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HEPATITIS AOLEHAYU RAHAYU
NIM: 0608120857
Supervisor:dr. Muhammad Nur, SpA
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Definition
Hepatitisviral infection at hepar
Hepatitis A hepatitis caused by HAV (RNA
viral -FamilyPicornavirus.)
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CLINICAL MANIFESTATION
>90% asimptomatik
preicterik phase : prodromal (fever, malaise,
nausea, vomit, anoreksia, abdominal pain,
diarre)
icterik (30%)10 days after that patient had
abdominal pain at upper right quadran,
hepatomegali, yellow urine, stool feces, yellow
skin and sclera, anoreksia, nausea, vomit.
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Patophysiologi
HAV enter to hepar and GIT through blood,
and replication at hepatosit
From hepar HAV eliminated at sinusoid ,
kanalikuli and go to the intestine after clinical
manifestation and laboratorium result
appearance
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IgM anti-HAV examination can stay in body 3-6
month
IgG anti-HAV can detection in 5-6 weeks after
infection
Polymerace Chain Reaction(PCR)
Protrombin Time(PT)
elevate urinalisis ; bilirubin urin dan urobilinogen,
bilirubin serum, alkalifosfatase.
Support examination
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Management
Bed rest
Avoid hepatotoksik material
vaksination
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CASE ILUSTRATION
Identity: An. S, perempuan, 13 years old,
Admitted to hospital : 7 -04-2014
Alloanamnesis: mother Chief complain: eye becoming yellow since 1
week
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Present Historical Disease
10 days, fever, nausea, vomit 2x contains food
Decrease of apetite, headache, abdominalpain at umbilical, brown feces, normal urine
1 week yellow eye, then skin become yellow,
fever (-), abdominal pain at umbilical, yellowfeces
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Past historical disease and family :
Same complain (-)
Imunitation : completeHome and environment :
Living in semipermanent house, clean
environment,
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Physical examination
General condition : mild
Counciusness : compomentis
Vital sign
Blood pressure: 120/80 mmHg
temperatured : 36,5 C
Heart rate : 98
Respiration 20 x/i
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nutrition:
height : 157 cm
weight : 50 kg Arm sircum: 25,5 cm
Head sircum : 54 cm
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Nutrition status : normal
Head : normocephali
Hair : black Eye : Konjungtiva anemis (-/-),
Sklera ikterik (+/+) bright
yellow,isokhor,diameter 3mm/ 3mm, lamp
Reflek : direct +/+, undirect +/+
Nose, mouth : normal
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Neck : enlargement limf(-), Kaku kuduk (-)
Paru : normal
Jantung : normal Abdomen :supel, hepatomegali 1/3
1/3,licin, press pain(+) at regio hipokondrium
dextra
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Genitalia :normal
Ekstremity : warm, CRT < 2 detik, edem (-
),ekstremitas jaundice (-)
Sistem neurologis : Reflek fisiologis (+/+)
normal, Reflek patologis (-/-)
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PEMERIKSAAN PENUNJANG
07 April 2014 :
Darah rutin
Hb : 12.7 g/dl, Ht : 32.3 %, Leu : 9700/
mm, Trom : 308.000/ mm Kimia darah
Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88
mg/dl, AST : 180 IU/L, ALT : 807 IU, Ureum : 15mg/dl, Creatinin : 0,40 mg/dl, BUN : 7,0 mg/dl,Albumin : 4, 31 gr/dl
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Pemeriksaan Koagulasi Darah :
FIB (PT PLUS) : 2, 761 g/L
PT HS Plus : 13,9
APTT : 34,0
Pemeriksaan Imunoserologi :
Anti HAV IgM : Reaktif 3,05
HbsAg kualitatif : Non Reakif
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10 April 2014
Urin :
Makroskopis : Warna kuning pekat
Mikroskopis :
Eritrosit 3-4 /LPB, Leukosit : 5-6 /LPB, Epitel +,Hialin +, Epitel lilin +, Bilirubin urin +
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Important thing in anamnesis
High fever, countinious
Decrease of appetite, nausea(+), vomit(+)
Headache, Yellow urine
Yellow eye
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Important thing in physical
examination
Nutrition statusnormal
eye: sklera ikterik +/+ bright yellow
Palpation of abdomen : hepatomegali
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Important thing in supporting
examination
Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88
mg/dl, AST : 180 IU/L, ALT : 807 IU
FIB (PT PLUS) : 2, 761 g/L, PT : 13,9. APTT :
34,0, Anti HAV IgM : Reaktif 3,05, HbsAg
kualitatif : Non Reakif
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Urinalisis
Makroskopis : yellow
Mikroskopis : Eritrosit 3-4 / LPB, Leukosit urin :1-2 / LPB, Epitel : +
Kimia Urin
Bilirubin urin : +
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DIAGNOSIS : Hepatitis virus A
NUTRITION DIAGNOSIS :Normoweight
THERAPY Medikamentosa : IVFD D5 NS 20 tpm (makro)
Domperidon syrup 3x 1cth
Curcuma 2x 1 tab
Nutrition: 1840 kkal
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PROGNOSIS
Quo ad vitam : bonam
Quo ad fungsionam : bonam
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FOLLOW UP & PEMBAHASAN
7/4/2014.
nausea, fever(-), vomit(-), epigastric pain (+).
BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:
hepatomegali, yellow skin of all body.
Urinalisis: deep yellow urine, Bilirubin urin : +
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Lab: leu 9.700/mm; Hb 12,7 mg/dl; Ht 35,4 %;
platelet 308.000/mm, Bil D : 6,12 mg/dl, Bil T :
8 mg/dl, Bil I : 1,88 mg/dl, AST : 180 IU/L, ALT :
807 IU, Anti HAV IgM : Reaktif 3,05.
Assessment: Hepatits A. IVFD D5 NS 20 tpm
(makro), Domperidon syrup 3x 1cth, Curcuma
2x 1 tab.
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This patien had been diagnosed with hepatitis A,
because :
Have prodromal sign like : fever, nausea, vomit,
headache, epigastric pain, decrease of appetitude
Icteric phase : deep yellow urine because of
problem at transportation, konjugation and
ekscretion of bilirubin. Icteric sklera +/+, kadar bilirubin direk (6,12
mg/dl) and bilirubin indirek up to (1,88 mg/dl).
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Icterus happen because obstruction of bile
flow and damaged of hepatosit
Sklera become ikterik if blood bilirubin2-
2.5 mg/dl or more.
Hepatomegali happen because compensation
damaged of hepatosit
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9/4/2014.
nausea, fever(-), vomit(-), epigastric pain (+).
BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:
hepatomegali, yellow skin of all body
Assessment: Hepatits A. IVFD D5 NS 20 tpm
(makro), Curcuma 2x 1 tab.