Pemeriksaan Fungsi Hati

Meningkat pada alkoholik kronis, sirosis. Terdapat di sel hati, jantung,

otot, ginjal, otak, paru-paru, pankreas, limfa, WBC,eritrosit.

Meningkat pada alkoholik kronis, pengobatan hepatitis B& Ckronik,

steatosis, NASH, hepatic fibrosis, sirosis, wilson disease  spesifik

Diagnosis obstructive jaundice, intrahepatik cholestasis, radang

pankreas
Pemeriksaan Fungsi Hati

Meningkat pada metastase hati maupun tulang, leukimia,

myelofibrosis, mastocytosis, dapat digunakan untuk tumor marker

Meningkat pada penyakit hepatobilier, malnutrisi, anemia,

pulmonary embolism, Congestive Heart Failure, Obat-obatan

Skrining untuk mengukur protein darah melalui pemisahan fraksi

albumin, α1, α2, γ, β-protein. Respon terhadap kanker,
sindrom ginjal-intestin, gangguan imun, disfungsi hati,
malnutrisi.
 Hepatitis???
Hepatitis is an inflammation of the liver.
It is usually caused by viral infections, toxic
agents or drugs but may be an autoimmune
response.

Characterised by jaundice, abdominal pain,

liver enlargement and sometimes fever.
Clinical Forms
Acute viral hepatitis
Recent infection and inflammation of the
liver

Chronic viralhepatitis
Persistent viral infection of liver tissue
lasting more than 6 months
 Type of Hepatitis
A B C D E
Source of feces blood/ blood/ blood/ feces
virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids

Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral

transmission permucosal permucosal permucosal

Chronic no yes yes yes no

infection

blood donor pre/post-

Prevention pre/post- pre/post- ensure safe
screening; exposure
exposure exposure drinking
risk behavior immunization;
immunization immunization water
modification risk behavior
modification
 6 kinds of
hepatitis viruses
Hepatitis A Virus
Naked RNAvirus
Related to enteroviruses, formerlyknown as
enterovirus 72, now put in its own family:
heptovirus
Difficult to grow in cell culture: primary
marmoset cell culture and also in vivoin
chimpanzees and marmosets
4 genotypes exist, but in practice mostof
them are group 1
Clinical Features
Incubation Average 30 days
period: Range 15-50 days
Jaundice by <6 yrs, <10%
age group: 6-14 yrs, 40%-50%
>14 yrs, 70%-80%
Complications: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Chronic None
sequel:
 Hepatitis A Infection
Symptoms Total anti-HAV

Titre ALT

Fecal
HAV
IgM anti-HAV

0 1 2 3 4 5 6 12 24
Months after exposure
Transmission
• Close personal contact
(e.g., household contact, sex contact,
child day care centers)
• Contaminated food, water
(e.g., infected food handlers, raw
shellfish)
• Blood exposure (rare)
(e.g., injecting drug use, transfusion)
 Global Patterns of Transmission
Endemicity Disea Peak Age of Transmissi
se Infection on
Rate Patterns
High Low to Early childhood Person to person;
High outbreaks uncommon
Moderate High Late Person to person;
childhood/ food and waterborne
young adults outbreaks
Low Low Young adults Person to person;
food and waterborne
outbreaks
Very low Ver Adults Travelers; outbreaks
y uncommon
low
Laboratory Diagnosis
• Acute infection is diagnosed by the
detection of HAV-IgM in serum by EIA.
• Past Infection i.e. immunity is determined
by the detection of HAV-IgG by EIA.
• Cell culture – difficult and take up to 4
weeks, not routinely performed

• Direct Detection 
RT-PCR of faeces. Can
detect illness earlier than
serology but rarely
performed.
Properties of HBV
• a member of the hepadnavirus group
• Circular partially double-stranded DNA
viruses
• Replication involves a reverse transcriptase.
 HBV Structure & Antigens
Dane particle

