Sirosis Hepatis

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\cols2\colno1\colw4306\colsr-0\colno2\colw6786\pard\li1853\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\
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d\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs24\c
f0\f0\charscalex100\b {PENDAHULUAN }\b0 \par\column\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-240\
slmult0 \fs28\cf0\f0\charscalex100\b {SIROSIS HEPATITIS}\b0 \par\pard\sect\sectd
\sbknone\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slm
ult0 \fs24\cf0\f0\charscalex100 {Di negara maju, sirosis hati merupaka
n penyebab kematian terbesar ketiga }\par\pard\li1853\ri0\sl-426\slmult0
\fs22\cf0\f0\charscalex100 {pada pasien yang berusia 45 \uc1\u8211X 46 tahun (s
etelah penyakit kardiovaskuler dan }\par\pard\li1853\ri0\sl-426\slmult0 \fs22\cf
0\f0\charscalex100 {kanker). Diseluruh dunia sirosis menempati urutan
ke tujuh penyebab }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {kematian. Sekitar 25.0
00 orang meninggal setiap tahun akibat penyakit ini. }\par\pard\li1853\
ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Sirosis hati merupakan peny
akit hati yang sering ditemukan dalam ruang }\par\pard\li1853\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscale
x100 {perawatan Bagian Penyakit Dalam. Perawatan di Rumah Sakit sebagian besar }
\par\pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {kasus terutama d
itujukan untuk mengatasi berbagai penyakit yang ditimbulkan }\par\pard\li1853\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\chars
calex100 {seperti perdarahan saluran cerna bagian atas,koma peptikum,
hepatorenal }\par\pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {
sindrom, dan asites, Spontaneous bacterial peritonitis serta Hepat
osellular }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl226\slmult0 \fs22\cf0\f0\charscalex100 {carsinoma. Gejala klinis dari sirosis ha
ti sangat bervariasi, mulai dari tanpa }\par\pard\li1853\ri0\sl-426\slmult0 \fs2
2\cf0\f0\charscalex100 {gejala sampai dengan gejala yang sangat jelas. Apabila d

iperhatikan, laporan }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {di negara maju, maka kasus Si
rosis hati yang datang berobat ke dokter hanya }\par\pard\li1853\ri0\sl-426\slmu
lt0 \fs22\cf0\f0\charscalex100 {kira-kira 30% dari seluruh populasi penyakit in,
dan lebih kurang 30% lainnya }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {ditemukan secara
kebetulan ketika berobat untuk penyakit lain, sisanya }\par\pard\li
1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {ditemukan saat atopsi.}\par\
pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\sl
mult0 \fs24\cf0\f0\charscalex100\b {DEFINISI }\b0 \par\pard\li1853\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmult0 \fs22\cf0\f0\charscalex100 {I
stilah Sirosis hati diberikan oleh Laence tahun 1819, yang berasal dari kata }\p
ar\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \
fs22\cf0\f0\charscalex100 {Khirros yang berarti kuning orange (orange yellow), k
arena perubahan warna }\par\pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscal
ex100 {pada nodul- nodul yang terbentuk. Pengertian sirosis hati
dapat dikatakan }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {sebagai berikut yaitu suatu k
eadaan disorganisassi yang difuse dari struktur }\par\pard\li1853\ri0\sl-426\slm
ult0 \fs22\cf0\f0\charscalex100 {hati yang normal akibat nodul regeneratif yang
dikelilingi jaringan mengalami }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {fibrosis. Secara l
engkap Sirosis hati adalah suatu penyakit dimana sirkulasi }\par\pard\li18
53\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {mikro, anatomi pembuluh
darah besar dan seluruh sitem arsitektur hati }\par\pard\li1853\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charsca
lex100 {mengalami perubahan menjadi tidak teratur dan terjadi penambahan jaring
an }\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {ikat (fibros
is) disekitar parenkim hati yang mengalami regenerasi.}\par\pard\li1853\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\c
harscalex100\b {INSIDENS}\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-240\slmult0 \fs22\cf0\f0\charscalex100 {Penderita sirosis
hati lebih banyak dijumpai pada kaum laki-laki jika }\par\pard\sec
t\sectd\sbknone\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\marg
rsxn133\margtsxn666\margbsxn386\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\par
f0\par\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {dibandingkan
dengan kaum wanita sekita 1,6 : 1 dengan umur rata-rata }\p
fs22\cf0\f0\charscalex100 {terbanyak antara golongan umur 30 \uc1\u8211X 59 tahu
n dengan puncaknya sekitar 40 \uc1\u8211X }\par\pard\li1853\ri0\sl-426\slmult0 \
fs24\cf0\f0\charscalex100 {49 tahun.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100\b {KL
ASIFIKASI }\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0
\sl-253\slmult0 \fs24\cf0\f0\charscalex100 {Berdasarkan morfologi Sherlock memba
gi Sirosis hati atas 3 jenis, yaitu : }\par\pard\li1853\ri0\sl-426\slmult0 \fs24
\cf0\f0\charscalex100 {
1. Mikronodular}\par\pard\li1853\ri0\sl-426\slmult0 \
fs24\cf0\f0\charscalex100 {
2. Makronodular}\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
3. Campuran (yang memperlihatkan gambaran mikro-dan makronodular)}\par\pard\li18
53\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Secara Fungsional Sirosis terb
agi atas :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl226\slmult0 \fs24\cf0\f0\charscalex100 {1. Sirosis hati kompensata}\par\pard\li2
093\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Sering disebut dengan Laten S
irosis hati. Pada atadiu kompensata ini belum }\par\pard\li2093\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li2093\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {terl
ihat gejala-gejala yang nyata. Biasanya stadium ini ditemukan pada saat }\par\pa
rd\li2093\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {pemeriksaan screening.}
\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmult0
\fs24\cf0\f0\charscalex100\b {2.}\b0 { }\fs24\cf0\f0\charscalex100 {Sirosis hat
i Dekompensata}\par\pard\li2093\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2093\ri0
\sl-240\slmult0 \fs22\cf0\f0\charscalex100 {Dikenal dengan Active Sirosis hati,
dan stadium ini biasanya gejala-gejala }\par\pard\li2093\ri0\sl-426\slmult0 \fs2
4\cf0\f0\charscalex100 {sudah jelas, misalnya ; ascites, edema dan ikterus.}\p
fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240
\slmult0 \fs24\cf0\f0\charscalex100\b {ETIOLOGI}\b0 \par\pard\li1853\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs24\cf0\f0\charscalex100
{1. Virus hepatitis (B,C,dan D)}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0
\charscalex100 {2. Alkohol}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {3. Kelainan metabolic :}
\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {a. Hemakhomatosi
s (kelebihan beban besi)}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charsc
alex100 {b. Penyakit Wilson (kelebihan beban tembaga)}\par\pard\li2573\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex10
0 {c. Defisiensi Alpha-antitripsin}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0
\f0\charscalex100 {d. Glikonosis type-IV}\par\pard\li2573\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {e. Galakto
semia}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {f. Tirosin
emia }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\s
lmult0 \fs24\cf0\f0\charscalex100 {4. Kolestasis }\par\pard\li2160\ri0\sl-426\sl
mult0 \fs22\cf0\f0\charscalex100 {Saluran empedu membawa empedu yang d
ihasilkan oleh hati ke usus, }\par\pard\li2160\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li2160\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {dimana
emp
edu membantu mencerna lemak. Pada bayi penyebab sirosis }\par\pard\li2160\ri0\sl
-426\slmult0 \fs22\cf0\f0\charscalex100 {terbanyak adalah akibat tersumbatnya sa
luran empedu yang disebut Biliary }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghs
xn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn413\pard\li2160\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri
calex100 {atresia. Pada penyakit ini empedu memenuhi hati karena saluran empedu
}\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri0\sl-226\slmult
0 \fs22\cf0\f0\charscalex100 {tidak berfungsi atau rusak. Bayi yang menderita Bi
liary berwarna kuning }\par\pard\li2160\ri0\sl-426\slmult0 \fs22\cf0\f0\charscal
ex100 {(kulit kuning) setelah berusia satu bulan. Kadang bisa di
atasi dengan }\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri
0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {pembedahan untuk membentuk salura
n baru agar empedu meninggalkan }\par\pard\li2160\ri0\sl-426\slmult0 \fs22\cf0\f
0\charscalex100 {hati, tetapi transplantasi diindikasikan untuk anak-a
nak yang menderita }\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i2160\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {penyakit hati stadium
akhir. Pada orang dewasa, saluran empedu dapat }\par\pard\li2160\ri
0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {mengalami peradangan, tersumbat
, dan terluka akibat Primary Biliary }\par\pard\li2160\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li2160\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {Sir
osis atau Primary Sclerosing Cholangitis. Secondary Biliary Cirrosi
s }\par\pard\li2160\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {dapat terjadi
sebagai komplikasi dari pembedahan saluran empedu.}\par\pard\li1853\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100
{5. Sumbatan saluran vena hepatica}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf
0\f0\charscalex100 {
- Sindroma Budd-Chiari}\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
- Payah jantung}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {
6. Gangguan Imunitas (Hepatitis Lupoid)}\par\pard\li1853\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {7. Toksin d
an obat-obatan (misalnya : metotetrexat, amiodaron,INH, dan lain-}\par\pard\li18
53\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {lain)}\par\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex

100 {8. Operasi pintas usus pada obesitas}\par\pard\li1853\ri0\sl-426\slmult0 \f
s24\cf0\f0\charscalex100 {9. Kriptogenik}\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {10. Malnut
risi}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {11. Indian
Childhood Cirrhosis}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100\b {GEJALA KLINIS }\b0
\fs20\cf0\f0\charscalex100 {Manifestasi klinis dari Sirosis hati dise
babkan oleh satu atau lebih hal-hal }\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {yang
tersebut di bawah ini : }\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\char
scalex100 {1. Kegagalan Prekim hati}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf
0\f0\charscalex100 {2. Hipertensi portal}\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {3. Asites}
\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {4. Ensefalophati
hepatitis}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl226\slmult0 \fs24\cf0\f0\charscalex100 {Keluhan dari sirosis hati dapat berupa :
}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 { a. Merasa k
emampuan jasmani menurun}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 { b. Nausea, nafsu makan
menurun dan diikuti dengan penurunan berat badan }\par\pard\li1853\ri0\sl-426\sl
mult0 \fs24\cf0\f0\charscalex100 { c. Mata berwarna kuning dan buang air kecil
berwarna gelap}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 { d. Pembesaran perut dan kaki ben
gkak}\par\pard\sect\sectd\sbkpage
7;32768}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn13
3\margtsxn666\margbsxn413\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 { e. Perdarahan sal
uran cerna bagian atas }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
f. Pada keadaan lanjut
dapat dijumpai pasien tidak sadarkan diri (Hepatic }\par\pard\li2213\ri0\sl-426
\slmult0 \fs24\cf0\f0\charscalex100 {enchephalopathy}\par\pard\li1853\ri0\sl-213
{ g. Perasaan gatal yang hebat }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0
\f0\charscalex100 {Seperti telah disebutkan diatas bahwa pada hati
terjadi gangguan }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {arsitektur hati yang men
gakibatkan kegagalan sirkulasi dan kegagalan }\par\pard\li1853\ri0\sl-42

6\slmult0 \fs24\cf0\f0\charscalex100 {perenkym hati yang masing-masing memperlih
atkan gejala klinis berupa :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {1. Kegagalan sirosis h
ati}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {a. edema}\pa
r\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \f
s24\cf0\f0\charscalex100 {b. ikterus}\par\pard\li2573\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {c. }\fs24\cf0\
f0\charscalex100\b {koma}\b0 \par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li2573\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100 {d. spider nevi}\par\pa
rd\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\
cf0\f0\charscalex100 {e. alopesia pectoralis}\par\pard\li2573\ri0\sl-426\slmult0
\fs24\cf0\f0\charscalex100 {f. ginekomastia}\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {g. ker
usakan hati}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {h. a
sites}\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\s
lmult0 \fs24\cf0\f0\charscalex100 {i. rambut pubis rontok}\par\pard\li2573\ri0\s
l-426\slmult0 \fs24\cf0\f0\charscalex100 {j. eritema palmaris}\par\pard\li2573\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\char
scalex100 {k. atropi testis}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\cha
rscalex100 {l. kelainan darah (anemia,hematon/mudah terjadi perdaarahan)}\par\pa
cf0\f0\charscalex100 {2. Hipertensi portal}\par\pard\li2573\ri0\sl-426\slmult0 \
fs24\cf0\f0\charscalex100 {a. varises oesophagus}\par\pard\li2573\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {b.
spleenomegali}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {c
. perubahan sum-sum tulang}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\char
scalex100 {d. caput meduse}\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {e. asites }\par\pard\li2
573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {f. collateral veinhemorrhoid}
\fs24\cf0\f0\charscalex100 {g. kelainan sel darah tepi (anemia, leukopeni dan t
rombositopeni)}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {K
lasifikasi Sirosis hati menurut criteria Child-pugh :}\par\pard\li1853\ri0\sl-21
0 {Skor / parameter}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex1
00 {1}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\s
lmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\sect\sectd\sbkpage
{\shp{\*\shpinst\shpleft2760\shptop13173\shpright3386\shpbottom13480\shpfhdr0\sh
pwr3\shpwrk0\shpfblwtxt1\shplid2030\shpz0\shpbxpage\shpbypage
7;32768}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}

7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {3}\par\pard\li1853\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\char
scalex100 {Bilirubin (mg%)}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\char
scalex100 {<2,0}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {2 - < 3}\par\pard\li1853\ri0\sl-426
\slmult0 \fs24\cf0\f0\charscalex100 {> 3,0}\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Albumin
(gr%)}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {>3, 5}\par
\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs
24\cf0\f0\charscalex100 {2,8 - < 3,5}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\c
f0\f0\charscalex100 {<2,8}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Prothrombin time (Quick%)
}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {> 70}\par\pard\
li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0
\f0\charscalex100 {40 - < 70}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\ch
arscalex100 {< 40}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Asites}\par\pard\li1853\ri0\sl-42
6\slmult0 \fs24\cf0\f0\charscalex100 {0}\par\pard\li1853\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Minimal \uc
1\u8211X sedang}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {
(+) \uc1\u8211X (++)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Banyak +++)}\par\pard\li1853\r
i0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Hepatic enchepha Lopathy}\par\pard
\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Tidak ada}\par\pard\li185
harscalex100 {Std 1 dan II}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\char
scalex100 {Std III dan IV}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100\b {KOMPLIKASI }\
b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmu
lt0 \fs24\cf0\f0\charscalex100 {1. Perdarahan gastrointestinal}\par\pard\li2160\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri0\sl-226\slmult0 \fs24\cf0\f0\cha
rscalex100 {Hipertensi portal menimbulkan varises oesopagus, dimana suatu saat a
kan }\par\pard\li2160\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {pecah seh
ingga timbul perdarahan yang masih.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100 {2.}{ }\fs24\cf0
\f0\charscalex100\b {Koma}\b0 { }\fs24\cf0\f0\charscalex100\b {Hepatikum}\b0 \fs
24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100 {3. Ulkus Peptikum }\par\
4\cf0\f0\charscalex100 {4. Karsinoma hepatosellural }\par\pard\li2093\ri0\sl-426

\slmult0 \fs22\cf0\f0\charscalex100 {Kemungkinan timbul karena adanya hiperflasi
a noduler yang akan berubah }\par\pard\li2093\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li2093\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {menjadi adenomata
multiple dan akhirnya menjadi karsinoma yang }\par\pard\sect\sectd\sbk
page\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn413\par
t0 \fs24\cf0\f0\charscalex100 {multiple.}\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {5. Infeksi
}\par\pard\li2093\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {Misalnya :
peritonisis, pnemonia, bronchopneumonia, tbc paru, }\par\pard\li2093\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li2093\ri0\sl-226\slmult0 \fs22\cf0\f0\charsc
alex100 {glomerulonephritis
kronis, pielonephritis, sistitis, peritonitis, en
dokarditis, }\par\pard\li2093\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {sri
sipelas, septikema}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {6. Penyebab kematian }\par\pard\
\fs24\cf0\f0\charscalex100\b {PENATALAKSANAAN }\b0 \par\pard\li1853\ri0\sl-213\
{Pengobatan sirosis hati pada prinsipnya berupa : }\par\pard\li1853\ri0\sl-426\s
lmult0 \fs24\cf0\f0\charscalex100 {1. Simtomatis}\par\pard\li1853\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {2.
Suportif, yaitu :}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex10
0 {
a. Istirahat yang cukup}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
b. Pengaturan
makanan yang cukup dan seimbang;}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f
0\charscalex100 {
misalnya : cukup kalori, protein 1gr/kgBB/hari dan vi
tamin}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\s
lmult0 \fs24\cf0\f0\charscalex100 {
c. Pengobatan berdasarkan etiologi}\par\
pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {
Misalnya
pada sirosis hati akibat infeksi virus C dapat dicoba dengan }\par\pard\li2400\
rscalex100 {interferon.
Sekarang telah dikembangkan perubahan strategi
terapi }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {bagian
pasien dengan hepatitis C kronik yang belum pernah }\par\pard\li
2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\sl-226\slmult0 \fs24\cf0\f
0\charscalex100 {mendapatkan pengobatan IFN seperti :}\par\pard\li2400\ri0\sl-42
6\slmult0 \fs24\cf0\f0\charscalex100 {a) kombinasi IFN dengan ribavirin}\par\par
f0\f0\charscalex100 {
Terapi kombinasi IFN dan Ribavirin terdiri dari IFN 3
juta unit 3 x }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {
seminggu dan RIB 1000-2000 mg perhari tergantung berat badan }\p
fs22\cf0\f0\charscalex100 {(1000mg untuk berat badan kurang dari 75k
g) yang diberikan }\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscal
ex100 {untukjangka waktu 24-48 minggu.}\par\pard\li2400\ri0\sl-426\slmult0 \fs24
\cf0\f0\charscalex100 { b) terapi induksi IFN}\par\pard\li2400\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li2400\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 { Te
rapi induksi Interferon yaitu interferon diberikan dengan dosis yang }\par\pard\
li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {lebih
tinggi dari
3 juta unit setiap hari untuk 2-4 minggu yang }\par\pard\li257
harscalex100 {dilanjutkan dengan 3 juta unit 3 x seminggu selama 48 minggu denga
n }\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {atau tanpa ko
mbinasi dengan RIB.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
c) terapi dosis IFN t
iap hari.}\par\pard\li1853\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {
Dasar pemberian IFN dengan dosis 3 juta atau 5 juta unit tiap hari }\par

24\cf0\f0\charscalex100 {sampai HCV-RNA negatif di serum dan jaringan hati.}\pa
r\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margts
xn666\margbsxn413\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {3. Pengobatan yang spesifik
dari sirosis hati akan diberikan jika telah terjadi }\par\pard\li2213\ri0\sl-213
{komplikasi seperti :}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscal
ex100 {
a. Asites }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
Dapat dikendalika
n dengan terapi konservatif yang terdiri atas : }\par\pard\li1853\ri0\sl-426\slm
ult0 \fs24\cf0\f0\charscalex100 {
- istirahat }\par\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex
100 {
- diet rendah garam : untuk asites ringan dicoba dulu dengan ist
irahat }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {dan diet
rendah garam dan penderita dapat berobat jalan dan apabila }\par\pard\li2573\
rscalex100 {gagal maka penderita harus dirawat.}\par\pard\li1853\ri0\sl-426\slm
- diuretik}\par\pard\li1853\ri0\sl-21
0 {
Pemberian diuretic hanya bagi penderita yang telah men
jalani diet }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {ren
dah
garam
dan pembatasan cairan namun penurunan berat }\par\pa
cf0\f0\charscalex100 {badannya kurang dari 1 kg setelah
4 hari.
Mengingat salah satu }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\cha
rscalex100 {komplikasi akibat pemberian diuretic adalah hipokalemia dan hal ini
0 \fs22\cf0\f0\charscalex100 {dapat mencetuskan encepalophaty hepatic, maka pili
han utama diuretic }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex1
00 {adalah spironolacton, dan dimulai dengan dosis rendah, serta
dapat }\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226
\slmult0 \fs22\cf0\f0\charscalex100 {dinaikkan dosisnya bertahap tiap 34 hari, apabila dengan dosis }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\
cf0\f0\charscalex100 {maksimal diuresinya belum tercapai maka dapat
kita kombinasikan }\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li25
73\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {dengan furosemid.}\par\pard\li
Terapi lain : }\pa
r\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Sebagian kecil
penderita asites tidak berhasil dengan pengobatan }\par\pard\li2400\ri
calex100 {konservatif. Pada keadaan demikian pilihan kita adalah pa
rasintesis. }\par\pard\li2400\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Men
genai parasintesis cairan asites dapat dilakukan 5 10 liter /
hari, }\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\sl-22
6\slmult0 \fs22\cf0\f0\charscalex100 {dengan catatan harus dilakukan infus album
in sebanyak 6 \uc1\u8211X 8 gr/l cairan }\par\pard\li2400\ri0\sl-426\slmult0 \fs
22\cf0\f0\charscalex100 {asites yang dikeluarkan. Ternyata parasintesa da
pat menurunkan masa }\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i2400\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {opname pasien. Prosedur
ini tidak dianjurkan pada Child\uc1\u8217Xs C, }\par\pard\li2400\ri
0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Protrombin < 40%, serum bil
irubin > dari 10 mg/dl, trombosit < }\par\pard\li2400\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li2400\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {40
.000/mm}\fs14\cf0\f0\charscalex100 {3}\fs24\cf0\f0\charscalex100 {, creatinin >
3 mg/dl dan natrium urin < 10 mmol/24 jam.}\par\pard\li1853\ri0\sl-426\slmult0 \
fs24\cf0\f0\charscalex100 {
b. Spontaneous bacterial peritonitis}\par\pard\
\f0\charscalex100 {Infeksi cairan dapat terjadi secara spontan, atau
setelah tindakan }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscal

ex100 {parasintese. Tipe yang spontan terjadi 80% pada penderita sirosis hati
0 \fs22\cf0\f0\charscalex100 {dengan asites, sekitar 20% kasus. Keadaan ini lebi
h sering terjadi pada }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscal
ex100 {sirosis hati stadium kompesata yang berat. Pada kebanyakan
kasus }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrs
xn133\margtsxn666\margbsxn413\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
\par\pard\li2400\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {penyakit ini
timbul selama masa rawatan. Infeksi umumnya terjadi }\par\pard\li24
00\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {secara Blood Borne dan 90% Monomicroba. Pada sirosi
s hati terjadi }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex1
00 {permiabilitas usus menurun dan mikroba ini beraasal dari usus. Adanya }\par\
4\cf0\f0\charscalex100 {kecurigaan akan SBP bila dijumpai keadaan sebagai beriku
t : }\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {- Sucpect g
rade B dan C cirrhosis with ascites}\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {- Clinical feat
ure my be absent and WBC normal}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0
\charscalex100 {- Ascites protein usually <1 g/dl}\par\pard\li2573\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {Usually monomicrobial and Gram-Negative}\par\pard\li2573\ri0\sl-426\slmult0 \fs
24\cf0\f0\charscalex100 {- Start antibiotic if ascites > 250 mm polymorphs}\par\
4\cf0\f0\charscalex100 {- 50% die}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\
f0\charscalex100 {- 69 % recur in 1 year}\par\pard\li1320\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1320\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {
Pengobatan SBP dengan memberikan Cephalosporins Generasi III }\par\
pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {(Cefotaxime), secar
a parental selama lima hari, atau Qinolon secara }\par\pard\li2573\ri
calex100 {oral. Mengingat akan rekurennya tinggi maka untuk profilaxis dapat }
\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {diberikan Norflo
xacin (400mg/hari) selama 2-3 minggu.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {
c. Hepat
orenal syndrome}\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {
Adapun criteria diagnostik dapat kita lihat sebagai berikut : }\par\par
f0\f0\charscalex100 {
Criteria for diagnosis of hepato-renal syndrome :}
\par\pard\li1853\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {
Major :
}\par\pard\li2400\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {- Chronic liver
disease with ascietes }\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i2400\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {- Low glomerular fitration
rate}\par\pard\li2400\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {- Serum cre
atin > 1,5 mg/dl}\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\r
i0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {- Creatine clearance (24 hour) < 4
,0 ml/minute}\par\pard\li2400\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {- A
bsence of shock, severe infection,fluid losses and Nephrotoxic drugs }\par\pard\
\f0\charscalex100 {- Proteinuria < 500 mg/day}\par\pard\li2213\ri0\sl-426\slmult
0 \fs24\cf0\f0\charscalex100 { - No improvement following plasma volume expans
ion}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slm
Minor :}\par\pard\li2400\ri0\sl-426\
slmult0 \fs24\cf0\f0\charscalex100 {- Urine volume < 1 liter / day}\par\pard\li2
400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\sl-226\slmult0 \fs24\cf0\f0
\charscalex100 {- Urine Sodium < 10 mmol/litre}\par\pard\li2400\ri0\sl-426\slmul
t0 \fs24\cf0\f0\charscalex100 {- Urine osmolarity > plasma osmolarity}\par\pard\
\f0\charscalex100 {- Serum Sodium concentration < 13 mmol / litre}\par\pard\li24

00\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {Sindroma ini dicegah den
gan menghindari pemberian Diuretik yang }\par\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}
\pard\li2400\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {berlebihan, pengen
alan secara dini setiap penyakit seperti gangguan }\par\pard\li2400\
rscalex100 {elekterolit, perdarahan dan infeksi. Penanganan secara konservatif
dapat }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {dilakukan
berupa : Ritriksi cairan,garam, potassium dan protein. Serta }\par\pard\li2400\
rscalex100 {menghentikan obat-obatan yang Nefrotoxic. Manitol tidak
bermanfaat }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {bahk
an dapat menyebabkan Asifosis intra seluler. Diuretik dengan dosis }\par\pard\li
0\charscalex100 {yang tinggi juga tidak bermanfaat, dapat mencetuskan perdaraha
n dan }\par\pard\li2400\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100 {shock. TI
PS hasil jelek pada Child\uc1\u8217Xs C, dan dapat dipertimbangkan pada }\par\pa
cf0\f0\charscalex100 {pasien yang akan dilakukan transplantasi. Piliha

n terbaik adalah }\par\pard\li2400\ri0\sl-426\slmult0 \fs24\cf0\f0\charscale
x100 {transplantasi hati yang diikuti dengan perbaikan dan fungsi ginjal.}\par\p
ard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-226\slmult0 \fs24
\cf0\f0\charscalex100 {
d. Ensefalophaty hepatic}\par\pard\li1853\ri0\sl-42
6\slmult0 \fs24\cf0\f0\charscalex100 {
e. Perdarahan karena pecahnya Varise
s Esofagus}\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\sl226\slmult0 \fs22\cf0\f0\charscalex100 {Kasus ini merupakan kasus emerge
nsi sehingga penentuan etiologi }\par\pard\li2400\ri0\sl-426\slmult0 \fs22
\cf0\f0\charscalex100 {sering dinomo rduakan, namun yang paling pent
ing adalah }\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2400\ri0\
sl-226\slmult0 \fs22\cf0\f0\charscalex100 {penanganannya lebih dulu. Prins
ip penanganan yang utama adalah }\par\pard\li2400\ri0\sl-426\slmult0 \fs
22\cf0\f0\charscalex100 {tindakan Resusitasi sampai keadaan pasien sta
bil, dalam keadaan ini }\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li2400\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {maka dilakukan :}\par
\pard\li2400\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {- Pasien diistiraha
tkan daan dpuasakan}\par\pard\li2400\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li240
0\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {- Pemasangan IVFD berupa garam
fisiologis dan kalau perlu transfusi}\par\pard\li2400\ri0\sl-426\slmult0 \fs22\
cf0\f0\charscalex100 {- Pemasangan Naso Gastric Tube, hal ini memp
unyai banyak sekali }\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0\f0\charsc
alex100 {kegunaannya yaitu : untuk mengetahui perdarahan, cooling dengan es, }\p
fs24\cf0\f0\charscalex100 {pemberian obat-obatan, evaluasi darah}\par\pard\li185
- Pemberian
obat-obatan berupa antasida, ARH2, Antifibrinolitik, }\par\pard\li257
harscalex100 {VitaminK, Vasopressin, Octriotide dan Somatostatin}\par\pard\li185
- Disamping
itu diperlukan tindakan-tindakan lain dalam rangka }\par\pard\li257
harscalex100 {menghentikan perdarahan misalnya Pemasangan Ballon Tampo
nade }\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {dan Tindak
an Skleroterapi / Ligasi atau Oesophageal Transection.}\par\pard\li1853\ri0\sl-2
00 {
e. Ensefalopati Hepatik}\par\pard\li2573\ri0\sl-426\slmult0 \fs22\cf0
\f0\charscalex100 {Suatu syndrome Neuropsikiatri yang didapatkan pada
penderita }\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\s
l-226\slmult0 \fs22\cf0\f0\charscalex100 {penyakit hati menahun, mulai d
ari gangguan ritme tidur, perubahan }\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100 {keprib
adian, gelisah sampai ke pre }\fs24\cf0\f0\charscalex100\b {koma}\b0 \fs24\cf0\
f0\charscalex100 { dan }\fs24\cf0\f0\charscalex100\b {koma}\b0 \fs24\cf0\f0\ch
arscalex100 {. Pada umumnya }\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li2573\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {enselopati Hepatik pad
a sirosis hati disebabkan adanya factor pencetus, }\par\pard\li2573\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {
antara lain : infeksi, perdarahan gastro intestinal, obat-obat y
ang }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn13
\pard\li2573\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {Hepatotoxic.}\par\pa
cf0\f0\charscalex100 {Prinsip penggunaan ada 3 sasaran : }\par\pard\li2573\ri0\s
l-426\slmult0 \fs24\cf0\f0\charscalex100 {1. mengenali dan mengobati factor penc
etua }\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-226\s
lmult0 \fs24\cf0\f0\charscalex100 {2. intervensi untuk menurunkan produksi dan a
bsorpsi amoniak serta }\par\pard\li2933\ri0\sl-426\slmult0 \fs24\cf0\f0\charscal
ex100 {toxin-toxin yang berasal dari usus dengan jalan : }\par\pard\li2933\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li2933\ri0\sl-226\slmult0 \fs24\cf0\f0\charscal

ex100 {- Dier rendah protein}\par\pard\li2933\ri0\sl-426\slmult0 \fs24\cf0\f0\ch
arscalex100 {- Pemberian antibiotik (neomisin)}\par\pard\li2933\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li2933\ri0\sl-226\slmult0 \fs24\cf0\f0\charscalex100 {- Pe
mberian lactulose/ lactikol}\par\pard\li2573\ri0\sl-426\slmult0 \fs24\cf0\f0\cha
rscalex100 {3. Obat-obat yang memodifikasi Balance Neutronsmiter}\par\pard\li257
harscalex100 {
- Secara langsung (Bromocriptin,Flumazemil)}\par\pard\li1853
\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100 {
- Tak langsun
g (Pemberian AARS)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-240\slmult0 \fs24\cf0\f0\charscalex100\b {KESIMPULAN}\b0 \par\
2\cf0\f0\charscalex100 {Mengingat pengobatan sirosis hati hanya merupa
kan simptomatik dan }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {mengobati penyulit, maka p
rognosa SH bisa jelek. Namun penemuan sirosis }\par\pard\li1853\ri0\sl-426\slmul
t0 \fs22\cf0\f0\charscalex100 {hati yang masih terkompensasi mempunyai prognosa
yang baik. Oleh karena }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-226\slmult0 \fs22\cf0\f0\charscalex100 {itu ketepatan diagnosa dan
penanganan yang tepat sangat dibutuhkan dalam }\par\pard\li1853\ri0\sl-426\slmul
t0 \fs24\cf0\f0\charscalex100 {penatalaksanaan sirosis hati.}\par\pard\li1853\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard
0\f0\charscalex100\b {KEPUSTAKAAN :}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {1. Rosenack,J, Diagnosis and Therapy of Chronic Liver an
d Biliarry Diseases}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {2. Hadi.Sujono, Gastroenterology,Penerbit Alumni / 1995 / Bandung}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3. Sherlock.S, Penyakit Ha
ti dan Sitim Saluran Empedu, Oxford,England }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Blackwell }\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {1997}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {4. Hakim Zain.L, Penatalaksanaan Penderita Sirosis Hepatitis}\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5. Soeparman, Ilmu Pen
yakit Dalam jilid I, Edisi II, Penerbit Balai FK UI, }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {Jakarta}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {1987}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {6. Anonymous http://alcoholism.about.com/library/blcirrosis.h
tm }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {7. Lesmana.L
.A, Pembaharuan Strategi Terapai Hepatitis Kronik C, Bagian }\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Ilmu}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {Penyakit Dalam FK UI. RSUPN Cipto Mangunkusumo
}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\ma
rgtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\r
t0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl
-453\slmult0 \fs24\cf0\f0\charscalex100 {Hipertensi Portal pada Anak}\par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Bambang Surif*, Julius Ro
ma**}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {*Bagi
an Ilmu Kesehatan Anak Rumah Sakit Umum Pusat Dr. Wahidin }\i0 \par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Sudirohusodo}\i0 \par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\i {Fakultas Kedokteran Universi
tas Hasanuddin, Ujung Pandang}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100\i {**Bagian Ilmu Kesehatan Anak (Subdivisi Gastrohepatoenterolo
gi) Rumah }\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i
{Sakit Umum Pusat }\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100\i {Dr. Wahidin Sudirohusodo/Fakultas Kedokteran Universitas Hasanuddin, }\
i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Ujung Panda
ng }\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {ABSTRA

