Dr Agasjtya Wisjnu Wardhana SpPD KGEH

FINASIM FACP
 Sirosis hati penyebab kematian ke 8 di AS
 Asites merupakan komplikasi tersering
dibanding ensefalopati hepatikum dan varises
esofagus
 Terdapat 27.000 kematian pertahun
 50% pasien masuk kriteria “kompensata”
 Asites umumnya baru muncul sekitar 10
tahun
Classification Description

Class I Conditions for which there is evidence and/or

general agreement that a given diagnostic evaluation, procedure or
treatment is beneficial,useful, and effective.

Class II Conditions for which there is conflicting evidence

and/or a divergence of opinion about the usefulness/efficacy of a diagnostic
evaluation,procedure or treatment.

Class IIa Weight of evidence/opinion is in favor of usefulness/efficacy.

Class IIb Usefulness/efficacy is less well established by evidence/opinion.

Class III Conditions for which there is evidence and/or general agreement that a
diagnostic evaluation/procedure/treatment is not useful/effective and in
some cases may be harmful.
 Level A Data derived from multiple
randomized clinical trials or meta-analyses.
 Level B Data derived from a single
randomized trial, or nonrandomized studies.
 Level C Only consensus opinion of experts,
case studies,or standard-of-care.
GAMBARAN PERJALANAN SIROS HATI

KARSINOMA
HCV / HBV ALKOHOL HEPATOSELULER
 Drug
Toxicity

Steatosis Alcohol
 Kerusakan parenkhim hati kronik
irreversibel
 Fibrosis luas - distorsi arsitektur
hati
 Pembentukan nodul regenerative
 Spider angiomas
 Palmar erythema
 Perubahan kuku
◦ Muehrcke's nails
◦ Terry’s nails
 Gynecomastia
 Atrophy testis
• Muehrcke's nails • Terry’s nails
• Fetor hepaticus • Cruveilhier-
• Jaundice Baumgarten
• Asterixis murmur
• Pigment gallstones • Hepatomegaly
• Parotid gland • Splenomegaly
enlargement • Caput medusa
~50% of cirrhotic patients
 Tes pemeriksaan hati :
 Enzim hati ( transaminase , alkali fosfatase ,
gamma glutamil transpeptidase , serum
bilirubin).
 Fungsi sintesis hati [albumin , kholin esterase
, protrombin time
• Dapat membantu penegakan diagnostik
tetapi kurang sensitif dan kurang spesifik
• Umumnya melihat komplikasi
1) Asites
2) Pelebaran vena porta
3) Splenomegali
• Biopsi hati

• Bisa melihat penyakit dasar penyebab

• Bila klinis , laboratorium serta radiologis

mendukung bisa menegakkan diagnosis
Alkoholik
HEPATITIS
• Micronodular cirrhosis
– Nodul kurang dari 3 mm diameter
– Disebabkan oleh alcohol, hemochromatosis,
cholestasis akibat sirosis, and obstruksi hepatic
venous outflow
 Macronodular cirrhosis

◦ Nodule lebih dari 3 mm

◦ Sekunder pada chronic viral hepatitis
Lini I
Penghentian alkohol ,
Diet rendah Sodium and edukasi
Diuretik ganda , spironolactone dan furosemide, oral dosis tunggal
Penghentian obat non-steroidal anti-inflammatory drugs
Evaluasiuntuk transplantasi hati
Lini II
Beta blockers, angiotensin converting enzyme inhibitors, and
angiotensin receptor blockers
Penambahan midodrine terutama pasien hypotensive
Paracenteses therapeutic serial
Evaluation untuk transplantasi hati
Transjugular intrahepatic portasystemic stent-shunt
Lini III
Peritoneovenous shunt
 Asites
 Ensefalopati hepatikum
 Varises esofagus
 Gastropati hipertensi portal
 Gangguan fungsi hemostasis