hepatology

1. HEPATITIS
Suatu proses inflamasi pada hati dengan gambaran klinis dan histologis
yang spesifik yaitu terdapatnya suatu keadaan nekrosis difus atau
sebagian pada lobus hepatikus
Etiologi
• Tiga penyebab utama hepatitis adalah virus hepatitis tipe A, tipe B,
alkohol dan obat2an, juga virus C,D dan E
• Infeksi yang jarang terjadi oleh karena mononukleosis, yellow fever,
cytomegalovirus, coxsachievirus, leptospirosis
• Infeksi parasit, schistosomiasis, amoebiasis, malaria, sasarannya
adalah liver tetapi tidak menyebabkan hepatitis
• infeksi piogenic dan abses merupakan masalah juga
• tuberkulosis pada liver dan infiltrasi granulomatous lain disebut ‘
granulomatous hepatitis” , akan tetapi mempunyai gejala klinis, biokemis
dan histologis yang berbeda

2. • Systemic infection dan penyakit lain dapat menghasilkan nekrosis
pada sebagian lobus liver dan proses peradangan, keadaan ini
sifatnya non spesifik disebut “reactive hepatitis”, menyebabkan
abnormalitas fungsi liver, biasanya asymptomatik.
ACUTE VIRAL HEPATITIS
• Inflamasi difuus hepatoseluler, disebabkan oleh 2 macam agent virus
• Terdapat tipe A : serum hepatitis (SH), post transfusion hepatitis
• Tipe B : infeksi virus B (long incubation hepatitis)
Etiologi
virusA
Virus B

3. Epidemiologi
• Virus A : terjadi oleh karena kontak fekal-oral , darah dan sekret
lain yang infeksius.
• Merupakan “food- borne” epidemics, terutama di negara
berkembang
• Secara sporadis terjadi oleh karena kontak “ person-to-person”
• Virus B : transmitted melalui parenteral
• Akibat transfusi darah
• Pemakaian jarum suntik secara bergantian pada pengguna narkoba
• Cuci darah (renal dialisis)
• Non parenteral juga dapat terjadi misalnya ok sex intercourse
• Inkubasi virus A : 2-6 minggu
virus b : 6-25 minggu
• Dapat mengenai semua umur
• Hepatitis A lebih sering terjadi pada anak2 dan orang muda

4. Patologi
• Semua lobus pada liver dpt mengalami patchy nekrosis dan infiltrat
mononuklear inflamasi
• Gambaran regresi histologik sering dijumpai, meskipun pada awal
penyakit
Symptom dan sign
• Bervariasi dari yang ringan seperti gejala flu s/d gejala fulminant yang
sangat berat, sampai fatal
• Phase prodromal :
- dimulai awal dengan gejala nausea, anorexia, malaise, panas.
- dapat terjadi urticaria (gatal), arthralgia (nyeri sendi), khususnya
pada hepatitis B
- setelah 3-10 hari terjadi fase ikterik, sampai terdapat warna lebih
gelap pada urin
- diikuti dengan jaundice

5. Gejala klinis (penderita dengan ascites)

6. Chronic viral hepatitis (cirrhosis hepatis)

7. • Jaundice mencapai puncak/peak dalam 1-2 minggu, kemudian terjadi
fase recovery dalam 2-4 minggu
• Terdapat pembesaran hati, kadang2 keras, biasanya teraba lunak dan
halus.
• Pembesaran limpa (splenomegali) terjadi pada 15-20% pasien
Laboratorium
• Peningkatan transaminase, terjadi pada awal masa prodromal,
puncaknya terjadi sebelum masa peak jaundice kemudian pelan2
turun pada fase recovery
• SGOT dan SGPT 1000-3000 u. Tidak terdapat hubungan dengan
gejala klinis
• SGPT biasanya lebih meningkat dibanding SGOT
• Bilirubin pada urine terjadi sebelum jaundice
• Kenaikan alkali fosfatase terjadi apabila terdapat cholelithiasis berat
• Tidak terdapat kenaikan protrombine time

8. Diagnosis
• Pada fase prodromal didapatkan gejala seperti influenza dan susah
didiagnose
• Apabila jaundice sudah tampak, dapat didiagnosa
• Hepatitis ok obat atau toxic dapat diperoleh ketr mell riwayat penyakit
• Gejala prodromal sakit tenggorokan, adenopati diffus
• Atipical limfositosis
• Alkoholik hepatitis ditanyakan melalui riwayat, terdapat spider nevi
• Keadaan ekstra hepatik obstruksi dan neoplasma kadang sulit
dibedakan
Prognosis
• Hepatitis sembuh spontan pada sebagian besar kasus, selama 6-12 mg
• Hepatitis B lebih jelek dibanding hepatitis A, khususnya pada orang2
tua, mortalitas sebesar 10-15%