K }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hipertens
i portal terjadi jika tekanan dalam sistim vena porta meningkat diatas }\par\par
d\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {10-12 mmHg yang dapat te
rjadi ekstrahepatik, intrahepatik dan suprahepatik. }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Penampakan dari ketiga jenis hipertensi por
tal ini dapat mirip satu dengan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {yang }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {lainnya, namun penyebab, komplikasi dan penanganan dapat sangat berbeda.}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Diagnosis hipert
ensi portal ditegakkan berdasarkan anamnesis, pemeriksaan }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {fisis,}\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {laboratorium, endoskopi, pencitraan, biopsi ha
ti dan pengukuran tekanan vena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {porta. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {Untuk dapat mengelola dengan baik, diagnosis yang tepat merupakan syarat
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {mutlak. }\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {PENDAHULUAN }\b0 \p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hipertensi portal
merupakan gabungan antara penurunan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {aliran darah porta dan peningkatan resistensi vena portal}\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(1)}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {Hipertensi portal dapat terjadi jika tekanan
dalam sistem vena }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00 {porta meningkat di atas 10-12 mmHg. Nilai normal tergantung }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dari cara pengukuran, terapi um
umnya sekitar 7 mmHg}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Peningkatan tekanan v
ena porta biasanya disebabkan oleh ada-}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {nya hambatan aliran vena porta atau peningkatan aliran d
arah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ke dalam ve
na splanikus. Obstruksi aliran darah dalam sistim }\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf0\f0\charscalex100 {portal dapat terjadi oleh karena obstruksi ve
na porta atau }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {c
abang-cabang selanjutnya (ekstra hepatik), peningkatan }\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {tahanan vaskuler dalam hati yang terjadi
dengan atau tanpa }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00 {pengkerutan (intra hepatik) yang dapat terjadi presinusoid,}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {parasinusoid atau postsinusoid d
an obstruksi aliran keluar vena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {hepatik (supra hepatik)}\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {(3)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {D
iagnosis hipertensi portal ditegakkan berdasarkan anam-}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {nesis, pemeriksaan fisis, laboratorium,
endoskopi, pencitraan, }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {biopsi hati dan pengukuran tekanan vena porta.}\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {Usaha penyelamat hidup seperti tindakan p
embedahan }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\marg
f0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {endoskopik ata
u pemberian obat-obatan terus berkembang. }\par\pard\li1853\ri0\sl-266\slmult0 \
fs24\cf0\f0\charscalex100 {Untuk dapat mengelola dengan baik, diagnosis yang tep
at }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {merupakan sy
arat mutlak}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Vena-vena yang membentuk sisti
m portal adalah vena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale

x100 {porta, vena mesenterika superior dan inferior, vena splanikus }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan cabang-cabangnya. Vena
porta sendiri dibentuk dari }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {gabungan vena splanikus dan vena mesenterika superior}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {(gambar 1).}\b0 \par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Anatomi vena porta}\b0 \p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Gambar 1. Anatom
i vena porta (dikutip dari}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100\b {(2)}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100\b {.}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{(a) Vena porta }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{(h) Vena gastrika dekstra }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {(b) Vena mesenterika superior}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {(i) Vena gastrika sinistra }\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf0\f0\charscalex100 {(c) Vena }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {splanikus }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {(j) Venapankreatiko-duodenale }\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {(d) Vena mesenterika inferior }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(k) Vena kistika }\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(e) Vena gastro-epipl
oika dekstra }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1
) Cabang kanan vena porta }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\char
scalex100 {(f) Vena gastro-epiploika sinistra }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {(m) Cabang kici vena}\par\pard\sect\sectd\sbkpage
\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsx
n666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Vena porta membawa darah ke h
ati dari lambung, usus,}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {limpa, pankreas dan kandung empedu. Vena mesenterika }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {superior dibentuk dari vena-vena y
ang berasal dari usus halus,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {kaput pankreas, kolon bagian kiri, rektum dan lambung. Vena }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {porta tidak mempunyai
katup dan membawa sekitar tujuh }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f
0\charscalex100 {puluh lima persen sirkulasi hati dan sisanya oleh arteri }\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hepatika. Keduanya me
mpunyai saluran keluar ke vena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {hepatika yang selanjutnya ke vena kava inferior. }\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {ETIOLOGI }\b0 \par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Seperti yang telah dijelaskan
di atas, hipertensi portal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {dapat terjadi ekstra hepatik, intra hepatik dan supra hepatik. }\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Obstruksi vena porta
ekstra hepatik merupakan penyebab }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {50-70% hipertensi portal pada anak, tetapi dua per tiga kasu
s }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tidak spesifi
k penyebabnya tidak diketahui, sedangkan obs-}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {truksi vena porta intra hepatik dan supra hepatik
lebih banyak }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {me
nyerang anak-anak yang berumur kurang dari 5 tahun yang}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {tidak mempunyai riwayat penyakit hati se
belumnya}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2,4)}\
par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pada hipertensi portal ekstra h
epatik, obstruksi terjadi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {pada aliran darah portal antara hilus lien dan hilus hepar atau }\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {meningkatnya aliran
darah vena porta. Sumbatan ini bisa }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {karena sisa-sisa jaringan fibrous, trombus, tekanan dari lu

ar, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {adanya }\fs
24\cf0\f0\charscalex100\i {web }\i0 \fs24\cf0\f0\charscalex100 {atau diafragma a
tau sekelompok kolateral yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {mengalami transformasi kavernous}\par\pard\li1853\ri0\sl-266\slmu
lt0 \fs24\cf0\f0\charscalex100 {(3)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {. Pernah dicoba peng-}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {ikatan vena porta pada binatang percobaan, tetapi tida
k }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {menimbulkan g
ejala-gejala seperti yang didapatkan pada }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {manusia. Ini menunjukkan bahwa proses hipertensi port
al }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berlangsung
perlahan-lahan}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(
3)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Penyebab-pe
nyebab hipertensi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {portal ekstrahepatik diperlihatkan pada }\fs24\cf0\f0\charscalex100\b {tabel
1}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\p
ard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {.}\b0 \par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Tabel 1. Penyebab hipertensi
portal ekstrahepatik }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100\b {Obstruksi vena porta dan vena splenikus }\b0 \par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {Idiopatik }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Septikemia }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {Kongenital Kolangitis }\par\pard\li1853\ri0\sl266\slmult0 \fs24\cf0\f0\charscalex100 {Kelainan struktural }\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Trauma }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Omfalitis }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {Ulkus abdomen }\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {Kateterisasi vena umbilikalis }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pankreatitis }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Piloflebitis Keganasan}\par\pard\li1
853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sepsis intra abdomen }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pembesaran kelenjar lim
fe }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133
\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Pembedahan dekat port
ahepatik }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Kista
duktus koledokus }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Hipertensi portal intra hepatik dapat timbul dari kelainan }\par\pard\li1853\r
i0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {hepar dengan pengkerutan dan tanpa
pengkerutan seperti }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {fibrosis hepatik kongenital, dimana sekitar 25% kasus-kasus }\par\pard\li1
853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {hipertensi portal anak diakib
atkan oleh kelainan hepar dengan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {pengkerutan. Pada kelainan hati dengan pengkerutan terjadi }\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jaringan ikat paru
t yang difus, pengkerutan jaringan ikat yang }\par\pard\li1853\ri0\sl-266\slmult
0 \fs24\cf0\f0\charscalex100 {selanjutnya akan meningkatkan tabanan vaskuler}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(3,4)}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Kelainan }\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {hati dengan pengkerutan merupakan
penyebab terbanyak }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {hipertensi portal di Amerika Serikat}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {(6)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {. Faktor terpenting }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0
\f0\charscalex100 {hipertensi portal intrahepatik adalah peningkatan resistensi
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {aliran darah po
rtal pada tingkat sinusoid oleh karena pe-}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {numpukan kolagen perisinusoid pada ruang Disse dan}\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {konsekuensi dari p

enyempitan sinusoid}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {(4)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Penyeb
ab lain dari }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {hi
pertensi portal intrahepatik tercantum dalam }\fs24\cf0\f0\charscalex100\b {tabe
l 2}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Tabel 2. Penyebab hipertensi por
tal intrahepatik }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscale
x100 {Presinusoid}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{: Hepatitis akut dan kronik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Sirosis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Fibrosis hati kongenital }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {Sistosomiasis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {Infiltrasi saluran porta }\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {Granuloma }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {Hemangioma }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {Intoksikasi vitamin A }\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {Sklerosis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0
\f0\charscalex100 {hepato-porta }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {Idiopatik }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {Parasinusoid : }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {Sirosis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {Hepatitis kronik dan akut }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {Perlemakan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Hiperplasia nodular fokal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {Perisinusoid : }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {Sirosis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscale
x100 {Keganasan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{dengan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {metasta
sis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Penyakit ve
no oklusif }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Trom
bosis vena hepatik }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsx
n666\margrsxn133\margtsxn666\margbsxn666\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\i {Dik
utip dari Mowat}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00\i {(2)}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hi
pertensi portal supra hepatik disebabkan karena kurang-}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {nya darah vena hepatik yang masuk ke ven
a cava inferie }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
misalnya pada sindroma Budd - Chiari, gagal jantung kanan }\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {berat, perikarditis konstriktiva, tro
mbosis vena hepatik atau }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {vena kava inferior}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {(3,4)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex10
0 {. Adapun penyebab lain dari hipertensi }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {portal suprahepatik diperlihatkan dalam }\fs24\cf0\f0
\charscalex100\b {tabel 3}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {(2)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Tabel 3. P
enyebab hipertensi portal suprahepatik }\b0 \par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Gagal jantung kongesif}\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {Perikarditis konstriktiva }\par\pard\li1853\r
i0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sindroma Budd-Chiari }\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Polisitemia }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Neoplasma }\par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Trauma }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100\i {Webs}\i0 \fs24\cf0\f0\charscalex100 { vena
kava inferior }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i

{Dikutip dari Mowat}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100\i {(2)}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0\b {PATOLOGI }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {Efek patologis yang utama adalah timbulnya kolatera-}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {kolateral yang membawa darah dari sirkul
asi portal ke }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {s
irkulasi sistemik yang dapat menerangkan banyak gejala- }\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {gejala dan tanda-tanda dari kelainan in
i. Kolateral terjadi (a)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {dimana epitel penyerapan bergabung dengan epitel bertingkat }\par\pard\
li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {di esofagus alas anus (b)
pada ligamentum falsiforme (c) pada }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {dinding perut bagian posterior yang membawa darah ke vena }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kava inferior (d
) aliran ke ginjal kiri dan jarang (e) ke vena }\par\pard\li1853\ri0\sl-266\slmu
lt0 \fs24\cf0\f0\charscalex100 {pulmonalis}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Pada obstruksi ekstrahepatik sementara, bagian terbesar }\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {hati dan sel-sel hati ukurannya mengec
il terutama jika terdapat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {sirkulasi kolateral yang luas. Fibrosis perilobular dan steatosis }\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {juga sering didapa
tkan. Limpa menjadi besar dengan penebal-}\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {an kapsul dan peningkatan retikulum di sekitar sinusoi
d yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berdilata
si. Proliferasi histiosit pada sinusoid-sinusoid. Arteri }\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {dan vena splenikus, vena porta berdila
tasi dan berkelok-kelok }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {serta kadang-kadang terjadi kalsifikasi. }\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100\i {Cermin Dunia Kedokteran No. 128, 2000}\i0 \
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {42}\i0 \par\par
d\sect\sectd\sbkpage\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666
\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
s18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b {GAMBARA
N KLINIK }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Ga
mbaran klinik pada hipertensi portal ekstra hepatik }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {muncul pada umumnya sebelum anak berumur 5
tahun, be-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berap
a anak muncul sebelum usia 1 tahun (yang termuda }\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {berumur 7 bulan), tetapi sebagian besar muncul
umur 3-5}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {tahun}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(4)}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Ada 2 kriteria klinik yang
sering terdapat pada }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {keadaan ini yaitu splenomegali dan hematemesis atau melena }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dari varises esofagus serta k
adang-kadang disertai asites}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {(1,2,7)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hipertens
i portal ekstrahepatik dicurigai jika didapatkan }\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {riwayat penyakit dan gambaran klinis sebagai b
erikut : anak }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {t
ampak baik, pertumbuhan dan berat badan tidak terlalu }\par\pard\li1853\ri0\sl-2
66\slmult0 \fs24\cf0\f0\charscalex100 {terganggu, tidak ada riwayat penyakit hat
i atau ikterus, ada }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {riwayat penyakit neonatus (omfalitis, sepsis, dehidrasi, riwayat }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kateterisasi vena umbilik
alis untuk Sindrom Distres Pernapas-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\c

f0\f0\charscalex100 {an atau untuk transfusi tukar), tidak ada tanda-tanda penya
kit }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati kronik
, pembesaran perut yang intermitten atau asites }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {yang sukar diterangkan, tidak ada riwayat penya
kit hati atau }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {p
enyakit ginjal}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(
2,4)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Splenomegali dapat merupa
kan gejala awal yang paling }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {sering yang terjadi karena terbukanya sinus-sinus vaskuler dan}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hiperplasia limpa. }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Anamnesis yang c
ermat dan evaluasi klinik dapat me-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {nyingkirkan banyak penyakit-penyakit infeksi yang menyebab-}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kan splenomegali
seperti mononukleus infeksiosa, infeksi }\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {traktus respiratorius atau gangguan metabolik seperti
penyakit }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Gauche
r. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pendarahan p
ada hipertensi portal ekstrahepatik dapat }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {berupa hematemesis atau melena yang dapat terjadi pad
a anak}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {yang sebe
lumnya sehat tapi mengeluh sakit perut tiba-tiba. }\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf0\f0\charscalex100 {Keadaan ini merupakan penyebab sekitar 12% ke
matian pada }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ana
k dengan hipertensi portal. Perdarahan saluran cerna biasa-}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {nya berhenti spontan, tapi perdaraha
n ulang dapat terjadi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {dengan interval tidak teratur yang makin lama makin sedikit }\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jika kolateral telah terjadi
. Ensefalopati jarang merupakan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {komplikasi perdarahan. Beberapa pasien dengan hipertensi }\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {portal tidak disertai
dengan perdarahan. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {Asites terjadi karena penurunan sintesis albumin, retensi }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {natrium dan efek mekanik peningg
ian tekanan portal serta }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {hiperaldosteronisme. }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0
\charscalex100 {Gambaran klinik hipertensi portal intrahepatik hampir }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sama dengan gambaran klin
ik }\fs24\cf0\f0\charscalex100\b {bentuk ekstrahepatik }\b0 \fs24\cf0\f0\charsca
lex100 {dimana }\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {
splenomegali yang dihubungkan dengan hipersplenisme paling }\par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {sering dijumpai. Pirau vena periumbi
likal dapat terjadi. Jika }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {terjadi perdarahan gastrointestinal dapat diikuti dengan mem-}\par\pa
rd\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn66
6\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-21
\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {buruknya fungsi hepar dan gambar
an ensefalopati hepatik }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {dapat terjadi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {(2,3)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Bentuk akut hiper
tensi portal supra hepatik biasanya }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\c
f0\f0\charscalex100 {dengan asites (95%), hepatomegali (70%) dan nyeri tekan }\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {daerah perut (50%)
disertai dengan muntah dan ikterus ringan. }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Diare merupakan komplikasi yang sering timbul. Jika
obs-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {truksi ven

a porta komplit, kematian dapat terjadi oleh karena }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {kegagalan hati. Pelebaran vena-vena superfi
sial perut biasanya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {sebanding dengan derajat obstruksi. Varises esofagus jarang }\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {terjadi kecuali bila perlangsu
ngan penyakit yang lama, oleh }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {sebab itu hematemesis jarang dijumai pada awal penyakit}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(3)}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100 {Adanya pelebaran vena-vena perut membuat kita men-}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {curigai suatu hi
pertensi portal. Pada daerah tersebut dapat }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {terdengar bising (bising Cruveilhier Baumgarten) ya
ng sering}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {didapa
tkan pada hipertensi portal intra hepatik. Hemoroid }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {jarang pada anak tetapi bisa menjadi serius
apabila ada. Ini }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {lebih sering ditemukan pada kelainan hati dengan peng-}\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {kerutan}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {(4)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100\b {DIAGNOSIS }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {Diagnosis suatu hipertensi portal berdasarkan atas }\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {anamnesis, pemeriksaan fisis, penci
traan, laboratorium, endos-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {kopi, pengukuran tekanan vena porta dan biopsi hati}\par\pard\li1853
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(1,3)}\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {Pemeriksaan-pemeriksaan yang dapat dilakukan untuk men-}
\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {deteksi adanya s
uatu hipertensi portal adalah sebagai berikut }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100\b {(tabel 4).}\b0 \par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100\b {Tabel 4. Pemeriksaan pada penderita yang didug
a hipertensi portal }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {Uji fungsi hati }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\chars
calex100 {Waktu protrombin }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {Pemeriksaan darah lengkap }\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {USG hati sistim bilier }\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {Pemeriksaan radioisotop sistim vena porta dan gin
jal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Endoskopi }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Esofagogram }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Mencari penyebab he
patitis kronik }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Biopsi hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pem
eriksaan sebelum operasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {Pemeriksaan radiologik sistim vena porta dan cabang-cabangnya atau }\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {portografi umbilik
al }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Venogram hep
atik retrograd }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Venocavogram interior }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Venografi porta transhepatik perkutan }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100\i {Dikutip dari Mowat}\i0 \par\pard\sect\sectd\sbkp
age\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\pard
0 \fs24\cf0\f0\charscalex100\i {(2)}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {Pencitraan sebagai salah satu penunjang diagnostik hiper
-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tensi portal j
uga memegang peranan penting untuk mendeteksi }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {secara akurat tanda-tanda klinis serta komplikasi

hipertensi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {por
tal}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(7)}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Pemeriksaan untuk meli
hat kelainan anatomis sistim }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {porta diperlukan untuk melakukan koreksi operatif maupun }\par\par
d\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {transplantasi hati. Untu
k hal ini USG Doppler sangat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {menolong sedangkan angiografi dan venografi vena splenikus }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berguna untuk melihat
potensi vena porta dan cabang- cabang-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100 {nya. CT scan tidak lebih unggul dari USG Doppler dalam }\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {melihat vena port
a dan kolateralnya. Portografi umbilikus }\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {dapat melihat vena porta dan cabang-cabangnya didalam
hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {serta sinu
soid hati sedangkan portografi transhepatik jarang }\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf0\f0\charscalex100 {digunakan karena banyak komplikasinya}\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1)}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmu
lt0 \fs24\cf0\f0\charscalex100 {Pengukuran tekanan vena hepatik dapat menentukan
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kelainan intra
hepatik bila cara lain merupakan kontraindikasi }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {dalam pemeriksaan penyebab hipertensi portal, s
edangkan}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {biopsi
hati dapat memberikaan informasi tentang diagnosis dan}\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {prognosis terutama hipertensi portal intr
ahepatik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sebelum diagnosis pasti dibuat, b
eberapa keadaan yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {berhubungan dengan splenomegali, lekopeni dan pansitopeni }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {harus dapat disingkirkan seperti
Gaucher disease, Niemann}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\chars
calex100 {Pick disease, Letterer Siwe disease dan penyakit-penyakit }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {dengan infiltrasi pada sums
um tulang dengan leukemia dan sel }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {neoplastik}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {(3)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Cermin Dun
ia Kedokteran No. 128, 2000 43}\i0 \par\pard\sect\sectd\sbkpage\pard\sect\sectd\
sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\
mult0 \fs24\cf0\f0\charscalex100\b {PENANGANAN }\b0 \par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf0\f0\charscalex100 {Perdarahan dari varises esofagus yang berman
ifestasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sebaga
i hematemesis dan melena biasanya berhenti spontan, }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {tapi perdarahan ulang dapat terjadi}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2,3,5)}\par\pard\li185
3\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {. Jika perdarahan masih}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tetap berlangsung dapat
dipikirkan pemberian transfusi darah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {segar, vasopressin, pemasangan pipa lambung untuk pembilas
-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {an dengan NaCl
dingin}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(4)}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {, tetapi peneliti la
in menganggap }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {b
ahwa pembilasan tidak berarti banyak dalam mengurangi }\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {perdarahan}\par\pard\li1853\ri0\sl-280\sl

cf0\f0\charscalex100 {. Vasopressin (pitressin) diberikan dengan tujuan }\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {menyebabkan vasokonstri
ksi arteri splanikus dengan dosis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {0,33 unit/kilogram berat badan intraavena selama 20 menit. }\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Jika perdarahan m
asih berlanjut, dosis dapat ditingkatkan tiga }\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {kali lipat. Glypressin adalah suatu prekursor pit
ressin inaktif. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Pada anak-anak, dapat diberikan dengan dosis 2 mg per infus }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {selama 6 jam. Dikatakan bahwa glyp
ressin ini lebih efektif dari }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100 {vasopressin. Efek samping yang dapat terjadi pada pemberian }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {obat-obatan ini adal
ah kemerahan pada kulit, kolik abdomen }\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {dan diare.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Apabila dengan cara di atas tidak berhasil dalam }\par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {mengatasi perdarahan dapat
dipikirkan pemasangan balon}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {untuk tamponade (Sengstaken-Blackmore). Pemasangan balon}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ini sulit dilaksanakan pada
anak dan dikuatirkan bisa }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {menyumbat jalan napas pada waktu dikeluarkan, aritmia }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jantung, robeknya esofagus da
n refluks darah dari esofagus }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {sehingga terjadi aspirasi. Apabila tetap tidak berhasil maka }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dilakukan ligasi va
rises. Kebanyakan hipertensi portal ekstra }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {hepatik dapat teratasi dengan cara-cara ini}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1-5)}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmu
lt0 \fs24\cf0\f0\charscalex100\b {Gambar 2. Anatomi normal pada hipertensi porta
l dan pirau porta}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100\b {(dikutip dari 2).}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Penanganan operasi untuk menghentikan perdarahan }\par\pard\li1853
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {masih merupakan kontroversi. Seb
enarnya pembuatan pirau}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {dengan tindakan operasi ini merugikan penderita karena dapat }\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {menurunkan aliran darah ke
hati yang akan mengurangi perfusi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {jaringan hati yang pada akhirnya akan menyebabkan }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ensefalopati porta sistem
ik. Pembuatan pirau mungkin berguna }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {pada penderita hipertensi portal ekstrahepatik dengan per-}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {darahan yang tid
ak bisa diatasi. Ada dua cara yang akhir-akhir}\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {ini digunakan, yaitu penanganan secara langsung p
ada }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {varisesnya
(ligasi transesofagal) dan pengalihan aliran darah }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {dari sirkulasi portal ke sirkulasi sistemik
(pintasan portokaval }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscale
x100 {dekompressi dan selektif). Skleroterapi merupakan pilihan }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penanganan awal, tetapi ini bia
sanya hanya merupakan }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marg
lsxn666\margrsxn133\margtsxn666\margbsxn413\pard\li1853\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {pe
nanganan sementara sambil menunggu operasi. Pintasan}\par\pard\li1853\ri0\sl-266
\slmult0 \fs24\cf0\f0\charscalex100 {untuk dekompressi yang terkenal adalah }\fs
24\cf0\f0\charscalex100\i {end to side }\i0 \fs24\cf0\f0\charscalex100 {portocav
al }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan pintasan

selektif adalah splenorenal distal }\fs24\cf0\f0\charscalex100\b {(gambar 2)}\b
0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1-}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5,8)}\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {. Pintasan splenorenal distal dibandi
ngkan dengan pintasan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {portokaval efeknya sama dalam mencegah perdarahan ulang }\par\pard\li1853\
ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {tetapi kemungkinan dalam terjadin
ya ensefalopati lebih rendah }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {pada pintasan splenorenal distal, selain itu pintasan portokaval }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {lebih membebani
hati setelah operasi. Setelah operasi dapat }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {terjadi komplikasi kegagalan hati, pnemoni aspirasi
dan}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {sepsis}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {(a) Anatomi normal hipertensi portal (b) pirau
splenorena I distal selektif yang }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {memperlihatkan (L) hati (S) limpa (K) ginjal (P) vena porta
(SV) vena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {splen
ikus (R) vena renalis (IVC) vena kava inferior (CV) vena koronaria.}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {KEPUSTAKAAN }\b0 \par\pard
\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {1.}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Wiharta AS. Tatalaksana Hipertensi Por
ta. Naskah Lengkap Simposium }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Konrres Nasional Ilmu Kesehatan Anak X; Bukitinggi, 1996; 1-7}\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {2.}\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Mowat AP. Disorders of the portal
and hepatic venous system. In Liver}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {disorders in childhood; 2}\par\pard\li1853\ri0\sl-120\slmul
t0 \fs10\cf0\f0\charscalex100 {nd}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {ed. London, Boston : Butterworth, 1987; }\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {298-322.}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {3. Byrne WJ. The gastrointestinaal tract. In
: Behrman RE, Kliegman R,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {Essentials of pediatrics. Philadelphia : WB Saunders Comp, 1990; 406.
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {4.}\par\pard\li
1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Roy CC, Silverman A, Cozzett
o FJ. Portal Hypertension. In : Roy CC et }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {al, Eds. Pediatric clinical gastroenterology. 2}\par\
pard\li1853\ri0\sl-120\slmult0 \fs10\cf0\f0\charscalex100 {nd}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ed. Saint Louis: The CV }\par\pard
\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Mosby Comp, 1975; 582-604
.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5. Shandling B
. Portaal hypertension and varices. In: Behrman RE,}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {Kliegman RM, Nelson WE, Vaughan VC, Eds. Tex
tbook of Pediatrics; }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscale
x100 {14}\par\pard\li1853\ri0\sl-120\slmult0 \fs10\cf0\f0\charscalex100 {th}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ed. Philadelphia: WB
Saunders Comp, 1993; 1029-30.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {6.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Braunwald E, Isselbacher KJ, Petersdorf RG et al. Principles of Internal }\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Medicine, 11}\par\pa
rd\li1853\ri0\sl-120\slmult0 \fs10\cf0\f0\charscalex100 {th}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ed. New York, St Louis: McGraw-Hill
Book Comp, 1987; }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{1346-7.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {7.}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Firman K. Pencitraa
n sebagai sarana penunjang diagnosis portal. Naskah}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {Lengkap Simposium Kongres Nasional Ilmu Kese
hatan Anak X; }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {B

ukittinggi, 1996; 8-19.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {Penanganan dietetik pada penderita hipertensi portal }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tergantung dari penyakit yang mend
asarinya. Terutama setelah }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840
\marglsxn666\margrsxn133\margtsxn666\margbsxn386\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-21
0 {dilakukan operasi, pembatasan diet protein yang ketat harus }\par\pard\li1853
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dilakukan untuk menghindari kega
galan hati Akut. Jika ter-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {dapat asites, diberikan diet rendah garam (kurang dari 500 mg)}\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan hidroklortiazid (7
5 mg/m}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {)}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(3,9)}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0
\f0\charscalex100 {8.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Buller HA, Rauws EAJ. Sclerotherapy for oesophageal varices. Naskah}\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Lengkap Simposium Kong
res Nasional Indonesia Ilmu Kesehatan Anak }\par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100 {X; Bukittinggi, 1996; 8-19.}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {9.}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {Davidson SS, Pasmore R, Brock JF. Diseases of the Liv
er, Biliary tract }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {and Pancreas. In Human Nutrition And Dietetics; 1}\par\pard\li1853\ri0\sl-106
\slmult0 \fs10\cf0\f0\charscalex100 {st}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {ed. Edinburgh,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {London: Churchill Livingstone, 1973; 410-21}\par\pard\li1
853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-306\slmult0 \fs28\cf0\f0\charscalex100\b {Meningkatkan Kual
itas Hidup Penderita Sirosis Hati }\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs28
\cf0\f0\charscalex100\b {dengan Nutrisi Khusus }\b0 \par\pard\li1853\ri0\sl-426\
slmult0 \fs20\cf0\f0\charscalex100 {Sirosis hati merupakan kelanjutan dari penya
kit hati menahun, misalnya hepatitis B }\par\pard\li1853\ri0\sl-226\slmult0 \fs2
0\cf0\f0\charscalex100 {atau C yang ditandai dengan perubahan anatomi sel-sel ha
ti menjadi jaringan ikat. Di }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\c
harscalex100 {samping itu, pasien sirosis hati umumnya mengalami gangguan dalam
proses }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {metaboli
sme zat menjadi energi. Gejala dan penyulit yang menyertai sirosis hati di }\par
\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {antaranya asites (bu
sung air), anemia, protein energi malnutrisi, mudah infeksi }\par\pard\li1853\ri
0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {(gangguan sistem imun), dan ensefal
opati hepatik. Penyulit ini menyebabkan kualitas }\par\pard\li1853\ri0\sl-240\sl
mult0 \fs20\cf0\f0\charscalex100 {hidup penderita menurun. Salah satu komplikasi
serius yang membutuhkan perhatian }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf
0\f0\charscalex100 {khusus adalah ensefalopati hepatik. Berdasarkan data, diketa
hui bahwa 40--85% }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex10
0 {penderita sirosis hati mengidap ensefalopati hepatik secara subklinis. Demiki
an }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dikatakan Pr
of. Dr. Nurul Akbar, SpPD-KGEH dalam seminar awam bertema }\par\pard\li1853\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {"Meningkatkan Kualitas Hidup Penderit

