasanya bisa dirasakan/diraba melalui
dinding perut.
Cairan di perut bisa diketahui dari adanya pembengkakan
perut dan pemeriksaan perkusi perut memberikan hasil
suara yang tumpul.
USG dilakukan untuk memeriksa aliran darah di dalam
pembuluh darah portal dan bisa menunjukkan adanya
pengumpulan carian di perut.
CT scan juga bisa digunakan untuk memeriksa pelebaran
pembuluh vena.
Tekanan dalam sistem portal bisa diukur secara langsung
dengan memasukkan jarum melalui dinding perut ke
dalam hati atau limpa.
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SAAG
Serum ascites albumin gradient
Untuk menentukan cairan transudat atau
eksudat
>1.1 = high gradient
22
A
1
B
2
C
3
Bilirubin (mg/dL)
Albumin (g/dL)
Ascites (g/dL)
Encefalopati
Nutrisi
< 2.0
>3.5
Baik
2.0 3.0
3.0 3.5
Terkontrol
Stadium I/II
Sedang
> 3.0
< 3.0
Tidak terkontrol
Stadium III/IV
Jelek
Total Skor
5-7
8 - 10
11 - 15
24
25
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ASCITES
Cirrhosis
Portal
hypertension
Splanchnic
vasodilatation
Splanchnic
pressure
Lymph
formation
Formation of
ascites
Plasma volume
expansion
Arterial
underfilling
Activation of
vasoconstrictors
and antinatriuretic
factors
Sodium
retention
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Hepatic Encephalopathy
29
30
Complications of
Cirrhosis
Portal Hypertension
Variceal Bleeding
Ascites
Spontaneus Bacterial Peritonitis (SBP)
Hepatorenal Syndrom
Hepatic Encephalophaty
31
Hipertensi portal
Vasokonstriksi renal
Sindrom Hepatorenal
32
Hepatitis B akut
2/16/15
dr.Siswanto D Sp.PK(K)
34
SEROLOGI HBV
Hepatitis kronik
aminotransferase > 6 bulan
Hepatitis C akut 80% menjadi
kronik
( B: 1-2% ) Cirrhosis (C:30%,B:40%,
C&B %>, atau dgn HIV %>)
Px Cirrhosis: 3-5%/ tahun HCC
Tanpa cirrhosis, virus B dgn replikasi
virus aktif HCC
36
AST,ALT,LDH
ALP
GGT
AST
ChE
37
37
38
38
Aminotransferase :
enzim yang mengkatalisis perpindahan
reversibel satu gugusan amino dari
asam amino ke asam alfa-keto.
39
39
PEMERIKSAAN LABORATORIK
Gambaran lab sirosis hepatis :
AST dan ALT
tak begitu tinggi.
AST lebih daripada ALT, bila transaminase normal
tidak mengenyampingkan adanya sirosis.
GGT pada penyakit hati alkoholik kronik --> alkohol
menginduksi GGT mikrosomal hepatik dan
menyebabkan bocornya GGT dari hepatosit.
Bilirubin bisa normal pada sirosis hati kompensata,
tapi bisa meningkat pada sirosis yang lanjut.
Albumin sesuai dengan perburukan sirosis.
42
PEMERIKSAAN LABORATORIK
Globulin
--> sekunder dari by pass ke liver: antigen
bakteri dari sistem porta ke jaringan limfoid-->
menginduksi produksi imunoglobulin.
Waktu protrombin --> memanjang
Natrium serum
dengan asites--> ketidakmampuan
ekskresi air bebas
Kelainan hematologi: anemia penyebabnya bisa
bermacam-macam, anemia monokrom, normositer,
hipokrom mikrositer atau hipokrom makrositer.
Anemia + trombositopenia, lekopenia, dan netropenia
--> splenomegali kongestif ok hipertensi porta
43
METABOLISME BILIRUBIN
Destruksi eritrosit (RES 80-85%,SuTul
15-20%)
Hb
Pool
Fe
oksidase,katalase
Heme
Globin
Protein
myoglobin,sitokrom
Biliverdin
Bilirubin bebas
albumin
(unconjugated bilirubin)
protein y,z
UDP glukuronyltransferase
2-5%
as.glukuronat
s
fece
e
k
80%
conjugated
n)
e
g
o
ilin(
b
o
c
ter
n
bilirubin
20%
Sirkulasi enterohepatik
44
44
urobilin(ogen)
Esophageal Varices
Esophageal varices (or oesophageal varices) are extremely dilated submucosal veins in the lower third [1] of the esophagus. They are most often a
consequence of portal hypertension, commonly due to cirrhosis; patients with
esophageal varices have a strong tendency to develop bleeding
Gastroscopy image of
esophageal varices
with prominent
cherry-red spots
45
Esophageal varices
In the cirrhotic liver, the scar tissue
blocks the flow of blood returning to the
heart from the intestines and raises the
pressure in the portal vein (portal
hypertension).
As a result of the increased flow of blood
and the resulting increase in pressure,
the veins in the lower esophagus and
upper stomach expand and then are
referred to as esophageal and gastric
varices.
47
Jenis
pemeriksaan
Transudat
Eksudat
Kadar protein
serum
lekosit
< 1000/mm3
> 1000/mm3
Rivalta
Negatif
Positif
58
Splenomegaly
The spleen normally acts as a filter to
remove older red blood cells, white blood
cells, and platelets.The blood that drains
from the spleen joins the blood in the
portal vein from the intestines. As the
pressure in the portal vein rises in
cirrhosis, it increasingly blocks the flow of
blood from the spleen. The blood "backsup," accumulating in the spleen, and the
spleen swells in size, a condition referred
to as splenomegaly.
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