9. Prophilactie
• Personal hygiene
• Isolasi faeces, urine dan darah dari penderita2 hepatitis A,
hendaknya diperlakukan sbg bahan infeksius
• Isolasi dari penderita hanya dapat menghindari pyebaran hepatitis B
• Mma 0globulin 0,02 ml/kg BB
• Transfusi darah - hati2 terhadap kontaminasi hepatitis B
• vaksinasi

11. What can you do to prevent hepatitis A?
Get vaccinated against hepatitis A if your travel
plans, job, health, or lifestyle puts you at risk.
Make sure your children get vaccinated. The U.S.
Centers for Disease Control and Prevention
recommends the vaccine for all children starting at
age 1 year. It's also important for children adopted
from other countries to get the vaccine.
Talk to your doctor if you've been around someone
who you know has hepatitis A. The hepatitis A
vaccine or an injection of immunoglobulin (IG) within
2 weeks of exposure may prevent you from getting
sick.1

12. Practice good hygiene habits.
Wash your hands well after using the
toilet, after changing a diaper, and
before you prepare or eat food.
Wash dishes in hot, soapy water or in
a dishwasher.
Discourage children from putting
objects in their mouths.
Don't eat or drink anything that you
think may have been prepared in
unclean conditions.

13. Don't eat raw or undercooked shellfish.
If you plan to travel to a part of the world where
sanitation is poor or where hepatitis A is a known
problem:
Ask your doctor about getting the hepatitis A vaccine,
a shot of immunoglobulin (IG), or the combination
hepatitis A and B vaccine.
Always drink bottled water or boil water before
drinking it. Avoid drinks with ice cubes.
Don't eat raw foods, such as unpeeled fruits or
vegetable

14. People with jaundice

15. Alcoholic hepatitis

16. Key facts about Hepatitis B
•Hepatitis B is a viral infection that attacks the liver and can cause both
acute and chronic disease.
•The virus is transmitted through contact with the blood or other body
fluids of an infected person.
•An estimated 240 million people are chronically infected with hepatitis B
(defined as hepatitis B surface antigen positive for at least 6 months).
•Approximately 780 000 persons die each year from hepatitis B infection -
- 650 000 from cirrhosis and liver cancer due to chronic hepatitis B
infection and another 130 000 from acute hepatitis B.1
•Hepatitis B is an important occupational hazard for health workers.
•However, it can be prevented by currently available safe and effective
vaccine.

17. Geographical distribution
Hepatitis B prevalence is highest in sub-Saharan Africa and
East Asia, where between 5–10% of the adult population is
chronically infected.
High rates of chronic infections are also found in the
Amazon and the southern parts of eastern and central
Europe.
In the Middle East and the Indian subcontinent, an estimated
2–5% of the general population is chronically infected.
Less than 1% of the population in western Europe and North
America is chronically infected.

18. Transmission
•The hepatitis B virus can survive outside the
body for at least 7 days.
• During this time, the virus can still cause
infection if it enters the body of a person who is
not protected by the vaccine.
•The incubation period of the hepatitis B virus is
75 days on average, but can vary from 30 to 180
days.
•The virus may be detected within 30 to 60 days
after infection and can persist and develop into
chronic hepatitis B.

19. In highly endemic areas, hepatitis B is most
commonly spread from mother to child at birth
(perinatal transmission), or through horizontal
transmission (exposure to infected blood),
especially from an infected child to an uninfected
child during the first 5 years of life.
The development of chronic infection is very
common in infants infected from their mothers or
before the age of 5 years.

20. Hepatitis B is also spread by percutaneous or mucosal
exposure to infected blood and various body fluids, as
well as through saliva, menstrual, vaginal, and seminal
fluids. Sexual transmission of hepatitis B may occur,
particularly in unvaccinated men who have sex with men
and heterosexual persons with multiple sex partners or
contact with sex workers. Infection in adulthood leads to
chronic hepatitis in less than 5% of cases. Transmission
of the virus may also occur through the reuse of needles
and syringes either in health-care settings or among
persons who inject drugs. In addition, infection can occur
during medical, surgical and dental procedures, tattooing,
or through the use of razors and similar objects that are
contaminated with infected blood.

21. All children and adolescents younger than 18
years old and not previously vaccinated should
receive the vaccine if they live in countries
where there is low or intermediate endemicity.
In those settings it is possible that more people
in high risk groups may acquire the infection
and they should also be vaccinated.
They include:

22. •people who frequently require blood or blood products,
dialysis patients, recipients of solid organ transplantations;
•people interned in prisons;
•people who inject drugs;
•household and sexual contacts of people with chronic HBV
infection;
•people with multiple sexual partners;
•
•health-care workers and others who may be exposed to
blood and blood products through their work; and
•travellers who have not completed their hepatitis B
vaccination series, who should be offered the vaccine
before leaving for endemic areas.

23. Good luck