CASE STUDIES OF HEPATITIS

Members of The Group :

Rahmi Zuraidah

Rima Nur Utami

Risky Dwi Pujianto

Shafira Nurianti

Siti Diana Sofia

Sri Wahyu Retno

Mawa Iman Sugiharta

PRODI ANALIS KESEHATAN

 PREFACE

In the name of Allah, the Most Gracious, the Most Pious, We praise and thank God
for His presence, which has bestowed His grace, guidance and inayah on us so that
we can finish the paper on Hepatitisini. This paper we have compiled with the
maximum and get help from various parties so as to facilitate the making of this
paper.

To that end we extend our gratitude to all those who have contributed in the
making of this paper. Apart from that, we are fully aware that there are still
shortcomings in terms of both sentences and grammar. Therefore with open arms
we receive all the suggestions and criticism from our readers so that we can
improve this scientific paper.

Finally, we hope that this hepatitis paper can provide benefits and inpirasi to the
reader.
 Definition/Prevalency of Hepatitis
Definition
Hepatitis is inflammation and liver injury due to hepatic reactions to various conditions,
especially viruses, drugs and alcohol. Hepatitis is a dominant systemic infection that attacks the
liver. Viral hepatitis is a term used for viral hepatic infections with necrosis and inflammation of
liver cells that produce a unique set of clinical, biochemical and cellular changes. Hepatitis is a
process of inflammation of the liver tissue. Hepatitis in lay language is often referred to as liver
or jaundice.Though the definition of lever itself is actually derived from the Dutch language
which means the liver, not the liver disease. But many of the assumptions that develop in society
mean liver is a disease of liver inflammation. while the term yellow pain can actually cause a
hiccup, because not all jaundice is caused by inflammation of the liver, but also because of
inflammation in the gallbladder. (M. Sholikul Huda)
Hepatitis is a diffuse inflammatory process in tissues that can be caused by viral infections and
by toxic reactions to drugs and chemicals. (Sujono Hadi, 1999).
Viral hepatitis is a systemic infection by virus with necrosis and clinical, biochemical and
cellular characteristics. (Smeltzer, 2001). From some of the above understanding can be
concluded that hepatitis is an inflammatory disease in liver tissue caused by viral infections that
cause cells liver cells are damaged so that it can not function properly.

History

The breakthrough understanding of hepatitis came in 1963 when Dr Baruch Blumberg

discovered an antigen that detected the presence of hepatitis B (HBV) in blood samples.

At the t ime, Dr Blumberg was actually researching the genetics of disease susceptibility. He
did not set out to discover hepatitis, but his work led to a major breakthrough and increased
understanding of the disease.

In the 1950s, Dr Blumberg started to explore whether inherited traits could make different
groups of people more or less susceptible to the same disease. He and his team travelled around
the world visiting native populations in remote locations to collect blood samples for analysis.
The intention was to look for genetic differences to see whether these differences were
associated with a particular disease.

Specifically, they studied hemophiliac patients who had received multiple blood transfusions and
therefore would be exposed to blood they had received from donors. The consequence of
receiving other people's blood is that the immune system produces 'antibodies' against the foreign
blood serum proteins, or 'antigens' from the donors.

Dr Blumberg and his team identified an unusual antigen from a blood sample of an Australian
Aborigine, which they called the Australia antigen. After further research, this turned out to be
the antigen that caused hepatitis B, which was officially recognised in 1967.
Just two years later in 1969, Dr Blumberg and his colleague, Dr Iriving Millman, invented the
hepatitis B vaccine. The US Food and Drug Administration named it the first 'anti-cancer'
vaccine because the prevention of chronic hepatitis infections results in the prevention
of primary liver cancer due to HBV (approximately 80% of people with chronic hepatitis B will
develop liver cancer). More than 500,000 people die each year from liver cancer.

The hepatitis B vaccine has been administered to millions of people, particularly in Asia and
Africa, thus saving many, many lives. In the early 1970s, the cause of infectious hepatitis was
found and named the Hepatitis A virus (HAV). In 1989 hepatitis C virus (HCV) was isolated.
Unfortunately, there is no vaccine for hepatitis C, but in 80% of cases, carriers who complete a
treatment course can be cured. In 1990 hepatitis E virus (HEV) and in 1995, Hepatitis G virus
(HGV), were identified. In 1976, Dr Baruch Blumberg was awarded the Noble Prize for
Medicine in recognition of his discovery of the hepatitis B virus. He died on 5 April 2011at the
age of 85 years.

