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Variceal bleeding
Ascites, refractory ascites
Hepatorenal syndrome
Hepatic encephalopathy
Spontaneous bacterial
peritonitis
Hepatocelluler carcinoma
Causes of death
Variceal hemorrhage
Spontaneous bacterial
peritonitis
Sepsis
Liver failure
Hepatic coma
Functional renal failure
Hepatocelluler carcinoma
Portal Hypertension Syndrome
Continuing Liver damage
Nodular regeneration
Fibrosis
Increased sinusoidal
pressure
Portal Hypertension
Algorithm For
Cirrhosis Without
Bleeding
Cirrhosis
Established
Upper Endoscopy
Algorithm For
Bleeding Cirrhotis
Resuscitae
Begin Octreotide
(or Vasopressin)
Early endoscopy
Rebleeding No rebleeding
Continue treatment
Shunt (Child A)
TiPSS. or Preventation of Rebleeding
• Pharmacological Treatment
Liver transplantation (Child B or C) • Ligation /Sclerotheraphy
Reguler Interval
Usually one week
Eradication
Repeated Endoscopy
3 – 6 month
Rebleeding
Shunt (Child A)
TIPSS or Liver transplantation
(Child B or C)
Dosis dan cara pemberian obat-obat vasoaktif pada perdarahan
varises
Pungsi asites:
periksa: PMN
Kultur
PBS
BMNN
(Bakterasites Monomikrobial
Non-Neutrosistik)
Penatalaksanaan Peritonitis Bakterialis Spontan
Ofloksasin
Antibiotik pilihan : Siprofloksasin
Sefotaksim 1-2 gram/hari selama 5-7 hari Dosis standar
Amoksisilin+Asam klavulanat selama 5-7 hari 5-7 hari
Antibiotik
Ganti antibiotik
diteruskan
HEPATORENAL SYNDROME
Pathogenesis of Hepatorenal Syndrome
Cirrhosis
Sinusoidal portal
hypertension
Splanchnic vasodilatation
Arterial underfilling
Renal vasoconstriction
Hepatorenal syndrome
HEPATOCELLULAR CARCINOMA
Treatment of HCC depends on
1. Local resources
2. Stage of the disease
3. Presence of cirrhosis
Liver Transplantation
Hepatic resection treatment of choice for
the few patients with HCC and normal liver.
Trans Arterial Chemo Embolization
Cytostatica
Interferon
Five years survival of pts with HCC treated by transplantation in 82
Europeans centers between 1988 and june 1994
p = 0.0004