a Sirosis Hati dengan Nutrisi Khusus", pada 6 }\par\pard\li1853\ri0\sl-226\slmul
t0 \fs20\cf0\f0\charscalex100 {April 2002, di Jakarta. }\par\pard\li1853\ri0\sl426\slmult0 \fs20\cf0\f0\charscalex100 {Lebih lanjut, dikatakan bahwa deteksi en
sefalopati hepatik subklinis dapat dilakukan }\par\pard\li1853\ri0\sl-226\slmult
0 \fs20\cf0\f0\charscalex100 {dengan NCT (}\fs20\cf0\f0\charscalex100\i {Number
Connection Test}\i0 \fs20\cf0\f0\charscalex100 {). Pada tes ini penderita dimint
a }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {menghubungkan
angka 1--25, kemudian dinilai lama waktu yang dibutuhkan untuk }\par\pard\li185
3\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menyelesaikan tes tersebut. Sem
akin lama waktu yang dibutuhkan untuk }\par\pard\li1853\ri0\sl-226\slmult0 \fs20
\cf0\f0\charscalex100 {menyelesaikan, semakin tinggi tingkat kemungkinan ensefal
opati hepatik. Sementara }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\chars
calex100 {itu, ensefalopati hepatik klinis berdasarkan derajat keparahan dibagi
menjadi 4 }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\marg
f0\par\pard\li1853\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {stadium. Stadi
um 0 menunjukkan tidak adanya gangguan yang tampak secara klinis, }\par\pard\li1
853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {stadium 1 terjadi gangguan st
atus mental (perubahan tingkah laku dan emosi), }\par\pard\li1853\ri0\sl-226\slm
ult0 \fs20\cf0\f0\charscalex100 {stadium 2 pasien cepat mengantuk yang menandai
mulai terjadi gangguan saraf }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {yang lebih lanjut, stadium 3 kesadaran pasien tambah menurun, dan
akhirnya pada }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {s
tadium 4 pasien kehilangan kesadaran (koma). }\par\pard\li1853\ri0\sl-426\slmult
0 \fs20\cf0\f0\charscalex100 {Koma hepatik terjadi karena beberapa kondisi, teru
tama adanya hiperamonia akibat }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {gangguan detoksifikasi oleh hati dan karena adanya gangguan kese
imbangan antara }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{asam amino rantai cabang dengan asam amino aromatik. }\par\pard\li1853\ri0\sl-4
40\slmult0 \fs20\cf0\f0\charscalex100 {Pada keadaan sirosis hati lanjut, terjadi
pemecahan protein otot. Asam amino rantai }\par\pard\li1853\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {cabang (AARC) yang terdiri dari valin, leusin, dan i
soleusin digunakan sebagai }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\cha
rscalex100 {sumber energi (kompensasi gangguan glukosa sebagai sumber energi) da
n untuk }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {metabol
isme amonia. Dalam hal ini, otot rangka berperan sebagai organ hati kedua }\par\
pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {sehingga disarankan p
enderita sirosis hati mempunyai massa otot yang baik dan }\par\pard\li1853\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {bertubuh agak gemuk. Dengan demikian,
diharapkan cadangan energi lebih banyak, }\par\pard\li1853\ri0\sl-226\slmult0 \f
s20\cf0\f0\charscalex100 {stadium kompensata dapat dipertahankan, dan penderita
tidak mudah jatuh pada }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charsca
lex100 {keadaan koma. }\par\pard\li1853\ri0\sl-440\slmult0 \fs20\cf0\f0\charscal
ex100 {Penderita sirosis hati harus meringankan beban kerja hati. Aktivitas seha
ri-hari }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {disesua
ikan dengan kondisi tubuh. Pemberian obat-obatan (hepatotoksik) harus }\par\pard
\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dilakukan dengan sangat h
ati-hati. Penderita harus melakukan diet seimbang, cukup }\par\pard\li1853\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {kalori, dan mencegah konstipasi. Pada
keadaan tertentu, misalnya, asites perlu diet }\par\pard\li1853\ri0\sl-240\slmul
t0 \fs20\cf0\f0\charscalex100 {rendah protein dan rendah garam. }\par\pard\li185
3\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Penentuan diet pada penderita s
irosis hati sering menimbulkan dilema. Di satu sisi, }\par\pard\li1853\ri0\sl-22
6\slmult0 \fs20\cf0\f0\charscalex100 {diet tinggi protein untuk memperbaiki stat
us nutrisi akan menyebabkan hiperamonia }\par\pard\li1853\ri0\sl-226\slmult0 \fs
20\cf0\f0\charscalex100 {yang berakibat terjadinya ensefalopati. Sedangkan bila
asupan protein rendah maka }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\cha
rscalex100 {kadar albumin dalam darah akan menurun sehingga terjadi malnutrisi y
ang akan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {memper

buruk keadaan hati. Untuk itu, diperlukan suatu solusi dengan nutrisi khusus }\p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {hati, yaitu Aminol
eban Oral. Aminoleban Oral mengandung AARC kadar tinggi serta }\par\pard\li1853\
ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {diperkaya dengan asam amino penti
ng lain seperti arginin, histidin, vitamin, dan }\par\pard\li1853\ri0\sl-240\slm
ult0 \fs20\cf0\f0\charscalex100 {mineral. Nutrisi khusus hati ini akan menjaga k
ecukupan kebutuhan protein dan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {mempertahankan kadar albumin darah tanpa meningkatkan risiko ter
jadinya }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {hiperam
onia. Pada penderita sirosis hati yang dirawat di rumah sakit, pemberian }\par\p
ard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {nutrisi khusus ini ter
bukti mempercepat masa perawatan dan mengurangi frekuensi }\par\pard\li1853\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {perawatan. }\par\pard\li1853\ri0\sl-4
26\slmult0 \fs20\cf0\f0\charscalex100 {Dengan nutrisi khusus ini diharapkan stat
us nutrisi penderita akan terjaga, mencegah }\par\pard\li1853\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {memburuknya penyakit hati, dan mencegah terjadinya
ensefalopati hepatik sehingga }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {kualitas serta harapan hidup penderita juga akan membaik. (}\fs20
\cf0\f0\charscalex100\b {Hidayati W.B.}\b0 \fs20\cf0\f0\charscalex100 {) }\par\p
ard\sect\sectd\sbkpage\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn6
66\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b {HASIL
PENELITIAN }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{Sonografi Sirosis Hepatis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {di RSUD Dr. Moewardi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100\b {Suyono, Sofiana, Heru, Novianto, Riza, Musrifah }\b0 \par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Bagian Radiologi Faku
ltas Kedokteran Universitas Sebelas Maret / }\i0 \par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100\i {Rumah Sakit Umum Daerah Dr. Moewardi Surakart
a}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {PENDAHUL
UAN }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penyaki
t hepar terutama hepatitis yang disebabkan oleh }\par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100 {virus (terutama virus hepatitis B) saat ini mel
anda dunia baik di }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {negara maju maupun negara berkembang. Munculnya virus }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {baru yaitu virus Hepatitis E menimbul
kan hepatitis akut yang}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {sporadik terutama pada usia dewasa (60%).}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {Sirosis hepatis sebagian besar disebabkan oleh
hepatitis}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1)}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penderitanya juga
tidak pernah berkurang terutama dari }\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100 {pengamatan di RSDM Surakarta sejak tahun 2001-2003.}\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {SIROSIS HEPATIS }\b
0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Definisi }\b
0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sirosis hepati
s adalah penyakit hati menahun difus ditandai }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {dengan adanya pembentukan jaringan ikat disertai
nodul}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\p
ard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Etiologi }\b0 \par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penyebab yang pasti sampai sekarang
belum jelas; di }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{antaranya}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(3)}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {:}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf0\f0\charscalex100 {Faktor kekurangan nutrisi }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {Hepatitis virus }\par\pard\li1853\ri0\sl-266\slm

ult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Zat hepatotoksik }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {Penyakit Wilson }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hemokr
omatosis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Geja
la klinis }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {G
ejala dini samar dan nonspesifik berupa kelelahan, }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {anoreksia, dispepsia, flatulen, konstipasi a
tau diare, berat badan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {berkurang, nyeri tumpul atau berat pada epigastrium atau }\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {kuadran kanan atas}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1)}\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {Manifestasi utama dan lanjut sirosis merupakan akibat
dari }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dua tipe
gangguan fisiologis}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {: }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\p
ard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Gagal sel hati }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\sect\sectd
\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400
18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-413\s
lmult0 \fs24\cf0\f0\charscalex100 {Ikterus }\par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Edema perifer }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {K
ecenderungan perdarahan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Erite
ma palmaris (telapak tangan merah)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100 {Angioma laba-laba }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Fetor
hepatikum }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ensefalopati hepati
k }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hipertensi portal }\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Splenomegali }\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-266\slmult0 \
fs24\cf0\f0\charscalex100 {Varises oesofagus dan lambung }\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Manifestasi sirkulasi kolateral lain }\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sedang asites dapat dianggap s
ebagai manifestasi gagal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {hepatoseluler dan hipertensi portal}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {(1)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00\b {PEMERIKSAAN PENUNJANG }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100\b {Pemeriksaan laboratorium }\b0 \par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {Tidak ada pemeriksaan uji biokimia hati yang da
pat }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {menjadi peg
angan dalam menegakkan diagnosis sirosis hepatis: }\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Darah}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {Anemia normokrom normositer, hipokrom normositer, }\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hipokrom mikrositer atau hipokrom
makrositer. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {b.
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Kenaikan kadar
enzim transaminase (SGOT/SGPT)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\

charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {c.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Albumin da
n globulin serum }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{Perubahan fraksi protein yang paling sering terjadi pada }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penyakit hati adalah penurunan kadar
albumin dan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ken
aikan kadar globulin akibat peningkatan globulin }\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {gamma}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {d.
}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Penurunan kadar
CHE }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {e.}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pemeriksaan kadar elekt
rolit, penting pada penggunaan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0
\charscalex100 {diuretik dan pembatasan garam dalam diet. }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {f.}\par\pard\sect\sectd\sbkpage\pgwsx
n11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\pard\li1853\r
f0\f0\charscalex100 {Pemanjangan masa protrombin, }\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf0\f0\charscalex100 {g.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Peningkatan kadar gula darah}\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {h.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Pemeriksaan }\fs24\cf0\f0\charscalex100\i {marker }\i0 \fs
24\cf0\f0\charscalex100 {serologi petanda virus seperti }\par\pard\li1853\ri0\sl
-266\slmult0 \fs24\cf0\f0\charscalex100 {HBsAg/HBsAb, HBeAg/HbeAb, HBv DNA penti
ng untuk}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {menentu
kan etiologi sirosis hepatis. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100\b {Pemeriksaan fisik }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {Hati: Biasanya membesar pada awal sirosis, bila hati }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {mengecil artinya prognosis kura
ng baik..Konsistensi hati }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\char
scalex100 {biasanya kenyal, tepi tumpul dan nyeri tekan.}\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Splenomegali. }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {c.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {Ascites dan vena kolateral di perut dan ekstra abdomen}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {d.}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {Manifestasi di luar perut : Spider nevi
di tubuh bagian atas, }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {bahu, leher, dada, pinggang, caput medusae}\par\pard\li1853\ri0\sl-280\sl
cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100\b {VIRUS HEPATITIS B }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100\b {Struktur virus }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {Virus hepatitis B (HBV) termasuk famili hepadnaviridae }\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan genus hepadna
virus, virus DNA, serat ganda parsial }\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100\i {(partially double stranded)}\i0 \fs24\cf0\f0\charscalex
100 {, panjang genom sekitar 3200}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {pasangan basa, mempunyai }\fs24\cf0\f0\charscalex100\i {envelo
pe}\i0 \fs24\cf0\f0\charscalex100 {/selubung}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {(7)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f
0\charscalex100 {. Protein yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {dibuat oleh virus yang bersifat antigenik serta memberi }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {gambaran tentang keadaa
n penyakit adalah : }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100\i {Cermin Dunia Kedokteran No. 150, 2006}\i0 \par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {22}\par\pard\sect\sectd\sbkpage\pard\sect\sectd

\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn360
lmult0 \fs24\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\
cf0\f0\charscalex100 {Antigen permukaan/}\fs24\cf0\f0\charscalex100\i {surface a
ntigen}\i0 \fs24\cf0\f0\charscalex100 {/HbsAg..}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {b.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Antigen core/}\fs24\cf0\f0\charscalex100\i {core antigen}\i0
\fs24\cf0\f0\charscalex100 {/HbcAg.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {c.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Antigen e/ }\fs24\cf0\f0\charscalex100\i {e antigen}\i0 \fs24\cf0\f0\char
scalex100 {/HbeAg}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{(7)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\par
d\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Skema partikel virus h
epatitis B }\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\b
\i {Mekanisme hipotetik penempelan VHB pada hepatosit }\b0 \i0 \par\pard\li1853
\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Mekanisme masuknya virus hepatit
is B masih }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dipe
rdebatkan. Dilaporkan bahwa suatu reseptor poli-HAS}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {atau disebut }\fs24\cf0\f0\charscalex100\i {
poli-HAS receptor}\i0 \fs24\cf0\f0\charscalex100 { (pAR) berperan dalam fase }\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {penempelan}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(8)}\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs26\cf0\f0\charscalex100\b \i {Mekanisme imunologi pada infeksi virus hepat
itis B }\b0 \i0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {
Virus hepatitis B bersifat tidak sitopatik. Pada infeksi akut, }\par\pard\li1853
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {terjadi infiltrasi sel-sel radan
g antara lain limfosit T yaitu sel }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {NK dan sel T sitotoksik. Antigen virus terutama HbcAg dan}\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {HbeAg yang diekspr
esikan di permukaan hepatosit bersama-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100 {sama dengan glikoprotein HLA }\fs24\cf0\f0\charscalex100\
i {class}\i0 \fs24\cf0\f0\charscalex100 { I, mengakibatkan }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hepatosit yang terinfeksi menjadi ta
rget untuk lisis oleh limfosit }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {T}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Selain i
tu sel hati yang mengalami infeksi virus hepatitis B }\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {ternyata dapat memproduksi sejenis protein
}\fs24\cf0\f0\charscalex100\i {Liver}\i0 { }\fs24\cf0\f0\charscalex100\i {Speci
fic }\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Prote
}\i0 \fs24\cf0\f0\charscalex100 {in yang bersifat antigenik}\par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(9)}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {. Perubahan-perubahan akibat }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {interferon akan menimbulkan suatu
status antiviral pada }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {hepatosit yang tidak terinfeksi, dan mencegah reinfeksi selama }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {proses lisis hepatosit ya
ng terinfeksi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(2
,10)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hepatitis virus B yang be
rlanjut menjadi kronis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {menunjukkan bahwa respon imunologi seluler terhadap infeksi }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {virus tidak baik}\par\pard\
li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Kegagalan lisis hepatosit yang terinfeksi virus oleh
limfosit }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {T dap
at terjadi akibat berbagai mekanisme : }\par\pard\li1853\ri0\sl-280\slmult0 \fs2

4\cf0\f0\charscalex100 {a.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {Fungsi sel T supresor (Ts) yang meningkat. }\par\pard\li1853\ri0\sl-2
66\slmult0 \fs24\cf0\f0\charscalex100 {b.}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {Gangguan fungsi sel T sitotoksik (Tc).}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {c.}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {Adanya antibodi penghambat di permukaan hepa
tosit. }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {d.}\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Kegagalan pengenalan
ekspresi antigen atau HLA class I}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsx
n16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0
alex100 {di permukaan hepatosit}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0
\charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {USG PADA
SIROSIS HEPATIS }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Gambarannya meliputi gambaran spesifik pada organ-}\par\pard\li1853\ri0\sl
-266\slmult0 \fs24\cf0\f0\charscalex100 {organ hati, lien, dan traktus biliaris.
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {a.}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Gambaran USG pada hati }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Terdapat gambaran i
regularitas penebalan permukaan hati, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {membesarnya lobus kaudatus, rekanalisasi v.umbilikus, dan
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ascites. Ekhop
arenkim sangat kasar menjadi hiperekhoik }\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {karena fibrosis dan pembentukan mikronodul menjadikan
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {permukaan hati
sangat ireguler, hepatomegali; kedua lobus hati }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {mengecil atau mengerut atau normal. Terlihat pu
la tanda }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sekund
er berupa asites, splenomegali, adanya pelebaran dan }\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf0\f0\charscalex100 {kelokan-kelokan v. hepatika, v. lienalis d
an v. porta (hipertensi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {porta). Duktus biliaris intrahepatik dilatasi, ireguler dan}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berkelok-kelok}\par\pard\li
1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(5,6)}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {b.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100 {Gambaran USG pada lien }\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {Tampak peningkatan ekhostruktur limpa karena adanya }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jaringan fibrosis, p
elebaran diameter v.lienalis serta tampak lesi }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {sonolusen multipel pada daerah hilus lienalis ak
ibat oleh }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {adany
a kolateral}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(5)}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {c.}\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Gambaran USG pada traktus biliaris. }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Sludge}\i0 \fs24\cf0
\f0\charscalex100 { (lumpur empedu) terlihat sebagai material }\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {hiperekhoik yang menempati bagian
terendah kandung empedu }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {dan sering bergerak perlahan-lahan sesuai dengan posisi }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penderita, jadi selalu memben
tuk lapisan permukaan dan tidak }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {memberikan bayangan akustik di bawahnya. Pada dasarnya }\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {lumpur empedu tersebut
terdiri atas granula kalsium bilirubinat }\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {dan kristal-kristal kolesterol sehingga mempunyai visk
ositas }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {yang leb

ih tinggi daripada cairan empedu sendiri. Dinding}\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {kandung empedu terlihat menebal. Duktus biliar
is }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ekstrahepati
k biasanya normal}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{(4)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {METODA PENELITIAN }\b0
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Data didapatkan
dari penderita dengan tanda klinis, data }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {laboratoris dan USG sebagai pemeriksaan penunjang. Da
ta }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dikumpulkan
secara retrospektif dari permintaan USG hepar di }\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {bagian Radiologi RSUD Dr.Moewardi Surakarta se
jak 2001-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2003.
Data tersebut diolah dan diklasifikasikan berdasarkan}\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf0\f0\charscalex100 {umur, jenis kelamin, keterangan klinik dan
hasil USG hepar.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
\b {HASIL PENELITIAN }\b0 \par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\m
arglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \f
{Data diambil antara tahun 2001-2003 di bagian Radiologi }\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {RSUD Dr.Moewardi Surakarta Hasil penel
itian dapat dilihat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {pada tabel di bawah ini. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100\b {Hasil pemeriksaan klinis }\b0 \par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100\b {Tabel 1. Distribusi berdasarkan jenis kelamin p
enderita }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {
Jenis kelamin }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0\b {Jumlah }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\
b {%}\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Laki-la
ki }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Wanita }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {44}\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {18}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {71}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {29}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {Total 62 100}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100\b {Tabel 2. Distribusi berdasarkan umur penderita }\b0 \par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Umur (th)}\b0 \par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Jumlah }\b0 \par\pard\li1853\ri0\sl
-266\slmult0 \fs24\cf0\f0\charscalex100\b {%}\b0 \par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {31 40}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {41 50}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100 {51 60}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {61 70}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {71
80}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {81 90}\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {91 100}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {10}\par\pard\li1853\ri0\sl-28
4\cf0\f0\charscalex100 {27}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {18}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1}
\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {16}\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {43}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {29}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\li185
3\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {Total 62 100}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100\b {Tabel 3. Gajala klinis (n=62) }\b0 \par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Keterangan klinik }\b0 \p

ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Jumlah }\b0 \par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {%}\b0 \par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ikterik }\par\pard\li1853\ri
0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Hematemesis }\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Ascites }\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {Hepatomegali }\par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100 {Splenomegali }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {Mekena }\par\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}
7;32768}}
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs22\cf0\f0\charscalex100 {37}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf
0\f0\charscalex100 {19}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscal
ex100 {33}\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf0\f0\charscalex100 {10}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {93}\par\pard\li1853
\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {13}\par\pard\li1853\ri0\sl-266\s
lmult0 \fs22\cf0\f0\charscalex100 {60}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\
cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charsc
alex100 {54}\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf0\f0\charscalex100 {16}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Hasil pemeriksa
an USG Abdomen }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00\b {Tabel 4. Ascites }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100\b {USG Abdomen }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100\b {Jumlah }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100\b {%}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {Ada }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Tidak
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {54}\par\pard\li
6\slmult0 \fs24\cf0\f0\charscalex100 {87}\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {13}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\s
l-253\slmult0 \fs24\cf0\f0\charscalex100\b {SINDROMA HEPATORENAL }\b0 \par\pard\
li1853\ri0\sl-306\slmult0 \fs24\cf1\f0\charscalex100\b {SRI MARYANI SUTADI }\b0
\par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {Fakultas Kedok
teran}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Bagi
an Ilmu Penyakit Dalam}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\char
scalex100\b {Universitas Sumatera Utara}\b0 \par\pard\li1853\ri0\sl-320\slmult0
\fs24\cf0\f0\charscalex100\b {Pendahuluan }\b0 \par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Dalam beberapa tahun terakhir ini, telah diketahu
i bahwa sindroma }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100
{hepatorenal (SHR) merupakan komplikasi terminal pada pasien }\fs24\cf0\f0\char
scalex100\b {sirosis}\b0 { }\fs24\cf0\f0\charscalex100\b {hati }\b0 \par\pard\li
1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ascites.}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {Timbulnya gagal ginjal tanpa adanya gejala k
linis dan bukti histologis yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {diketahui}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {sebagai penyebab timbulnya gagal ginjal tersebut.}\par\pard\li1853\ri
0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {1,2}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Pada SHR kelainan yang dijumpai pada ginjal hanya berupa kega
galan fungsi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tan
pa ditansai dengan kelainan anatomi. Hal ini dapat dibuktikan bila ginjal }\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tersebut }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ditansplantasikan pada pend
erita lain yang tidak didapati kelainan}{ }\fs24\cf0\f0\charscalex100\b {hati}\b
0 \fs24\cf0\f0\charscalex100 {, maka }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\

cf0\f0\charscalex100 {fungsi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {ginjal tersebut akan kembali normal atau penderita yang mengalami S
HR }\par\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {dilakukan}\par\pard\
li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {transpalantasi }\fs24\cf0\
f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { maka fungsi ginjalnya
akan kembali normal.}\par\pard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex
100 {3}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Selain perubahan fungsi
ginjal, penderita SHR juga ditandai dengan perubahan }\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {sirkulasi arteri sistemik dan aktifitas s
istim }\fs24\cf0\f0\charscalex100\i {vasoactive endogen}\i0 { }\fs24\cf0\f0\char
scalex100 {yang berperan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {dalam }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{terjadinya hipoperfusi ke ginjal. Dengan alsan ini SHR merupakan kumpulan}\par\
pard\li1853\ri0\sl-293\slmult0 \fs22\cf0\f0\charscalex100 {patofisiologi yang un
ik untuk diketahui hubungan antara sirkulasi sistemik dan }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {fungsi}\par\pard\li1853\ri0\sl-293\sl

mult0 \fs24\cf0\f0\charscalex100 {ginjal serta pengaruh factor vasokonstriktor d
an vasodilator pada sirkulasi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {ginjal}\par\pard\li1853\ri0\sl-160\slmult0 \fs14\cf0\f0\charscale
x100 {4,5}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {.}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {SHR dilaporkan perta
ma sekali oleh Austin Flint dan Frerichs (1863), yang}\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {masing-masing melaporkan timbulnya oligura
pada pasien-pasien}{ }\fs24\cf0\f0\charscalex100\b {sirosis }\b0 \par\pard\li18
53\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {asites, mereka tidak menemukan adanya p
erubahan histology ginjal yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {nyata }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {pada pemeriksaan post mortem. Pierre Vesin salah satu peneliti tentang as
pek }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {klinis}\par
\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {fungsi ginjal pada }
\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 {, mengusul
kan definisi SHR dengan nama terminal}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\
cf0\f0\charscalex100 {\uc1\u8220Xfungtional rernal failure\uc1\u8221X.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Beliau menekankan gagal g
injal pada SHR tidak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {berhubungan dengan kerusakan struktur ginjal dan berkembangnya sindroma }\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ini}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {merupakan keadaan terminal dan
orreversible pada }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\chars
calex100 { dengan asites}\par\pard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\charsc
alex100 {1}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Pad
a}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {tahun 1956, He
cker dan Sherlock melaporkan sembilan pasien penyakit }\fs24\cf0\f0\charscalex10
0\b {hati}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {be
rsamaan dengan gagal ginjal yang ditandai dengan protein uria dan ekskresi }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {NA}\par\pard\li1853\
ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {+}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {yang rendah.}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100\b {Defenisi}\b0 \par\pard\li1853\ri0\sl-320\slmult0
\fs24\cf0\f0\charscalex100 {Defenisi Sindroma Hepato Renal yang diusulkan oleh}
{ }\fs24\cf0\f0\charscalex100\b {International Ascites }\b0 \par\pard\li1853\ri0
\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Club }\b0 \fs24\cf0\f0\charscalex1
00 {(1994) adalah sindroma klinis yang terjadi pada pasien penyakit }\fs24\cf0\f
0\charscalex100\b {hati }\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\ch
arscalex100 {kronik}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {dan kegagalan}{ }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charsca
lex100 { lanjut serta hipertensi portal yang ditandai oleh penurunan }\par\pard\
li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {fungsi}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjaldan abnormalitas yang nyata d
ari sirkulasi arteri dan aktifitas system}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100\i {vasoactive endogen}\i0 \fs24\cf0\f0\charscalex100 {.
Pada ginjal terdapat vasokonstriksi yang menyebabkan }\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {laju}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {filtrasi glomerulus rendah, dimana sirkulasi diluar
ginjal terdapat vasodilasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {arteriol}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {yang luas menyebabkan penurunan resistensi vaskuler sistemik total dan }\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hipotensi.}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Meskipun sindroma hepato
renal lebih umum terdapat pada penderita dengan }\par\pard\li1853\ri0\sl-306\slm
ult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 \par\pard\sect\sectd\sbkpage
{\shp{\*\shpinst\shpleft2480\shptop4626\shpright10160\shpbottom4933\shpfhdr0\shp
wr3\shpwrk0\shpfblwtxt1\shplid2045\shpz0\shpbxpage\shpbypage

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\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {lanjut, hal ini dapa
t juga timbul pada penderita penyakit }\fs24\cf0\f0\charscalex100\b {hati}\b0 \f
s24\cf0\f0\charscalex100 { kronik atau }\par\pard\li1853\ri0\sl-306\slmult0 \fs2
4\cf0\f0\charscalex100 {penyakit}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { akut lain seperti hepat
itis alkoholik atau kegagalan}{ }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf
0\f0\charscalex100 { akut3.}\par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\cha
rscalex100\b {Insiden }\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {Dagher dkk}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscale
x100 {4,6}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {melapo
rkan insiden SHR terjadi kira-kira 4% pada penderita }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 { }\fs24\cf0\f0\charscalex10
0\b {hati}\b0 \fs24\cf0\f0\charscalex100 { dekompensata yang dirawat, dan kemung
kinan mencapai 18% }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex1
00 {pada }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tahun
pertama dan akan meningkat hingga 39% pada tahun ke lima. Gines dkk }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {3}\par\pard\li8706\ri0\sl-3
46\slmult0 \fs24\cf0\f0\charscalex100\b {Page 2}\b0 \par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital library}\i0 \
3\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {melaporkan insiden SHR pada pen
derita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 { }\fs24\cf0\f0\charscalex100\
b {hati}\b0 \fs24\cf0\f0\charscalex100 { dengan ascites yang }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dirawat }\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {mencapai 10% kasus. }\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {Patofisiologi }\b0 \par\pard\li185
3\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Hal yang sama ditemukan pada SH
R adalah vasokonstriksi ginjal yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {reversible dan hipotensi sistemik. Keberadaan vasokonstriks
i ginjal yang nyata }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {pada }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pende
rita SHR telah ditunjukkan dengan beberapa metode eksplorasi termasuk }\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {arteriografi ginjal, klir
ens para aminohipuric acid dan yang terbaru }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {ultrasonografi}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {Doppler. Pemakaian beberapa teknik ini mendapatkan b
eberapa perubahan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {dalam }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {perfus
i ginjal yang berkesinambungan pada penderita }\fs24\cf0\f0\charscalex100\b {sir
osis}\b0 \fs24\cf0\f0\charscalex100 { dengan ascites, }\par\pard\li1853\ri0\sl-3
06\slmult0 \fs24\cf0\f0\charscalex100 {dan }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {SHR adalah akhir dari spectrum ini 2,3,7. Penyebab u

tama dari vasokonstriksi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {ginjal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{ini belum diketahui secara pasti, tapi kemungkinan melibatkan banyak factor }\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {antara}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {lain perubahan system hemod
inamik, meningginya tekanan vena porta, }\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {peningkatan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {vasokonstriktor dan penurunan vasodilator yang berperan dal
am sirkulasi di }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{ginjal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {(Tabel 1
)}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {2,5}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {Teori hipoperfusi ginjal menggambarkan m
anisfestasi dari kekurangan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {pengisian}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {sirkulasi arteri terhadap adanya vasodilasi pembuluh darah splanik. }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Pengurangan}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pengisian arteri ini aka
n menstimulasi baroreseptor mengaktifkan }\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {vasokonstriktor}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {(seperti rennin angiotension dan system saraf simpatis
)1.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 1. Fak
tor-faktor Vasoaktif secara potensial berperan dalam pengaturan }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {perfusi}\par\pard\sect\sectd\sb
kpage
{\shp{\*\shpinst\shpleft2480\shptop13453\shpright10160\shpbottom13760\shpfhdr0\s
hpwr3\shpwrk0\shpfblwtxt1\shplid2055\shpz0\shpbxpage\shpbypage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {ke ginjal pada pende
erita sindroma hepatorenal}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\char
scalex100 {3}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {.}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Vasokonstriktor}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Angiotension II}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Norepineprine}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Neuropeptide Y }\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Endothelin}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Adenosine }\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Cysteinyl leukotrines}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {F2-isoprostanes}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Vasodilators :}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Prostaglandins}\par\pard

