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PENEGAKAN DIAGNOSA
KELAINAN HEPAR &
SISTEM BILIER
Dr. Rahma Triliana, S.Ked. M.Kes
Blok Gastroenterohepatologi II
Mei 2011
ANATOMY of LIVER
a) A liver lobule to show the direction of blood flow from the portal system
to the centrilobular veins and thence to the inferior vena cava
b) The blood flow through the sinusoids of the liver lobule and the passage
of bile from the bile canaliculi to the bile ducts
LIVER FUNCTION
Excretion
Metabolism
10
DIAGNOSING
HEPATIC & BILIARY
SYSTEM DISORDER
12
SYMPTHOMS of
HEPATOBILIARY DISEASE
13
SIGN
Hepatomegaly
Fetor Hepaticus
Scleral icterus
Skin-yellow discoloration
Spider telangiectases
Skin hyperpigmentation &
hemochromatosis
Xanthomatosis, xanthelasmas
Purpura
Telangiectases
Excoriations & prurigo
nodularis
Parotid Glands enlargement
Testicular atrophy &
feminization, gynecomastia.
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15
LABORATORY
EXAMINATION IN
HEPATIC &
BILIARY SYSTEMS
DISORDERS
BLOOD TEST
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Liver Function
Cancer
Alpha fetoprotein
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LIVER ENZYMES
Cellular Integrity
19
AbNormal LFT
AST > 3x URL
ALP < 2X URL
Penyakit Hepatoseluler
Penyakit Kolestatik
Albumin
Normal
Hepatitis
Akut
Menurun
Hepatitis
Kronis
Kolestasis
Akut
Kolestasis
Kronis
USG / Kolangiograf
Intrahepatik
Kolestasis
Ekstrahepati
kKolestasis
LIVER ENZYMES
Cholestatic Enzymes
ALP Meningkat
5 nucleotidase / GGT
Normal
Meningkat
Dari tulang,
plasenta atau
usus
Dilatasi Bilier
Ekstrahepatik
kolestasis
Penyakit Hepatobilier
USG / CT Scan
Focal Mass
Kemungkinan:
Ca
Hepatoseluler
Limfoma
Metastase
Aspirasi Hati
Biopsi Hati
Dilatasi / Massa
(-)
AMA Test
(+)
Sirosis
()
Bilier
Primer
Kemungkinan:
Drug induce
TBC
Histoplasmosis
OTHER TESTS
23
COMMON
DISORDERS
25
Liver Disorders
Asymptomatic
Malaise, fatigue, Loss of appetite, Nausea
Jaundice
Pain in the right upper quadrant
Common disorders:
Viral Hepatitis
Toxic hepatitis >> alcohol, drugs, herbs & toxics substance
Liver abscesses by amoebae, bacteria or parasites.
Liver damage Liver failure defects in drugs, nutrition,
metabolism & coagulation systems
Chronic damage Liver fibrosis Cirrhosis.
Cancer (metastatic >> primary liver cancers)
Portal hypertension Esophageal bleeding, Asites
Hepatic Coma.
26
SPESIFIC HEPATITIS
CAUSES
MARKER
MARKER
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Autoimmune
Biopsy
ASTMA: Anti smooth muscle antibody, LKM: Anti-liver-kidney microsomal antibody, SLA:
Soluble liver antigen
+++
+++
+++
++
+++
+++
+
++
+++
-
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Harissons: Principles of Internal Medicine
Inkubasi
Fase Akut
Fase
Konvalesen
Sembuh
4-12 minggu
2-12 minggu
2-16 bulan
Tahun
Total Anti-HBc
Anti HBe
HBsAg
Anti HBs
IgM Anti-HBc
HBeAg
Kontak
HBV DNA
Window period
Imunitas
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INTERPRETATION of HEPATITIS B
MARKER
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Inkubasi
Fase Akut
Penyembuhan
4-7 minggu
4-12 minggu
Tahun
Anti HCV
HCV RNA
HCV Ag
Kontak
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Cardiac drugs
Methyldopa
Amiodarone
Psychotropic drugs
Paracetamol
Aspirin
Nonsteroidal antiinflammatory drugs
Others
Sodium valproate
Oestrogens (oral contraceptives & hormone replacement
therapy)
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36
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Biliary Disorders
Gallstones
Cholecystitis, Cholangitis
Pancreatitis
39
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Prehepatik Hepatic
Jaundice
Jaundice
Posthepatic
Jaundice
Unconjugated
Bilirubin (Indirect Bil)
Conjugated Bilirubin
Bilirubin in urine
Trace
2+ - 4+
> 3+
Urobilin in urine
++
+/-
+/-
Brown
Light
Brown
pale
(Direct Bil)
Feces colour
41
CAUSES PORTAL
IncreasedHYPERTENSION
resistance to flow
Hepatic
Cirrhosis
Acute alcoholic liver disease
Congenital hepatic fibrosis
Idiopathic portal hypertension (hepatoportal sclerosis)
Schistosomiasis
Posthepatic
BuddChiari syndrome
Constrictive pericarditis
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