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SISTEM PENCERNAAN

dr. Sri Kartika Sari, SpPK


20 Nopember 2013

Function of the Digestive System


Ingestion
Taking

Break

food and water into the mouth

down the food

Mechanical

digestion: chewing, mixing, and


churning food
Chemical digestion: digestive enzymes
breakdown food

Absorb

nutrients

Movement

of nutrients from the GI tract to the


blood or lymph

Release

of waste

Elimination

of indigestible solid wastes

The GI tract
(gastrointestinal tract)

The muscular alimentary


canal
Mouth
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Anus

The accessory
digestive organs

Supply secretions
contributing to the
breakdown of food
Teeth & tongue
Salivary glands
3Gallbladder

The Digestive Process

Ingestion

Propulsion (movement of food)

Transport of digested end products into


blood and lymph in wall of canal

Defecation

By secreted enzymes: see later

Absorption

Chewing
Churning in stomach
Mixing by segmentation

Chemical digestion

Swallowing
Peristalsis propulsion by alternate
contraction &relaxation

Mechanical digestion

Taking in food through the mouth

Elimination of indigestible substances


from body as feces

Chemical digestion

Complex food molecules (carbohydrates, proteins


and lipids) broken down into chemical building
blocks (simple sugars, amino acids, and fatty acids
and glycerol)
Carried out by enzymes secreted by digestive
glands into lumen of the alimentary canal

Ways to divide.
The more common

Plus:
epigastric
periumbilical
suprapubic
flank

Histology of alimentary canal wall

Same four layers from esophagus to anal canal

1.
2.
3.
4.

Mucosa
Submucosa
Muscularis
externa
Serosa

from lumen (inside)


out

Inner layer: the mucosa*


(mucous membrane)

Three sub-layers
*

1.
2.
3.

Lining epithelium
Lamina propria
Muscularis
mucosae

More about the mucosa

Epithelium: absorbs nutrients, secretes


mucus

Lamina propria

Continuous with ducts and secretory cells of


intrinsic digestive glands (those within the wall)
Extrinsic (accessory) glands: the larger ones
such as liver and pancreas
Loose connective tissue with nourishing and
absorbing capillaries
Contains most of mucosa-associated lymphoid
tissue (MALT)

Muscularis mucosae

Thin layer of muscle producing only local

Second layer: the submucosa*

10

Connective tissue
containing major
blood and lymphatic
vessels and nerves
Many elastic fibers
so gut can regain
shape after food
passes

Next in, the muscularis externa*


(AKA just muscularis)

Two layers of smooth


muscle
responsible for
peristalsis and
segmentation
Inner circular
*
layer
(circumferential)

11

Squeezes
In some places
forms sphincters
(act as valves)

Outer longitudinal

Last (outer), the serosa*


(the visceral peritoneum)

Simple squamous
epithelium
(mesothelium)

Exceptions:

12

Thin layer of areolar


connective tissue
underneath
Parts not in
peritoneal cavity
have adventitia, lack
serosa
Some have both,
e.g. retroperitoneal
organs

Smooth muscle
Smooth muscle

Muscles are spindle-shaped cells


One central nucleus
Grouped into sheets: often running
perpendicular to each other
Peristalsis
No striations (no sarcomeres)
Contractions are slow, sustained and
resistant to fatigue
Does not always require a nervous
signal: can be stimulated by stretching
6 major locations:
or hormones
1. inside the eye 2. walls of vessels 3. respiratory
tubes
13
4. digestive tubes 5. urinary organs 6. reproductive

Review of some definitions.

Peritoneum: serous membranes of the


abdominopelvic cavity
Visceral peritoneum: covers external surfaces
of most digestive organs
Parietal peritoneum: lines body wall
Peritoneal cavity: slit-like potential space
between visceral and parietal peritoneum

14

Serous fluid lubricating

The Mouth

Mouth = oral cavity

Lining: thick stratified


squamous epithelium

Lips- orbicularis oris


muscle
Cheeks buccinator
muscle

15

Vermillion border or
red border

Between highly
keratinized skin of face
and mucosa of mouth
Needs moisture

Note frenulums (folds


of mucosa)
Palate roof of mouth

16

Hard plate anteriorly


Soft palate posterioly

Uvula

Tongue

Mostly muscles

Grip and reposition food


Forms bolus of food (lump)
Help in swallowing
Speech help form some consonants

Note frenulum on previous slide: can be too tight


Taste buds contained by circumvallate and fungiform papillae
Lingual tonsil back of tongue