Prevalency

Prepalency according to the Ministry of Health RI Conditions indicate that by 2013 nationality it
is estimated that 1,2% of the popultion in Indonesia has Hepatitis disease, and this condition has
increased 2-fold compared to 2007, which is about 0,6%. When converted into the absolute
number of indonesia’s population in 2013 about 248,422,956 people, it can be said 2,918,075
people in Indonesia are infected with hepatitis.
 Mechanism Disease of Hepatitis
The specific mechanism varies and depends on the underlying cause of the hepatitis. Generally,
there is an initial insult that causes liver injury and activation of an inflammatory response,
which can become chronic, leading to progressive fibrosis and cirrhosis.
Viral hepatitis

The pathway by which hepatic viruses cause viral hepatitis is best understood in the case of
hepatitis B and C. The viruses do not directly cause apoptosis (cell death) Rather, infection of
liver cells activates the innate and adaptive arms of theimmune system leading to an
inflammatory response which causes cellular damage and death. Depending on the strength of
the immune response, the types of immune cells involved and the ability of the virus to evade the
body's defense, infection can either lead to clearance (acute disease) or persistence (chronic
disease) of the virus. The chronic presence of the virus within liver cells results in multiple
waves of inflammation, injury and wound healing that overtime lead to scarring or fibrosis and
culminate in hepatocellular carcinoma. Individuals with an impaired immune response are at
greater risk of developing chronic infection. Natural killer cells are the primary drivers of the
initial innate response and create acytokine environment that results in the recruitment of CD4 T-
helper and CD8 cytotoxic T-cells. Type I interferons are the cytokines that drive the antiviral
response. In chronic Hepatitis B and C, natural killer cell function is impaired.
Steatohepatitis
Steatohepatitis is seen in both alcoholic and non-alcoholic liver disease and is the culmination of
a cascade of events that began with injury. In the case of non-alcoholic steatohepatitis, this
cascade is initiated by changes in metabolism associated with obesity, insulin resistance, and
lipid dysregulation. In alcoholic hepatitis, chronic excess alcohol use is the culprit. Though the
inciting event may differ, the progression of events is similar and begins with accumulation of
free fatty acids (FFA) and their breakdown products in the liver cells in a process
called steatosis. This initially reversible process overwhelms the hepatocyte's ability to maintain
lipid homeostasis leading to a toxic effect as fat molecules accumulate and are broken down in
the setting of an oxidative stress response. Overtime, this abnormal lipid deposition triggers
theimmune system via toll-like receptor 4 (TLR4) resulting in the production of
inflammatory cytokines such as TNF that cause liver cell injury and death. These events mark
the transition to steatohepatitis and in the setting of chronic injury, fibrosis eventually develops
setting up events that lead to cirrhosis and hepatocellular carcinoma. Microscopically, changes
that can be seen include steatosis with large and swollen hepatocytes (ballooning), evidence of
cellular injury and cell death (apoptosis, necrosis), evidence of inflammation in particular in zone
3 of the liver, variable degrees of fibrosis and Mallory bodies.
 Symptoms of Hepatitis
Hepatitis has a broad spectrum of presentations that range from a complete lack of
symptoms to severe liver failure. The acute form of hepatitis, generally caused by viral infection,
is characterized by constitutional symptoms that are typically self-limiting. Chronic hepatitis
presents similarly, but can manifest signs and symptoms specific to liver dysfunction with long-
standing inflammation and damage to the organ
Acute hepatitis
Acute viral hepatitis follows a pattern of infection that involves three distinct phases:
1. The initial prodromal phase (preceding symptoms) involves non-specific and flu-like
symptoms common to many acute viral infections. These
include fatigue, nausea, vomiting, poor appetite, joint pain, and headaches. Fever, when
present, is most common in cases of hepatitis A and E. Late in this phase, people can
experience liver-specific symptoms, including choluria (dark urine) and clay-colored
stools.
2. Yellowing of the skin and whites of the eyes follow the prodrome after about 1–2 weeks
and can last for up to 4 weeks.The non-specific symptoms seen in the prodromal typically
resolve by this time, but people will develop an enlarged liver and right upper abdominal
pain or discomfort. 10–20% of people will also experience an enlarged spleen, while
some people will also experience a mild unintentional weight loss.
3. The recovery phase is characterized by resolution of the clinical symptoms of hepatitis
with persistent elevations in liver lab values and potentially a persistently enlarged liver.
All cases of hepatitis A and E are expected to fully resolve after 1–2 months. Most
hepatitis B cases are also self-limiting and will resolve in 3–4 months. Few cases of
hepatitis C will resolve completely.
Both drug-induced hepatitis and autoimmune hepatitis can present very similarly to acute viral
hepatitis, with slight variations in symptoms depending on the cause. Cases of drug-induced
hepatitis can manifest with systemic signs of an allergic reaction including rash,
fever, serositis (inflammation of membranes lining certain organs), elevated eosinophils (a type
of white blood cell), and suppression of bone marrow activity.
The most common symptom of hepatitis is :
 Appetite is gone
 Fatigue
 Fever
 Pegal whole body
 Nausea
 Gag
 Abdominal pain
 Specific symptoms of hepatitis are

