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Pemicu 3 "Medical Check-Up": Mishael Octaviany Jireh 405130097
Pemicu 3 "Medical Check-Up": Mishael Octaviany Jireh 405130097
“MEDICAL CHECK-UP”
Mishael Octaviany Jireh
405130097
CIRRHOSIS
• Cirrhosis is defined as a diffuse process characterized
by fibrosis and the conversion of normal liver
architecture into structurally abnormal nodules.
• Its major causes include chronic viral infections,
alcoholic or nonalcoholic steatohepatitis (NASH),
autoimmune diseases affecting hepatocytes and/or
bile ducts, and iron overload.
• Cryptogenic cirrhosis : unknown cirrhosis.
• Fibrous septa in the form of delicate bands or
broad scars around multiple adjacent lobules.
• Parenchymal nodules, ranging in size from
very small (less than 3 mm in diameter—
micronodules) to large (over 1 cm—
macronodules), encircled by these fibrous
bands.
Alcoholic Cirrhosis
Postnecrotic Cirrhosis
Passive Congestion
Cardiac Cirrhosis
Billiary Cirrhosis
Macronodul Cirrhosis Micronodul Cirrhosis
(Hep B n C, Wilson, a1 antitrypsin def) Chronic Alcoholism, Hemokromatosis
Complications
• Hepatic failure
• Portal hypertension
• Ascites
• Bacterial peritonitis
• Esophageal varices
• Encephalopathy hepaticum
• Increased risk for development of hepatocellular
carcinoma
Portal hypertension
• Increased resistance to portal blood flow may develop
from prehepatic, intrahepatic, and posthepatic.
• The dominant intrahepatic cause is cirrhosis,
accounting for most cases of portal hypertension.
• Portal hypertension in cirrhosis results from :
– Compression of central veins by perivenular fibrosis and
expanded parenchymal nodules Increased resistance to
portal flow at the level of the sinusoids.
Ascites
Diagnosis Ascites
• Inspeksi = perut buncit, umbilikus – Asites hemoragik : kemerahan, sering
bergerak seolah ke arah kaudal dihubungkan dengan keganasan. (
mendekati symphisis os pubis, sering ruptus kapiler peritoneum yang
menyebabkan sirosis hati)
dijumpai hernia umbilikalis akibat – Chillous ascites ruptur pembuluh
tekanan intrabdomen. limfe.
• Perkusi = pekak, shifting dullness + – Serum-ascites albumine gradient :
• Pemeriksaan khusus = pudle sign untuk membedakan asites hipertensi
porta atau asites eksudat. Jika gradien
untuk menemukan asites. tinggi (>1,1gr/dL) hipertensi porta.
• Pemeriksaan penunjang = USG – PMN >250mm3 = Peritonitis bakteri
spontan. MN = Peritonitis tuberkulosa /
karsionmatosis.
– Polimikroba = asites akibat perforasi
usus. Monomikroba = peritonitis
bakteri spontan.
• Pemeriksaan cairan asites :
Portosystemic Shunt
Hepatorenal sydrome
Prognosis
HCC
Epidemiology
• The highest incidences of HCC are found in Asian countries
(southeast China, Korea, Taiwan) and sub-Saharan African
countries in which HBV is transmitted vertically.
• Aflatoxin, which when combined with HBV infection
increases the risk of hepatocellular carcinoma dramatically.
• In Western countries the incidence of hepatocellular
carcinoma is rapidly increasing, largely owing to the
hepatitis C epidemic.
Morphology
(1) Unifocal, usually massive tumor
(2) Multifocal tumor made of nodules of variable size.
(3) Diffusely infiltrative cancer, permeating widely and
sometimes involving the entire liver, blending imperceptibly
into the cirrhotic background.
★ Extensive intrahepatic metastases are characteristic, and
occasionally snakelike masses of tumor invade the portal vein
(with occlusion of the portal circulation) or inferior vena cava,
extending even into the right side of the heart.
Well-differentiated hepatocellular carcinoma has distortions of normal
structures: Liver cell plates are markedly widened, and frequent
“pseudoacinar” structures (arrows)—abnormal bile canaliculi—often contain
bile.
Acidophilic hyaline inclusions within the cytoplasm may be present,
resembling Mallory bodies.
Sign and symptoms
• Rapid increase in liver size, sudden worsening
of ascites, or the appearance of bloody
ascites, fever, and pain call attention to the
development of a tumor.
• The most commonly used marker is serum
alpha-fetoprotein level, but it rises only with
advanced tumors and only in 50% of patients.
• Radiologic screening of patients with cirrhosis
at 6-month intervals, looking for dysplastic
nodules or early, small hepatocellular
carcinomas, is the current clinical frontier.
FATTY LIVER DISEASE
FATTY LIVER DISEASE