17

Teeth

Called dentition (like dentist)

Teeth live in sockets (alveoli) in the gumcovered margins of the mandible and maxilla

Chewing: raising and lowering the mandible


and moving it from side to side while tongue
positions food between teeth

18

Teeth

Two sets

Primary or deciduous

Baby teeth
Start at 6 months
20 are out by about 2 years
Fall out between 2-6 years

Permanent: 32 total

All but 3rd set of molars by end


of adolescence
3rd set = wisdom teeth

Variable

Some can be impacted


(imbedded in bone)

19

Teeth are classified according to shape


and function

incisor

canine

premolar

Incisors: chisel-shaped for


chopping off pieces
Canines: cone shaped to tear
and pierce
Premolars (bicuspids) and
Molars - broad crowns with
4-5 rounded cusps for
grinding

molar

20

Cusps are surface bumps

Tooth structure

Two main regions


A.
B.
C.

Enamel
.
.

Crown (exposed)
Root (in socket)
Meet at neck

99% calcium crystals


Hardest substance in
body

Dentin bulk of the


tooth (bone-like but
harder than bone,
with collagen and
mineral)
Pulp cavity with
vessels and nerves
21
.

Root canal: the part of

Tooth structure

Cementum bone
layer of tooth root

Periodontal
ligament

Attaches tooth to
periodontal ligament

Anchors tooth in
boney socket of the
jaw
Continuous with
gingiva (gums)

Cavities or caries rot


22Plaque film of

Salivary glands
(tuboalveolar glands)

Intrinsic salivary
glands within
mucosa

Secrete saliva all the


time to keep mouth
moist

Extrinsic salivary
glands

Saliva: mixture of water, ions, mucus, enzymes


keep mouth moist
dissolves food so can be tasted

moistens food

starts enzymatic digestion


buffers acid

23
antibacterial and antiviral

Paired (2 each)

Parotid
Submandibular
Sublingual

External to mouth
Ducts to mouth
Secrete saliva only right
before or during eating

Extrinsic salivary glands

Parotids* - largest (think mumps)

Facial nerve branch at risk during surgery here

Submandibular # - medial surface


mandible
Sublingual + - under tongue; floor of
mouth
*

+
24

Compound = duct branches


Tubo = tubes
Alveolar = sacs

Pharynx
___oropharynx

Oropharynx and
laryngopharynx

___laryngopharynx

Three constrictor
muscles*

*
*

Stratified squamous
epithelium

Sequentially squeeze
bolus of food into
esophagus
Are skeletal muscles

*
25

Voluntary action
Vagus nerve (X)

Esophagus

Continuation of pharynx
in mid neck
Muscular tube collapsed
when lumen empty
Esophagus___________
Descends through
thorax

On anterior surface of
vertebral column
Behind (posterior to)
trachea

26

Esophagus continued

Passes through esophageal hiatus in the


diaphragm to enter the abdomen
Abdominal part only 2 cm long
Joins stomach at cardiac orifice*

Cardiac sphincter at cardiac orifice to prevent


regurgitation (food coming back up into esophagus)
Gastroesophageal junction and GERD

___________________esophageal hiatus
(hiatus means opening)

27

Microscopic anatomy of esophagus

Contains all 4
layers (see
right)

Epithelium: nonkeratinized stratified squamous epithelium

Mucus glands in wall


Muscle (muscularis externa) changes as it goes down

At GE junction thin simple columnar epithelium

Superior 1/3 of esophagus: skeletal muscle (like pharynx)


Middle 1/3 mixture of skeletal and smooth muscle
Inferior 1/3 smooth muscle (as in stomach and intestines)

28
When
empty, mucosa and submucosa lie in longitudinal folds

Esophagus histology

29

Stomach
J-shaped; widest part of alimentary canal
Temporary storage and mixing 4 hours

Starts food breakdown

Into chyme

Pepsin (protein-digesting enzyme needing acid


environment)
HCl (hydrochloric acid) helps kill bacteria
Stomach tolerates high acid content but
esophagus doesnt why it hurts so much when
stomach contents refluxes into esophagus
(heartburn; GERD)

Most nutrients wait until get to small


intestine to be absorbed; exceptions are:

30

Water, electrolytes, some drugs like aspirin and


alcohol (absorbed through stomach)

