Penatalaksanaan

Sirosis Hati dan

Hepatitis

Penatalaksanaan hepatitis B
Pengobatan medika mentosa meliputi :
Interferon alfa
Pegylated iFN-a 2A
Lamivudine
Adefovir dipivoxil
Entecavir
Telbivudine
tenofovir

Interferon alfa
Sejenis protein yang memiliki sifat antiviral , antiproliferative dan
efek mediator inflamasi
Efek kerja anti virus pada interferon :
Mengikat 2 macam enzim yaitu protein kinase dan 25oligodenylate
synthetase
Indikasi :
1. Penderita dengan HBeAg dan HBV-DNA positif.
2. Penderita Hepatitis Kronik Aktif, dibuktikan dengan pemeriksaan
histopatologi.

Lamivudine
It is phosphorylated to the triphosphate (3TC-TP) which competes with dCTP
for incorporation into growing DNA chains, causing chain termination
Deoxycytidine triphosphate (dCTP) is a nucleoside triphosphate that
contains the pyrimidine base cytosine. The triphosphate group contains highenergy phosphoanhydride bonds, which liberate energy when hydrolized.
This may occur during reverse transcription of the first strand of HBV DNA,
and during synthesis of the second strand of HBV DNA
Lamivudine may also reverse the T cell hyporesponsiveness to hepatitis B viral
antigens observed in patients who have chronic HBV infection, although this
effect appears to be transient

Adefovir divifoxir
Adefovir is another third-line agent that is indicated for
treatment ofchronic hepatitis B disease with evidence of
active viral replication
This agent is a nucleoside analogue, a potent inhibitor of
the viral polymerase.
The optimal dose seems to be 10 mg/day
nephrotoxic

Entecavir
This drug is a potent guanosine analogue inhibitor of the
viral polymerase
Advantages of therapy with this agent include potent
antiviral activity and a lowdrug resistance rate

Telbivudine

A cytosine nucleoside analogue

Second-line agent
This drug is a potent inhibitor of HBV DNA polymerase
it is more expensive and plays a limited role in primary
therapy

Tenofovir
Tenofovir is a nucleotide analogue (adenosine
monophosphate) reverse transcriptase and HBV
polymerase inhibitor.
Tenofovir may be used as first-line therapy for treatmentnave patients
preferred as additional therapy in patients with resistance
to 3TC, telbivudine, or entecavir

Dietary change
For individuals with decompensated cirrhosis (prominent
signs of portal hypertension or encephalopathy), the
following dietary limitations are indicated:
1. A low-sodium diet (1.5 g/day)
2. High-protein diet (ie, white-meat protein [eg, chicken,
turkey, fish])
3. Fluid restriction (1.5 L/day) in cases of hyponatremia

Penatalaksanaan sirosis
Specific medical therapies may be applied to many liver
diseases in an effort to diminish symptoms and to prevent or
forestall the development of cirrhosis
1. Prednisone and azathioprine - For autoimmune hepatitis
2. Interferon and other antiviral agents - For hepatitis B and C
3. Phlebotomy - For hemochromatosis
4. Ursodeoxycholic acid - For primary biliary cirrhosis
5. Trientine and zinc - For Wilson disease

 Once cirrhosis develops, treatment is aimed at the

management of complication as they arise
Liver transplantation
Patients should be referred for consideration for liver
transplantation after the first signs of hepatic
decompensation.

SKDI 2013

Sirosis Hepatis
1) mencegah kerusakkan lebih jauh pada hati, 2)
mencegah komplikasi-komplikasi sirosis,
3) mencegah kanker hati atau mendeteksinya dini, dan
4) pencangkokan hati.

Model for End-stage Liver Disease score = 6.43 + 3.78 Ln(serum total bilirubin [mg per dL]) +
11.2 Ln(International Normalized Ratio) + 9.57 Ln(serum creatinine [mg per dL])