Sirosis

Anatomi
 Fisiologi
Liver

regulasi
regulasi produksi
hematolo
metabolik empedu
gik
 Regulasi Metabolik Regulasi Hematologik

metabolisme karbohidrat
fagositosis antigen
metabolisme lipid
sintesis protein plasma
metabolisme asam amino
menghilangkan hormon
menghilangkan hasil yang ada disirkulasi PD
buangan (waste product
removal) menghilangkan antibiotik
penyimpanan vitamin menghilangkan toksin
penyimpanan mineral sintesis dan sekresi
empedu
inaktivasi obat
PRODUKSI EMPEDU

cystic duct

common bile duct

common hepatic duct
Patofisiologi Stenosis (Fatty Liver)

V. Martin Dominguez, et. al

Patofisiologi Sirosis
Ascites

(Dipiro, 2008)
esophageal hemorrhage
portal hypertension

increase portal vein pressure (PVP)

backflow of blood from portal vein to vein

raise esophageal transmural pressure

esophageal and gastric varices

PVP >12 mmHg increase risk of hemorrhage

(Koda-kimble,2012)
Hepatic Encephalopathy
Hepatorenal Syndrome
Penatalaksanaan Ascites (EASL, 2010)
Grade of Ascites Definition treatment

mild ascites only

Grade 1 detecable by no treatment
ultrasound

moderate ascites
evident by moderate restriction of sodium
Grade 2
symmetrical distension intake and diuretics
of abdomen

large volume
paracentesis followed
large or gross ascites by restriction of
Grade 3 with marked abdominal sodium intake and
distension diuretics (unless
patients have
refractory ascites)
Mekanisme Kerja Diuretik

(Katzung, 2012)
 Outcome therapy
weight loss 0.5 kg/day (without
peripheral edema)
weight loss 1 kg/day (with peripheral
edema)

(EASL, 2010)
Esophageal
hemorrhage

Sarin, 2011
Sarin, 2011
 Hepatic
encephalopath
y

EASL, 2014
Diagnostic
Testing

(Lab)

EASL, 2014
Nonabsorbabl
e disaccharide

Lactulosa
25 ml syrup Prebiotic Effect
setiap 12 jam Laxative Effect

Rifaximin 3 6 bulan
Menurunkan amonia

Glutaminase Inhibitor Menurunkan amonia

Other Antibiotics Neomycin

Metronidazole
Flumazenil

Albumin
EASL, 2014
EASL, 2014
EASL, 2014
Hepatorenal
syndrome

EASL, 2010
EASL, 2010
EASL, 2010
EASL, 2010
EASL, 2010