\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Nitric oxide}\par\pard\li
1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Natriuretic peptides}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Kallikrein \uc1\u8211X
kinin system}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {V
aktor Vasokonstriktor }\b0 \par\pard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\char
scalex100\b {3,4}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {Sistem rennin \uc1\u8211X angiotension dan system saraf simpatik, beberapa
dari}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {system utam
a yang mempunyai efek vasokonstriksi pada sirkulasi ginjal }\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {berperan}\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {sebagai mediator utama vasokonstriksi ginja
l pada sindroma hepatorenal. }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {Aktifitas}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsca
lex100 {dari system vasokonstruksi ini meningkat pada penderita dengan }\fs24\cf
0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { dan }\par\pard\li
1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ascites,}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {terutama penderita dengan sindroma
hepatorenal dan berkolerasi terbalik }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {aliran darah ginjal dan laju filtrasi glomerulus. Kadar hormon anti
diuretic atau }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
vasopressin meninggi pada penderita SHR karena stimulasi non osmolar, }\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {walaupun}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sering timbul hiponatremia.}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Vasopressin ini meni
mbulkan vasokonstriksi di ginjal. Endothelin adalah }\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {substansi}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {vasokonstriktor lain dalam plasma meningkat pada
SHR, kemungkinan karena }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsc
alex100 {penambahan produksi peptide dalam }\fs24\cf0\f0\charscalex100\b {hati}\
b0 \fs24\cf0\f0\charscalex100 { atau dalam sirkulasi splandik yang}\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hubungannya dengan vasokonstr
iksi ginjal masih controversial. Soper dkk}\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {melaporkan pada tiga penderita SHR memperlihatkan per
baikan fungsi ginjal }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100 {setelah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pe
mberian antagonis spesifik reseptor endhothelin \uc1\u8211XA. Beberapa penelitia
n}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {melaporkan pen
ingkatan produksi }\fs24\cf0\f0\charscalex100\i {cysteinyl leukotrienes }\i0 \fs
24\cf0\f0\charscalex100 {sebagai }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {vasokonstriksi ginjal}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {yang kuat pada penderita SHR.}\par\pard\li8706\ri0\sl-34
6\slmult0 \fs24\cf0\f0\charscalex100\b {Page 3}\b0 \par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital library}\i0 \p
ar\pard\li1853\ri0\sl-386\slmult0 \fs32\cf0\f0\charscalex100 {3}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Substansi vasoactive lainnya sep
erti adenisin,F2 \uc1\u8211X isoprostanes dapat juga }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {sebagai}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {factor yang mempengaruhi patogenesa vasokonstriksi
ginjal dalam SHR, tapi}\par\pard\sect\sectd\sbkpage

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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {mekanisme yang pasti
masih belum diketahui. Akhir ini disebutkan endotoksin }\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {dan }\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {sitokin juga berperan dalam timbulnya vasokonstrik
si ginjal yang poten daan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {SHR }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {
timbul setelah infeksi bakteri yang berat pada }\fs24\cf0\f0\charscalex100\b {si
rosis}\b0 \fs24\cf0\f0\charscalex100 {. Hal ini diduga katrena }\par\pard\li1853

\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {peningkatan translokasi bakteri
dan portosystemic shunting. Bagaimanapun }\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {peran}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0
\charscalex100 {endotoksin dan sitokin dalam disfungsi ginjal pada }\fs24\cf0\f0
\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { masih merupakan}\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {perdebatan. }\par\par
d\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Faktor Vasodilator }\b
0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Sebuah penelit
ian pada penderita dengan}{ }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0
\f0\charscalex100 { atau percobaan pada }\par\pard\li1853\ri0\sl-306\slmult0 \fs
24\cf0\f0\charscalex100 {binatang memperlihatkan bahwa sintesa factor vasodilato
r local pada ginjal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {memaikan peran yang penting dalam }\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {mempertahankan perfusi ginjal dengan}\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {meelindungi sirkulasi ginjal dari ef
ek yang merusak dari factor }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {vasokonstriktor.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Mekanisme vasodilator ginjal yang paling penting adalah prostaglan
din (PGs). }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {PGs}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {membentuk sitem
yang unik dimana ginjal mampu mengimbangi efek }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {peningkatan}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {kadar vasokonstriktor tanpa merusak fungsi sitemikny
a. Bukti yang paling }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100 {kuat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {meny
okong peran PGs ginjal dalam mempertahankan perfusi ginjal pada }\par\pard\li185
3\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 \par\pard\li1853\
ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {dengan ascietes diperoleh dari pe
nelitian yang menggunakan obat non steroid }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {aanti}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {inflamasi untuk menghambat pembentukan prostaglandin ginjal. P
emberian }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {NSAIDs
,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sekalipun dala
m dosis tunggal pada penderita }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0
\charscalex100\b {sirosis}\b0 { }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf
0\f0\charscalex100 { dengan ascites}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {menyebabkan penurunan yang nyata dalam aliran darah ginjal d
an laju filtrasi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{glomerulus, yang perubahannya menyerupai kejadian dalam SHR pada }\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dengan aktifitas vasokonstriktor y
ang nyata, tetapi tidak atau sedikit efek pada }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {penderita dengan aktifitas vasokonstriktor yang
nyata, tetapi tidak atau sedikit }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {atau}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {sedikit efek pada penderita tanpa aktifitas vasokonstriktor. Vasodilator
ginjal }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {lainnya
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {yang mungkin be
rpartisipasi dalam mempertahankan perfusi ginjal pada }\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 \par\pard\li1853\ri0\sl-306
\slmult0 \fs24\cf0\f0\charscalex100 {adalah nitrit oksida. Jika produksi nitrit
oksida dan PGs dihambat secara tidal}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\c
f0\f0\charscalex100 {langsung dalam percobaan}{ }\fs24\cf0\f0\charscalex100\b {s
irosis}\b0 \fs24\cf0\f0\charscalex100 { dengan ascites terjadi penurunan perfusi
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjal}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3,4. Vasodilator lain y
ang mungkin mempengaruhi pengaturan perfusi ginjal }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {pada }\par\pard\li1853\ri0\sl-306\slmult0 \f
s24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { adalah natr
iuretic peptide. Gulberg dkk menemukan peningkatan }\par\pard\li1853\ri0\sl-306\

slmult0 \fs24\cf0\f0\charscalex100 {jumlah C}\par\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Type natriuretic pep
tide (CNP) di urin penderita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf
0\f0\charscalex100 { dan gagal ginjal }\par\pard\li1853\ri0\sl-306\slmult0 \fs24
\cf0\f0\charscalex100 {fungsional,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {selanjutnya ditemukan hubungan yang terbalik antara CNP di ur
in dengan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ekskr
esi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {natrium urin
,CNP ini berperan dalam pengaturan keseimbangan natrium. }\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {Penemuan}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {ini membuktikan aktifitas vasodilator ginjal
meningkat pada }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscale
x100 { dan }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {berp
eran}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dalam penga
turan perfusi ginjal, terutama pada aktifitas yang berlebihan dari}\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {mekanisme vasokonstriktor gin
jal}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {8}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl306\slmult0 \fs24\cf0\f0\charscalex100\b {Sistem saraf simpatis }\b0 \par\pard\l
i1853\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100\b {4}\b0 \par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Stimulasi system saraf simpatis san
gat tinggi pada penderita SHR dan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {menyebabkan vasokonstriksi ginjal dan meningkatnya retensi nat
rium. Hal ini }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {t
elah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {diperlihatk
an oleh beberapa peneliti adanya peningkatan sekresi katekolamin }\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {di}\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {pembuluh darah ginjal dan splanik. Kostreva
dkk mengamati vasokonstruksi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {pada }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {arteiol afferent ginjal menimbulkan penurunan aliran darah ginjal dan GFR }
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dan }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {meningkatkan penyerapan air
dan natrium di tubulus.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsc
alex100\b {Patogenesia}\b0 \par\pard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\char
scalex100\b {3,9}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {Ada dua jenis teori yang dianut untuk menerangkan hipoperfusi ginjal yang}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {timbul pada pende

rita SHR. Teori pertama, menjelaskan hipoperfusi ginjal}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {berhubungan dengan penyakit }\fs24\cf0\f
0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { itu sendiri tanpa ada p
atogenetik yang}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {
berhubungan dengan gangguan system hemodinamik. Teori ini berdasarkan}\par\pard\
li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {hubungan langsung}{ }\fs24
\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { \uc1\u8211X ginja
l, yang didukung oleh dua mekanisme yang }\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {berbeda }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0
\f0\charscalex100 {yang mana penyakit }\fs24\cf0\f0\charscalex100\b {hati}\b0 \f
s24\cf0\f0\charscalex100 { dapat menyebabkan vasokonstriksi ginjal dengan}\par\p
ard\li8706\ri0\sl-346\slmult0 \fs24\cf0\f0\charscalex100\b {Page 4}\b0 \par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU di
gital library}\i0 \par\pard\li1853\ri0\sl-386\slmult0 \fs32\cf0\f0\charscalex100
{4}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {penurunan pe
mbentukan atau pelepasan vasodilator yang dihasilkan}{ }\fs24\cf0\f0\charscalex1
00\b {hati}\b0 \fs24\cf0\f0\charscalex100 { yang }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {dapat }\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {menyebabkan pengurangan perfusi ginjal dan pada percoba
an binatang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dip
erlihatkan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {bahwa
}\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { mengatur f
ungsi ginjal melalui refleks hepatorenal. Teori kedua }\par\pard\li1853\ri0\sl-3
06\slmult0 \fs24\cf0\f0\charscalex100 {menerangkan bahwa hipoperfusi ginjal berh
ubungan dengan perubahan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {patogenetik}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscale
x100 {dalam system hemodinamik dan SHR adalah bentuk terakhir dari pengurangan }
\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {pengisian arteri
pada }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 {. H
ipotesis ini menerangkan bahwa kekurangan}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {pengisian sirkulasi arteri bertanggung jawab terhadap
hipoperfusi yang bukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {sebagai akibat penurunan volume vaskuler, tetapi vasodilatasi arteriolar
yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {luar}\par\
pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {biasa terjadi teruta
ma pada sirkulasi splanik. Hal ini dapat menyebabkan }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {aktifasi}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {yang progresif dari mediator baroreseptor system
vasokonstriktor (Gambar1), }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{mana dapat menimbulkan vasokonstruksi tidak hanya pada sirkulasi ginjal }\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tetapi}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {juga pada pembuluh darah yang
lain. Splanik dapat bebas dari efek }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {vasokonstriktor}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {dan vasodilasi dapat bertahan, kemingkinan karena adanya ra
ngsangan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {vasodi
lator}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {local yang
sangat kuat. Timbulnya hipoperfusi ginjal menyebabkan SHR dapat }\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {terjadi}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {sebagai akibat aktifitas yang maksimal
vasokonstriktor sistemik yang tidak }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {dapat }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {dihalangi oleh vasodilator, penurunan aktifitas vasodilator atau pe
ningkatan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {produ
ksi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {vasokonstrik
tor ginjal atau keduanya.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\chars

calex100\b {Sirosis}\b0 { }\fs24\cf0\f0\charscalex100\b {hati}\b0 \par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Vasodilatasi arteri splanik}\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Arterial underfill
ing}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Sintesa fact
or vasodilator}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {B
aroreseptor}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Snte
sa factor vasokonstriktor}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {Intra renal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {Aktifitas factor vasokonstriktor}\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {intra renal }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {Sistemik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {Vasokonstriksi renal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {SHR }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsca
lex100\b {Gambar 1 : Patogenesa sindroma hepatorenal.}\b0 \par\pard\li1853\ri0\s
l-186\slmult0 \fs14\cf0\f0\charscalex100\b {9}\b0 \par\pard\li1853\ri0\sl-306\sl
mult0 \fs24\cf0\f0\charscalex100\b {Gambaran Klinis }\b0 \par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {Mekanisme klinis penderita SHR ditandai
dengan kombinasi antara gagal}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\
charscalex100 {ginjal, gangguan sirkulasi dan gagal }\fs24\cf0\f0\charscalex100\
b {hati}\b0 \fs24\cf0\f0\charscalex100 {. Gagal ginjal dapat timbul secara }\par
\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {perlahan}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {atau progresif dan biasanya
diikuti dengan retensi natrium dan air yang}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {menimbulkan ascites, edema dan dilutional hyponatre
mia, yang ditandai oleh }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {ekresi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
natrium urin yang rendah dan pengurangan kemampuan buang air (oliguri \uc1\u8211
X}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {anuria ).}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Gangguan sirkulasi s
istemik yang berat ditandai dengan tekanan arteri yang }\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {rendah,}\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {peningkatan cardiac output, dan penurunan total
tahanan pembuluh darah }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca
lex100 {sistemik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{(Tabel 2)}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {3,4}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Gambaran klinis dari uremia jar
ang dijumpai, begitu juga dengan analisa urin }\par\pard\sect\sectd\sbkpage
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3\margtsxn666\margbsxn373\cols2\colno1\colw8706\colsr-0\colno2\colw2386\pard\li1
s24\cf0\f0\charscalex100 {dalam }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {keadaan normal 10.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {Secara klinis SHR dapat dibedakan atas 2 tipe yaitu}\par\par
d\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {1-4,11}\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {: }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {1. Sindroma Hepatorenal tipe I}\par\pard\li185
harscalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li1853\ri0\sl
-386\slmult0 \fs32\cf0\f0\charscalex100 {5}\par\column\pard\li0\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs24\cf0\f0\ch
arscalex100\b {Page 5}\b0 \par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\m
arglsxn666\margrsxn133\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Tipe I ditandai oleh peningkatan yang cepat dan progresif dari BUN (Blood}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {urea nitrogen) dan k

reatinin serum yaitu nilai kreatinin >2,5 mg/dl atau }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {penurunan}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {kreatinin klirens dalam 24 jam sampai 50%, keada
an ini timbul dalam }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {beberapa hari}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {hingga 2 minggu. Gagal ginjal sering dihubungkan dengan penurunan yang }\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {progresif}\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {jumlah urin,}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 2. Gangguan hemodinamik
yang sering ditemukan pada sindroma }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {hepatorenal}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f
0\charscalex100 {3}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Cardiac out
put meninggi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tek
anan arterial menurun}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100 {Total tahanan pembuluh darah sistemik menurun }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Total volume darah meninggi}\par\pard\li185
3\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Aktifasi system vasokonstriktor
meninggi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tekana
n portal meninggi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Portosystemic shunting }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {Tekanan pembuluh darah splanik menurun }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {Tekanan pembuluh darah ginjal meninggi}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Tekanan arteri brachial
dan femoral meninggi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100 {Tahanan pembuluh darah otak meninggi}\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {retensi natrium dan hiponatremi . Penderita dengan ti
pe ini biasanya dalam }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {kondisi}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {k
linik yang sangat berat dengan tanda gagal }\fs24\cf0\f0\charscalex100\b {hati}\
b0 \fs24\cf0\f0\charscalex100 { lanjut seperti ikterus, }\par\pard\li1853\ri0\sl
-306\slmult0 \fs24\cf0\f0\charscalex100 {ensefalopati}\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {atau koagulopati. Tipe ini umum pada }\fs2
4\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { alkoholik ber
hubungan dengan }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100
{hepatitis}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {alkoh
olik, tetapi dapat juga timbul pada }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \
fs24\cf0\f0\charscalex100 { non alkoholik. Kira-kira }\par\pard\li1853\ri0\sl-30
6\slmult0 \fs24\cf0\f0\charscalex100 {setengah}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {kasus SHR tipe ini timbul spontan tanpa ada facto
r presipitasi yang diketahui,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {kadang-kadang pada sebagian penderita terjadi hubungan sebab akiba
t yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {erat }\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dengan beberapa ko
mplikasi atau intervensi terapi (seperti inveksi bakteri,}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {perdarahan gastrointestinal, parasinte
sis). Spontaneus bacterial peritonirtis }\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {(SBP) }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {adalah penyebab umum dari penurunan fungsi ginjal pada }\fs24\cf
0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 {. Kira-kira }\par\
pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {35%}\par\pard\sect\se
ctd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\pard\sect\sectd\sbkp
age

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\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {penderita }\fs24\cf0
\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { dengan SBP timbul
SHR tipe I.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {SHR
Tipe I adalah komplikasi dengan prognostic yang sangat buruk pada }\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charsca
lex100 {, dengan mortalitas mencapai 95%. Rata-rata wktu harapan hidup }\par\par
d\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {penderita }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ini kurang dari dua minggu, l
ebih buruk dari lamanya hidup disbanding }\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {dengan gagal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {ginjal akut dengan penyebab lainnya.}\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {2. Sindroma Hepatorenal Tipe II }\
b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Tipe II SHR i
ni ditandai dengtan penurunan yang sedang dan stabil dari laju}\par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {filtrasi glomerulus (BUN dibawah
50 mg/dl dan kreatinin serum < 2 mg / dl). }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Tidak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {seperti tipe I SHR, tipe II SHR biasanya terjadi pada penderit
a dengan fungsi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\
b {hati}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {rela
tif baik. Biasanya terjadi pada penderita dengan ascites resisten diuretic. }\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Diduga }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {harapan hidup penderita den
gan kondisi ini lebih panjang dari pada SHR tipe }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {I.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\c
f0\f0\charscalex100\b {Diagnosis }\b0 \par\pard\li1853\ri0\sl-186\slmult0 \fs14\
cf0\f0\charscalex100\b {3,4,6}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {Tidak ada tes yang spesifik untuk diagnostik SHR. Kriteria dia
gnostik yang}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dia
nut sekarang adalah berdasarkan}{ }\fs24\cf0\f0\charscalex100\i {International A
scites Club\uc1\u8217Xs Diagnostic }\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100\i {Criteria}\i0 \par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100\i {of Hepatorenal Syndrome }\i0 \fs24\cf0\f0\charscalex10
0 {(Tabel 3).}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ta
bel 3. Kriteria Mayor diagnostik SHR berdasarkan International Axcites }\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Club}\par\pard\li1853\ri
0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {4}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {1. Penyakit }\fs24\cf0\f0\charscalex100\b {hati}\
b0 \fs24\cf0\f0\charscalex100 { akut atau kronik dengan gagal }\fs24\cf0\f0\char
scalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { lanjut dan hipertensi }\par\p
ard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {portal.}\par\pard\li87
06\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 6}\b0 \par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital li
brary}\i0 \par\pard\li1853\ri0\sl-386\slmult0 \fs32\cf0\f0\charscalex100 {6}\par

\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2. GFR rendah, kerat
in serum >1,5 mg/dl atau kreatinin klirens 24 jam < 40}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {ml/mnt.}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {3. Tidak ada syok,infeksi bakteri sedang berlangs
ung, kehilangan cairan dan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {mendapat obat nefrotoksik.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {4. Tidak ada perbaikan fungsi ginjal dengan pemberian pla
sma ekspander 1,5 }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {ltr}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan diure
tic (penurunan kreatinin serum menjadi < 1,5 mg/dl atau}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {peningkatan kreatinin klirens menjadi >
40 ml/mnt) }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5. P
roteinuria < 0,5 g/hari dan tidak dijumpai bstruktif uropati atau penyakit}\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {parenkim ginjal secar
a ultrasonografi.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{Kriteria tambahan :}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100 {1. Volume urin < 500 ml / hari}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {2. Natrium urin < 10 meg/liter}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {3. Osmolalitas urin > osmolalitas plasma}\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {4. Eritrosit urin <
50 /lpb}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5. Natr
ium serum <130 meg / liter}\par\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {Semua kriterua mayor
harus dijumpai dalam menegakkan diagnosa SHR, }\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {sedangkan}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {criteria tambahan merupakan pendukung untuk diagnosa S
HR. Beberapa }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pa
ktor}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {predictor u
ntuk timbulnya SHR pada penderita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs
24\cf0\f0\charscalex100 { dengan ascites dapat }\par\pard\li1853\ri0\sl-306\slmu
lt0 \fs24\cf0\f0\charscalex100 {dilihat}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {pada table 4.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\
cf0\f0\charscalex100 {Tabel 4. factor predictor timbulnya SHR pada }\fs24\cf0\f0
\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { dengan ascites}\par\p
ard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {3}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Peningkatan ringan BUN dan atau krea
tinin serum }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Men
urunnya ekskresi air setelah pemberian cairan}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {Ekskresi natrium urin yang rendah}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Hipotensi arterial}\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Aktifitas plasma rennin menin
ggi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Kadar norepi
nefrin plasma tinggi}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {Refrakter ascites}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {Tidak ada hepatomegali}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {Peningkatan vascular resistive index ginjal}\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100\b {Penatalaksanaan }\b0 \par\pard\li185
3\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100\b {1-3}\b0 \par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dengan mengetahui beberapa factor pen
cetus untuk timbulnya SHR pada }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0
\charscalex100 {penderita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f
0\charscalex100 { dengan ascites maka kita dapat mencegah timbulnya gagal }\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjal}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pada penderita ini. Pemberian
plasma ekspander setelah parasintesis dalam }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {jumlah }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {besar, terutama albumin, mengurangi insiden SHR. Begitu pul
a pemberian }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ant

ibiotik}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {untuk me
ncegah SBP pada penderita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 { }\fs24\cf
0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { dengan resiko tinggi
untuk}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {timbulnya
komplikasi ini akan mengurangi insiden SHR. Ada beberapa }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {modalitas}\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {terapi digunakan pada penderita dengan SHR
dengan efek yang hanya sedikit }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {atau}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {tidak ada sama sekali.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\cha
rscalex100\b {Vasodilator }\b0 \par\pard\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\
charscalex100\b {4}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {Obat-obatan dengan aktifitas vasodilator, terutama PGs telah dipakai pada
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penderita deng
an SHR dalam usaha untuk menurunkan resistensi vaskuler }\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjal.}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {Pemberian PGs intra vena atau pengobatan dengan
misoprostol (analog PGs }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {oral}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {a
ktif) pada penderita }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 { }\fs24\cf0\f0\
charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { dengan SHR tidak diikuti
dengan perbaikan }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100
{fungsi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {renal.}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dopamin pada dos
is non pressor juga digunakan dalam usaha menimbulkan}\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {vasodilatasi renal pada penderita SHR. Inf
us dopamine selama 24 jam hanya }\par\pard\li8706\ri0\sl-333\slmult0 \fs24\cf0\f
0\charscalex100\b {Page 7}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li1853\ri0\sl
-373\slmult0 \fs32\cf0\f0\charscalex100 {7}\par\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {menyebabkan peningka
tan yang ringan pada aliran darah ginjal tanpa }\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {perubahan}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {yang berarti dalam laju filtrasi glomerulus. Pemberian
antagonis endhothelin }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {spesifik}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{segera berhubungan dengan perbaikan fungsi ginjal pada pasien dengan SHR.}\par\
pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Vasokonstriktor}\b0
\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Hipoperfusi gin
jal pada SHR pada }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charsc
alex100 { dipikirkan berhubungan dengan }\par\pard\li1853\ri0\sl-306\slmult0 \fs
24\cf0\f0\charscalex100 {pengurangan pengisian sirkulasi arteri , vasokonstriksi
telah digunakan dalam }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {usaha }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {m
emperbaiki perfusi ginjal dengan menaikkan resistensi vaskuler sistemik dan }\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {menekan aktifitas v
asokonstriktor sistemik. Pemberian}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {vasokonstriktor segera (}\par\pard\li1853\ri0\sl-306\slmult0
\fs24\cf0\f0\charscalex100 {norepinefrin, angiotension II, ornipressin) pada pas
ien}{ }\fs24\cf0\f0\charscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 { de
ngan ascites }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {da
n}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {SHR menyebabka
n vasokonstriksi arteri,yang mana meningkatkan tekanan }\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {arteri}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {dan resistensi vaskuler sistemik. Vasokonstriktor
pada dosis yang digunakan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {pada }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{penelitian yang dipublikasikan dan pemberian pada periode waktu yang }\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {singkat,}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hanya menyebabkan perubahan yan
g ringan atau tidak ada dalam aliran darah }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {ginjal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {meskipun perubahan yang menguntungkan dalam pengamatan di sir
kulasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sistemik
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {mungkin berhubu
ngan baik dengan efek vasokonstriksi obat pada sirkulasi }\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjal}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {atau aktifitas yang menetap dari vasokonstrikto
r}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {12,13}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {. Kombinasi pemberian}\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {vasokonstriktor}\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {(ornipressin,}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {norepenephrine) }\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dan }\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {vasodilator}\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjal}\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {(dopamine,prostacyclin) juga gagal memperba
iki fungsi ginjal}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100
{14}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penelitian Guevara dkk me
nunjukkan bahwa pemberian kombinasi ornipressin }\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {dengan penambahan volume plasma dengan almumin
memperbaiki fungsi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {ginjal dan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {m
enormalkan perubahan hemodinamik pada pasien }\fs24\cf0\f0\charscalex100\b {siro
sis}\b0 \fs24\cf0\f0\charscalex100 { dengan SHR. Tiga }\par\pard\li1853\ri0\sl-3
06\slmult0 \fs24\cf0\f0\charscalex100 {hari}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {pengobatan dengan ornipressin dan albumin dapat meno
rmalkan aktifitas yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {berlebihan dari rennin \uc1\u8211X angiotension dan system saraf simpati
s, peningkatan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
kadar}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {natriuetik
peptide arteri dan hanya memperbaiki sedikit fungsi ginjal. }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pemberian}\par\pard\sect\sectd\sbk
page
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {ornipressin dan albu
min selama 15 hari, perbaikan fungsi ginjal dijumpai }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {peningkatan aliran darah ginjal dan laju filtrasi g
lomerulus. Terapi ini dapat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {digunakan dengan kewaspadaan yang tinggi, pada beberapa pasien hal
ini }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tidak}\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dilanjutkan karena ko
mplikasi iskemik}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100
{15}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {. Angeli dkk
memberikan Midodrine dan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {Ocreotide pada 13 penderita SHR tipe I, setelah 20 hari pengobatan }\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {didapatkan}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penurunan aktifitas pla
sma renin, vasopressin dan glukagon. 1 penderita }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {bertahan}\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {hidup sampai 472 hari, 1 penderita dilakukan transpla
ntasi }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { dan y
ang lain}\par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {meningg
al setelah 75 hari karena gagal }\fs24\cf0\f0\charscalex100\b {hati}\b0 \par\par
d\li1853\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {16}\par\pard\li1853\ri0\

sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-306\slmult0
\fs24\cf0\f0\charscalex100\b {Peritoneovenous shunt }\b0 \par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {Peritoneovenous shunt telah digunakan
secarasporadis pada masa yang lau di}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\c
f0\f0\charscalex100 {dalam pelaksanaan pasien-pasien SHR dengan }\fs24\cf0\f0\ch
arscalex100\b {sirosis}\b0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {Pemasangan shunt }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {menyebabkan aliran yang terus menerus
cairan ascites dari rongga peritoneum }\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {ke}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {sirkulasi sistemik yang berperan dalam meningkatkan curah jantung (ca
rdiac }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {output)}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dan penambahan vo
lume intravaskuler. Efek hemodinamik dari }\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {peritoneovenous}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {shunt dihubungkan dengan penekanan yang nyata dari}\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {aktifitas}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {system}\par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {vasokonstriktor, peningkatan eksk
resi natrium dan beberapa kasus }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {memperbaiki}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {aliran darah ginjal dan laju filtrasi glomerulus, hal nilah yang me
nyebabkan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {rasion
alisasi tindakan pada penderita SHR 3.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24
\cf0\f0\charscalex100\b {Portosystemic shunt}\b0 \par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {Anastomosis shunt, baik side to side maupun end
to side, belum merupakan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {terapi standar dalam pelaksanaan SHR karena tingkat morbiditas dan }\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {mortalitas}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {yang tinggi, dihubungka
n dengan prosedur operasi ini pada sebagian pasien }\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-306\slmult0 \
fs24\cf0\f0\charscalex100 {penyakit }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs2
4\cf0\f0\charscalex100 { lanjut. Akhir-akhir ini telah diperkenalkan suatu metod
e }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {nenbedah dari
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {kompresi portal
yaitu}{ }\fs24\cf0\f0\charscalex100\i {Transjugular intrahepatic portosystemic
shunt }\i0 \fs24\cf0\f0\charscalex100 {(TIPS).}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Keuntungan metode ini disbanding dengan operasi p
ortocaval shunt adalah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {penurunan mortalitas akibat operasi. Komplikasi yang paling sering pada }
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pasien yang}\par
\pard\li8706\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 8}\b0 \par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU
digital library}\i0 \par\pard\li1853\ri0\sl-386\slmult0 \fs32\cf0\f0\charscalex1
00 {8}\par\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {mendapat pengobatan
dengan TIPS adalah hepatic encephalophaty dan }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {obstruksi}\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {dari stent. Beberapa laporan yang melibatkan sejumlah p
asien cendrung}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {m
emperlihatkan bahwa prosedur ini meningkatkan fungsi ginjal pada pasien }\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {sirosis}\b0 \par\pard
\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\c
harscalex100 { dengan SHR yang tidak dapat lagi untuk dilakukan transplantasi }\
fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 {. }\par\pard\l
i1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Penelitian}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {diatas}\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {menunjukkan bahwa TIPS}\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {memberikan banyak}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {keuntungan pada }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penatalaksanaan SHR. Walaupun d
emikian, penggunaan TIPS masih }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {memerlukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {penelitian kontrol untuk dapat merokomendasikan}\par\pard\li1853\ri0\
sl-173\slmult0 \fs14\cf0\f0\charscalex100 {3}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {Guevara dkk melakukan TIPS pada 7 penderita SHR tipe 1 dan menyim
pulkan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {TIPS }\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dapat memperbaiki
fungsi ginjal,menurunkan aktifitas renin angiotension dan }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {system}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {saraf simpatis}\par\pard\li1853\ri0\sl-173\slm
ult0 \fs14\cf0\f0\charscalex100 {17}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscale
x100\b {Dialisa }\b0 \par\pard\li1853\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex
100\b {1,18}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
Hemodialisa atau peritoneal dialisa telah dipergunakan pada penatalaksanaan}\par

\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penderita dengan SHR
, dan pada beberapa kasus dilaporkan dapat }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {meningkatkan}\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {fungsi ginjal. Walupun tidak terdapat penelitian kontro
l yang mengevaluasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {efektifitas}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{dari sialisa pada kasus ini, tetapi pada laporan penelitian tanpa kontrol }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {menunjukkan}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {efektifitas yang buruk,
karena banyaknya pasien yang meninggal selama }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {pengobatan}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {dan terdapat insiden efek samping yang cukup tinggi. P
ada beberapa pusat }\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex1
00 {penelitian hemodialisa masih tetap digunakan untuk pengobatan pasien dengan
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {SHR }\par\pard\
li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {yang sedang menunggu trans
plantasi }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 {.}\
par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Transplantasi H
ati}\b0 \par\pard\li1853\ri0\sl-186\slmult0 \fs12\cf0\f0\charscalex100\b {3,4,19
,20}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Transpla
ntasi }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { ini s
ecara teori adalah terapi yang tepat untuk penderita }\par\pard\li1853\ri0\sl-32
0\slmult0 \fs24\cf0\f0\charscalex100 {SHR, yang dapat menyembuhkan baik penyakit
}\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 { maupun dis
fungsi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ginjalny
a.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tindakan tran
spalntasi ini merupakan masalah utama mengingat prognosis }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {buruk}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {dari SHR dan daftar tunggu yang lama untuk tind
akan tersebut di pusat }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsca
lex100 {transplantasi. Segera setelah transplantasi }\fs24\cf0\f0\charscalex100\
b {hati}\b0 \fs24\cf0\f0\charscalex100 {, kegagalan fungsi ginjal dapat }\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {diamati selama 48 jam s
ampai 72 jam. Setelah itu laju filtrasi glomerulus }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {mulai }\par\pard\sect\sectd\sbkpage
7;32768}}