Stomach

Lies mostly in LUQ

epigastrium

But pain can be epigastric or


lower

Just inferior to (below)


diaphragm
Anterior (in front of)
spleen and pancreas
Tucked under left lower
margin of liver
junction
Anchored at both ends
with
but mobile in between
esophag
contains
Main regions in drawing
us
pyloric
to
sphincter
right----------------------------funnel shaped
--31
Capacity: 1.5 L food; max

dome

32

Stomach Regions

Cardiac region
Fundus (dome shaped)
Body

Pyloric region

33

Greater curvature
Lesser curvature
Antrum
Canal
Sphincter

dome
junction
with
esophag
contains
us
pyloric
sphincter
funnel shaped

Rugae: longitudinal
folds on internal
surface (helps
distensibility)
Muscularis: additional
innermost oblique layer
(along with circular and
longitudinal layers)

34

Histology of
stomach

Simple columnar
epithelium: secrete
bicarbonatebuffered mucus
Gastric pits opening
into gastric glands

Mucus neck cells


Parietal cells

HCL
Intrinsic factor (for
B12 absorption)

Chief cells

Pepsinogen
(activated to pepsin
with HCL)
Stimulated by
gastrin: a stomach
hormone

35

Small intestine

Longest part of alimentary canal (2.7-5 m)


Most enzymatic digestion occurs here

Most enzymes secreted by pancreas, not small


intestine

Almost all absorption of nutrients


3-6 hour process
Runs from pyloric sphincter
to RLQ
Small intestine___________
36

Small intestine has 3 subdivisionsBlood supply: superior

Duodenum 5% of length
Jejunum almost 40%
Ileum almost 60%

mesenteric artery;
Veins drain into hepatic
portal vein

Duodenum is retroperitoneal (stuck down under peritoneum); others are loose


Duodenum receives
bile from liver and gallbladder via bile duct*
enzymes from pancreas via main pancreatic duct*

37

Small intestine designed for absorption

Huge surface area because of great length


Structural modifications also increase absorptive area

Circular folds (plicae circulares)


Villi (fingerlike projections) 1 mm high simple columnar epithelium:
velvety
Microvilli

*
Lacteal*: network of
blood and lymph
capillaries
-Carbs and proteins into blood
to liver via hepatic portal vein
-Fat into lymph: fat-soluble
toxins
38e.g. pesticides circulate
systemically before going to

Absorptivie
cell with
microvilli to
increase
surface
area &
many
mitochondr
ia: nutrient
uptake is
energydemanding

Intestinal crypts

* (of Lieberkuhn) inbetween villi

Cells here divide every 3-6 days to renew epithelium (most rapidly dividing
cells of the body)
Secrete watery intestinal juice which mixes with chyme (the paste that food
becomes after stomach churns it)

Intestinal flora the permanent normal bacteria

Manufacture some vitamins, e.g. K, which get absorbed

Duodenal glands
Mucus to counteract
acidity from stomach
Hormones:
Cholecystokinin (stimulates
GB to release stored bile, also
pancreas)
39
Secretin (stimulates

*
*

-have
many
mitochon
dria:
nutrient
-produce
uptake
is
mucus
energydemandin

General histology of digestive tract

40

41

42

Large intestine
Digested residue reaches it
Main function: to absorb water
and electrolytes

Subdivisions
Cecum
Appendix
Colon
Rectum
Anal canal

43

Three special
features

1.
2.
3.

Teniae coli (3 longitudinal


muscle strips)
Haustra (puckering into
sacs)
Epiploic appendages
(omental or fat pouches)

3.
2.
1.

44

Colon has segments: ascending, transverse and descending colon; then sigmoid colon
Right angle turns: hepatic flexure* in RUQ and splenic flexure* in LUQ

*
*

Between
ileum and
cecum
1st part

S-shaped

Blind tube

45

Movement sluggish and weak except for a few mass peristaltic


movements per day to force feces toward rectum powerfully

Rectum

In pelvis
No teniae
Strong longitudinal
muscle layer
Has valves

Anal canal

Pectinate line*

Hemorrhoids (enlarged
veins)

Inferior to it: sensitive


to pain
Superior to pectinate
line: internal
Inferior to pectinate
line: external

Sphincters (close
opening)

Internal*

smooth muscle
involuntary

External*

46 skeletal muscle

voluntary

*
*

Defecation
1.

2.

3.

