Modul

Penyakit Hati Khronis

Dr. I Gede Arinton,SpPD
Bagian/SMF. Penyakit Dalam
RSUD. Margono/FK UNSOED
Purwokerto
2005

Paradigma Lama

Paradigma Baru

15-20 tahun

Reversibel ------------- obat anti fibrotik

Symptom
& sign
Hepatic
insufficiency
Portal
hypertension

Prognosis

Portal Hypertension
Compression
Portal vein,hepatic veins, sinusoids
Obstruction of portal blood flow
Portal Hypertension
Venous pressure, splenomegaly,
collateral circulation (caput medusae),
esophageal & gastric varices,, &
hemorrhoids, ascites,

Hepatic Encephalopathy
BRAIN
Porta systemic
shunts
LIVER

Toxic N2 metabolites
From Intestines

Hepatic Encephalopathy
Bacterial & enzymatic deamination of amino
acids in the intestines ammonia without
liver detoxification crosses blood-brain
barrier toxic neuro symptoms
Euphoria, irritability, confusion, slurred
speech, slow & deep respiration, hyperactive
reflexes, positive Babinskis reflex
Asterixis, fetor hepaticus, deep coma

Hepatorenal Syndrome
Portal hypertension splanchnic
& systemic vasodilation
arterial blood volume renal
vasoconstriction renal failure
Fungsional

Modul
ASITES
Dr. I Gede Arinton,SpPD
Bagian/SMF. Penyakit Dalam
RSUD. Margono/FK UNSOED
Purwokerto
2005

 Ascites ---- bhs.

Yunani askos ---
kantong.
sejak Hippocrates 400 SM
- parasintesis-Th/.

Komplikasi

Pemeriksaan

Anamnesis
Dimensi :
Perut membesar seperti ada
cairan
Sejak ?
G/ yang menyertai :
Hati
Jantung
Ginjal

Pemeriksaan fisik
Inspeksi :
perut katak
Hernia umbilikalis

Palpasi - cembung

Pemeriksaan fisik
Perkusi :
Kranial-kaudal

Pemeriksaan fisik
Perkusi :
Medial-lateral: pekak alih

Pemeriksaan fisik
Perkusi :
Undulasi

Pemeriksaan fisik
Auskultasi Tanda Puddle

Hepatic Cirrhosis

Introduction
Cirrhosis is common end result of
many chronic liver disorders.
Starts as hepatocellular necrosis &
inflammation .
Proceeds to bridging fibrous septa.
Regeneration of remaining
hepatocytes form nodules.
Loss of normal architecture &
function.

Definition:
Diffuse disorder of liver characterised
by;
Complete loss of normal
architecture,
Replaced by extensive fibrosis with,
Regenerating parenchymal nodules.

Etiology of Cirrhosis
Alcoholic liver disease

60-70%

Viral hepatitis

10%

Biliary disease

5-10%

Primary hemochromatosis 5%
Cryptogenic cirrhosis

10-15%

Wilsons, 1AT def

rare

DIAGNOSIS
Can be asymptomatic for decades
History
Physical findings: Hepatomegaly,
jaundice, ascites, spider angioma,
splenomegaly, palmar erythema,
fetor hepaticus, purpura etc.
Elevated LFTs, thrombocytopenia,

DIAGNOSIS
Definitive diagnosis is by biopsy
or gross inspection of liver
Noninvasive methods include
US, CT scan, MRI
Indirect evidence - esophageal
varices seen during endoscopy

Acute Variceal Bleeding