7;32768}}
7;32768}}
7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {mengalami perbaikan.
}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Kesimpulan}\b
0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {1. SHR adalah

komplikasi dari penyakit }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\ch
arscalex100 { yang lanjut yang ditandai tidak }\par\pard\li1853\ri0\sl-306\slmul
t0 \fs24\cf0\f0\charscalex100 {hanya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {gagal ginjal, tapi juga gangguan system hemodinamik dan ak
tifitas system}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {v
asoaktif endogen.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{2. Patogenesa SHR belum diketahui pasti, tapi diduga pengurangan pengisian}\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sirkulasi arteriol
sekunder terhadap sirkulasi vasodilasi arteriol di splanik,}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {gangguan keseimbangan antara factor
vasokonstriktor dan vasodilator.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {3. Diangnosa SHR berdasarkan International Ascites Club\uc1\u82
17Xs Diagnostic }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{Criteria of}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hep
atorenal Syndrome.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex10
0 {4. Pilihan pengobatan yang baik adalah transplantasi }\fs24\cf0\f0\charscalex
100\b {hati}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {
5. Pengobatan pendukung hanya diberikan jika fungsi }\fs24\cf0\f0\charscalex100\
b {hati}\b0 \fs24\cf0\f0\charscalex100 { dapat kembali }\par\pard\li1853\ri0\sl306\slmult0 \fs24\cf0\f0\charscalex100 {normal}\par\pard\li1853\ri0\sl-306\slmul
t0 \fs24\cf0\f0\charscalex100 {atau sebagai jembatan untuk menunggu tindakan tra
nsplantasi }\fs24\cf0\f0\charscalex100\b {hati}\b0 \fs24\cf0\f0\charscalex100 {.
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Kepustakaan}\pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {1. Arroyo V.New Tre
atment for Hepatorenal Syndrome. Liver Transplantation}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {2000;6 (3)}{ }\fs24\cf2\f0\charscalex100\
ul {{\field{\*\fldinst{HYPERLINK "http://hepatology.aasldjournals.org/scripts/om
.dll/serve?article.htm"}}{\fldrslt {http://hepatology.aasldjournals.org/scripts/
om.dll/serve?article.htm}}}}\ul0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {2. Platt}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {JF,Ellis JH, Rubin JM et al. Renal Duplex Doppler Ultrasonography: A}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Noninvasive Predi
ctor Of Kidney Dysfunction and Hepatorenal Failure in }\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {Liver}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {Disease. Hepatology 1994;20:362-9.}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3. Gines P, Arroyo V. Hepatorena
l Syndrome.J Am Soc Nephrol }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {1999;10:1833-9}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha
rscalex100 {4. Dagher L, Moore K. The Hepatorenal Syndrome. Gut 2001;49:729-737}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5. Arroyo V, Gin
es P,Gerbes Al et al. Defenition and Diagnostic criteria of }\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Refractory}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {ascites and Hepatorenal Syndrome in Cirr
hosis Hepatology 1996;23:164}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
\cf3\f1\charscalex100 {Sirosis hati adalah penyakit hati menahun yang mengenai s
eluruh organ }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {ha
ti, ditandai dengan pembentukan jaringan ikat disertai nodul. Keadaan }\par\pard
\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {tersebut terjadi karena i
nfeksi akut dengan virus hepatitis dimana terjadi }\par\pard\li1853\ri0\sl-240\s
lmult0 \fs20\cf3\f1\charscalex100 {peradangan sel hati yang luas dan menyebabkan
banyak kematian sel. }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscal
ex100 {Kondisi ini menyebabkan terbentuknya banyak jaringan ikat dan }\par\pard\
li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {regenerasi noduler dengan
berbagai ukuran yang dibentuk oleh sel }\par\pard\li1853\ri0\sl-240\slmult0 \fs2
0\cf3\f1\charscalex100 {parenkim hati yang masih sehat. Akibatnya bentuk hati ya
ng normal akan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {
berubah disertai terjadinya penekanan pada pembuluh darah dan }\par\pard\li1853\
ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {terganggunya aliran darah vena po
rta yang akhirnya menyebabkan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\

charscalex100 {hipertensi portal. Pada sirosis dini biasanya hati membesar, tera
ba kenyal, }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {tepi
tumpul, dan terasa nyeri bila ditekan.}\par\pard\li1853\ri0\sl-440\slmult0 \fs2
0\cf3\f1\charscalex100 {Penyebab sirosis hati beragam. Selain disebabkan oleh in
feksi virus }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {hep
atitis B ataupun C, juga dapat diakibatkan oleh konsumsi alkohol yang }\par\pard
\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {berlebihan, berbagai maca
m penyakit metabolik, adanya gangguan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20
\cf3\f1\charscalex100 {imunologis , dan sebagainya. Di Indonesia, sirosis hati l
ebih sering }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {dij
umpai pada laki-laki daripada perempuan.}\par\pard\li1853\ri0\sl-440\slmult0 \fs
20\cf3\f1\charscalex100 {Keluhan yang timbul umumnya tergantung apakah sirosisny
a masih dini }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\m
argrsxn133\margtsxn666\margbsxn386\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\
8\cf0\par\pard\li1853\ri0\sl-373\slmult0 \fs20\cf3\f1\charscalex100 {atau sudah
fase dekompensasi. Selain itu apakah timbul kegagalan fungsi }\par\pard\li1853\r
i0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {hati akibat proses hepatitis kroni
k aktif atau telah terjadi hipertensi portal. }\par\pard\li1853\ri0\sl-253\slmul
t0 \fs20\cf3\f1\charscalex100 {Bila masih dalam fase kompensasi sempurna maka si
rosis kadangkala }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100
{ditemukan pada waktu orang melakukan pemeriksaan kesehatan }\par\pard\li1853\r
i0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {menyeluruh (general check-up) kare
na memang tidak ada keluhan sama }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\
f1\charscalex100 {sekali. Namun, bisa juga timbul keluhan yang tidak khas sepert
i merasa }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {badan
tidak sehat, kurang semangat untuk bekerja, rasa kembung, mual, }\par\pard\li185
3\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {mencret kadang sembelit, tidak
selera makan, berat badan menurun, otot-}\par\pard\li1853\ri0\sl-240\slmult0 \fs
20\cf3\f1\charscalex100 {otot melemah, dan rasa cepat lelah. Banyak atau sedikit
nya keluhan yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100
{timbul tergantung dari luasnya kerusakan parenkim hati. Bila timbul }\par\pard
\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {ikterus maka berhenti sed
ang terjadi kerusakan sel hati. Namun, jika }\par\pard\li1853\ri0\sl-240\slmult
0 \fs20\cf3\f1\charscalex100 {sudah masuk ke dalam fase dekompensasi maka gejala
yang timbul }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {be
rtambah dengan gejala dari kegagalan fungsi hati dan adanya hipertensi }\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {portal.}\par\pard\li1853
\ri0\sl-440\slmult0 \fs20\cf3\f1\charscalex100 {Kegagalan fungsi hati menimbulka
n keluhan seperti rasa lemah, turunya }\par\pard\li1853\ri0\sl-240\slmult0 \fs20
\cf3\f1\charscalex100 {barat badan, kembung, dan mual. Kulit tubuh di bagian at
as, muka, dan }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {l
engan atas akan bisa timbul bercak mirip laba-laba }\fs20\cf3\f0\charscalex100\i
{(*spider nevi)}\i0 \fs20\cf3\f1\charscalex100 {. }\par\pard\li1853\ri0\sl-240\
slmult0 \fs20\cf3\f1\charscalex100 {Telapak tangan bewarna merah }\fs20\cf3\f0\c
harscalex100\i {(eritema palmaris)}\i0 \fs20\cf3\f1\charscalex100 {, perut membu
ncit }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {akibat pen
imbunan cairan secara abnormal di rongga perut }\fs20\cf3\f0\charscalex100\i {(a
sites)}\i0 \fs20\cf3\f1\charscalex100 {, }\par\pard\li1853\ri0\sl-240\slmult0 \f
s20\cf3\f1\charscalex100 {rambut ketiak dan kemaluan yang jarang atau berkurang,
buah zakar }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {men
gecil }\fs20\cf3\f0\charscalex100\i {(atrofi testis)}\i0 \fs20\cf3\f1\charscalex
100 {, dan pembesaran payudara pada laki-laki. Bisa }\par\pard\li1853\ri0\sl-240
\slmult0 \fs20\cf3\f1\charscalex100 {pula timbul }\fs20\cf3\f0\charscalex100\i {
hipoalbuminemia}\i0 \fs20\cf3\f1\charscalex100 {, pembengkakan pada tungkai bawa
h sekitar }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {tulan
g }\fs20\cf3\f0\charscalex100\i {(edema pretibial)}\i0 \fs20\cf3\f1\charscalex10
0 {, dan gangguan pembekuan darah yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs2
0\cf3\f1\charscalex100 {bermanifestasi sebagai peradangan gusi, mimisan, atau ga
ngguan siklus }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {h

aid. Kegagalan hati pada sirosis hati fase lanjut dapat menyebabkan }\par\pard\l
i1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {gangguan kesadaran akibat }
\fs20\cf3\f0\charscalex100\i {encephalopathy hepatic}\i0 \fs20\cf3\f1\charscalex
100 { atau koma hepatik.}\par\pard\li1853\ri0\sl-440\slmult0 \fs20\cf3\f1\charsc
alex100 {Tekanan portal yang normal antara 5-10 mmHg. Pada hipertensi portal }\p
ar\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {terjadi kenaikan t
ekanan dalam sistem portal yang lebih dari 15 mmHg }\par\pard\li1853\ri0\sl-240\
slmult0 \fs20\cf3\f1\charscalex100 {dan bersifat menetap. Keadaan ini akan menye
babkan limpa membesar }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f0\charscal
ex100\i {(splenomegali)}\i0 \fs20\cf3\f1\charscalex100 {, pelebaran pembuluh dar
ah kulit pada dinding perut }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\ch
arscalex100 {disekitar pusar }\fs20\cf3\f0\charscalex100\i {(caput medusae)}\i0
\fs20\cf3\f1\charscalex100 {, pada dinding perut yang menandakan }\par\pard\li18
53\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {sudah terbentuknya sistem kola
teral, wasir }\fs20\cf3\f0\charscalex100\i {(hemoroid)}\i0 \fs20\cf3\f1\charscal
ex100 {, dan penekanan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charsca
lex100 {pembuluh darah vena esofagus atau cardia }\fs20\cf3\f0\charscalex100\i {
(varices esofagus)}\i0 \fs20\cf3\f1\charscalex100 { yang dapat }\par\pard\li1853
\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {menimbulkan muntah darah }\fs20\
cf3\f0\charscalex100\i {(hematemesis)}\i0 \fs20\cf3\f1\charscalex100 {, atau ber
ak darah }\fs20\cf3\f0\charscalex100\i {(melena)}\i0 \fs20\cf3\f1\charscalex100
{. }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {Kalau pendar
ahan yang keluar sangat banyak maka penderita bisa timbul }\par\pard\li1853\ri0\
sl-240\slmult0 \fs20\cf3\f1\charscalex100 {syok }\fs20\cf3\f0\charscalex100\i {(
renjatan)}\i0 \fs20\cf3\f1\charscalex100 {. Bila penyakit akan timbul asites, en
cephalopathy, dan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex10
0 {perubahan ke arah kanker hati primer (hepatoma).}\par\pard\li1853\ri0\sl-440\
slmult0 \fs20\cf3\f1\charscalex100 {Diagnosa yang pasti ditegaskan secara mikros
kopis dengan melakukan }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charsca
lex100 {biopsi hati. Dengan pemeriksaan histipatologi dari sediaan jaringan hati
}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {dapat ditentuk
an keparahan dan kronisitas dari peradangan hatinya, }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf3\f1\charscalex100 {mengetahui penyebab dari penyakit hati kro
nis, dan mendiagnosis apakah }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\c
harscalex100 {penyakitnya suatu keganasan ataukah hanya penyakit sistemik yang }
\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {disertai pembesa
ran hati.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-2
3\ri0\sl-266\slmult0 \fs20\cf3\f1\charscalex100 {Pemeriksaan laboraturium pada s
irosis hati meliputi hal-hal berikut.}\par\pard\li2213\ri0\sl-480\slmult0 \*\tx2
573\fs24\cf3\f0\charscalex100 {1.}\tab \fs20\cf3\f1\charscalex100 {Kadar Hb yang
rendah }\fs20\cf3\f0\charscalex100\i {(anemia)}\i0 \fs20\cf3\f1\charscalex100 {
, jumlah sel darah putih menurun }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\
f0\charscalex100\i {(leukopenia)}\i0 \fs20\cf3\f1\charscalex100 {, dan trombosit
openia.}\par\pard\li2213\ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\f0\charscalex100
{2.}\tab \fs20\cf3\f1\charscalex100 {Kenaikan SGOT, SGPT dan gamma GT akibat keb
ocoran dari sel-sel }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex
100 {yang rusak. Namun, tidak meningkat pada sirosis inaktif.}\par\pard\li2213\r
i0\sl-453\slmult0 \fs20\cf3\f1\charscalex100 {3. Kadar albumin rendah. Terjadi b
ila kemampuan sel hati menurun.}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn1
6840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\pard\li2213\ri0\sl-213\slmu
ex100 {4. Kadar kolinesterase (CHE) yang menurun kalau terjadi kerusakan }\par\p
ard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {sel hati.}\par\pard\li
2213\ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\f0\charscalex100 {5.}\tab \fs20\cf3\f
1\charscalex100 {masa protrombin yang memanjang menandakan penurunan fungsi }\pa
r\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {hati.}\par\pard\li2
213\ri0\sl-440\slmult0 \fs20\cf3\f1\charscalex100 {6. pada sirosis fase lanjut,
glukosa darah yang tinggi menandakan }\par\pard\li2573\ri0\sl-253\slmult0 \fs20\

cf3\f1\charscalex100 {ketidakmampuan sel hati membentuk glikogen.}\par\pard\li22
13\ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\f0\charscalex100 {7.}\tab \fs20\cf3\f1\
charscalex100 {Pemeriksaan marker serologi petanda virus untuk menentukan }\par\
pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {penyebab sirosis hati
seperti HBsAg, HBeAg, HBV-DNA, HCV-RNA, }\par\pard\li2573\ri0\sl-240\slmult0 \f
s20\cf3\f1\charscalex100 {dan sebagainya.}\par\pard\li2213\ri0\sl-440\slmult0 \f
s20\cf3\f1\charscalex100 {8. Pemeriksaan alfa feto protein (AFP). Bila ininya te
rus meninggi atau }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex10
0 {>500-1.000 berarti telah terjadi transformasi ke arah keganasan }\par\pard\li
2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {yaitu terjadinya kanker hati
primer (hepatoma).}\par\pard\li1853\ri0\sl-453\slmult0 \fs20\cf3\f1\charscalex1
00 {Pemeriksaan penunjang lainnya yang dapat dilakukan antara lain }\par\pard\li
1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {ultrasonografi (USG), pemeri
ksaan radiologi dengan menelan bubur }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\
cf3\f1\charscalex100 {barium untuk melihat varises esofagus, pemeriksaan esofago
skopi untuk }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {mel
ihat besar dan panjang varises serta sumber pendarahan, pemeriksaan }\par\pard\l
i1853\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {sidikan hati dengan penyunt
ikan zat kontras, CT scan, angografi, dan }\par\pard\li1853\ri0\sl-240\slmult0 \
fs20\cf3\f1\charscalex100 {endoscopic retrograde chlangiopancreatography (ERCP).
}\par\pard\li1853\ri0\sl-440\slmult0 \fs20\cf3\f1\charscalex100 {Pengobatan terg
antung dari derajat kegagalan hati dan hipertensi portal. }\par\pard\li1853\ri0\
sl-240\slmult0 \fs20\cf3\f1\charscalex100 {Bila hati masih dapat mengkompensasi
kerusakan yang terjadi maka }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf3\f1\ch
arscalex100 {penderita dianjurkan untuk mengontrol penyakitnya secara teratur, }
\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {istirahat yang c
ukup, dan melakukan diet sehari-hari yang tinggi kalori }\par\pard\li1853\ri0\sl
-240\slmult0 \fs20\cf3\f1\charscalex100 {dan protein disertai lemak secukupnya.
Dalam hal ini bila timbul }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf3\f1\char
scalex100 {komplikasi maka hal-hal berikut harus diperhatikan.}\par\pard\li2213\
ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\f0\charscalex100 {1.}\tab \fs20\cf3\f1\cha
rscalex100 {Pada ensefaopati pemasukan protein harus dikurangi. Lakukan }\par\pa
rd\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {koreksi faktor pencetus
seperti pemberian kalium pada }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1
\charscalex100 {hipokalemia, pemberian antibiotik pada infeksi, dan lain-lain.}\
par\pard\li2213\ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\f0\charscalex100 {2.}\tab
\fs20\cf3\f1\charscalex100 {apabila timbul asites lanjut maka penderita perlu is
tirahat di }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {temp
at tidur. Konsumsi garam perlu dikurangi hingga kira-kira 0.5 }\par\pard\li2573\
ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {g per hari dengan botol cairan ya
ng masuk 1.5 1 per hari. }\par\pard\li2573\ri0\sl-253\slmult0 \fs20\cf3\f1\chars
calex100 {Penderita diberi obat diureti distal yaitu Spronolakton 4x25 g per }\p
ar\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {hari, yang dapat d
inaikkan sampai dosis total 800 mg perhari. Bila }\par\pard\li2573\ri0\sl-240\sl
mult0 \fs20\cf3\f1\charscalex100 {perlu, penderita diberikan obat diuretik loop
yaitu Furosemid dan }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex
100 {dilakukan koreksi kadar albumin di dalam darah.}\par\pard\li2213\ri0\sl-453
\slmult0 \fs20\cf3\f1\charscalex100 {3. Pada pendarahan varises esofagus penderi
ta memerlukan }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {p
erawatan di rumah sakit.}\par\pard\li2213\ri0\sl-480\slmult0 \*\tx2573\fs24\cf3\
f0\charscalex100 {4.}\tab \fs20\cf3\f1\charscalex100 {Apabila timbul sindroma he
patorenal yaitu terjadinya gagal ginjal }\par\pard\li2573\ri0\sl-240\slmult0 \fs
20\cf3\f1\charscalex100 {akut yang berjalan progresif pada penderita penyakit ha
ti kronis }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex100 {dan u
mumnya disertai sirosis hati dengan asites maka perlu }\par\pard\li2573\ri0\sl-2
40\slmult0 \fs20\cf3\f1\charscalex100 {perawatan segera di rumah sakit. Keadaan
ini ditandai dengan }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf3\f1\charscalex
100 {kadar urea yang tinggi di dalam darah (azotemia) dan air kencing }\par\pard
\li2573\ri0\sl-253\slmult0 \fs20\cf3\f1\charscalex100 {yang keluar sangat sediki
t (oliguria).}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\m
argrsxn133\margtsxn666\margbsxn373\cols2\colno1\colw5693\colsr-0\colno2\colw5400
lmult0 \fs18\cf0\par\pard\li2546\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100\b
{Abstrak}\b0 \par\pard\li2546\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100 {Si
rosis hepatis yang merupakan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {suatu tahap akhir dari hepatitis }\par\pard\li2546\ri0\sl-226\slmu
lt0 \fs20\cf0\f0\charscalex100 {kronik termasuk masalah }\par\pard\li2546\ri0\sl
-226\slmult0 \fs20\cf0\f0\charscalex100 {kesehatan yang cukup penting }\par\pard
\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {saat ini. Akan tetapi, sa
mpai saat }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {ini b
elum ada suatu terapi yang }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\cha
rscalex100 {dapat memberikan hasil secara }\par\pard\li2546\ri0\sl-226\slmult0 \
fs20\cf0\f0\charscalex100 {efektif. Transplantasi sel menjadi }\par\column\pard\
li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li0\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100\b {Abstract}\b0 \par\p
ard\li0\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100 {Cirrhosis hepatic as an e
ndpoint }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {of chronic
liver failure was }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{determine as a current medical }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {problems. Several improvement }\par\pard\li0\ri0\sl-240\slmult0 \f
s20\cf0\f0\charscalex100 {methods had conducted with }\par\pard\li0\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {unsuccesful result. Actual y liver }\par\pard
\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {trasnplantation has a promis
ing }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {result, but th
ere\uc1\u8217Xs so many }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\ma
rglsxn666\margrsxn133\pard\li2546\ri0\sl-240\slmult0 \*\tx5693\fs20\cf0\f0\chars
calex100 {alternatif baru, mengingat adanya }\tab \fs20\cf0\f0\charscalex100 {te
chnical difficulities (include \uc1\u8220Xhow }\par\pard\sect\sectd\sbknone\pgws
xn11893\pghsxn16840\marglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2
\colw5400\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {kemungkinan
sel hepatosit dapat }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscale
x100 {ditransplantasikan dan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {berintegrasi dengan jaringan }\par\pard\li2546\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {hepar resipien. Perkembangan }\par\column\pard\li0\r
i0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {to get a donor?\uc1\u8221X, compat
ibility, }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {and surge
ry requirements) which }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex
100 {inhibits wide range acceptance of }\par\pard\li0\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {this techniques. }\par\pard\sect\sectd\sbknone\pgwsxn11893\
pghsxn16840\marglsxn666\margrsxn133\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {teknis medis saat ini menunjukkan }{ }\fs20\cf0\f0\charscalex100
{Cytotransplantation was }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\m
arglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2\colw5400\pard\li2546
\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {bahwa transplantasi sel hati }\p
ar\column\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dettermine whe
ter hepatocytes }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn66
6\margrsxn133\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {secara
intra portal mulai dilakukan }{ }\fs20\cf0\f0\charscalex100 {could transplanted
and integrated }\par\pard\li2546\ri0\sl-240\slmult0 \*\tx5693\fs20\cf0\f0\charsc
alex100 {untuk mensubtitusi jaringan hepar }\tab \fs20\cf0\f0\charscalex100 {wit
h liver parenchyma in portal }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn168
40\marglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2\colw5400\pard\li
2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang telah rusak. Hanya saja
, }\par\column\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {zone. The
recent focus on }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn6
66\margrsxn133\pard\li2546\ri0\sl-226\slmult0 \*\tx5693\fs20\cf0\f0\charscalex10
0 {teknik trasnplantasi sel intra porta }\tab \fs20\cf0\f0\charscalex100 {hepato
cytes transplantation as an }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn1684

0\marglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2\colw5400\pard\li2
546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang telah dilakukan memiliki
}\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {beberapa kelem
ahan, terutama }\par\column\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex1
00 {alternative therapy for cirrhosis }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf
0\f0\charscalex100 {hepatic has heightened interest in }\par\pard\sect\sectd\sbk
none\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\pard\li2546\ri0\sl-226\slmu
lt0 \*\tx5693\fs20\cf0\f0\charscalex100 {terkait dengan terjadinya nekrosis }\ta
b \fs20\cf0\f0\charscalex100 {the reversal of cel transplantation }\par\pard\se
ct\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\cols2\colno1\co
lw5693\colsr-0\colno2\colw5400\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\chars
calex100 {di jaringan hepar resipien karena }\par\pard\li2546\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {terbentuknya oklusi di sepanjang }\par\pard\li2546\
ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {pembuluh porta. }\par\pard\li2546
\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Tingkat ketahanan hidup sel }\pa
r\column\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {using intra por
tal infusion. }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Mean
while a conventional }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex10
0 {teckniques had several problems }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {like necrotic spread caused by an }\par\pard\li0\ri0\sl-226\slm
ult0 \fs20\cf0\f0\charscalex100 {occlution. Locus transplant }\par\pard\sect\sec
td\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\pard\li2546\ri0\sl-25
3\slmult0 \fs20\cf0\f0\charscalex100 {hepatosit donor di daerah barunya }{ }\fs2
0\cf0\f0\charscalex100 {viability rate also poor and }\par\pard\li2546\ri0\sl-26
6\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {juga sangat minim sehingga }\tab
\fs20\cf0\f0\charscalex100 {contribute as an important failure }\par\pard\li2546
\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {mempengaruhi tingkat }\
tab \fs20\cf0\f0\charscalex100 {parameter. We try to introduce a }\par\pard\li25
46\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {keberhasilan transpla
ntasi intra }\tab \fs20\cf0\f0\charscalex100 {novel methods and cyto }\par\pard\
li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {porta. Kami berup
aya untuk }\tab \fs20\cf0\f0\charscalex100 {transplantation equipment }\par\pard
\li2546\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {menyajikan suatu
metode baru }\tab \fs20\cf0\f0\charscalex100 {(Hepatocyte Cytotransplantator) t
o }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {bese
rta alat bantunya untuk }\tab \fs20\cf0\f0\charscalex100 {cut some impairment ca
used by }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100
{menyempurnakan proses }\tab \fs20\cf0\f0\charscalex100 {an old techniques. In
our design }\par\pard\li2546\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {tran
splantasi hepatosit intra porta. }{ }\fs20\cf0\f0\charscalex100 {hepatocytes cel
s wil colecting, }\par\pard\li2546\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\f0\ch
arscalex100 {Metode dan alat tersebut dinamai }\tab \fs20\cf0\f0\charscalex100 {
manipulating, and sending by a }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs
20\cf0\f0\charscalex100 {\uc1\u8220XHepatosit Sitotransplantator\uc1\u8221X. }\t
ab \fs20\cf0\f0\charscalex100 {comprehensive approach. }\par\pard\li2546\ri0\sl253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {Dengan metode ini, upaya }\tab
\fs20\cf0\f0\charscalex100 {Hepatocytes was col ected by }\par\pard\li2546\ri0\s
l-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {penanganan proses transplanta
si }\tab \fs20\cf0\f0\charscalex100 {biopsy surgery and grown in }\par\pard\li25
46\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {sel di kendalikan sec
ara }\tab \fs20\cf0\f0\charscalex100 {CRML-1066 medium. During pre-}\par\pard\li
2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {komprehensif dan si
stematis. }\tab \fs20\cf0\f0\charscalex100 {transplantation process }\par\pard\l
i2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {Bahan baku sel hep
atosit yang }\tab \fs20\cf0\f0\charscalex100 {hepatocytes wil treated by }\par\
pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {akan digunak
an untuk }\tab \fs20\cf0\f0\charscalex100\i {Nafamostat Mesilate}\i0 \fs20\cf0\f
0\charscalex100 { (protease }\par\pard\li2546\ri0\sl-266\slmult0 \*\tx5693\fs20\
cf0\f0\charscalex100 {transplantasi diambil dari subjek }\tab \fs20\cf0\f0\chars
calex100 {inhibitor) as a cytoprotective. To }\par\pard\li2546\ri0\sl-253\slmult

0 \*\tx5693\fs20\cf0\f0\charscalex100 {transplan (autotransplan) dengan }\tab \f
s20\cf0\f0\charscalex100 {send the hepatocytes into portal }\par\pard\li2546\ri0
\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {cara biopsi terarah dengan
}\tab \fs20\cf0\f0\charscalex100 {area we use liquid pressure from }\par\pard\li
2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {bantuan USG. Sel sa
mpel }\tab \fs20\cf0\f0\charscalex100 {recipient own blood flow. Artificial }\pa
r\pard\li2546\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {dibiakkan
dalam media kultur }\tab \fs20\cf0\f0\charscalex100 {closed blood circulation ha
s }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {CRML
-1066 (Mediatech) dan }\tab \fs20\cf0\f0\charscalex100 {conducted by using inlet
-outlet }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100
{mendapat proteksi seluler dari }\tab \fs20\cf0\f0\charscalex100 {needle connec
ted to silicon }\par\pard\li2546\ri0\sl-253\slmult0 \*\tx5693\fs20\cf0\f0\charsc
alex100 {Nafamostat Mesilate (suatu }\tab \fs20\cf0\f0\charscalex100 {tubing. Bl
ood pressure in 3.2x1.6 }\par\pard\li2546\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\
f0\charscalex100 {protease inhibitor). Selanjutnya, }\tab \fs20\cf0\f0\charscale
x100 {mm diameters silicon tubing wil }\par\pard\li2546\ri0\sl-253\slmult0 \*\t
x5693\fs20\cf0\f0\charscalex100 {sel hasil kultur akan dikirim }\tab \fs20\cf0\f
0\charscalex100 {enhancing by peristaltic pump to }\par\pard\li2546\ri0\sl-253\s
lmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {kembali ke hepar resipien dengan }\t
ab \fs20\cf0\f0\charscalex100 {conduct a higher pressure. Blood }\par\pard\li254
6\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {bantuan tekanan alir yang beras
al }{ }\fs20\cf0\f0\charscalex100 {wil temporary col ecting in }\par\pard\li254
6\ri0\sl-266\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {dari aliran darah resi
pien. Untuk }\tab \fs20\cf0\f0\charscalex100 {multiport ejector which acted as a
}\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {mendapatkan te
kanan alir }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\mar
grsxn133\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133
\margtsxn666\margbsxn426\cols2\colno1\colw5693\colsr-0\colno2\colw5400\pard\li25
18\cf0\par\pard\li2546\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {tersebut,
didesain suatu sirkulasi }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\chars
calex100 {vaskular tertutup dengan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf
0\f0\charscalex100 {menggunakan jarum }\fs20\cf0\f0\charscalex100\i {inlet-outle
t }\i0 \par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang terh
ubung dengan }\fs20\cf0\f0\charscalex100\i {silicon }\i0 \par\pard\li2546\ri0\sl
-226\slmult0 \fs20\cf0\f0\charscalex100\i {tubing}\i0 \fs20\cf0\f0\charscalex100
{ berdiameter 3,2x1,6 mm. }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\cha
rscalex100 {Untuk membantu meningkatkan }\par\pard\li2546\ri0\sl-226\slmult0 \fs
20\cf0\f0\charscalex100 {tekanan intra tuba, ditambahkan }\par\pard\li2546\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {sebuah pompa peristaltis untuk }\par\p
ard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {mendorong darah memasu
ki }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {multiport
ejector}\i0 \fs20\cf0\f0\charscalex100 { yang sekaligus }\par\pard\li2546\ri0\sl
-226\slmult0 \fs20\cf0\f0\charscalex100 {berfungsi sebagai }\fs20\cf0\f0\charsca
lex100\i {mixer.}\i0 \fs20\cf0\f0\charscalex100 { Sel }\par\pard\li2546\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {hepatosit yang telah dipindahkan }\par\pa
rd\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dari botol kultur ke da
lam pompa }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {syr
inge}\i0 \fs20\cf0\f0\charscalex100 { akan didorong menuju }\par\pard\li2546\ri0
\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {multiport ejector}\i0 \fs20\cf0\f0
\charscalex100 { untuk bertemu }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {dengan darah dari sirkulasi }\par\pard\li2546\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {tertutup. Sementara itu, pompa }\par\pard\li2546\ri
0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {syringe }\i0 \fs20\cf0\f0\charsca
lex100 {II akan mengirimkan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\ch
arscalex100 {larutan anti penggumpalan sel }\par\pard\li2546\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {(EGTA), anti koagulan (EDTA), }\par\pard\li2546\ri0\
sl-226\slmult0 \fs20\cf0\f0\charscalex100 {serta faktor-faktor pertumbuhan }\par