47

Triggered by stretching
of wall, mediated by
spinal cord
parasympathetic reflex
Stimulates contraction of
smooth muscle in wall
and relaxation of
internal anal sphincter
If convenient to defecate
voluntary motor neurons
stimulate relaxation of
external anal sphincter
(aided by diaphragm
and abdominal wall
muscles -called Valsalva
maneuver)

Histology large intestine

No villi

Columnar cells in
pic = absorptive
cells

48

Take in water and


electrolytes

A lot of goblet cells


for mucus

Fewer nutrients
absorbed

Lubricates stool

More lymphoid
tissue

A lot of bacteria in

LIVER DAN PANKREAS


Dr. Sri Kartika Sari, SpPK
Kuliah D4 Analis Kesehatan
4 Desember 2013

The Liver

Largest gland in the


body (about 3 pounds)
Over 500 functions
Inferior to diaphragm
in RUQ and epigastric
area protected by ribs
R and L lobes

Falciform ligament

Mesentery binding liver


to anterior abdominal
wall

2 surfaces

Plus 2 smaller lobes

Diaphragmatic
Visceral

Covered by
50
peritoneum

posterior

Fissure on visceral surface


Porta hepatis: major vessels and
nerves
enter and leave - see pics
Ligamentum teres: remnant of
umbilical vein in fetus, attaches to
51

anterior

Fetal
circulation

___________
Umbilical vein

Ligamentum
teres__________

Navel_______

52

53

Just some of the livers repertoire

Produces bile
Picks up glucose from blood
Stores glucose as glycogen
Processes fats and amino acids
Stores some vitamins
Detoxifies poisons and drugs
Makes the blood proteins

54

Liver histology

Liver lobules (about one million of them)

55

Hexagonal solid made of sheets of hepatocytes


(liver cells) around a central vein
Corners of lobules have portal triads
(see next pic)

Portal triad

Portal arteriole
Portal venule

Bile duct

Carries bile away

Liver sinusoids

Branch of hepatic
portal vein
Delivers substances
from intestines for
processing by
hepatocytes

Large capillaries
between plates of
hepatocytes
Contribute to central
vein and ultimately to
hepatic veins and IVC

Kupffer cells

Liver macrophages
Old blood cells and
microorganisms
removed

56

57

Anatomy and Histology of the Liver

Portal triads consist of

Hepatic duct: conduct bile toward the


duodenum
Hepatic artery: supplies oxygen-rich blood
to the liver
Hepatic portal vein: carries venous blood
with nutrients from digestive viscera

The hepatic cords are composed of


columns of hepatocytes separated by the
bile canaliculi
Sinusoids are enlarged spaces filled with
blood and lined with endothelium and
hepatic phagocytic cells

Kupffer cells: hepatic macrophages found in

Fig. 21.18

Functions of the Liver

Produces bile, which contains bile salts that


emulsify fats
Stores and processes nutrients, produces
new molecules, and detoxifies molecules
Hepatic phagocytic cells phagocytize red
blood cells, bacteria, and other debris
Produces blood components

Blood Flow Through the Liver

Branches of the hepatic artery and the


hepatic portal vein in the portal triads
empty into hepatic sinusoids
Hepatic sinusoids empty into central veins,
which join to form the hepatic veins, which
leave the liver

Fig. 21.19
Blood and Bile
Flow Through the
Liver

Hepatocytes (liver cells)

Many organelles

Produce 500-1000 ml bile each day

Rough ER manufactures blood proteins


Smooth ER help produce bile salts and
detoxifies blood-borne poisons
Peroxisomes detoxify other poisons, including
alcohol
Golgi apparatus packages
Mitochondria a lot of energy needed for all this
Glycosomes - role in storing sugar and
regulation of blood glucose (sugar) levels
Secrete into bile canaliculi (little channels) then
ducts

Regeneration capacity through liver stem


cells

63

Bile Transport

Bile canaliculi collect bile from


hepatocytes and join the small hepatic
ducts in the portal triads
Small hepatic ducts converge to form the
right and left hepatic ducts, which exit the
liver
The left and right hepatic ducts join to
form the common hepatic duct
The cystic duct from the gallbladder joins
the common hepatic duct to form the
common bile duct
The common bile duct and pancreatic duct
join at the hepatopancreatic ampulla,

Gallbladder and Bile


Gallbladder

A small sac on the inferior surface of the liver


Stores and concentrates bile

Bile

A yellow-green, alkaline solution containing bile salts,


bile pigments, cholesterol, neutral fats, phospholipids,
and electrolytes
Bile salts are cholesterol derivatives that:

Emulsify fat
Facilitate fat and cholesterol absorption
Helps make cholesterol soluble

Enterohepatic circulation recycles bile salts therefore


they are never voided in the feces
The chief bile pigment is bilirubin, a waste product of
heme.

