Viral Hepatitis new.pptx
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Transcript of Viral Hepatitis new.pptx
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Viral HepatitisOleh :
Yosin Guruh Herawati (09-024)Lidya Dinda Dwi D. (09-025)
Meita Eryanti (09-026)
Maya Nuswantari (09-027)
Defi Krishartantri (09-031)
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Patofisiologi Hepatitis A
HVA yang terdapat pada makanan, dan air yang tekontaminasi masuk ke dalam
saluran pencernaan
Menuju hati(vena porta),lalu menginvasi ke sel parenkim hati.
Di sel parenkim hati virus mengalami replikasi yang menyebabkan sel parenkim
hati menjadi rusak
. Sel parenkim yang telah rusak akan merangsang reaksi inflamasi akan
menekan ductus biliaris sehinnga aliran bilirubin direk terhambat
Bilirubin konjugasi(direk) akan terus menumpuk dalam sel hati yang akan
menyebabkan reflux(aliran kembali keatas) ke pembuluh darah
partikel bilirubin direk berukuran kecil sehingga dapat masuk ke ginjal dan di
eksresikan melalui urin.
Akibat bilirubin direk yang kurang dalam usus mengakibatkan gangguan dalam
produksi asam empedu (produksi sedikit) sehingga proses pencernaanmenyebabkan timbulnya gejala mual, muntah dan menurunnya nafsu makan
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Patofisiologi hepatitis B
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Patofisiologi Hepatitis C
VHC Masuk ke hepar
Hepar
rusak
Salinan-salinan
virus VHC
(quasispecies)
bereplikasi
RNA-dependent
RNA polimerase
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Gejala & Tanda
Hepatitis A Kulit dan mata menjadi kuning
Sakit perut bagian kanan atas
Hilangnya nafsu makan
Mual & muntah
Feses berwarna gelap
Umumnya gejala ini munculnya 2-4 minggu
setelah terinfeksi
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Hepatitis B
Akut
Kulit dan mata menjadi kuning
Sakit perut bagian kanan atas
Hilangnya nafsu makan
Mual & muntahFeses berwarna gelap
Umumnya gejala ini munculnya 4-6
minggu setelah terinfeksi
Hepatitis B
Kronik
Bila sistem kekebalan tubuh
tidak mampu mengendalikan HBV
selama 6 bulan, maka gejala
Hepatitis B kronis bisa muncul.
Gejala = Hepatitis A.
Namun gejala tambahan yang
terjadi berupa ruam, urtikaria,
peradangan sendi, dan
polineuropati
Gejala & Tanda
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Hepatitis C
Hilangnya nafsu makan
Mual & muntah
Demam
Sakit kuning
Hilangnya berat badan
Sakit pada otot dan sendi
Perut membuncit
Umumnya gejala ini munculnya 5-8
minggu setelah terinfeksi
Gejala & Tanda
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TREATMENT FOR HAV
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DESIRED OUTCOME
Complete clinical resolution
Reducing complications from the
infection
Normalization of liver function
Reducing infectivity and transmission
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GENERAL APPROACH FOR
TREATMENT No specific treatment option => general suporting care
Patient who liver failure => transplantation liver
Steroid use is not recommended!
Prevention and prophylaxis
Imunoglobulin => prophylaxis and passive immunity Vaccination => active immunity
Prevaccination serologic testing to determinesusceptibility
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PREVENTION HAV
Routine prevention of HAV
transmission includes regular hand
washing with soap and water after
using the bathroom, changing adiaper, and before food preparation.
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Di AMERIKA..
Vaccines to prevent HAV
havrix
Pake pengawet 2-phenoxyphenolantigen is expressed as ELISA
units
Vaqta
Gak pake pengawetuses units of HAV antigen to
express potency
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Side effect:
The most common: soreness and warmth at the
injection site, headache, malaise, and pain.
The serious adverse event: anaphylaxis, guillain-
Barre syndrome, brachial plexus neuropathy,
transverse myelitis,multiple sclerosis,
encephalopathy, and erythema multiforme.
THE VACCINE IS CONSIDERED
SAFE!!!
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Immunoglobulin
Provides protection by passive transfer of antibody
Most effective if given in the incubation period of theinfection (the first 2 weeks)
Do not need for people who just received HAVvaccine
Serious adverse events are rare => that may happen:anaphylaxis
Postexposure prophylaxis
short-therm preexposure
coverage < 3 months
A single dose of
0,02 mL/kg I.M
Deltoid or glutealmuscle
Long-therm preexposure
prophylaxis < 5 months
A single dose of
0,06mL/kg I.M
Younger than 24 months Anterolateral muscle
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Imunoglobulin.
Can interfere with the response ofother vaccines (MMR and varicella)
and should be delayed.
In general, Ig doesnt interfere withinactived vaccines and may be
administered safely with other
vaccines.
