You are on page 1of 18

Dr.WAN NEDRA Sp.

A
Child Health Dept. School of Medicine University of YARSI

organ paling besar Fungsi utama: 1. Regulasi Metabolite dalam dara 2.Detoxikasi Regenerate jk

Spleen

Old Erythrocytes Small amount entero-hepatic circulation

Unconj bilirubin

Conj. bilirubin Urobilinogen

terjadi kerusakan
HEPATITIS Inflammasi & necrosis Infeksi & non Inf
Stercobiline

Morbidity - mortality Epidemiology endemic area carrier rate - transmission rate Therapeutics ? Quality of life?
Prevention - !!!

Epidemiology, virology, patophysiology: Diagnosis DINI Supportive & monitoring Detection dini:

fulminant, chronicity Prevention of spreading


Pengobatan Antivirus

HAV
Virus Inkubasi Onset Oral-fekal Parenteral Kronisitas Picorna

HBV
Hepadna

HCV
Flavi

HGV
Flavi ? 2 mg (-) (++) (+)

15-40 hr 50-160hr 1-5 bln Akut (++) Jarang (-) (-) (++) (+) (-) (++) (+)

Subklinik Subklinik Akut/sub

Complication in chronic liver disease 8x Self limiting disease Single exposure Long life immunity

Endemic - young children reservoir Morbidity mortality at older age

Receptor

Hepatocyte

CTL

Excretion in stool

Excretion in bile

HAV Pathogenesis

HAV infection
Asymptomatic Non icteric

Icteric
Cholestatic Liver failure

Complication -

Relapsing

Resolved
Transplantation

Death

OUTCOME HAV infection

Anti HAV total

HVA stool

IgM-Anti HVA

Heat stable virus Endemic - reservoir Fecal-oral, kontak erat High risk: children, CLD cases, etc Susceptible: High sosio-economic population

Hygiene - sanitation Proper cooking, hand washing, septic tank,diapers, etc Isolate index case Immunization Pre-post exposure (activepassive)

IgM anti HAV (+)

PT/INR
INR < 2 Repeat LFTs 57 d Improved INR > 2 Not improved (clinic-laboratory) Refer

Repeat LFT 6wk


No follow up
Normal

Abnormal

PENCEGAHAN VAKSIN HVA

Inactivated, safe

Long immunity Simultaneous other vaccine Interchangeable Serologic test: pre- likely exposed post- vaccination: (-)

Individual risk: Children, CLD cases, IVDU, homosexuals multitransfused, household contact, traveler - low endemic Professional risk: food sector, health, sewage, waste water, in contact with children, lab-military staff

Age ys
<2

Individual Community protection Vaccine (-)

Routine immunization

Post-exposure immunization
NHIG household contact

2 18 Havrix 720 EU, Avaxim 160 Vaccine or AU/ml, 2x (0, 6 12) Vaccine & NHIG#
> 18 Havrix 1440 EU, Avaxim 160 AU/ml, 2x (0, 6 12) None or Vaccine or Vaccine & NHIG#

Protective anti HAV 20 mIU/ml

AGE (ys)

DURATION protection

RECOMMENDATION

<2

< 3 months 3-5 months Long term < 3 months 3-5 months Long term

NHIG 0.02 ml/kg, 1x NHIG 0.02 ml/kg, 1x NHIG 0.06 ml/kg, repeat 5/12 Vaccine or NHIG (0.02 ml/kg) Vaccine or NHIG (0.06 ml/kg) Vaccine

Initial consultation: - LFTs - Anti HAV-IgM - HBsAg Bilirubin > 6 mg/dl

Bilirubin > 6 mg/dl

Refer

GGT cholestatic or obstruction

Alanine transaminase
IgM HAV (+)
IgM HAV ()

Refer

Treat as HAV

Refer