Bilirubin is metabolized by bacteria in the small intestines


and urobilogen is produced, which gives feces its dark color

Liver, Gallbladder, Pancreas, and Duct


System

Fig. 21.20

Regulation of Bile Secretion


Acidic, fatty chyme causes the duodenum
to release:

Cholecystokinin (CCK) and secretin into the


bloodstream

Cholecystokinin causes:

The gallbladder to contract and releases bile


Relaxation of the sphincters of the bile duct and
hepatopancreatic ampulla

Secretin increases bile secretion (water and


bicarbonate ions)
As a result, bile enters the duodenum

Bile salts and secretin transported in blood


stimulate the liver to produce bile
Vagal stimulation causes weak
contractions of the gallbladder

Control of Bile Secretion and Release


Fig. 21.21

Gallbladder*

Bile is produced in the liver


Bile is stored in the
gallbladder
Bile is excreted into the
duodenum when needed
(fatty meal)
Bile helps dissolve fat and
cholesterol
If bile salts crystallize, gall
stones are formed

Intermittent pain: ball valve


effect causing intermittent
obstruction
Or infection and a lot of pain,
fever, vomiting, etc.

69

Lies in LUQ kind of behind stomach


Is retroperitoneal
Pancreas
Has a head, body and tail
(exocrine and
Head is in C-shaped curve of duodenum
Tail extends left to touch spleen
endocrine)
Main pancreatic duct runs the length of the
pancreas, joins bile duct

70

71

Fig. 21.22

Pancreatic Secretions

The aqueous component of pancreatic


juice is produced by the small pancreatic
ducts and contains bicarbonate ions

Water solution of enzymes and electrolytes


(primarily HCO3)

Neutralizes acidic chyme


Provides optimal environment for pancreatic
enzymes

The enzymatic component of pancreatic


juice is produced by the acini and
contains enzymes that digest
carbohydrates, lipids, and proteins

Enzymes are released in inactive form and

Regulation of Bile Secretion and Release

Secretin stimulates the release of the


aqueous component, which neutralizes
acidic chyme
Cholecystokinin stimulates the secretion
of the enzymatic component and
relaxation of the sphincters of the
pancreatic duct and hepatopancreatic
ampulla
Parasympathetic stimulation increases
and sympathetic stimulation decreases
secretion of enzymes

Fig. 21.23

one acinus

Pancreatic
exocrine function
Compound acinar
(sac-like) glands
opening into large
ducts (therefore
exocrine)
Acinar cells make 22
kinds of enzymes

76

Stored in zymogen
granules
Grape-like arrangement

Enzymes to
duodenum, where

Pancreatic endocrine function


(hormones released into blood)

Islets of Langerhans (AKA islet cells) are


the hormone secreting cells
Insulin (from beta cells)

Lowers blood glucose (sugar)

Glucagon (from from alpha cells)

Raises blood glucose (sugar)

(more later)

77

Endocrine cells:

78

Thank you

dr. Sri Kartika Sari, SpPK


Kuliah D4 Analis Kesehatan
11 Desember 2013

Fungsi Hati

Menghasilkan cairan empedu


Menghasilkan bahan bahan yang terdapat di
dalam darah

Protrombin
Heparin
Fibrinogen
Albumin
Globulin

Menyimpan zat besi dan vitamin (B12, A, D,


K)
Melemahkan / memusnahkan racun dan obat
Metabolisme KH, Protein, Lemak

SISTEM BILIER

Fungsi Kandung Empedu

Penampung empedu yang dihasilkan oleh


hati
Memekatkan empedu

Sebagian besar kandungan empedu adalah air


(90%).
Sisanya tdd : pigmen (bilirubin dan biliverdin),
asam empedu, garam empedu, kolesterol.
Jika pigmen empedu terkumpul secara
berlebihan di dalam darah..tjd jaundice.

