CASE STUDY OF

DM
HEPATIC
CHRONIC RENAL FAILURE

Dwi Rahmasari
Erlina Kusumastuti
Faiz Mundzir A
Fetira Helena
Hepatic
 VIRAL HEPATITIS
HEPATITIS - HEPATITIS - HEPATITIS - HEPATITIS - HEPATITIS -
A B C D E

VIRUS PICORNA DNA VIRUS RNA FLAVI RNA RNA VIRUS

VIRUS VIRUS DEFECTIVE
VIRUS

INCUBATION 2-7 weak 6-23weak 2-26 weak 2-7weak

PERIOD (average 4 (average 17 (average 8 (average 4
weak) weak) weak) weak)

CHRONO ACUTE LEAD TO LEAD TO LEAD TO ACUTE

CITY CIRROSIS & CIRROSIS & CIRROSIS &
CANCER CANCER CANCER
ACUTE
 HEPATITIS - HEPATITIS - HEPATITIS - HEPATITIS - HEPATITIS
A B C D -E

SPREAD Infected Feacal-oral

Infected Blood, Infected Blood,
Feacal-Oral Blood, Route
Route Needles, Sexual Needles, Needles,
Sexual
Contact Sexual Contact
Contact
phase jaundice duration Symptoms

Preicteric precedes 1-21 days (max in •Malaise

(prodormal) •Myalgia
•atralgia easily tired
•Anorexia
•Nause & vomiting
•Weight loss
•low-grade fever hepatitis A

icteric Present 2-4 weeks •worsening of symptoms in phase prodormal

•liver enlargement and pain
• jaundice
•Splenomegaly
•Darks urine
•pale stool

Posticteric Disappearing 2-4 month (begins with the disappearance of jaundice and
(Convalescent (convalescent period ) other complaints but hepatomegaly and liver
phase ) abnormalities persist)
•improved appetite
•feel healthier
Prevalence of hepatitis A 39.8 - 68.3%
hepatitis B → 2.5 - 25.61%
hepatitis C → 15.5 - 46.4%.
from Hepatitis D, hepatitis infection is closely
related to hepatitis B infection.
HBsAg : Male 9,7 % , Female 9,3 %
Age : 45 – 49 y.o 11,9 %
 Global Prevalence of Hepatitis A Infection

HAV Prevalence
High
Intermediate
Low
Very Low
Geographic Distribution of Chronic HBV Infection

10th cause of death

(1 million / year)

Cirrhosis in 20% HBsAg Prevalence

(75 - 100 million)
8% - High
HCC in 5 - 10% 2-7% - Intermediate
(20 - 40 million) < 2% - Low

> 350 million carriers (HBsAg + > 6 months)

 Hepatitis ; Disease Progression

Liver Cancer
(HCC)
5%-10%

2-6%

Acute Chronic Liver

Infection Infection Cirrhosis Death
Transplantation
10-30%

90% in perinatal
30-90% in children<5yrs old Chronic HBV is the 6th
5% in healthy adults Liver Failure leading cause of liver
(Decompensation) transplantation in the
Higher in HIV, US
immune suppressed 23% within 5
years
 Chronic & complex metabolism disease
 Hyperglycemia
 Defect of insulin
 Type 1 / IDDM Type 2 /
NIDDM
 Gestational Diabetes
 Polyuria

 Polydipsia

 Polyphagia
 Weight loss

 fatigue and muscle weakness

 Blurry vision

 Tingling or numbness in the hands or

feet
 Indonesia = 1,4 – 1,6 %
 Urban > Rural
 DM type 1 = ± 10%

DM type 2 = ±90 %
GDM = ± 4-5 % of pregnant woman
Anatomy Physiology
 Located
 Size
 Weight
Glomerolus
Function
 Spending on toxic substances
or toxin
 Body fluid balance
acid & alkaline
 Remove the waste of metabolism
 Activated Vit. D maintain bone
 Production hormon control blood pressure
 Erythropoietin Manufacture RBC
Definition
Etiology
Pathogenesis
Symptoms

> Hemopoetic disorder

Anemia >deficiency erytropoetin
>Gastrointestinal disorder>

>skin> itching, dry skin

>Neurology>
>cardiopulmonal >hipertention
literatur

 www.3dhealthcare.org
 Patofisiologi. Sylvia A.,2006
 Ilmu Penyakit Dalam. Sudoyo dkk, 2009
 Patologi. Robin dan Kumar, 2004