Multiple Nodul Hepar

Stase Gastro
LIVER LESIONS
BENIGN MALIGNANT
 Liver cysts  Metastasis
 Cyst adenoma  Hepatocellular carcinoma
(hepatoma)
 Biliary hamartomas
 Fibrolamellar carcinoma
 Hemangioma
 Intrahepatic
 Focal nodular hyperplasia cholangiocarcinoma
 Hepatic adenoma  Hepatoblastoma
 Regenerative nodules  Infantile
 Atypical regenerative nodules hemangioendothelioma
 Biliary cystadenoma
/cystadenocarcinoma
 Angiosarcoma
 Epithelioid
hemangioendothelioma
 Lymphoma
 PADA KASUS :
• Lesi Multipel

CURIGA METASTASIS

Gore et al. Management of Incidental Liver Lesions on CT: A White Paper of the ACR
Incidental Findings Committee. J Am Coll Radiol 2017:1-9.
Jawad Ahmad, Scott L. Friedman, Henryk Dancygier. Mount Sinai Expert Guides: Hepatology (2014)
Gambar MSCT Abdomen 3 Fase pada Pasien
Gambar MSCT Abdomen 3 Fase pada Pasien
 Pada kasus :
• Perubahan pola BAB
(-)
• Nyeri perut (+)
• Gangguan BAK (-)
• Pembesaran KGB (+)
• HbsAg: NR
• Anti HCV: NR
• Anti HbC 0.05
(Reaktif)
• AFP 2.1
Sumber primer belum
diketahui

Turdean S, et al. Liver Metastases: Incidence and Clinicopathological Data. Acta Medica Marisiensis 2012;58(4):254-258.
 2010 AASLD Algorithm for Investigation of Small Nodules
Found On Screening in Patients with Cirrhosis
DIAGNOSIS : patients with cirrhosis or chronic hepatitis (even without cirrhosis)
Liver nodule

< 1 cm > 1 cm

4 – phase MDCT/dynamic
Reapeat US at 3 months Contrast enhanced MRI

Arterial hypervascularity AND

venous or delayed phase washout

Growing/changing Stable
character
Other contrast enhanced No
Yes
Study (CT or MRI)

Arterial hypervascularity AND Biopsy

Investigate HCC venous or delayed phase washout
according to size

Yes No

Bruix J and Sherman M. AASLD Practice Guidelines , Management of Hepatocellular Carcinoma Hepatology November 2011
KEBUTUHAN NUTRISI

• TB 166, BB 46 kg, IMT 16,63

• Kebutuhan kalori basal = BB x 30 kal = 46 x 30 = 1380 kal
• Kebutuhan kalori basal + aktivitas fisik 10% + stress metabolik 20% = 1794 kal
• Kebutuhan protein 1,5 g x BB = 1,5 x 46 = 69 g x 4 kal = 276 kal
• Kebutuhan lemak dan karbohidrat = 1794 – 276 = 1518 kal
• Karbohidrat : lemak = 70 : 30 = 1062 kal : 456 kal
 Sintesa Stase
Data: Laki-laki 56 tahun, Nyeri perut bagian kanan atas dan perut membesar selama 5 bulan. Riwayat BB
turun 9 kg dalam 5 bulan (55->46 kg). Riwayat minum alcohol sekitar 3 tahun, perubahan pola BAB(-), sakit
kuning (-), penggunaan jarum suntik (-), minum jamu – jamuan (-).

Pemeriksaan fisik :
- Pembesaran KGB multiple sin 1x0,5 cm, lunak, mobile, tidak nyeri, warna kulit sama dengan sekitar.
- Hepatomegaly (teraba massa ukuran 15x10 cm, bernodul-nodul, batas tidak tegas) tepi tumpul, NT (+)

Penunjang:
Alb: 7,2 OT: 77 PT: 60 AFP: 2,1 hbsag NR antihcv NR anti HBC 0.05
USG abd 22/1/19: suspek multifokal KHS dd nodul metastase, pembesaran kel.limfe paraaorta
MSCT Abdomen 10/2/19: multiple nodul metastase hepar (metastasis hypovaskuler kemungkinan dari
epitelial tumor), multipel limfadenopati paraaorta, nefrolitiasis kecil pada ren sinistra
Ro Thorax 16/2/19: efusi pleura dex minimal dd subpleural type pulmonal metastasis

Assesment:
• Multipel limfadenopati cum multiple nodul hepar et causa susp limfoma dd karsinoma hepatoseluler
Plan:
- Diet 1800 kalori per hari
- pain managemen
- AJH hepar