Tes faal hati (Liver Function Test) dan Saluran


Empedu
Kerusakan sel hepatosit
SGOT (AST)
SGPT (ALT)
LDH, GLDH.
Sistem bilier/empedu
Bilirubin (serum, urine)
ALP
GGT
Sintesa
Albumin
Faktor Koagulasi

KERUSAKAN SEL

Transminase petunjuk
yang peka kerusakan / nekrosis sel hati

hepatitis virus transaminase


pada hepatitis virus enzim dulu daripada
lain, dan tetap tinggi, lain-lain normal

persistensi
nekrosis oleh karena toksin transaminase

cholestasis, sirosis transaminase

SGOT(Serum Glutamic Oxalocetic


Transaminase ) = AST (Aspartate Transaminase )
JANTUNG, HATI, OTOT-OTOT SKELET,
GINJAL, PANKREAS.
SGPT ( Serum Glutamic Pyruvic Transaminase)
= ALT (Alanine Transaminase )
HATI, JANTUNG, GINJAL, OTOT SKELET.

SGOT dan SGPT


sitoplasma.
SGOT
organel (mitokondria)
Waktu paruh SGOT 18 jam
Waktu paruh SGPT 48 jam

bila tidak terlalu tinggi


sering dipakai ratio sgot / sgpt
( de ritis )
<1
>1

kerusakan hati akut.


kerusakan hati menahun /
sirosis

dasar :
sgpt kerusakan membran.
sgot kerusakan organel.
25

GLUTAMATE DEHYDROGENASE
( GLDH )

terdapat dalam mitokondria sel hati.


pada kerusakan sel yang berat
( nekrosis ).
deteksi dini kerusakan sel hati oleh
karena alkohol.

26

LACTATE DEHYDROGENASE
( LD / LDH )

terdapat dalam semua jaringan


tubuh.
bukan indikator yang peka dan tidak
spesifik untuk nekrosis sel hati
( kecuali LD5 ).

juga pada :

kerusakan organ lain-lain jantung, ginjal.


keganasan.

27

ALKALI PHOSPHATASE
( ALP )

JARINGAN : TULANG, USUS

HALUS,

HATI, PLACENTA.
( TLG 40 70% DALAM SERUM )
PADA ANAK 2 3 X DEWASA.

INDIKATOR YANG PEKA

KOLESTASIS
INTRA HEP.
EXTRA HEP.

PENYAKIT HATI INFILTRATIF O.K. TUMOR/


GARNULOME.

KOLESTASIS BIASANYA > 3 x BATAS ATAS


NORMAL.

28

JUGA PADA KEADAAN BUKAN


PENYAKIT HATI.
(PENYAKIT PAGET, METASTASE TUMORTULANG, HODGKIN TK. I & II,
PYELONEPHRITIS AKUT, ENTERITIS
REGIONALIS, DLL ).

29

GAMMA GLUTAMYL TRANSPEPTIDASE


(GGT)

TERDAPAT PADA JARINGAN HATI, SISTIM


EMPEDU DAN GINJAL.
INDIKATOR PEKA KOLESTASIS
TIDAK SPESIFIK OLEH KARENA PADA :
PENYAKIT NEUROLOGIK
POST INFARK MIOKARD.
OBAT YANG MERANGSANG PROD.
ENZIM (ANTICONVULSANT,
BARBITURAT, ALKOHOL)
30

5 NUCLEOTIDASE
( 5 NT )

TERDAPAT DALAM :
SALURAN EMPEDU
GINJAL
ORGAN LAIN ( SEDIKIT )
KEPEKAANNYA = ALP
( Pada Penyakit Tulang Normal ).

31

FETOPROTEIN
(AFP)

1 GLOB. - JAR. HATI EMBRIONAL,


YOLKSEC & USUS JANIN
NORMAL.
TERDAPAT DALAM SERUM BAYI SAMPAI
UMUR 6 MINGGU.
SEL-SEL HATI GANAS PRIMER ORANG
DEWASA PRODUKSI.
TERDETEKSI CARA ID PADA :
40 80 % HEPATOMA
1/3 TERATOBLASTOMA

32

Pemeriksaan Fungsi Sintesa

Albumin
Faktor Koagulasi :

Faktor koagulasi vitamin K dependent :

Virus penyebab Hepatitis


HAV : Hepatitis A virus
HBV : Hepatitis B virus
HCV : Hepatitis C virus
HDV : Hepatitis D virus
HEV : Hepatitis E virus ( penyebaran secara enterik
di Asia dan epidemik )
HGV : Hepatitis G virus
TTV : TT virus ( penularan melalui transfusi )
SEN-V : non-ABCDE hepatitis ( penularan melalui
transfusi )
99