\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {(HGF, IGF-1, dan VEG
F) ke }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dalam }\f
s20\cf0\f0\charscalex100\i {multiport ejector.}\i0 \fs20\cf0\f0\charscalex100 {
Larutan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang te
lah bercampur tersebut }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charsca
lex100 {selanjutnya akan mengalami }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf
0\f0\charscalex100 {manipulasi getar resiprokal }\par\pard\li2546\ri0\sl-226\slm
ult0 \fs20\cf0\f0\charscalex100 {melalui }\fs20\cf0\f0\charscalex100\i {micro vi
brator}\i0 \fs20\cf0\f0\charscalex100 { yang }\par\pard\li2546\ri0\sl-226\slmult
0 \fs20\cf0\f0\charscalex100 {terletak di bawah }\fs20\cf0\f0\charscalex100\i {m
ultiport }\i0 \par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {
ejector/mixer}\i0 \fs20\cf0\f0\charscalex100 { yang dimaksudkan }\par\pard\li254
6\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {untuk menghomogenisasi dan }\pa
r\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {mengkondisikan sel
hepatosit }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dalam
keadaan tunggal. }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex10
0 {Selanjutnya, suspensi sel }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\c
harscalex100 {hepatosit-darah-faktor anti }\par\pard\li2546\ri0\sl-226\slmult0 \
fs20\cf0\f0\charscalex100 {penggumpalan-anti koagulan-}\par\column\pard\li0\ri0\
li0\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {mixer too. Hepatocyte cel s f
rom }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {culture flask
had to move to first }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex10
0 {syringe pump and pushed to joint }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\
f0\charscalex100 {with transporter blood. Supporting }\par\pard\li0\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {agent like anti clumping reagent }\par\pard\l
i0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {(EGTA), anti coagulant (EDTA),
}\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {and growth factor
s (HGF, IGF-1, }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {and
VEGF) has been enriched }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscal
ex100 {from second syringe pump and }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\
f0\charscalex100 {combine together with hepatocyte }\par\pard\li0\ri0\sl-226\slm
ult0 \fs20\cf0\f0\charscalex100 {cel s in mixer chamber. After al , }\par\pard\l
i0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {mix solution wil facing a }\p
ar\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {reciprocating vibrati
on conducted }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {by a
micro vibrator laid under }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charsca
lex100 {mixer, to derive hepatocytes }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0
\f0\charscalex100 {become a single cel . Filtration by }\par\pard\li0\ri0\sl-226
\slmult0 \fs20\cf0\f0\charscalex100 {micro filter with 80 m porus also }\par\par
d\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {conducted to keep hepatocyt
es as }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {a single, be
fore it goes to portal }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex
100 {vein through silicon tubing and }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0
\f0\charscalex100 {outlet needle. To keep hepatocyte }\par\pard\li0\ri0\sl-240\s
lmult0 \fs20\cf0\f0\charscalex100 {cel wil always in a condusive }\par\pard\li
0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {environment, thermal regulation
}\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {was provided in o
ur methods }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {using a
water jacket which }\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{connected to a water bath which }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {supply a 37}\fs12\cf0\f0\charscalex100 {0}\fs20\cf0\f0\charscale
x100 {C warm water. }\par\pard\li0\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100
{Pre-experimental research has }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {shown a promising result, that }\par\pard\li0\ri0\sl-240\slmult0 \
fs20\cf0\f0\charscalex100 {BUDr labeled transplanted }\par\pard\li0\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {hepatocytes could grown in rapid }\par\pard\l
i0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {proliferate rate in recipient
liver }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Rappaport zo

ne. }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn13
3\pard\li2546\ri0\sl-280\slmult0 \*\tx5693\fs20\cf0\f0\charscalex100 {faktor per
tumbuhan akan difiltrasi }\tab \fs20\cf0\f0\charscalex100\b \i {Keyword}\b0 \i0
\fs20\cf0\f0\charscalex100 {: hepatocyte, }\par\pard\sect\sectd\sbknone\pgwsxn11
893\pghsxn16840\marglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2\col
w5400\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {melalui filter
mikro dengan }\par\column\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{hepatocyte-cytotransplantator, }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsx
n16840\marglsxn666\margrsxn133\pard\li2546\ri0\sl-293\slmult0 \*\tx5693\fs20\cf0
\f0\charscalex100 {diameter porus 80 m. Pada tahap }\tab \fs20\cf0\f0\charscalex
100 {intra portal, silicon tubing, syringe }\par\pard\sect\sectd\sbknone\pgwsxn1
1893\pghsxn16840\marglsxn666\margrsxn133\cols2\colno1\colw5693\colsr-0\colno2\co
lw5400\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {akhir, suspens
i hepatosit akan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{masuk ke pembuluh darah vena }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {porta melalui }\fs20\cf0\f0\charscalex100\i {silicon tubing}\i0
\fs20\cf0\f0\charscalex100 { dan }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\
f0\charscalex100 {jarum}\fs20\cf0\f0\charscalex100\i { outlet}\i0 \fs20\cf0\f0\c
harscalex100 {. Untuk menciptakan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0
\f0\charscalex100 {kondisi lingkungan yang kondusif }\par\pard\li2546\ri0\sl-226
\slmult0 \fs20\cf0\f0\charscalex100 {bagi sel hepatosit, salah satu }\par\pard\l
i2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {upaya yang dilakukan adalah
}\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {dengan meregul
asi suhu melalui }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{penggunaan \uc1\u8220Xjaket air\uc1\u8221X yang }\par\pard\li2546\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {terhubung dengan }\fs20\cf0\f0\charscalex100\
i {waterbath }\i0 \par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{sebagai penyedia air hangat }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\
charscalex100 {dengan suhu 37}\fs12\cf0\f0\charscalex100 {0}{\sub \fs20\cf0\f0\c
harscalex100 {C. }}\par\pard\li2546\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex10
0 {Hasil penelitian pendahuluan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {pada subjek}{ }\fs20\cf0\f0\charscalex100\i {goat}\i0 \fs20\cf0
\f0\charscalex100 { menunjukkan }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {minimalnya daerah nekrosis di }\par\pard\li2546\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {hepar resipien dan tingginya }\par\pard\li2546\r
i0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {tingkat kolonisasi di daerah }\par
\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Rappaport hepar yang
ditandai }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {denga
n peningkatan ekspresi sel }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\cha
rscalex100 {hepatosit yang berlabel BUDr. }\par\column\pard\li0\ri0\sl-226\slmul
t0 \fs20\cf0\f0\charscalex100 {pump, multiport ejector, micro }\par\pard\li0\ri0
\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {vibrator, micro filter, anti clumpin
g, }\par\pard\li0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {anti coagulant,
growth factors. }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn6
66\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margr
sxn133\margtsxn666\margbsxn386\pard\li2546\ri0\sl-213\slmult0 \fs18\cf0\par\pard
0 \fs20\cf0\f0\charscalex100 {Pada pengecatan HE, terlihat }\par\pard\li2546\ri0
\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {adanya vaskularisasi baru yang }\par
\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {mendukung pertumbuha
n koloni }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {baru s
el hepatosit. }\par\pard\li2546\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100\b
\i {Kata kunci}\b0 \i0 \fs20\cf0\f0\charscalex100 {: hepatosit, hepatosit-}\par\
pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {sitotransplantator, i
ntra porta, }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {s
ilicon tubing}\i0 \fs20\cf0\f0\charscalex100 {, pompa }\fs20\cf0\f0\charscalex10
0\i {syringe}\i0 \fs20\cf0\f0\charscalex100 {, }\par\pard\li2546\ri0\sl-226\slmu
lt0 \fs20\cf0\f0\charscalex100\i {multiport ejector}\i0 \fs20\cf0\f0\charscalex1
00 {, }\fs20\cf0\f0\charscalex100\i {micro vibrator}\i0 \fs20\cf0\f0\charscalex1

00 {, }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {filter mi
kro, anti penggumpalan, }\par\pard\li2546\ri0\sl-240\slmult0 \fs20\cf0\f0\charsc
alex100 {anti koagulan, faktor }\par\pard\li2546\ri0\sl-226\slmult0 \fs20\cf0\f0
\charscalex100 {pertumbuhan. }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {Pendahuluan}\b0 \pa
r\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Kerusakan hepar ter
minal yang termanifestasi dalam bentuk sirosis hepatis }\par\pard\li1853\ri0\sl226\slmult0 \fs20\cf0\f0\charscalex100 {merupakan suatu masalah kesehatan yang b
elum dapat terselesaikan. Pendekatan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\
cf0\f0\charscalex100 {kuratif yang telah dilakukan selama ini adalah dengan meng
eradikasi faktor }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{penyebab terjadinya hepatitis kronik. Hepatitis kronik yang dapat menimbulkan
sirosis }\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {hepatis
memiliki faktor penyebab yang berbeda-beda. Secara epidemiologis diketahui }\pa
r\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {bahwa pada ras kauk
asian penyebab utamanya proses autoimun}\fs12\cf0\f0\charscalex100 {1}\fs20\cf0\
f0\charscalex100 {. Sedangkan pada }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf
0\f0\charscalex100 {ras melanesia-polynesia penyebab utamanya adalah infeksi vir
us. Hal ini terbukti dari }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\char
scalex100 {hasil uji saring HbsAg, di mana jumlah pengidap positif di seluruh du
nia adalah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {seki
tar 300 juta orang (1995), dengan bagian terbesar (sekitar 220 juta orang) }\par
\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {terdapat di daerah A
sia}\fs12\cf0\f0\charscalex100 {2}\fs20\cf0\f0\charscalex100 { . Sedangkan di In
donesia diperkirakan terdapat sekitar 11 }\par\pard\li1853\ri0\sl-226\slmult0 \f
s20\cf0\f0\charscalex100 {juta pengidap HbsAg positif (1993). Indonesiapun terma
suk daerah endemik dengan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\char
scalex100 {tingkat penularan yang cukup tinggi, yaitu 4 sampai 30%}\fs12\cf0\f0\
charscalex100 {3}\fs20\cf0\f0\charscalex100 {. Selain hepatitis kronik B, }\par\
pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {penyebab lain sirosis
hepatis adalah hepatitis kronik C, di mana prevalensi anti-HCV }\par\pard\li185
3\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {pada penderita sirosis hepatis
di Indonesia pada 1993 berkisar antara 30,8-89,2%}\fs12\cf0\f0\charscalex100 {4}
\fs20\cf0\f0\charscalex100 {. }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {Terapi standar yang telah diterapkan selama ini adalah terapi unt
uk mengeradikasi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{virus hepatitis seperti penggunaan interferon dan lamivudine. Masalah yang tim
bul }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {adalah belu
m adanya suatu metode untuk meregenerasi dan merefungsionalisasi }\par\pard\li18
53\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {organ hepar yang telah mengala
mi perubahan morfologi dan fungsi. Sirosis hepatis }\par\pard\li1853\ri0\sl-226\
slmult0 \fs20\cf0\f0\charscalex100 {ditandai dengan adanya lokus peradangan, nek
rosis, daerah-daerah yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\char
scalex100 {beregenerasi, dan penumpukan jaringan ikat yang difus, sehingga terbe
ntuklah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {nodul-n
odul yang akan mengganggu aspek fungsional lobulus hepar}\fs12\cf0\f0\charscalex
100 {5}\fs20\cf0\f0\charscalex100 {. Asupan kuratif }\par\pard\li1853\ri0\sl-226
\slmult0 \fs20\cf0\f0\charscalex100 {yang paling bermanfaat adalah dengan membua
t koloni baru intra hepatik untuk }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0
\f0\charscalex100 {menjalankan fungsi-fungsi hepar yang terganggu dengan adanya
perkembangan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {ma
sif proses sirosis. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex
100 {Terapi yang paling ideal untuk kerusakan hepar terminal saat ini adalah tra
nsplantasi }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {orga
n hati. Hanya saja, proses transplantasi ini memiliki banyak kesulitan dalam }\p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {pelaksanaannya. Ke
sulitan utama adalah mencari donor yang mau menyumbangkan }\par\pard\li1853\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {heparnya. Tentu saja proses pendonasi
an ini baru dapat berlangsung pada saat }\par\pard\li1853\ri0\sl-226\slmult0 \fs
20\cf0\f0\charscalex100 {donor telah meninggal dunia (berbeda dengan ginjal yang

dapat didonasikan pada }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charsc
alex100 {saat donor masih hidup). Masalah yang tak kalah pentingnya adalah kecoc
okan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {organ dono
r dengan sistem pertahanan tubuh penerima (kompatibilitas). Masalah }\par\pard\l
i1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {lainnya adalah teknis pemas
angan organ hepar ke tubuh penderita yang amat rumit, }\par\pard\li1853\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {mengingat hepar memiliki begitu banyak pe
mbuluh darah yang harus disambung. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf
0\f0\charscalex100 {Mengingat permasalahan yang dihadapi proses transplantasi cu
kup berat maka }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {
persentasi penderita kerusakan hepar terminal yang dapat diselamatkan melalui }\
par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {proses ini terhit
ung masih sangat kecil. Saat ini, di Amerika Serikat mulai }\par\pard\li1853\ri0
\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dikembangkan suatu metode baru yang
disebut ELAD (}\fs20\cf0\f0\charscalex100\i {Extracorporeal Liver Assist }\i0 \p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {Device}\i0 \fs20
\cf0\f0\charscalex100 {). Alat tersebut dirancang untuk menggantikan beberapa fu
ngsi hepar seperti }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex1
00 {detoksifikasi, metabolisme beberapa jenis asam amino, protein, enzim, faktor
}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {pembekuan dara
h, dan asam lemak. Penggunaan alat ini mirip dengan alat }\par\pard\li1853\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {haemodialisis (pencuci darah) yang men
ggantikan fungsi ginjal secara sementara. }\par\pard\li1853\ri0\sl-226\slmult0 \
fs20\cf0\f0\charscalex100 {ELAD dilengkapi dengan sistem sirkulasi darah ekstern
al yang akan membawa darah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\cha
rscalex100 {penderita menuju suatu ruang penyaring yang di dalamnya terdapat sek
umpulan sel }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\ma
rgrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
\cf0\par\pard\li1853\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {hepatosit ha
sil pengkulturan. Sel hepatosit hasil kultur tersebut melekat di membran }\par\p
ard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang akan dilalui oleh
darah, sehingga darah akan tersaring dan mengalami }\par\pard\li1853\ri0\sl-226
\slmult0 \fs20\cf0\f0\charscalex100 {detoksifikasi, penambahan asam amino, asam
lemak, ataupun faktor pembekuan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {darah}\fs12\cf0\f0\charscalex100 {6}\fs20\cf0\f0\charscalex100
{. Hanya saja, penggunaan ELAD bersifat sementara dan sekadar }\par\pard\li1853\
ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {mensubstitusi beberapa fungsi hep
ar dan tidak memberikan suatu solusi yang }\par\pard\li1853\ri0\sl-226\slmult0 \
fs20\cf0\f0\charscalex100 {menyeluruh. Organ hepar yang rusak tetaplah rusak dan
penderita harus }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{mendapatkan terapi ELAD secara berkesinambungan (terus-menerus). }\par\pard\li
1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Upaya lain yang mulai dijaja
ki oleh para ahli hepatologi adalah dengan melakukan }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {pencangkokan sel hepatosit melalui pembulu
h darah vena porta, atau sering disebut }\par\pard\li1853\ri0\sl-226\slmult0 \fs
20\cf0\f0\charscalex100 {transplantasi intra porta. Proses transplantasi ini dap
at mereduksi masalah-masalah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\c
harscalex100 {yang terjadi pada proses transplantasi organ. Sifat transplantasi
sel hati adalah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{autotransplan, di mana sel-sel hepatosit yang akan dicangkok berasal dari organ
}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {hepar penderit
a sendiri. Masalah lain yang dapat diminimalisir adalah kompatibilitas, }\par\pa
rd\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {karena sistem pertahana
n tubuh tentu tidak akan menyerang \uc1\u8220Xwarga negara\uc1\u8221X-nya }\par\
pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {sendiri. Sedangkan ke
sulitan yang ditemui adalah pencangkokan sel melalui }\par\pard\li1853\ri0\sl-22
6\slmult0 \fs20\cf0\f0\charscalex100 {pembuluh darah vena ini menimbulkan oklusi
(sumbatan) di ujung-ujung pembuluh }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {darah. Sumbatan tersebut akan mengakibatkan terjadinya nekr

osis (pembusukan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{jaringan) akibat kurangnya asupan oksigen di daerah pasca sumbatan. Keadaan in
i }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {terjadi akiba
t proses transplantasi sel dilakukan menggunakan jarum suntik biasa }\par\pard\l
i1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {berukuran besar. Pada metod
e yang lebih canggih digunakan }\fs20\cf0\f0\charscalex100\i {French pediatric }
\i0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {feeding tu
be no 8}\i0 \fs20\cf0\f0\charscalex100 { yang hanya memanfaatkan gaya gravitasi
untuk mendorong }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{masuknya sel-sel hepatosit ke dalam vena porta. Turbulensi yang terjadi dan }\p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {sempitnya volume r
uang dalam jarum akan mengakibatkan sel-sel hati berkelompok }\par\pard\li1853\r
i0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {(}\fs20\cf0\f0\charscalex100\i {cl
umping}\i0 \fs20\cf0\f0\charscalex100 {). Selaian itu, ikatan antar sel yang kua
t dengan diprakarsai oleh molekul }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0
\f0\charscalex100\i {cadherin }\i0 \fs20\cf0\f0\charscalex100 {akan menyebabkan
gumpalan sel bertambah besar dan tersangkut di }\par\pard\li1853\ri0\sl-226\slmu
lt0 \fs20\cf0\f0\charscalex100 {pembuluh darah sebelum sampai di daerah sasaran.
Kesulitan lain adalah gagalnya }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {sel-sel hati bertumbuh di tempat barunya. Keadaan ini terjadi k
arena lemahnya }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {
kondisi sel akibat perlakuan penanaman serta kurangnya dukungan biokimiawi dan }
\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {fisis dari lingk
ungan sekitar. Dukungan biokimiawi yang dibutuhkan sel untuk }\par\pard\li1853\r
i0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {membentuk koloni baru adalah adany
a faktor-faktor pertumbuhan, sedangkan }\par\pard\li1853\ri0\sl-226\slmult0 \fs2
0\cf0\f0\charscalex100 {dukungan fisis adalah adanya jaringan pembuluh darah bar
u (}\fs20\cf0\f0\charscalex100\i {neo vascularisasi}\i0 \fs20\cf0\f0\charscalex1
00 {) yang }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dapa
t menjamin asupan nutrisi dan oksigen. Kesulitan lain yang tak kalah penting }\p
ar\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {adalah menjaga kek
uatan hidup (}\fs20\cf0\f0\charscalex100\i {viabilitas}\i0 \fs20\cf0\f0\charscal
ex100 {) sel-sel hati yangt akan di cangkokkan. }\par\pard\li1853\ri0\sl-426\slm
ult0 \fs20\cf0\f0\charscalex100\b {Hepatosit Sitotransplantator}\b0 \par\pard\li
1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Berdasar pengamatan terhadap
berbagai kendala trasnplantasi sel hati di atas maka }\par\pard\li1853\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {sebuah tim gabungan dari berbagai institu
si dan ilmuwan independen di Bandung }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\
cf0\f0\charscalex100 {telah mendesain suatu alat dan metode transplantasi sel ha
ti yang disebut \uc1\u8220XHepatosit }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\
cf0\f0\charscalex100 {Sitotransplantator\uc1\u8221X. Setelah melalui serangkaian
uji coba dan proses registrasi paten, }\par\pard\li1853\ri0\sl-226\slmult0 \fs2
0\cf0\f0\charscalex100 {maka cetak biru desain alat dan protokol sementara metod
e transplantasi telah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscal
ex100 {menunjukkan hasil yang menjanjikan. Adapun secara prinsip metode transpla
ntasi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {sel hati
ini dapat dijelaskan sebagai berikut: }\par\pard\li2213\ri0\sl-426\slmult0 \fs18
\cf0\f0\charscalex100 {1. Proses pengambilan sel hati normal dari penderita seba
gai bahan baku kultur }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscal
ex100 {dilakukan dengan teknik biopsi terarah dengan panduan gambar USG dan }\pa
r\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dikonfirmasikan den
gan pemeriksaan sitologi. }\par\pard\li2213\ri0\sl-440\slmult0 \fs20\cf0\f0\char
scalex100 {2. Proses pengkulturan sel menggunakan media CRML-1066 (Mediatech) }\
par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dengan proteksi a
ntibiotik Gentamisin dan anti mikotik Fungizone. Suhu }\par\pard\li2573\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {eraman ideal adalah 28}\fs12\cf0\f0\chars
calex100 {0}\fs20\cf0\f0\charscalex100 {C. }\par\pard\li2213\ri0\sl-426\slmult0
\fs20\cf0\f0\charscalex100 {3. Pembedahan mikro (laparotomi) untuk memasang jaru
m }\fs20\cf0\f0\charscalex100\i {inlet}\i0 \fs20\cf0\f0\charscalex100 { di vena
}\fs20\cf0\f0\charscalex100\i {post }\i0 \par\pard\li2573\ri0\sl-240\slmult0 \fs

20\cf0\f0\charscalex100\i {hepatic}\i0 \fs20\cf0\f0\charscalex100 { dan jarum }\
fs20\cf0\f0\charscalex100\i {outlet}\i0 \fs20\cf0\f0\charscalex100 { di vena por
ta. }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {4. Pengirim
an sel hati menuju daerah portal dengan bantuan alat \uc1\u8220XHepatosit }\par\
pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Sitotransplantator\uc
1\u8221X. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100\b {Ala
t \uc1\u8220XHepatosit Sitotransplantator\uc1\u8221X memiliki rangkain seperti i
ni (lihat gambar }\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscal
ex100\b {1 \uc1\u8211X 4):}\b0 \par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16
840\marglsxn666\margrsxn133\margtsxn666\margbsxn360\pard\li2213\ri0\sl-213\slmul
x100 {1. Jarum }\fs20\cf0\f0\charscalex100\i {inlet}\i0 \fs20\cf0\f0\charscalex1
00 { yang terhubung dengan silikon }\fs20\cf0\f0\charscalex100\i {tubing}\i0 \fs
20\cf0\f0\charscalex100 { dengan diameter 3,2x1,6 }\par\pard\li2573\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {mm. }\par\pard\li2213\ri0\sl-426\slmult0 \fs2
0\cf0\f0\charscalex100 {2. Pompa peristaltis yang akan memompakan darah dari sal
uran silikon }\fs20\cf0\f0\charscalex100\i {inlet }\i0 \par\pard\li2573\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {menuju }\fs20\cf0\f0\charscalex100\i {mul
tiport ejector}\i0 \fs20\cf0\f0\charscalex100 { yang berfungsi juga sebagai }\fs
20\cf0\f0\charscalex100\i {mixer}\i0 \fs20\cf0\f0\charscalex100 {, melalui salur
an }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {silikon deng
an diameter yang sama dengan saluran }\fs20\cf0\f0\charscalex100\i {inlet}\i0 \f
s20\cf0\f0\charscalex100 {. }\par\pard\li2213\ri0\sl-426\slmult0 \*\tx2573\fs20\
cf0\f0\charscalex100 {3.}\tab \fs20\cf0\f0\charscalex100\i {Multiport ejector}\i
0 \fs20\cf0\f0\charscalex100 { yang berperan sebagai ruang penampung sebelum sel
hati }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dikirim m
elalui vena porta. }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex1
00 {4. Pompa }\fs20\cf0\f0\charscalex100\i {syringe}\i0 \fs20\cf0\f0\charscalex1
00 { yang akan memompakan kultur sel untuk bergerak menuju }\par\pard\li2573\ri0
\sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {multiport ejector}\i0 \fs20\cf0\f0
\charscalex100 {. }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex10
0 {5. Pompa }\fs20\cf0\f0\charscalex100\i {syringe}\i0 \fs20\cf0\f0\charscalex10
0 { II yang akan memompakan larutan pendukung yang terdiri }\par\pard\li2573\ri0
\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dari anti }\fs20\cf0\f0\charscalex10
0\i {clumping}\i0 \fs20\cf0\f0\charscalex100 { (Ethyl-Eneglycoltetraacetic/EGTA)
, faktor pertumbuhan }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscale
x100 {(HGF, IGF-1, dan VEGF), serta antikoagulan (EDTA). }\par\pard\li2213\ri0\s
l-440\slmult0 \*\tx2573\fs20\cf0\f0\charscalex100 {6.}\tab \fs20\cf0\f0\charscal
ex100\i {Micro vibrator}\i0 \fs20\cf0\f0\charscalex100 { dengan }\fs20\cf0\f0\ch
arscalex100\i {burst firing mode}\i0 \fs20\cf0\f0\charscalex100 { yang berfungsi
untuk menciptakan }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex1
00 {getaran pengocok agar larutan penunjang dapat bercampur dengan baik }\par\pa
rd\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dengan kultur sel dan d
arah, serta membantu proses separasi sel menjadi }\par\pard\li2573\ri0\sl-226\sl
mult0 \fs20\cf0\f0\charscalex100 {unit tunggal. Vibrator ini bekerja secara }\fs
20\cf0\f0\charscalex100\i {reciprocating}\i0 \fs20\cf0\f0\charscalex100 { sekita
r 1 mm, dan }\par\pard\li2573\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {dik
endalikan dengan modus}{ }\fs20\cf0\f0\charscalex100\i {burst firing mode}\i0 \f
s20\cf0\f0\charscalex100 { sehingga getaran yang }\par\pard\li2573\ri0\sl-226\sl
mult0 \fs20\cf0\f0\charscalex100 {ditimbulkan tidak kontinyu, melainkan secara p
eriodik waktu }\fs20\cf0\f0\charscalex100\i {delay}\i0 \fs20\cf0\f0\charscalex10
0 { (msec) }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dan
frekuensi (<1 kHz) yang dapat diatur sesuai dengan kebutuhan. }\par\pard\li2213\
ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {7. Filter mikro dengan porus berd
iameter 80 mikron untuk menyaring sel hati }\par\pard\li2573\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {agar terlarut dalam bentuk soliter (per unit). }\par
\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {8. Silikon }\fs20\cf
0\f0\charscalex100\i {tubing outlet}\i0 \fs20\cf0\f0\charscalex100 { berdiameter
3,2x1,6 mm yang terhubung dengan jarum }\par\pard\li2573\ri0\sl-226\slmult0 \fs

20\cf0\f0\charscalex100\i {outlet}\i0 \fs20\cf0\f0\charscalex100 {. }\par\pard\l
i2213\ri0\sl-426\slmult0 \*\tx2573\fs20\cf0\f0\charscalex100 {9.}\tab \fs20\cf0\
f0\charscalex100\i {Waterbath}\i0 \fs20\cf0\f0\charscalex100 { yang disetel deng
an suhu 37}\fs12\cf0\f0\charscalex100 {0}\fs20\cf0\f0\charscalex100 {C untuk men
suplai \uc1\u8216Xair hangat\uc1\u8217X ke }\par\pard\li2573\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {seluruh }\fs20\cf0\f0\charscalex100\i {water jacket}
\i0 \fs20\cf0\f0\charscalex100 { dalam suatu sirkulasi tertutup. }\par\pard\li22
13\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {10.}{ }\fs20\cf0\f0\charscalex
100\i {Water jacket}\i0 \fs20\cf0\f0\charscalex100 { yangt berfungsi untuk menja
ga suhu kultur sel, larutan }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\ch
arscalex100 {penunjang, dan darah yang terdapat di dalam pompa }\fs20\cf0\f0\cha
rscalex100\i {syringe}\i0 \fs20\cf0\f0\charscalex100 { dan }\fs20\cf0\f0\charsca
lex100\i {multiport }\i0 \par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charsc
alex100\i {ejector}\i0 \fs20\cf0\f0\charscalex100 { untuk tetap berada pada suhu
optimal 37}\fs12\cf0\f0\charscalex100 {0}\fs20\cf0\f0\charscalex100 {C. }\par\p
ard\li2213\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100 {11.}{ }\fs20\cf0\f0\ch
arscalex100\i {Control er box}\i0 \fs20\cf0\f0\charscalex100 {, yang berfungsi s
ebagai alat kendali utama dalam }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f
0\charscalex100 {pengoperasian Hepatosit sitotransplantator. }\par\pard\li2213\r
i0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {12. Saat ini sedang dikembangkan }
\fs20\cf0\f0\charscalex100\i {pressure sensors}\i0 \fs20\cf0\f0\charscalex100 {
berbentuk}{ }\fs20\cf0\f0\charscalex100\i {tubing}\i0 \fs20\cf0\f0\charscalex100
{ dari }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {bahan k
aret silikon yang dilengkapi dengan panel digital untuk mengetahui }\par\pard\li
2573\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {fluktuasi volume cairan dara
h }\fs20\cf0\f0\charscalex100\i {intratube}\i0 \fs20\cf0\f0\charscalex100 {. }\p
ar\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100\b {Prosedur Isolasi
Sel Hepatosit}\b0 \par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex10
0 {Pengambilan sampel untuk bahan baku kultur dilakukan dengan metode biopsi }\p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {terarah yang diban
tu panduan USG. Penggunaan USG, selain memberikan arahan }\par\pard\li1853\ri0\s
l-240\slmult0 \fs20\cf0\f0\charscalex100 {yang tepat dalam pengambilan jaringan,
juga dimaksudkan untuk memberikan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\c
f0\f0\charscalex100 {gambaran awal (morfologis) daerah hepar normal. Sebagian sa
mpel disisihkan untuk }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscal
ex100 {uji sitologi, sementara sebagian lagi mendapatkan perlakuan pencucian den
gan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menggunakan
Liberase HI (0,47 mg/ml) (Roche, Indianapolis, IN) (suhu kamar/25}\fs12\cf0\f0\
charscalex100 {0}\fs20\cf0\f0\charscalex100 {C) }\par\pard\li1853\ri0\sl-240\slm
ult0 \fs20\cf0\f0\charscalex100 {yang dilarutkan dalam }\fs20\cf0\f0\charscalex1
00\i {Hank\uc1\u8217Xs Balanced Salt Solution}\i0 \fs20\cf0\f0\charscalex100 { (
HBSS) yang mengandung }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscal
ex100 {1U/ml DNAase I (Sigma). Tujuan pencucian ini untuk menghapus kemungkinan
}\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {adanya sel-sel
lain seperti fibroblast turut serta dalam kelompok kultur hepatosit. }\par\pard\
li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Setelah itu, sel hepatosit
dicuci dengan larutan RPMI 1640 yang mengandung FBS }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {10%. Lalu, sel hepatosit dipindah ke larut
an Eurocol ins (Mediatech, Indianapolis, IN) }\par\pard\li1853\ri0\sl-226\slmult
0 \fs20\cf0\f0\charscalex100 {yang mengandung FBS 20%. Sel hepatosit akan di sol
asi dalam prosesor darah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\chars
calex100 {COBE (COBE laboratories, Lakewood, CO) dan disentrifugasi dalam }\fs20
\cf0\f0\charscalex100\i {discontinuous }\i0 \par\pard\li1853\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100\i {Euroficol gradient}\i0 \fs20\cf0\f0\charscalex100
{ (Mediatech). Sel hepatosit hasil isolasi dieramkan dalam medium }\par\pard\li
1853\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {kultur CRML-1066 (Mediatech)
yang mengandung FBS 10% dan CO}{\sub \fs12\cf0\f0\charscalex100 {2}}\fs20\cf0\f
0\charscalex100 { 5%, dengan }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn168
40\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex

100 {suhu eraman 28}\fs12\cf0\f0\charscalex100 {0}\fs20\cf0\f0\charscalex100 {C.
Setelah 24 jam dilakukan panen dan uji viabilitas dengan }\par\pard\li1853\ri0\
sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menggunakan ethidium bromide}\fs12\cf
0\f0\charscalex100 {7}\fs20\cf0\f0\charscalex100 {. Pada penelitian pendahuluan,
sel hepatosit }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {
kambing (Goat) mencapai persentasi viabilitas mendekati 90% pada hari pertama. }
\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Kultur dilanjutk
an sampai tercapai persediaan garis sel hepatosit (}\fs20\cf0\f0\charscalex100\i
{cel line }\i0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\
i {hepatocytes}\i0 \fs20\cf0\f0\charscalex100 {) yang mencukupi untuk proses tra
nsplantasi. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100\b {P
rosedur Pra-transplantasi}\b0 \par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\c
harscalex100 {Meskipun sel hepatosit berasal dari calon resipien (autotransplant
asi), perlu }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dil
akukan upaya preventif untuk mencegah terjadinya reaksi penolakan oleh sistem }\
par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {komplemen. Untuk
itu, sebelum ditransplantasikan sel hepatosit yang telah dipanen }\par\pard\li18
53\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dieramkan bersama cairan plasm
a dari darah resipien yang telah mengandung }\par\pard\li1853\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100\i {Nafamostat Mesilate}\i0 \fs20\cf0\f0\charscalex10
0 { dengan konsentrasi 3,8 x 10}\fs12\cf0\f0\charscalex100 {-5}\fs20\cf0\f0\char
scalex100 { M selama 6 jam dengan suhu }\par\pard\li1853\ri0\sl-226\slmult0 \fs2
0\cf0\f0\charscalex100 {28}\fs12\cf0\f0\charscalex100 {0}\fs20\cf0\f0\charscalex
100 {C. Setelah itu, sel hepatosit dicuci dengan larutan RPMI 1640 yang mengandu
ng }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {25 m mol/l H
EPES}\fs12\cf0\f0\charscalex100 {8}\fs20\cf0\f0\charscalex100 {. Sel hepatosit s
iap dipindahkan ke tabung pompa syringe secara }\par\pard\li1853\ri0\sl-226\slmu
lt0 \fs20\cf0\f0\charscalex100 {steril (di dalam laminar }\fs20\cf0\f0\charscale
x100\i {flow}\i0 \fs20\cf0\f0\charscalex100 {). }\par\pard\li1853\ri0\sl-426\slm
ult0 \fs20\cf0\f0\charscalex100\b {Pembahasan Teknis}\b0 \par\pard\li1853\ri0\sl
-426\slmult0 \fs20\cf0\f0\charscalex100 {Secara teknis, alat dan metode hepatosi
t sitotransplantator didesain untuk mengatasi }\par\pard\li1853\ri0\sl-240\slmul
t0 \fs20\cf0\f0\charscalex100 {berbagai kendala dalam proses transplantasi hepat
osit. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100\b {a. Anti
penggumpalan}\b0 \par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100
{Kendala utama dalam proses transplantasi sel intra-porta adalah terjadinya }\p
ar\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {penggumpalan yang
berakibat munculnya sumbatan di pembuluh darah (}\fs20\cf0\f0\charscalex100\i {v
enulae}\i0 \fs20\cf0\f0\charscalex100 {). }\par\pard\li1853\ri0\sl-240\slmult0 \
fs20\cf0\f0\charscalex100 {Kondisi tersebut dapat terjadi karena adanya aktifita
s}{ }\fs20\cf0\f0\charscalex100\i {cel junction}\i0 \fs20\cf0\f0\charscalex100
{ yang diperankan }\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex10
0 {oleh matrik ekstra-seluler yang didominasi oleh cadherin. Untuk mencegah terj
adinya }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {penggump
alan dan pengelompokan sel maka pada metode ini dikembangkan }\par\pard\li1853\r
i0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {pendekatan multi aspek dengan bert
umpu pada pendekatan biokimiawi, biofisik, dan }\par\pard\li1853\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {struktural. Secara mekanis, terjadinya pengelomp
okan sel dapat disimpulkan karena }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0
\f0\charscalex100 {adanya akumulasi sejumlah besar sel dalam waktu dan ruang yan
g bersamaan. Hal }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{ini dihindari dengan perancangan sirkulasi eksternal tertutup yang konstituen
fasa }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {cair trans
porternya berasal dari darah }\fs20\cf0\f0\charscalex100\i {vena post hepatic}\i
0 \fs20\cf0\f0\charscalex100 {. Dengan adanya sistem }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {sirkulasi mirip hemodialisis ini, jumlah s
el hepatosit terlarut dapat dimanipulasi dan }\par\pard\li1853\ri0\sl-226\slmult
0 \fs20\cf0\f0\charscalex100 {diatur pelepasannya dari pompa syringe dengan frek
uensi ritmis dalam jumlah }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\char

scalex100 {terbatas. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscale
x100 {Upaya lain yang dilakukan secara biokimiawi adalah dengan pemberian }\fs20
\cf0\f0\charscalex100\i {ethyl }\i0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf
0\f0\charscalex100\i {eneglycoltetraacetic}\i0 \fs20\cf0\f0\charscalex100 { (EGT
A). EGTA akan mengkelasi ion Ca}\fs12\cf0\f0\charscalex100 {2+}\fs20\cf0\f0\char
scalex100 { ekstraselular dan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {menghambat asupan intraselular. Dengan demikian, akan terjadi def
isiensi kalsium }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{yang berakibat gagalnya }\fs20\cf0\f0\charscalex100\i {adherens junction}\i0 \f
s20\cf0\f0\charscalex100 { yang diperankan oleh cadherin}\fs12\cf0\f0\charscalex
100 {9}\fs20\cf0\f0\charscalex100 {. Secara }\par\pard\li1853\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {biokimiawi juga telah dipertimbangkan penggunaan an
tikoagulan EDTA/heparin }\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charsc
alex100 {untuk mencegah terjadinya agregasi trombosit pada saat darah dari resip
ien bertemu }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {den
gan kultur sel hepatosit di }\fs20\cf0\f0\charscalex100\i {multiport mixer}\i0 \
fs20\cf0\f0\charscalex100 {. Pendekatan secara fisis ditunjukkan }\par\pard\li18
53\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dengan penggunaan }\fs20\cf0\f
0\charscalex100\i {micro vibrator}\i0 \fs20\cf0\f0\charscalex100 { yang dimaksud
kan untuk menstimulasi energi }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {kinetik sel yang akan berakibat pada teraktifasinya suatu gerakan
acak yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {meng
acu kepada gerak Brown. Pendekatan fisis terakhir adalah dengan }\par\pard\li185
3\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menggunakan }\fs20\cf0\f0\chars
calex100\i {micro filter}\i0 \fs20\cf0\f0\charscalex100 { dengan diameter porus
80 m sesuai dengan ukuran sel }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\
charscalex100 {hepatosit primata secara individual (tidak berkelompok), sehingga
sel hepatosit yang }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex
100 {akan lolos dari proses filtrasi adalah sel hepatosit tunggal. }\par\pard\li
1853\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100\b {b. Viabilitas di lokus tra
nsplan}\b0 \par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Sel h
epatosit yang telah terperangkap di daerah porta hepar memiliki kemungkinan }\pa
r\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {untuk mati dan bert
ahan hidup sama besarnya. Untuk dapat bertahan hidup dan }\par\pard\li1853\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {mengembangkan koloni sel baru maka sel
hepatosit hasil transplan haruslah }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {didukung oleh adanya faktor-faktor pemicu pertumbuhan dan f
aktor pemicu }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {pe
mbentukan jaringan vaskular baru (untuk asupan nutrisi dan oksigen). Untuk }\par
\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menunjang viabilitas
sel hepatosit di tempat barunya maka pada metode ini }\par\pard\li1853\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {digunakan pengayaan faktor pertumbuhan de
ngan pemberian }\fs20\cf0\f0\charscalex100\i {Hepatocytes Growth }\i0 \par\pard\
sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\m
argbsxn373\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-373\slmult0 \fs20\cf0\f0\charscalex100\i {Factor}\i0 \fs20\cf0\f0\charscale
x100 { (HGF) untuk menstimulasi pertumbuhan sel hepatosit baru, dan }\fs20\cf0\f
0\charscalex100\i {Insulin like }\i0 \par\pard\li1853\ri0\sl-226\slmult0 \fs20\c
f0\f0\charscalex100\i {Growth Factor-1}\i0 \fs20\cf0\f0\charscalex100 { (IGF-1)
yang juga memiliki aktivitas stimulasi proliferasi sel }\par\pard\li1853\ri0\sl226\slmult0 \fs20\cf0\f0\charscalex100 {hepatosit. Sedangkan untuk menunjang ter
jadinya proses}{ }\fs20\cf0\f0\charscalex100\i {neovascularisasi}\i0 \fs20\cf0\f
0\charscalex100 { dilakukan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\ch
arscalex100 {pemberian }\fs20\cf0\f0\charscalex100\i {Vascular Endothelial Growt
h factor}\i0 \fs20\cf0\f0\charscalex100 { (VEGF). }\par\pard\li1853\ri0\sl-440\s
lmult0 \fs20\cf0\f0\charscalex100\b {c. Perlindungan Sel}\b0 \par\pard\li1853\ri
0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Perlindungan terhadap sel hepatosit
yang telah dikultur dilakukan dengan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20
\cf0\f0\charscalex100 {menyediakan suasana lingkungan yang kondusif di alat tran

splantator, terutama yang }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\char
scalex100 {terkait dengan faktor fisis suhu. Suhu di semua bagian alat transplan
tator (baik }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {sal
uran maupun ruangan) disetarakan pada suhu 37}\fs12\cf0\f0\charscalex100 {0}\fs2
0\cf0\f0\charscalex100 {C dengan bantuan }\fs20\cf0\f0\charscalex100\i {water ja
cket }\i0 \par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang t
erhubung dengan }\fs20\cf0\f0\charscalex100\i {waterbath}\i0 \fs20\cf0\f0\charsc
alex100 {. Secara biokimiawi, sel hepatosit dilindungi }\par\pard\li1853\ri0\sl226\slmult0 \fs20\cf0\f0\charscalex100 {dengan menggunakan }\fs20\cf0\f0\charsca
lex100\i {Nafamostat Mesilate}\i0 \fs20\cf0\f0\charscalex100 { yang dieramkan se
lama 6 jam sebelum }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex1
00 {sel ditransplantasikan. Nafamostat Mesilate adalah suatu protease inhibitor
yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {memiliki e
fek sitoprotektif dan dapat menghambat aktivitas faktor komplemen. }\par\pard\li
1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Meskipun kultur sel hepatosi
t berasal dari hepar resipien, tetap perlu diperhatikan }\par\pard\li1853\ri0\sl
-226\slmult0 \fs20\cf0\f0\charscalex100 {adanya kemungkinan-kemungkinan perubaha
n struktur antigen permukaannya yang }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\
cf0\f0\charscalex100 {diakibatkan berbagai proses dalam perlakuan. Pemberian }\f
s20\cf0\f0\charscalex100\i {Nafamostat Mesilate }\i0 \par\pard\li1853\ri0\sl-240
\slmult0 \fs20\cf0\f0\charscalex100 {diharapkan dapat mengurangi kemungkinan sel
hepatosit tidak dikenali oleh sistem }\par\pard\li1853\ri0\sl-226\slmult0 \fs20
\cf0\f0\charscalex100 {pertahanan tubuh resipien. }\par\pard\li1853\ri0\sl-426\s
lmult0 \fs20\cf0\f0\charscalex100\b {Capaian Sementara}\b0 \par\pard\li1853\ri0\
sl-426\slmult0 \fs20\cf0\f0\charscalex100 {Hasil uji coba pra-eksperimental deng
an menggunakan }\fs20\cf0\f0\charscalex100\i {goat}\i0 \fs20\cf0\f0\charscalex10
0 { sebagai subjek }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex1
00 {penelitian menunjukkan bahwa penggunaan metode dan prototipe \uc1\u8220XHepa
tosit }\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {Sitotrans
plantator\uc1\u8221X telah menunjukkan hasil yang menjanjikan. Hasil autopsi }\f
s20\cf0\f0\charscalex100\i {goat}\i0 \fs20\cf0\f0\charscalex100 { 7 }\par\pard\l
i1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {hari setelah mendapatkan tr
ansplantasi sel hepatosit memperlihatkan tidak adanya }\par\pard\li1853\ri0\sl-2
26\slmult0 \fs20\cf0\f0\charscalex100 {daerah porta yang mengalami nekrosis akib
at penyumbatan. Pemeriksaan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\ch
arscalex100 {histopatologi dari beberapa zona }\fs20\cf0\f0\charscalex100\i {Rap
paport}\i0 \fs20\cf0\f0\charscalex100 { memperlihatkan bahwa sel hepatosit }\par
\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {yang telah dilabel B
UDr (Merck) telah membentuk neokolonisasi dengan tingkat }\par\pard\li1853\ri0\s
l-226\slmult0 \fs20\cf0\f0\charscalex100 {proliferasi yang cukup tinggi. Sedangk
an hasil pengecatan HE memperlihatkan }\par\pard\li1853\ri0\sl-226\slmult0 \fs20
\cf0\f0\charscalex100 {adanya beberapa pembuluh darah baru di sekitar koloni sel
hepatosit hasil }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{transplantasi. }\par\pard\li1853\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100
\b {Kesimpulan}\b0 \par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex10
0 {1. Perlu dilakukan penelitian lebih lanjut mengenai efektivitas metode dan al
at }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {\uc1\u8220XH
epatosit Sitotransplantator\uc1\u8221X. }\par\pard\li2213\ri0\sl-440\slmult0 \fs
20\cf0\f0\charscalex100 {2. Perlu dilakukan amatan jangka panjang untuk mengeval
uasi efek samping }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex10
0 {metode ini. }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {
3. Perlu dilakukan penelitian bertingkat dari skala laboratoris sampai dengan uj
i }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {klinis. }\par
\pard\li2213\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100 {4. Perlu dipertimban
gkan beberapa kriteria faktor fisis yang lebih sesuai untuk }\par\pard\li2573\ri
0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {penggunaan pada manusia (misal diam
eter porus pada filter). }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\chars
calex100 {5. Perlu dipertimbangkan penggunaan beberapa faktor penunjang lain yan
g }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {dapat membant
u meningkatkan viabilitas sel hepatosit dan memperbesar }\par\pard\li2573\ri0\sl

-240\slmult0 \fs20\cf0\f0\charscalex100 {peluangnya untuk bertahan hidup di loku
s transplan. }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100 {6.
Perlu dipertimbangkan penyempurnaan beberapa teknik dasar yang }\par\pard\li257
3\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {menyangkut pengambilan sampel u
ntuk bahan kultur (sebaiknya dapat }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf
0\f0\charscalex100 {meminimalisasi jejas). }\par\pard\li2213\ri0\sl-440\slmult0
\fs20\cf0\f0\charscalex100 {7. Perlu dipertimbangkan penggunaan sel hepatosit da
ri donor lain }\par\pard\li2573\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {(
alotransplan atau bahkan xenotransplan). }\par\pard\li2213\ri0\sl-426\slmult0 \f
s20\cf0\f0\charscalex100 {8. Perlu dipertimbangkan penggunaan selubung mikrokaps
ul }\fs20\cf0\f0\charscalex100\i {Smal Alginate }\i0 \par\pard\li2573\ri0\sl-22
6\slmult0 \fs20\cf0\f0\charscalex100\i {Poly-L-Lysine}\i0 \fs20\cf0\f0\charscale
x100 { bila sel hepatosit donor berasal dari individu lain (alotransplan }\par\p
ard\li2573\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {atau xenotransplan). }
\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\mar
gtsxn666\margbsxn440\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li2213\ri0\sl-373\slmult0 \fs20\cf0\f0\charscalex100 {9. Perlu dipertimbangkan
untuk mengintrodusir perlakuan pra-transplantasi }\par\pard\li2573\ri0\sl-226\sl
mult0 \fs20\cf0\f0\charscalex100 {pada resipien (mungkin imunosupresi bila bukan
autotransplan). }\par\pard\li2213\ri0\sl-426\slmult0 \fs20\cf0\f0\charscalex100
{10. Perlu dikembangkan protokol baku beserta }\fs20\cf0\f0\charscalex100\i {re
quirement parameter}\i0 \fs20\cf0\f0\charscalex100 { bagi calon }\par\pard\li257
3\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {donor dan resipien.}\par\pard\l
i1853\ri0\sl-440\slmult0 \fs20\cf0\f0\charscalex100\b {Daftar Pustaka}\b0 \par\p
ult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-453\slmult0 \fs28\cf2\f0\charsca
lex100\b \ul {{\field{\*\fldinst{HYPERLINK "http://ilmukedokteran.blogspot.com/2
007/07/pendahuluan-sirosis-hepatis-adalah.html"}}{\fldrslt {Sirosis Hepatis}}}}\
b0 \ul0 \fs28\cf4\f0\charscalex100\b {{\field{\*\fldinst{HYPERLINK "http://ilmuk
edokteran.blogspot.com/2007/07/pendahuluan-sirosis-hepatis-adalah.html"}}{\fldrs
lt { }}}}\b0 \par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf4\f2\charscalex100 {PEN
DAHULUAN}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-32
0\slmult0 \fs24\cf4\f2\charscalex100 {Sirosis hepatis adalah penyakit hati menah
un yang difus ditandai }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charsca
lex100 {dengan adanya pembentukan jaringan ikat disertai nodul. Biasanya }\par\p
ard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {dimulai dengan adanya
proses peradangan, nekrosis sel hati yang luas, }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf4\f2\charscalex100 {pembentukan jaringan ikat dan usaha regenerasi
nodul.Distorsi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {
arsitektur hati akan menimbulkan perubahan sirkulasi mikro dan }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {makro menjadi tidak teratur akib
at penambahan jaringan ikat dan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f
2\charscalex100 {nodul tersebut.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {PATOGENESIS}\par\p
\cf4\f2\charscalex100 {Mekanisme terjadinya sirosis hepatis bisa secara :}\par\p
\cf4\f2\charscalex100 {- mekanik}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- imunologis}\par\
4\cf4\f2\charscalex100 {- campuran}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0
\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Dalam hal mekani
sme terjadinya sirosis secara mekanik dimulai dari }\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf4\f2\charscalex100 {kejadian hepatitis viral akut, timbul perada
ngan luas, nekrosis luas dan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\c
harscalex100 {pembentukan jaringan ikat yang luas disertai pembentukan nodul }\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {regenerasi oleh se

l parenkim hati yang masih baik. Jadi fibrosis pasca }\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf4\f2\charscalex100 {nekrotik adalah dasar timbulnya sirosis he
patis.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\
slmult0 \fs24\cf4\f2\charscalex100 {Pada mekanisme terjadinya sirosis secara imu
nologis dimulai dengan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charsca
lex100 {kejadian hepatitis viral akut yang menimbulkan peradangan sel }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {hati.nekrosis/nekrosis br
idging dengan melalui hepatitis kronik agresif }\par\pard\li1853\ri0\sl-266\slmu
lt0 \fs24\cf4\f2\charscalex100 {diikuti timbulnya sirosis hati. Perkembangan sir
osis dengan cara ini }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscale
x100 {memerlukan waktu sekitar 4 tahun, sel yang mengandung virus ini }\par\pard
\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {merupakan sumber rangsang
an terjadinya proses imunologis yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf4\f2\charscalex100 {berlangsung terus sampai terjadi kerusakan sel hati.}\par\
4\cf4\f2\charscalex100 {KLASIFIKASI}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {1. Klasifikasi
Etiologi}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrs
xn133\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
\par\pard\li1853\ri0\sl-400\slmult0 \fs24\cf4\f2\charscalex100 {- Etiologi yang
diketahui penyebabnya}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {a. Hepatitis Virus Tipe B dan
C}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmu
lt0 \fs24\cf4\f2\charscalex100 {b. Alkohol}\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {c. Metab
olik ;Hemakromatosis idiopatik, penyakit Wilson,defisiensi }\par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {alpha 1, anti tripsin, galaktosemia,
tirosinemia kongenital, DM, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\c
harscalex100 {penyakit penimbunan glikogen.}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {d. Kole
stasis kronik/sirosis biliar sekunder intra dan ekstrahepatik.}\par\pard\li1853\
rscalex100 {e. Obstruksi aliran vena hepatik ; Penyakit vena oklusif, sindrom Bu
dd }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {Chiari, peri
karditis konstriktiva, payah jantung kanan.}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {f. Gang
guan Imunologis ; Hepatitis lupoid, hepatitis kronik aktif.}\par\pard\li1853\ri0
alex100 {g. Toksik dan Obat ; MTX, INH, Metildopa}\par\pard\li1853\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {h
. Operasi pintas usus halus pada obesitas}\par\pard\li1853\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {i. Malnut
risi, infeksi seperti malaria, sistosomiasis}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Etio
logi tanpa diketahui penyebabnya.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {2. Klasifikasi Mo
rfologi}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333
\slmult0 \fs24\cf4\f2\charscalex100 {Secara makroskopik sirosis dibagi atas :}\p
fs24\cf4\f2\charscalex100 {1. Sirosis mikronodular}\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf4\f2\charscalex100 {2. Sirosis makronodular}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf4\f2\charscalex100 {3. Sirosis campuran}\par\pard\li1853\
rscalex100 {3. Klasifikasi Fungsional}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Secara fungsi
sirosis hati dibagi atas :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {1. Kompensasi baik (lat
en, sirosis dini)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100
{2. Dekompensasi (aktif, disertai kegagalan hati dan hipertensi portal)}\par\pa

rd\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {* Kegagalan hati/hepato
selular}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333
\slmult0 \fs24\cf4\f2\charscalex100 {Dapat timbul keluhan sistemik subjektif ber
upa lemah, berat badan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charsca
lex100 {menurun, gembung, mual, dll.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Spider nevi/an
giomata pada kulit tubuh bagian atas. Muka dan lengan }\par\pard\li1853\ri0\sl-2
66\slmult0 \fs24\cf4\f2\charscalex100 {atas.Eritema palmaris, asites, pertumbuha
n rambut berkurang, atrofi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\cha
rscalex100 {testis dan ginekomastia pada pria.}\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Seba
gai tambahan dapat timbul : ikterus/ jaundice, subfebris, sirkulasi }\par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {hiperkinetik dan factor hep
atic.Ensefalopati hepatic, bicara }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4
\f2\charscalex100 {gagok/slurred speech,gangguan koagulasi darah/defisiensi prot
rombin.}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsx
n133\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-466\slmult0
\fs24\cf4\f2\charscalex100 { Hipertensi Portal}\par\pard\li1853\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Terja
di akibat meningkatnya resistensi portal dan splanknik karena }\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {mengurangnya sirkulasi akibat fib
rosis. Atau meningkatnya aliran }\par\pard\li1853\ri0\sl-266\slmult0 \fs22\cf4\f
2\charscalex100 {portal karena transmisi dari tekanan arteri hepatic ke system p
ortal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {akibat di
storsi arsitektur hati. Biasanya yang dominant adalah }\par\pard\li1853\ri0\sl-2
66\slmult0 \fs24\cf4\f2\charscalex100 {peningkatan resistensi, lokasi peningkata
n resistensi biasa :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Pre hepatik, biasa congenita
l, trombosis vena porta waktu lahir.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Intra hepati
k :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slm
ult0 \fs24\cf4\f2\charscalex100 {Pre sinusoidal (fibrosis da parasit)}\par\pard\
\f2\charscalex100 {Sinusoidal (Sirosis hati)}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Post s
inusoidal(vena oklusif)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
i1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Biasa terdapat lokasi obstr
uksi campuran}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\
sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Post hepatik karena perikarditis ko
nstriktiva, insufisiensi trikuspidal.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {DIAGNOSIS}\pa
s24\cf4\f2\charscalex100 {1. Gejala Klinis}\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Fase k
ompensasi sempurna}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Pasien merasa tidak bugar/fit, m
erasa kurang kemampuan kerja, selera }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\
cf4\f2\charscalex100 {makan berkurang, perasaan perut kembung, mual, kadang menc
ret }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {atau konsti
pasi, berat badan menurun, kelemahan otot dan perasaan }\par\pard\li1853\ri0\sl266\slmult0 \fs24\cf4\f2\charscalex100 {cepat lelah, pengurangan masa otot terut
ama daerah pektoralis mayor, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\c
harscalex100 {kadang kala pasin ditemukan menderita sirosis sewaktu pemeriksaan
}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {rutin medis.}\p
fs24\cf4\f2\charscalex100 {- Fase dekompensasi}\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Dapa
t ditegakkan diagnosisnya dengan bantuan pemeriksaan klinis, }\par\pard\li1853\r

i0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {laboratorium dan pemeriksaan penun
jang lainnya. Ditemukannya }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\cha
rscalex100 {eritema palmaris, spider nevi, vena kolateral pada dinding perut, }\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {ikterus,edema pre
tibial, splenomegalli dan asites. Bisa juga pasien }\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf4\f2\charscalex100 {datang dengan gangguan pembekuan darah seper
ti perdarahan gusi, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex
100 {epistaksis, gangguan haid atau haid berhenti. Sebagian pasien dating }\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {dengan gejala hematem
esis,hematemesis dan melena atau melena saja }\par\pard\li1853\ri0\sl-266\slmult
0 \fs24\cf4\f2\charscalex100 {akibat perdarahan varises sofagus. Kadang terjadi
gangguan kesadaran }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex1
00 {berupa ensefalopati hepatis atau koma hepatik.}\par\pard\li1853\ri0\sl-213\s
Suharyono Soebandri memformulasikan bahwa 5 dari 7 tanda dibawah }\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {ini sudah dapat menegakkan dia
gnosis sirosi hepatis dekompensasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
4\f2\charscalex100 {yaitu :}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840
\marglsxn666\margrsxn133\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0
\ri0\sl-466\slmult0 \fs24\cf4\f2\charscalex100 {1. Asites}\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf4\f2\charscalex100 {2. Splenomegali}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf4\f2\charscalex100 {3. Perdarahan varises(hematemesis)}\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {4. Albumin yang mer
endah}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {5. Spider
nevi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {6. Eritema
palmaris}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {7. Vena
kolateral}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl333\slmult0 \fs24\cf4\f2\charscalex100 {2. Laboratorium}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf4\f2\charscalex100 {1. Hb menurun, anemia normokrom normosit
er, hipokrom mikrositer }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charsc
alex100 {atau hipokrom makrositer.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4
\f2\charscalex100 {2. Protombin time (PT), bilirubin, SGOT/SGPT }\fs24\cf4\f0\ch
arscalex100 {\uc1\u8594X}\fs24\cf4\f2\charscalex100 { meningkat}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {3. Albumin menurun, globulin men
ingkat. }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-33
3\slmult0 \fs24\cf4\f2\charscalex100 {3. Penunjang}\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf4\f2\charscalex100 {1. USG abdomen}\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf4\f2\charscalex100 {2. Pemeriksaan marker serologi pertanda virus
seperti HbsAg/HbsAb, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscale
x100 {HbeAg/HbeAb,HBV DNA, HCV RNA untuk menentukan etiologi.}\par\pard\li1853\r
i0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {3. Endoskopi.}\par\pard\li1853\ri0
alex100 {KOMPLIKASI}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {1. Kegagalan hati}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {2. Hipertensi portal}\par\par
d\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {3. Asites}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {4. Ensefalopati}\par\pard\li18
53\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {5. Peritonitis bacterial spont
an}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {6. Sindrom he
patorenal}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {7. Hep
atoma}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\s
lmult0 \fs24\cf4\f2\charscalex100 {PENATALAKSANAAN}\par\pard\li1853\ri0\sl-213\s
1. Tindakan segera}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Jika perdarahan diyakini dari pe
cahnya varises, dapat dilakukan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f
2\charscalex100 {pemasangan SB-tube (balon tamponade, dengan tiga pipa dan dua }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {balon lambung da

n esophagus) dengan syarat tidak boleh lebih dari 24 }\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf4\f2\charscalex100 {jam karena dapat menyebabkan nekrosis,lare
sari dan atau perforasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charsc
alex100 {esophagus sampai obstruksi jalan nafas akibat migrasi balon ke }\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {hipofaring. Jika tidak
yakin darimana sumber perdarahan, dapat }\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf4\f2\charscalex100 {dipakai NG-tube, karena cukup aman,dapat juga menghenti
kan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {perdarahan
di esophagus serta dapat memonitor kecepatan }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf4\f2\charscalex100 {perdarahan.}\par\pard\li1853\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {2. Tindak
an lanjutan}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl
-333\slmult0 \fs24\cf4\f2\charscalex100 {Upaya mempertahankan agar perdarahan te
tap berhenti atau }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex10
0 {mengusahakan berhenti sesegera mungkin,menjelan tindakan }\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {diagnostik dan pengobatan spesifikdefinitif dikerjakan. Pada situasi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
4\f2\charscalex100 {ini dapat diberikan terapi empirik medikamentosa untuk mempe
rbaiki }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsx
n133\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
par\pard\li1853\ri0\sl-400\slmult0 \fs24\cf4\f2\charscalex100 {keadaan umum deng
an alas an yang jelas seperti :}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Pertimbangkan mem
berikan FFP (plasma segar beku) pada sirosis }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf4\f2\charscalex100 {hati yang umumnya telah terjadi defisiensi faktor
pembekuan, tetapi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex10
0 {tidak perlu jika perdarahan bukan oleh sirosis hati}\par\pard\li1853\ri0\sl-2
00 {- Untuk memperbaiki faal hemostasis dapat diberikan injeksi vitamin K }\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {dan asam traneksamat,
terutama pada pasien dengan sirosis hati.}\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Untuk
memperbaiki sirkulasi splanikus(vasodilatasi) sekaligus }\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf4\f2\charscalex100 {menurunkan PP(Portal Pressure)dengan tu
juan menghentikan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex10
0 {perdarahan, dapat diberikan obat-obat vasoaktif seperti somatostatin }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {atau octreotid. Obat va
soaktif dapat diberikan tanpa }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\
charscalex100 {mempertimbangkan etiologi hipertensi portal.}\par\pard\li1853\ri0
alex100 {- Pemberian obat-obat yang dapat menekan sekresi asam, seperti }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {antasida p.o, sukralfat
p.o, penyekat H2 p.o/.i.v atau penghambat }\par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf4\f2\charscalex100 {pompa proton (PPI) p.o atau i.v, diharapkan dapat me
mfasilitasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {kin
erja faktor pembekuan darah.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {- Pemberian obat-obat
sterilisasi usus, seperti preparat neomisin dan }\par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf4\f2\charscalex100 {laktulosa serta tindakan klisma tinggi biasanya
bermanfaat mencegah }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscale
x100 {kemungkinan ensefalopati hepatika.}\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {PROGNOSIS}
\fs24\cf4\f2\charscalex100 {Tergantung pada penyebab dan keparahan. Untuk siros
is alkoholik, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {m
ortalitas pada orang yang terus minum alcohol adalah 65 % setelah 5 }\par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf4\f2\charscalex100 {tahun dibandingkan dengan 3
0 % pada orang yang berhenti minum }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
4\f2\charscalex100 {alkohol.Penilaian keparahan didapat dinilai dari kelas Child