From some of the above symptoms of hepatitis that appears, it's natural most people generally do
not think it is quite dangerous. Under these conditions a person has been said to be exposed to
"acute hepatitis" which can take place within a matter of weeks to a few months only. If left
untreated seriously it can lead to "chronic hepatitis" and progresses to more serious symptoms

To distinguish more specific disease symptoms from Hepatitis A, B, and C, as follows:

Hepatitis A
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort
• Clay-colored bowel movements
• Loss of appetite
• Low-grade fever
• Dark urine
• Yellowing of the skin and eyes (jaundice)
Hepatitis B
• Abdominal pain
• Dark urine
• Fever
• bitter taste in the mouth
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)
Hepatitis C
• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Yellow discoloration of the skin and eyes (jaundice)
• Dark-colored urine
• Itchy skin
• Swelling in your legs
• Weight loss

Method & Equipment of Hepatitis

1. Method : Kinetic IFCC

Principle : Aminotransferasi ( AST ) mengkatalis transaminasi dari L aspartate dan a –
kataglutarate membentuk L – glutamate dan oxaloacetate. Oxaloacetate direduksi
menjadi malate oleh enzym malate oleh enzym malate dehydrogenase ( MDH ) dan
niconamide adenine dinucleotide ( NADH ) teroksidasi menjadi NAD. Banyaknya
NADH yang teroksidasi, berbanding langsung dengan aktivitas AST dan diukur secara
fotometrik dengan panjang gelombang 340 nm.
Equipment :

2. Method : Rapid Test / strip

Principle : The HBsAg in the sample will bind to the anti HBs colloidal gold conjugate
forming a complex that will move through the membrane of the test area coated by anti
HBs. Then the reaction occurs to form a purplish pink line that shows positive results
Equipment :
 Lab Result of Hepatitis

Management care of Hepatitis

The occurrence of hepatitis disease many people who do not realize it because the
symptoms of hepatitis disease sometimes not experienced, and if it has developed its new
symptoms will be felt. However, if the disease of hepatitis disease causes any symptoms, then
the symptoms are only mild symptoms. Mild symptoms such as headache, digestive disorders,
fever, joint pain are symptoms of hepatitis that can be experienced after infection occurs.
Symptoms of hepatitis is mild but can be more developed if the let stand and its severity can be
increased. Therefore as good as his hepatitis is treated. Treatment of hepatitis can be done to stop
the infection so it will not get worse hepatitis disease. Treating hepatitis can be done at the
hospital after a blood test. And intensive treatment is done so that the virus in the body is not
growing more infect and will cause more severe health problems. After the treatment is done as
well as doing the prevention of hepatitis disease, because it is possible if the virus infects the
body back and infect more severe in comparison before it. If you want to do prevention can by
doing way like the one below:

Maintain cleanliness

Prevention of hepatitis can be done easily, because if you want to do prevention of hepatitis
disease should be done that is to maintain cleanliness. Maintaining cleanliness of body and
environment will help for the prevention of hepatitis disease. The most important thing is to
maintain the cleanliness of the environment and food hygiene, which will enter the body.
Because many causes of hepatitis that occurs because the food in his hygiene consumption is not
well maintained therefore can cause hepatitis disease.
Eat ripe food

In addition to clean food, prevention of hepatitis can be done by reducing eating raw foods in
order not to cause hepatitis disease. And not just on food, unripe raw water as well as its also not
in consumption for the prevention of hepatitis disease.

Avoid alcohol

Prevention of hepatitis disease by avoiding drinking unhealthy drinks like liquor containing
alcohol in it. Because alcohol is not good for the liver, and alcohol can trigger hepatitis disease if
in consumption. Therefore, it is better to drink more water than drink too often drinks containing
alcohol.

Increase endurance

Prevention of hepatitis disease is good that is by increasing the immune system because if the
immune system is strong then the outbreak of viral hepatitis can be treated well by a strong
immune body.

Not sharing personal items

Goods that are personally should be used alone and not in use by others, because goods can
transmit the disease. Therefore the prevention of hepatitis disease by keeping good personal
items so not used by others. If in use by others then its good use new goods.

Conclucsion
Hepatitis is a disease caused by several types of viruses that attack and cause inflammation and
damage the cells of the human liver. In Indonesia, people with hepatitis are generally more likely
to have hepatitis A, B and hepatitis C. If we look at Blum's concept of health, the most important
factor in causing hepatitis is genetic and environmental factors. As in the type of hepatitis A
where the stools become the main dispersing factor. In this case, environmental sanitation is the
most important factor.