HBsAg = surface (coat) protein ( 4 phenotypes : adw, adr, ayw and ayr)
HBcAg = inner core protein (a singleserotype)
HBeAg = secreted protein; function unknown
Open Reading Frames
Replication
Clinical Features
Incubation Average 60-90 days
period: Range 45-180 days
Jaundice by <<5 yrs, <10%
age group: 5 yrs, 30%-50%
1/3 adults-no symptoms
Acute case- 0.5%-1%
fatality rate:
Chronic infection: <5 yrs, 30%-90%
5 yrs, 2%-10%
More likely in
ansymptomatic infections
Premature mortality
from chronic liver 15%-25%
disease
 Acute Hepatitis BVirus Infection with Recovery

Symptoms
HBeAg anti-HBe

Total anti-HBc
Titre

HBsAg IgM anti-HBc anti-HBs

0 4 8 12 16 20 24 28 32 36 52 100

Weeks after Exposure

Progression to Chronic Hepatitis BVirusInfection

Acute Chronic
(6 months) (Years)
HBeAg anti-HBe
HBsAg
Total anti-HBc
Titre

IgM anti-HBc

0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
Concentration in Body Fluids

High Moderate Low/Not

Detectable
blood semen urine
serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
Transmission
 Sexual - sex workers and homosexuals
are particular at risk.
 Parenteral - IVDA, Health Workers are at
increased risk.
 Perinatal - Mothers who are HBeAg
positive are much more likely to
transmit to their offspring than those
who are not. Perinatal transmission is
the main means of transmission in high
prevalence populations.
Diagnosis
• A battery of serological tests are used for the diagnosis of
acute and chronic hepatitis B infection.
• HBsAg - used as a general marker of infection.
• HBsAb - used to document recovery and/or immunity to
HBV infection.
• anti-HBc IgM - marker of acute infection.
• anti-HBcIgG - past or chronic infection.
• HBeAg - indicates active replication of virus and therefore
infectiveness.
• Anti-Hbe - virus no longer replicating. However, the
patient can still be positive for HBsAg which is made by
integrated HBV.
• HBV-DNA - indicates active replication of virus, more
accurate than HBeAg especially in cases of escape mutants.
Used mainly for monitoring response to therapy.
HBV DNA

Fase Replikasi Mutan

HBV DNA (amplikasi) Positif Positif

HBeAg Positif Negatif

Metode Pemeriksaan HBVDNA
Metode
LiquidHybridization(RIA)
HybridCaptureChemiluminescent * nonradioisotop
(HCC)
Keterangan
* radioisotop(umurreagenpendek)
* penanganankhususdlm.prosedur
kerjadanlimbah
* teknikhibridisasidg.amplifikasisignal
(substratchemiluminescent)
* sensitivitasawal:5-10pg/ml
metodeultra:4.7x10^3c/ml
Metode Pemeriksaan HBVDNA
Metode Keterangan

branchedDNA(bDNA)
* nonradioisotop
* teknikhibridisasidg. amplifikasisignal
(substratchemiluminescent+molekulbDNA)
* sensitivitasv 1.0 =2,5pg/ml(7.5x10^5c/ml)
v 3.0=2x10^3c/ml

Polymerase ChainReaction(PCR) * nonradioisotop

* teknikhibridisasidg. amplifikasitarget
* sensitivitas:2x 10^2c/ml
(metodeultrasensitive--->kesulitan dlm
penetapanclinical cutoff)
Instrumentation: System 340
 Marker Acute
Incubation Infectio Past Chronic Vaccination
Infectio Infectio
n n n
HBsAg +a + - + -
HBeAg + + - +/ - -
HBVDNA + + -b +/ - -
Anti HBc
IgM - + - + / -c -
Total - + + + -
Anti HBe - - +/ - + / -d -
Anti HBs - - + - +
a+, detectable; -, not detectable; +/- may bedetectable
bNon-PCR methods
cMay be positive in 10 – 15% patients with reactivationof
infection
dPatients with chronic HBV infection usually havedetectable
HBeAg or anti Hbe