Pada penderita immunocompromised dan


immunocompetent ( jarang ) harus diingat
sebagai diagnosa banding : virus
Cytomegalo, Epstein-Barr, Herpes simplex.
Peningkatan hebat dari aminotransferase
( ALT/GPT dan AST/GOT dapat terjadi pada
SARS (Severe acute respiratory syndrome )
100

Anti-HAV IgM untuk diagnosis


Hepatitis A akut
Anti-HAV IgG menunjukkan pemaparan
dengan HAV yang lampau,
tidak infeksius, ada kekebalan
Anti- HAV tersebut dapat positif terus
sampai tahunan
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Penanda virus untuk HBV ( virus DNA):


Lihat tabel 15-4 untuk interpretasinya
HBsAg ( infeksius )
Anti-HBs ( memberi kekebalan )
Anti-HBc ( 30% infeksius karena HBV DNA + )
HBeAg ( infeksius )
Anti-HBe ( infeksius )
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Serologic diagnosis of viral hepatitis


Significance

HBsAg

HBeAg

Anti-HBc

Anti-HBc

Anti-HBs

IgG

IgM

IgG

Acute HBV

Chronic HBV,

Resolved HBV

Postvaccine

Active replication

Chronic HBV,
quiescent

Immune HBV
Quiescent = inactive = quiet
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Hepatitis C
Perjalanan infeksi Hepatitis C akut dan
kronik lihat gambar 15-3
Virus RNA ini mempunyai 6 genotipe utama.
Penularan utama melalui transfusi (90%
kasus, sekarang hanya 4% kasus )
Sekarang lebih dari 50% penularan melalui
pengguna suntikan obat/ narkoba
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Koinfeksi dengan virus HCV dijumpai pada


sedikitnya 30% pada kelompok dengan
infeksi HIV. Pada infeksi HIV perjalanan
Hepatitis C kronik lebih cepat progresif
menjadi sirosis hati, sedangkan HCV sendiri
meningkatkan hepato-toxicity terapi HAART
( highly active antiretroviral ) pada infeksi
HIV/AIDS.
Pada kehamilan, transaminase serum dapat
turun menjadi normal walau viremianya
menetap, enzim tsb dapat meningkat lagi
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setelah kelahiran bayi.

Diagnosis Hepatitis C:
adanya anti-HCV (metode EIA )
Anti-HCV tidak mempunyai daya proteksi,
malah pada hepatitis akut maupun kronis
sebagai penanda adanya HCV
sebagai penyebab

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Karena adanya hasil anti-HCV palsu


negatif maupun palsu positif maka diagnosis
hepatitis C dapat dikonfirmasi dengan uji
RNA HCV ( PCR), pada kasus tertentu cukup
dengan uji RIBA.
Hasil RIBA positif berarti infeksius.
Kasus dengan Anti-HCV positif, RIBA positif
tetapi uji RNA HCV serum ( uji PCR ) negatif
berarti adanya rekoveri/ penyembuhan
infeksi HCV masa lampau
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Tes anti-HCV pada donor darah akan


mengurangi risiko hepatitis pasca transfusi
( darah donor dengan anti-HCV positif
akan ditolak)

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Hepatitis E :
Kasus dengan infeksi virus E ini adalah
self-limited ( tidak menjadi carrier ), tetapi
pada wanita hamilmempunyai angka
kematian tinggi (10-20 % )
dan mempunyai risiko yang meningkat
untuk terjadinya dekompensasi hati
pada kasus yang pada dasarnya
mempunyai penyakit hati kronis.
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Pencegahan dengan cuci tangan kita


yerhadap kontaminasi virus.
Jarum suntik disposebel ditangani
dengan baik ( UP ), desinfektan
hipoklorit 0,5-1,0 % atau glutaraldehid 2%.
Skrining darah donor HBsAg, anti HBc
dan anti-HCV
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Pencegahan dengan vaksinasi terhadap


HAV dan HBV
( belum ada vaksin terhadap HCV )
Imunisasi pasif dengan pemberian imun
globulin baik terhadap hepatitis A
maupun hepatitis B (HBIG)
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Prognosis
Hepatitis A :
tidak menyebabkan penyakit hati kronik
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
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Thank You

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