Sugest
We must pay attention to the cleanliness of the environment, daily interactions, and also
medicines. Because with the little things that we do not notice can cause things that we will not
expect later. Hepatitis can be caused by such a small thing. For people with hepatitis disease
should be concerned with foods rich in vitamins and minerals.
 BIBLIOGHRAPHY
http://penyakithepatitis.org/pencegahan-penyakit-hepatitis/
http://www.cevhap.org/index.php/en/about-viral-hepatitis/a-brief-history-of-
hepatitis
https://en.wikipedia.org/wiki/Hepatitis
Hepatitis memiliki spektrum presentasi yang luas yang berkisar dari kurangnya gejala sampai gagal hati
parah. Bentuk akut hepatitis, umumnya disebabkan oleh infeksi virus, ditandai dengan gejala
konstitusional yang biasanya membatasi diri. Hepatitis kronis hadir dengan cara yang sama, namun dapat
menampakkan tanda dan gejala yang spesifik pada disfungsi hati dengan peradangan dan kerusakan organ
yang telah berlangsung lama.
Hepatitis akut
Hepatitis virus akut mengikuti pola infeksi yang melibatkan tiga fase berbeda:
1. Fase prodromal awal (gejala sebelumnya) melibatkan gejala non-spesifik dan gejala seperti flu yang
umum terjadi pada banyak infeksi virus akut. Ini termasuk kelelahan, mual, muntah, kurang nafsu makan,
sakit sendi, dan sakit kepala. Demam, bila ada, paling umum terjadi pada kasus hepatitis A dan E.
Terlambat pada fase ini, orang dapat mengalami gejala spesifik hati, termasuk choluria (urine gelap) dan
kotoran berwarna di tanah liat.
2. Menguningnya kulit dan putih mata mengikuti prodrom setelah sekitar 1-2 minggu dan bisa
berlangsung hingga 4 minggu. Gejala non spesifik yang terlihat pada prodromal biasanya sembuh saat ini,
namun orang akan mengalami pembesaran. hati dan nyeri perut bagian atas kanan atau ketidaknyamanan.
10-20% orang juga akan mengalami pembesaran limpa, sementara beberapa orang juga akan mengalami
penurunan berat badan ringan yang tidak disengaja.
3. Tahap pemulihan ditandai dengan resolusi gejala klinis hepatitis dengan peningkatan nilai lab hati
secara persisten dan berpotensi membesar secara terus-menerus. Semua kasus hepatitis A dan E
diperkirakan akan sembuh total setelah 1-2 bulan. Sebagian besar kasus hepatitis B juga membatasi diri
dan akan sembuh dalam 3-4 bulan. Beberapa kasus hepatitis C akan sembuh total.

Kedua hepatitis yang diinduksi obat dan hepatitis autoimun dapat hadir sangat mirip dengan hepatitis
virus akut, dengan sedikit variasi gejala tergantung pada penyebabnya. Kasus hepatitis yang diinduksi
obat dapat bermanifestasi dengan tanda-tanda sistemik dari reaksi alergi termasuk ruam, demam, serositis
(radang membran yang melapisi organ tertentu), peningkatan eosinofil (sejenis sel darah putih), dan
penekanan aktivitas sumsum tulang.
Gejala hepatitis yang paling umum adalah:
• Appetite hilang
• Kelelahan
• Demam
• Seluruh tubuh Pegal
• Mual
• Gag
•Sakit perut

Dari beberapa gejala hepatitis di atas yang muncul, memang wajar kebanyakan orang pada umumnya
tidak menganggapnya cukup berbahaya. Dengan kondisi ini seseorang telah dikatakan terpapar dengan
"hepatitis akut" yang dapat terjadi dalam hitungan minggu sampai beberapa bulan saja. Jika tidak diobati
secara serius dapat menyebabkan "hepatitis kronis" dan berlanjut ke gejala yang lebih serius

Untuk membedakan gejala penyakit yang lebih spesifik dari Hepatitis A, B, dan C, sebagai berikut:

Hepatitis A
• Kelelahan
• Mual dan muntah
• Nyeri perut atau ketidaknyamanan
• Gerakan usus berwarna abu-abu
• Kehilangan selera makan
• Demam ringan
• Urin gelap
• Menguningnya kulit dan mata (ikterus)
Hepatitis B
• Sakit perut
• Urin gelap
• Demam
• Rasa pahit di mulut
• Kehilangan selera makan
• Mual dan muntah
• Kelemahan dan kelelahan
• Menguningnya kulit Anda dan bagian putih mata Anda (sakit kuning)
Hepatitis C
• Perdarahan dengan mudah
• Memar dengan mudah
• Kelelahan
• Nafsu makan buruk
• Perubahan warna kuning pada kulit dan mata (ikterus)
• Urin berwarna gelap
• Kulit yang gatal
• Bengkak di kaki Anda
• Penurunan berat badan