Pendekatan diagnostik pasien

dengan ikterus.

Dr yustar mulyadi SpPD – KGEH.

• Pengertian hiperbilirubinemia.
• Metabolisme bilirubin.
• Pembagian hiperbilirubinemia,
• Gambaran fungsi hati pada kolestasis.
• Pendekatan diagnostik ikterus.
• Hyperbilirubinemia results in clinical jaundice
at serum bilirubin concentration greater than
2,0 to 2,5 mg/dl.
• Increased bilirubin levels may results from
overproduction of bilirubin,impaired hepatic
uptake binding,conjugation or secretion and
leakage of the bilirubin from demage cells or
bile ducts.
Pembagian hiperbilirubinemia :

1. Unconjugated hiperbilirubinemia.
2. Conjugated hiperbilirubinemia.
• Hyperbilirubinemia :
• 1. Unconjugated hiperbilirubinemia.
• 2. Conjugated hiperbilirubinemia.

• 1. Unconjagated hiperbilirubinemia.
• A. Hemolysis caused increased production of
bilirubin.
• B. Ineffective erythropoiesis.
• Thalassemia,anemia sideroblastic.
 Unconjugated hiperbilirubinemia
• C. Hereditary.
• 1. Gilbert syndrome.
• 2. Crigler najjar type I syndrome.
• 3. Crigler najjar type II syndrome.
• 4. Acquired deficiency of glucuronil
transferase.
 Conjugated hiperbilirubinemia.
• A. Familial conjugated hiperbilirubinemia.
• 1. Dubin johnson syndrome.
• 2. Rotors syndrome.
• B. Recurrent jaundice of pregnancy.
• C. Druge induce cholestasis.
• 1. Oral contraceptives.
• 2. Male sex hormone analogs.
• 3. Drugs produce cholestasis and liver injury.
• D. Post operative jaundice.
• E. Sepsis.
• F. Hepatocellular disease:
• 1.The major causes of intrahepatic icterus.
• a. Alcohol liver disease.
• b. Drugs
• c. Viral hepatitis.
• d. Toxic hepatitis.
• e. Sepsis.
• f. Infiltrative disorders.
 Extrahepatic
• 1.Biliary obstruction due to stones,
strictures,lymadenophaty or tumors
can occur anywhere along the route
of yhe bile ducts from the hilum of
the liver to the duodenal papilla.
• 2.Cancer.Pancreatic cancer,
cholangiocarcinoma,adenocarcinom
a of the duodenum and ampulla of
vater.
 Diagnostic studies.
• A. Noninvasive techniques.
• 1.An abdominal flat plate.
• 2.Usg.
• 3.Ct scan.
• 4.Cholescintigraphy scan.
• 5.Radionuclide scan.
• 6.The oral cholecystogram.
• 7.The iv cholangiogram
• 8.MRCP.
 B.Invasive techniques.
• 1.Liver biopsy.
• 2.Laparoscopy.
• 3.Percutaneous transhepatic cholangiograpy.
• 4.ERCP.
• 5.Angiography.
Thank You