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TREATMENT FOR HBV
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Desired outcome
Increase the chances for
seroclearance
Prevent disease progression to
cirrhosis and HCC
To minimize further injury in patients
with ongoing liver damage
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General approach treatment
Not all chronic HBV patients are candidates
for treatment. Some patients may be best
managed with periodic monitoring fordisease progression because the chances
for therapeutic response are unlikely and do
not outweigh the risk and costs associated
with treatment.
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TREATMENT FOR HCV
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Desired outcome
To eradicate HCV infection
Even patients who are unable to
achieve cure may see historical
improvements with therapy.
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General approach to treatment
Treatment is indicated for patients
previously untreated who have chronic
HCV, circulating HCV RNA, increased ALT
levels, evidence on biopsy of moderate tosevere hepatic grade and stage, and
compensated liver disease.
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Therapy is not without risk, and somecases may not be recommended
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Before therapy is initiated.
Quantitative HCV testing => to obtain
baseline information on the viral load
Genotyping => to deside response to
therapy and duration of therapy
Liver biopsy => to determine histologic
grade and stage and to guide therapy
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Treatment response is monitored according to
the following terminology:
Early virologic response (EVR): patient who experiences atleast 2-log reduction in viral load by the 12th week oftreatment
End-of-treatment response (ETR): patient with no detectableviral load at the end of treatment
Sustained virologic response (SVR): patient with nodetectable viral load at the conclusion of therapy and 6months later
Relapser: patient who responds to therapy but whose viralload becomes detectable at the conclusion of therapy
Nonresponder: patient with a stable viral load during the
course of therapy Partial responder: patient with t least a 2-log reduction in
viral load but who never has undetectable viral levels.
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Nonpharmacology therapy
Patients should be encourage to maintain
good overall health, stop smoking, and
avoid alcohol and illicit drug.
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Pharmacology Therapy
The current standard treatment => combinationtherapy of a once-weekly of PEG-IFN and daily
oral dose ribavirin.
Therapy is optimized based on genotype, patient
weight, and response to therapy.
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Algoritma therapy HCV
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Interferon.
PEG-IFN yang efektif dan aman.
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Ribavirin.
Ineffective as a monotherapy
Dosed based on weight
Side effect nya banyak Inevitable effect: ANEMIA
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Alternative treatment.
VX-950
valopcitabine
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In special population
Patient withnormal ALTs
Patients withdecompensated
cirrhosis
Relapsedpatients
nonresponders
Accidentalneedle-stickexposures
Intravenous-drug users
alcoholismEnd-stage renal
disease
HIV infection Children
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Kasus
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Riwayat pengobatan pasien
Pria Caucasian (43 thn)
Hepatitis B
thn 1996
150mg/hari
Before
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150mg/hari
HBIg
Uji Lab bulan Maret 2000
Uji
LaboratoriumHasil Normal
ALT 503 IU/L 10-40 U/L
AST 366 IU/L 14-20 U/L
ALP 322 IU/L 25-100 U/L
Bilirubin 52 mol/L 5-17mol/L
albumin 43 g/L 35-48 gr/L
Kreatinin 147 mol/L 80-115 mol/L
WBC 3.5 4,5-10,5 x 103/sel/mm3
platelets 97 140-400 x 103/mm3
HBV DNA titre >40 juta negatif
4 minggu kemudianpasien mengalami graft failure with ascites & jaundice
Uji
LaboratoriumHasil
ALT 488 IU/L
AST 557 IU/L
ALP 260 IU/L
Bilirubin 260 mol/L
Albumin 33 g/L
Kreatinin 160 mol/L
WBC 2,3
Platelets 134
HBV DNA titre 9 juta
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150mg/hari
HBIg
100mg/hari 10 mg/hari HBIg
Kurva waktu pengobatan vs Bilirubin, ALT, HBV DNA
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Lamivudine treatment HIV dan HBV
HBIg memberikan imunitas pasif pada infeksi
hepatitis B
Adefovir pengobatan hepatitis B kronik
Obat yang diberikan
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DTP Keterangan
Penggunaan Obat tanpaIndikasi
Tidak Ada
Adanya Indikasi dan Tidak
Diterapi
Tidak Ada
Pemilihan Obat Tidak Tepat Tidak Ada
Dosis kurang atau lebihDosis berlebih (sebelum transplantasi hati)menurut Dipiro dosis treatment Hepatitis B
100mg/hari
Interval dan Lama Pemberian
Tidak Tepat
Pada pengobatan tidak diketahui berapa
lama penggunaan obat
ESO Tidak Ada
Interaksi Obat Tidak Ada
DTP
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Monitoring Pasien
1Monitoring terhadap data-data laboratorium
( bilirubin, ALT, dan HBV DNA )
2
Monitoring efek samping obat yang mungkin timbul
selama pengobatan
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Matur Nuwun..............