.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmul
t0 \fs24\cf4\f2\charscalex100 {Tabel Klasifikasi Child}\par\pard\li1853\ri0\sl-2
00 {Angka}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-2
00 {1}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\s
2}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-386\slmult0 \fs24\cf4\f2\charscalex100 {3}\p
fs24\cf4\f2\charscalex100 {Ensefalopati}\par\pard\li1853\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Bilirubin (
mol/l)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\
slmult0 \fs24\cf4\f2\charscalex100 {Albumin (g/l)}\par\pard\li1853\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {P
T (dalam detik)}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666
\margrsxn133\margtsxn666\margbsxn426\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
slmult0 \fs24\cf4\f2\charscalex100 {Asites}\par\pard\li1853\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-386
\slmult0 \fs24\cf4\f2\charscalex100 {Tidak ada}\par\pard\li1853\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {<34}
\fs24\cf4\f2\charscalex100 {>35}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {<4}\par\pard\li185
harscalex100 {Tidak ada}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
f2\charscalex100 {Ringan}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {34-50}\par\pard\li1853\ri0
alex100 {28-35}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0
\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {4-6}\par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Rin
gan}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li1853\ri0\sl-386\slmult0 \fs24\cf4\f2\charscalex100 {Je
las}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-333\slm
ult0 \fs24\cf4\f2\charscalex100 {>50}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {<28}\par\pard\
\f2\charscalex100 {>6}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1
853\ri0\sl-333\slmult0 \fs24\cf4\f2\charscalex100 {Jelas}\par\pard\li1853\ri0\sl
x100 {Bilirubin (dalam PBC dan kolangitis sklerosans)}\par\pard\li1853\ri0\sl-21
\ri0\sl-400\slmult0 \fs24\cf4\f2\charscalex100 {<68}\par\pard\li1853\ri0\sl-213\
i0\sl-386\slmult0 \fs24\cf4\f2\charscalex100 {68-170}\par\pard\li1853\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
ri0\sl-386\slmult0 \fs24\cf4\f2\charscalex100 {>170}\par\pard\li1853\ri0\sl-213\
{Tambahkan masing-masing <7 9 =" Child">9 = Child C. Kelangsungan }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf4\f2\charscalex100 {hidup untuk Child C, yang mer
upakan kelompok dengan prognostik }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf4
\f2\charscalex100 {terburuk, adalah kurang dari 12 bulan.}\par\pard\sect\sectd\s
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}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn453\par
t0 \fs24\cf4\f2\charscalex100 {Sumber : Hayes, Peter, Thomas w. Mackay. \uc1\u82
20XBuku Saku Diagnosis dan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf4\f2\cha
rscalex100 {Terapi\uc1\u8221X. Penerbit Buku Kedokteran EGC, Jakarta.1997.}\par\
pard\li2240\ri0\sl-413\slmult0 \fs24\cf2\f0\charscalex100\b \ul {{\field{\*\fldi
nst{HYPERLINK "http://www.kompas.com/kirim_berita/index.cfm?nnum=78693"}}{\fldrs
lt {Kirim Teman}}}}\b0 \ul0 \fs24\cf0\f0\charscalex100 {{\field{\*\fldinst{HYPER
LINK "http://www.kompas.com/kirim_berita/index.cfm?nnum=78693"}}{\fldrslt { |}}}
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ompas.com/kirim_berita/print.cfm?nnum=78693"}}{\fldrslt {Print Artikel}}}}\b0 \u
l0 \par\pard\li2906\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2906\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li2906\ri0\sl-453\slmult0 \fs24\cf0\f0\charscalex100\b {B
erita Terkait:}\b0 \par\pard\li2053\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2053
\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u8226X}{ }\fs24\cf2\f0\char
scalex100\ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\\\kesehatan\\\\news\\\\0
502\\\\23\\\\143506.htm"}}{\fldrslt {Hepatitis C, Bisa Ditularkan }}}}\ul0 \par\
pard\li2053\ri0\sl-266\slmult0 \fs24\cf2\f0\charscalex100\ul {{\field{\*\fldinst
{HYPERLINK "file:///G:\\\\kesehatan\\\\news\\\\0502\\\\23\\\\143506.htm"}}{\fldr
slt {Lewat Sisir & Koin Kerokan}}}}\ul0 \par\pard\li2053\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li2053\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u8226X
}{ }\fs24\cf2\f0\charscalex100\ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\\\k
esehatan\\\\news\\\\0409\\\\19\\\\184804.htm"}}{\fldrslt {Konsultasi: Infeksi pa
da Sirosis }}}}\ul0 \par\pard\li2053\ri0\sl-280\slmult0 \fs24\cf2\f0\charscalex1
00\ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\\\kesehatan\\\\news\\\\0409\\\\
19\\\\184804.htm"}}{\fldrslt {Hati}}}}\ul0 \par\pard\li2053\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li2053\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u82
26X}{ }\fs24\cf2\f0\charscalex100\ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\
\\kesehatan\\\\news\\\\0407\\\\31\\\\083129.htm"}}{\fldrslt {Cak Nur dan Transpl
antasi Hati}}}}\ul0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
\f0\charscalex100\b {Jakarta, Kompas}\b0 \par\pard\li1853\ri0\sl-466\slmult0 \fs
24\cf0\f0\charscalex100\b {Transplantasi, dalam rangkaian pengobatan penyakit ya
ng menyerang }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
\b {hati (umumnya diawali hepatitis B dan C) merupakan upaya terakhir }\b0 \par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {untuk mengembalikan
kualitas hidup pasien.}\b0 \par\pard\li1853\ri0\sl-480\slmult0 \fs22\cf0\f0\cha
rscalex100 {Cara ini ditempuh setelah tidak mungkin lagi mengobati pasien dengan
terapi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {konvens
ional, seperti minum obat, suntikan, operasi pembedahan atau }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kemoterapi.}\par\pard\li1853\ri0\s
l-480\slmult0 \fs24\cf0\f0\charscalex100 {Artinya, bila pemasangan organ hati da

ri orang lain ke tubuh pasien tidak }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\c
f0\f0\charscalex100 {dilakukan, maka tidak ada jaminan kualitas hidup pasien di
masa depan.}\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Haru
s ada bukti medis yang kuat, sebelum pasien dengan gangguan fungsi hati }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {mendapat rekomendasi tr
ansplantasi. Di antaranya, memastikan tingkat }\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {kerusakan fungsi hati akibat serangan virus melal
ui uji laboratorium, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {pemeriksaan CT Scan, dan ultrasonografi (USG).}\par\pard\li1853\ri0\sl-480
\slmult0 \fs24\cf0\f0\charscalex100 {Menurut Konsultan Gastroentero-Hepatologi d
i Divisi Hepatologi Bagian }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia (FKUI)
Prof }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dr Ali Su
laiman PhD FACG, sebelum kerusakan fungsi hati mencapai tahap }\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tertentu, transplantasi hati umum
nya tidak direkomendasi dokter, sekalipun }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {pasien menghendakinya.}\par\pard\li1853\ri0\sl-466\sl
mult0 \fs24\cf0\f0\charscalex100 {\uc1\u8221XKalau tidak perlu kenapa mesti ditr
ansplantasi?\uc1\u8221X kata dia ketika ditemui di }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {Divisi Hepatologi Rumah Sakit Cipto Mangunku
somo (RSCM) Jakarta, Senin }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {(29/8).}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsx
0 \fs18\cf0\par\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b \ul
{Tahap sirosis}\b0 \ul0 \par\pard\li2213\ri0\sl-480\slmult0 \*\tx2573\fs20\cf0\f
3\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100\b {Pasien dengan k
erusakan fungsi hati yang harus ditransplantasi }\b0 \par\pard\li2573\ri0\sl-266
\slmult0 \fs24\cf0\f0\charscalex100\b {adalah mereka yang berada di tahap sirosi
s (pengerasan hati).}\b0 \par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charsc
alex100 {Pada tahap tersebut, peran hati yang berfungsi menggerakkan metabolisme
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tubuh, mengola
h asupan makanan menjadi energi, dan membuang racun hasil }\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {penghancuran protein terganggu.}\par\
pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100\i {Tanda-tanda fisik y
ang menonjol pada orang dengan sirosis hati parah }\i0 \par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100\i {adalah perut membuncit, kesadaran menur
un, dan mata menguning. Mereka }\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100\i {cepat letih dan sering muntah darah.}\i0 \par\pard\li1853\
ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Operasi transplantasi hati dilaku
kan cepat. Pasalnya, hati hanya boleh berada }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {di luar tubuh kira-kira kurang dari enam jam. Umum
nya, operasi pengambilan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\chars
calex100 {hati dari tubuh donor yang telah meninggal (kadaver) atau donor orang
yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {masih hidu
p (ortho living transplantation/OLT) dilakukan bersamaan dengan }\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pemindahannya.}\par\pard\li1853
\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Beberapa dokter harus terlibat l
angsung, seperti pakar kardiovaskuler, }\par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {anestesi, penyakit dalam, dan hepatolog yang memahami st
ruktur hati, serta }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {pakar peredam penolakan tubuh (imunologis).}\par\pard\li1853\ri0\sl-480\slmu
lt0 \fs24\cf0\f0\charscalex100 {Keterbatasan jumlah pendonor serta rumitnya tran
splantasi amat membatasi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\chars
calex100 {akses. Biayanya Rp 800.000 juta hingga Rp 2,5 miliar. \uc1\u8221XItu p
un antrenya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {san
gat panjang,\uc1\u8221X kata Ali, yang pasiennya pernah antre setahun di Amerika
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tanpa hasil.}\
par\pard\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {Pasien dengan org
an hati baru dapat bertahan hidup puluhan tahun (ada juga }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {yang menyatakan sekitar lima tahun).
Akan tetapi, sepanjang hidupnya mereka }\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {bergantung penuh pada obat-obatan. Selain itu, pantangan
beberapa jenis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{makanan dan minuman.}\par\pard\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscale
x100 {Hingga kini, transplantasi hati tidak dapat dilakukan di Indonesia karena
tidak }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ada perat
uran perundang-undangan yang mendukungnya. Padahal, tahun 2005 }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jumlah penduduk yang terpapar vi
rus hepatitis B dan C diperkirakan 15 juta.}\par\pard\li1853\ri0\sl-466\slmult0
\fs24\cf0\f0\charscalex100 {Menurut Ali, meskipun transplantasi hati banyak dila
kukan di negara-negara }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {maju, transplantasi tetap saja berisiko seperti terjadinya penolakan ata
u }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berkembangnya
kembali virus hepatitis di dalam tubuh pasien pasca-}\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf0\f0\charscalex100 {transplantasi.}\par\pard\li1853\ri0\sl-480
\slmult0 \fs24\cf0\f0\charscalex100 {Kini, untuk menghindari penolakan dari dala
m tubuh pasien sudah ada jenis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {obat sistem imun yang memiliki keberhasilan tinggi. Yang mengkha
watirkan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {adalah
kekambuhan penyakit yang sama. Untuk mengatasinya, dokter akan }\par\pard\li185
3\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {menegatifkan virus di dalam tub
uh pasien sebelum menerima organ hati baru }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {agar hati baru tetap sehat dan berfungsi normal.}\pa
r\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Bagi pasien transpl
antasi hati dengan latar belakang sirosis hati karena }\par\pard\li1853\ri0\sl-2
66\slmult0 \fs24\cf0\f0\charscalex100 {serangan virus hepatitis B, dokter akan m
emberi tablet atau suntikan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {interveron. Alternatif penggantinya, tablet nucleasid analog.}\par\
pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Bagi pasien berlatar
belakang hepatitis C akan diberi suntikan interveron }\par\pard\sect\sectd\sbkpa
ge
7;32768}}
\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {dikombinasi minum ta
blet ribavirin. \uc1\u8221XIni gold standard untuk membunuh }\par\pard\li1853\ri
0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {virus. Yang ini tidak ada alternati
f obat lain,\uc1\u8221X kata dia.}\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\
f0\charscalex100 {Sayangnya, meski berkategori gold standard, jaminan menegatifk
an virus }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u

8221Xhanya\uc1\u8221X 50-80 persen. Artinya, virus tetap berpotensi kembali meny
erang.}\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100\b \ul {Seb
elum terlambat}\b0 \ul0 \par\pard\li2213\ri0\sl-480\slmult0 \*\tx2573\fs20\cf0\f
3\charscalex100 {\uc1\u61623X}\tab \fs24\cf0\f0\charscalex100\b {Sirosis hati pa
rah yang sering kali berujung pada transplantasi, }\b0 \par\pard\li2573\ri0\sl-2
66\slmult0 \fs24\cf0\f0\charscalex100\b {sebenarnya dapat dicegah sejak dini. Um
umnya, sirosis hati }\b0 \par\pard\li2573\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100\b {berawal dari hepatitis B dan C. Pada istilah kedokteran, dimulai }\b0
\par\pard\li2573\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {dari hepatiti
s akut, kronis, baru kemudian sirosis}\b0 \fs24\cf0\f0\charscalex100 {.}\par\par
d\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Hepatitis B atau C akut
umumnya ditandai demam, rasa mual, kurang }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {bersemangat, susah tidur, mudah letih, dan perut seri
ng kembung. Pada }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{tingkatan kronis, penderita didera rasa kantuk dan lemas. Gejala khas yang }\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kadang muncul adal
ah mata dan air kencing yang kekuning-kuningan.}\par\pard\li1853\ri0\sl-480\slmu
lt0 \fs24\cf0\f0\charscalex100 {\uc1\u8221XNamun, umumnya gejala awal tidak khas
dan menyesatkan. Bisa berbahaya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {bila tidak segera ditindaklanjuti dengan cek ke dokter,\uc1\u8
221X kata Ali.}\par\pard\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {U
ntuk memastikan perkembangan virus ke organ hati, dokter akan memeriksa }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kadar SGOT/SGPT dalam d
arah. Kadar keduanya yang meninggi merupakan }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {tanda-tanda awal yang mencurigakan.}\par\pard\li18
53\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {Ada dua pilihan pengobatan dal
am tahap ini, yakni memberi obat pembunuh }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {virus atau memperkuat organ hati.}\par\pard\li1853\ri
0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Untuk memastikan tahap kronis ke ta
hap sirosis, ditempuh penelitian jaringan }\par\pard\li1853\ri0\sl-266\slmult0 \
fs24\cf0\f0\charscalex100 {sel tubuh di laboratorium (biopsi). Tanda sirosis hat
i ditunjukkan munculnya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {jaringan serat di sana.}\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f
0\charscalex100 {Berdasarkan pengalaman, dari hepatitis kronis ke tahap sirosis
parah }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {membutuhk
an waktu perkembangan sekitar 10-20 tahun tanpa intervensi }\par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {pengobatan berarti. Dalam hal ini, s
iapa pun perlu berhati-hati karena gejala }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {hepatitis akut dan kronis sering kali tidak khas, seh
ingga tidak jarang penderita }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {datang setelah menuju sirosis. (GESIT ARIYANTO)}\par\pard\li2040\r
-400\slmult0 \fs24\cf0\f0\charscalex100\b {Terapi Albumin pada Asites Refraktori
}\b0 \par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\sl
alex100\b \ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\\\category_news.asp?IDC
ategory=12"}}{\fldrslt {GERAI}}}}\b0 \ul0 \fs24\cf0\f0\charscalex100\b {{\field{
\*\fldinst{HYPERLINK "file:///G:\\\\category_news.asp?IDCategory=12"}}{\fldrslt
{ }}}}\b0 \fs24\cf0\f0\charscalex100 {-}{ }\fs24\cf2\f0\charscalex100\ul {{\fiel
d{\*\fldinst{HYPERLINK "file:///G:\\\\mag_detail.asp?mid=33"}}{\fldrslt {Edisi S
eptember 2006}}}}\ul0 \fs24\cf0\f0\charscalex100 {{\field{\*\fldinst{HYPERLINK "
file:///G:\\\\mag_detail.asp?mid=33"}}{\fldrslt { (V}}}ol.6 No.2), oleh{\field{\
*\fldinst{HYPERLINK "file:///G:\\\\author_profile.asp?aid=55"}}{\fldrslt { }}}}\
fs24\cf2\f0\charscalex100\ul {{\field{\*\fldinst{HYPERLINK "file:///G:\\\\author
_profile.asp?aid=55"}}{\fldrslt {andra}}}}\ul0 \fs24\cf0\f0\charscalex100 {{\fie
ld{\*\fldinst{HYPERLINK "file:///G:\\\\author_profile.asp?aid=55"}}{\fldrslt { }
}}}\par\pard\li2040\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\i {Pemberian
albumin pada tindakan paracentesis meningkatkan respon }\i0 \par\pard
\li2040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\i {terhadap pemberian diur
etika pada pasien asites refraktori.}\i0 \par\pard\li2040\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li2040\ri0\sl-346\slmult0 \fs24\cf0\f0\charscalex100 {Asites ada
lah satu kondisi dimana terdapat akumulasi cairan berlebih yang }\par\pard\sect\
sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbs
xn400\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult
0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl413\slmult0 \fs24\cf0\f0\charscalex100 {mengisi rongga peritoneal. Diperkirakan
sekitar 85 % pasien asitesadalah }\par\pard\li2040\ri0\sl-266\slmult0 \fs22\cf0\
f0\charscalex100 {pasien sirosis hati atau karena penyakit hati lainnya yang par
ah. \uc1\u8220XHampir }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscal
ex100 {60 % pasien sirosis hati akan menjadi asitesdalam masa 10 tahun,\uc1\u822
1X jelas }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {Prof.
Dr. H.M. Sjaifoellah Noer SpPD-KGEH dari divisi Hepatologi, }\pa
r\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {Departemen Penyakit
Dalam FKUI, Jakarta dalam Liver Up Date 2006 di }\par\pard\li2040\ri0\sl-266\sl
mult0 \fs22\cf0\f0\charscalex100 {Hotel Borobudur Jakarta, 28-30 Juli lalu. Na
mun, sekitar 15 % pasien }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\chars
calex100 {asitestidak disebabkan oleh gangguan fungsi hati retensi
cairan. }\par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Asites
yang terjadi dapat berupa asitestransudatif atau eksudatif. }\par\pard\li2040\ri
calex100 {Asites pada sirosis merupakan prognosis yang buruk karena menyebabkan
}\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {kematian sebesa
r 50 % dalam waktu tiga tahun jika tanpa transplantasi }\par\pard\li2040\ri0\sl266\slmult0 \fs22\cf0\f0\charscalex100 {liver. Dari prevalensi ascites,
10 % nya adalah asites refraktori yang }\par\pard\li2040\ri0\sl-280\
slmult0 \fs22\cf0\f0\charscalex100 {umumnya diterapi dengan pemberian di
uretika. \uc1\u8220XAsitesdikategorikan }\par\pard\li2040\ri0\sl-280\slmult0 \
fs22\cf0\f0\charscalex100 {refraktori bila tidak bisa dimobilisasi atau dicegah
dengan terapi medis. }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscale
x100 {Gejala umum pada asites refraktori adalah asites mengalami kekambuhan }\pa
r\pard\li2040\ri0\sl-266\slmult0 \fs22\cf0\f0\charscalex100 {sesudah tindakan pa
racentesis, meningkatnya risiko sindroma hepatorenal, }\par\pard\li2040\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {dan prognosis yang buruk,\uc1\u8221X tamb
ahnya lagi. }\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\s
l-333\slmult0 \fs22\cf0\f0\charscalex100 {Dalam melakukan terapi pada as
ites refraktori perlu diperhatikan }\par\pard\li2040\ri0\sl-280\slmult0 \f
s22\cf0\f0\charscalex100 {mengenai durasi pengobatan, respon yang lambat, kekamb
uhan asitesyang }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100
{cepat, serta komplikasi yang dipicu oleh pemberian diuretika. P
ilihan }\par\pard\li2040\ri0\sl-266\slmult0 \fs22\cf0\f0\charscalex100 {terapi u
ntuk asites refraktoriadalah, terapi paracentesis, TIPS (transjugular }\par\pard
\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {intrahepatic portosyste
mic shunting), peritoneovenus shunts, dan }\par\pard\li2040\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {transplantasi hati. }\par\pard\li2040\ri0\sl213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-333\slmult0 \fs22\cf0\f0\charscalex
100 {Terapi paracentesis merupakan pengobatan lini pertama untuk a
sites }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {refraktor
i karena penerimaannya yang luas di kalangan medis. Prosedur ini }\par\pard\li20
40\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {merupakan pengulangan pemb
erian }\fs24\cf0\f0\charscalex100\i {large volume paracentesis}\i0 \fs24\cf
0\f0\charscalex100 { (LVP) }\par\pard\li2040\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {ditambah albumin. Pemberian LVP 5 L/hari dengan infus albumin (6-8
g/l }\par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ascites yan
g dibuang) lebih efetif mengeliminasi asites dan menghasilkan }\par\pard\li2040\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {komplikasi yang minimal jika diba
ndingkan dengan terapi diuretika. }\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0

\par\pard\li2040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Kombinasi parace
ntesis dengan infus albumin ini juga menyingkat masa }\par\pard\li2040\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {perawatan di rumah sakit. Tindakan paracen
tesis dapat dilakukan tiap 2 }\par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {hingga 4 pekan tanpa keharusan opname. Namun tindakan ini tidak be
rarti }\par\pard\li2040\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {menghilan
gkan kebutuhan akan diuretic (spironolakton atau furosemida), }\par\pard\li2040\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {karena kekambuhan asites bi
sa ditunda pada pasien yang menerima }\par\pard\li2040\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {diuretik pascaparacentesis. Hipovolemia pa
scaparacentesis efektif bisa }\par\pard\li2040\ri0\sl-266\slmult0 \fs24\cf0\
f0\charscalex100 {dicegah dengan pemberian albumin dibandingkan pember
ian plasma }\par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {si
ntetik ekspander. }\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li204
0\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Sesudah paracentesis, pasien ha
rus melakukan diet sodium rendah (70-90 }\par\pard\li2040\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {mmol/hari). Pasien yang menerima diuretika dosis tinggi
harus mengecek }\par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{kadar sodium pada urine, jika kurang dari 30 mEq/hari maka pemberian }\par\pard
\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {diuretika harus dihentika
n. Komplikasi pada asites refraktori yang tidak }\par\pard\li2040\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100 {diintervensi dengan pengobatan akan berkemba
ng menjadi infeksi SBP }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\char
scalex100 {(}\fs22\cf0\f0\charscalex100\i {spontaneous bacterial peritonitis
}\i0 \fs22\cf0\f0\charscalex100 {), sindrom hepatorenal, }\fs22\cf0\f0\char
scalex100\i {hepatic }\i0 \par\pard\li2040\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100\i {encephalopathy}\i0 \fs24\cf0\f0\charscalex100 {, dan kerusakan fungs
i sirkulasi.
}\par\pard\li2040\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2040\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {\uc1\u8
220XKondisi hipoalbuminemia kerap dijumpai pada sirosis hati. Hal
ini }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn
133\margtsxn666\margbsxn373\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li2040\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {disebabkan oleh p
enurunan mekanisme sintesa karena disfungsi liver atau }\par\pard\li2040\ri0\sl
-266\slmult0 \fs22\cf0\f0\charscalex100 {diet protein rendah, peningkatan katabo
lisme albumin, serta adanya asites. }\par\pard\li2040\ri0\sl-280\slmult0 \fs22\c
f0\f0\charscalex100 {Albumin sendiri disintesa secara lengkap pada o
rgan hati,\uc1\u8221Xlanjut Prof. }\par\pard\li2040\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {H.M Sjaifoellah. }\par\pard\li2040\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li2040\ri0\sl-333\slmult0 \fs22\cf0\f0\charscalex100 {Indikasi t
erapi albumin pada sirosis hati adalah adanya asites, sindrom }\par\pard\li2040
\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {hepatorenal, adanya SBP, d
an kadar albumin di bawah 2,5 g%. }\par\pard\li2040\ri0\sl-280\slmul
t0 \fs22\cf0\f0\charscalex100 {Penggunaan albumin dimaksudkan untuk meme
lihara }\fs22\cf0\f0\charscalex100\i {colloid oncotic }\i0 \par\pard\li2040\r
i0\sl-266\slmult0 \fs22\cf0\f0\charscalex100\i {pressure }\i0 \fs22\cf0\f0\chars
calex100 {(COP), mengikat dan menyalurkan obat, dan sebagai penangkap }\par\pard
\li2040\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {radikal bebas. Albumi
n juga memiliki efek antikoagulan, efek }\par\pard\li2040\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {prokoagulatori, efek permeabilitas vaskular,
serta ekspansi volume plasma}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ult0 \fs28\cf1\f0\charscalex100\b {Nutrisi dan Penyakit Hati}\b0 \par\pard\li185
3\ri0\sl-480\slmult0 \fs24\cf0\f0\charscalex100 {Organ hati merupakan salah satu
organ yang mempunyai kemampuan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {pemulihan yang besar. Tapi untuk melakukan pemulihan tersebut,
ia }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {memerlukan d
ukungan asupan nutrisi yang baik. Oleh karena itu, asupan }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {nutrisi yang baik merupakan pondasi t
ata laksana penderita pada sebagian }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\c
f0\f0\charscalex100 {kasus penyakit hati. }\par\pard\li1853\ri0\sl-480\slmult0 \
fs24\cf0\f0\charscalex100\b {Nutrisi dan sirosis hati}\b0 \par\pard\li1853\ri0\s
l-480\slmult0 \fs24\cf0\f0\charscalex100 {Nutrisi yang seimbang baik dari segi k
alori, karbohidrat, protein dan lemak, }\par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {akan membawa pengaruh yang baik untuk memperbaiki kerusa
kan sel hati. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {P
ada tingkat tertentu, kerusakan sel hati masih bisa diperbaiki dengan cara }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {memproduksi sel hati
baru yang sehat.}\par\pard\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100
{Istilah sirosis hati merujuk pada keadaan dimana sel-sel hati yang sehat telah
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {digantikan ole
h jaringan parut. Akibatnya, fungsi hati tentu saja terganggu. }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Gangguan hati kronik ini dapat d
isebabkan oleh berbagai faktor seperti radang }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {hati (hepatitis), sumbatan kandung empedu dan jug
a akibat paparan substansi }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {berbahaya termasuk alkohol. }\par\pard\li1853\ri0\sl-480\slmult0 \fs
24\cf0\f0\charscalex100 {Pada jaman dahulu, diet rendah protein diberikan pada p
enderita sirosis hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {dengan maksud untuk menghindarkan risiko terjadinya peninggian kadar }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {amonia darah yang b
erbahaya. Padahal, penderita sirosis hati seringkali }\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {mengalami penurunan nafsu makan, mual dan
muntah. Akibatnya, penderita }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {mengalami penurunan berat badan dan kekurangan protein. }\par\pard
\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {Pemberian protein pada pe
nderita sirosis memang cukup memusingkan. }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {Kelebihan protein dapat mengakibatkan peningkatan amo
nia darah yang }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
berbahaya, sedangkan kekurangan protein akan menghambat penyembuhan sel }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati. }\par\pard\li1853
\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {Saat ini para dokter lebih memil
ih untuk memberikan diet tinggi kalori tinggi }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {protein dengan maksud agar sel-sel hati dapat ber
egenerasi. Sedangkan untuk }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {mengontrol tingkat amonia darah digunakan laktulosa dan/atau suatu j
enis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {antibiotik
yang bernama neomisin.}\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\charsca
lex100 {Selain hal-hal di atas, ada beberapa hal lagi yang perlu diperhatikan ol
eh }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133
\margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {penderita sirosis hat
i, misalnya pengurangan konsumsi garam. Untuk itu }\par\pard\li1853\ri0\sl-266\s
lmult0 \fs24\cf0\f0\charscalex100 {tingkatkan konsumsi makanan segar dan hindari
makanan awetan seperti }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {makanan kaleng. }\par\pard\li1853\ri0\sl-480\slmult0 \fs24\cf0\f0\chars
calex100 {Penderita sirosis juga bisa mengalami penyumbatan saluran empedu di da
lam }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati. Akiba
tnya, empedu tidak bisa keluar dan lemak tidak bisa diserap. Pada }\par\pard\li1
853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {keadaan ini, penderita akan m
engalami perubahan defekasi (buang air besar) }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {yang disebut steatore. }\par\pard\li1853\ri0\sl-4
80\slmult0 \fs24\cf0\f0\charscalex100 {Bila hal ini terjadi, lemak sebaiknya dig
anti dengan lemak trigliserida rantai }\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100 {sedang (medium chain triglycerides/MCT). MCT sangat baik
digunakan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {karen
a untuk penyerapannya jenis lemak ini tidak terlalu tergantung pada }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {keberadaan asam empedu. }\p
ar\pard\li1853\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100 {Saat ini telah ter
sedia produk nutrisi khusus yang diformulasikan untuk para }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penderita gangguan hati. Salah satun
ya adalah Hepatosol yang juga }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {mengandung Trigliserida Rantai Sedang (MCT).}\par\pard\li1853\ri0
\fs18\cf0\par\pard\li1853\ri0\sl-400\slmult0 \fs20\cf5\f0\charscalex100\b {PEME
RIKSAAN ENDOSKOPI SALURAN PENCERNAAN}\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f1\charscalex100 {Fasilitas
pemeriksaan endoskopi saluran pencernaan di RS Medistra telah }\par\pard\li1853\
ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {dilengkapi dengan berbagai perala
tan yang mampu memeriksa seluruh }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\
f1\charscalex100 {saluran pencernaan dengan menggunakan kamera serat optic fleks
ibel }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {(flexible
videoscope). }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\
sl-280\slmult0 \fs20\cf0\f1\charscalex100 {RS Medistra memiliki reputasi yang sa
ngat baik sebagai ahli endoskopi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\
f1\charscalex100 {saluran pencernaan, sehingga sering menjadi rujukan dari rumah
sakit lain }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {di
Indonesia.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl266\slmult0 \fs20\cf0\f1\charscalex100 {Pelayanan endoskopi saluran pencernaan d
i RS Medistra meliputi seluruh }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1
\charscalex100 {pemeriksaan mulai dari kerongkongan (esophagus) sampai pangkal d
ubur.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\s
lmult0 \fs20\cf0\f1\charscalex100 {Pada umumnya pemeriksaan endoskopi dibagi ata
s dua jenis, yaitu }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex1
00 {endoskopi saluran pencernaan bagian atas yang meliputi saluran }\par\pard\li
1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {esophagus, lambung, usus 12
jari, saluran empedu dan saluran pancreas }\par\pard\li1853\ri0\sl-240\slmult0 \
fs20\cf0\f1\charscalex100 {dan endoskopi saluran pencernaan bawah meliputi pemer
iksaan usus }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {hal
us, usus besar dan rectum}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li1853\ri0\sl-280\slmult0 \fs20\cf5\f0\charscalex100\b {Indikasi Pemeriksaan En
doskopi}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Peme
riksaan endoskopi merupakan prosedur pilih utama untuk }\par\pard\li1853\ri0\sl240\slmult0 \fs20\cf0\f1\charscalex100 {mendiagnosa dan menghentikan pendarahan
pada saluran pencernaan. }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\chars
calex100 {Selain itu endoskopi sangat diperlukan untuk beberapa keadaan antara }
\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {lain mengangkat
batu dalam saluran empedu, mendeteksi keadaan usus }\par\pard\li1853\ri0\sl-253\
slmult0 \fs20\cf0\f1\charscalex100 {besar, mengangkat polip pada usus, memasang
cincin penyanggah }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex10
0 {saluran empedu dan mengevaluasi gejala gangguan pencernaan seperti }\par\pard
\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {mual, muntah, sulit menel
an atau terasa terbakar di dada.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs20\cf5\f0\charscalex100\b {Endoskopi pada s
aluran pencernaan}\b0 \par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscale
x100 {Pendarahan pada saluran pencernaan seringkali membahayakan nyawa }\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {pasien, karena shock hem
oraghik. Dengan endoskopi, upaya }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\
f1\charscalex100 {menghentikan pendarahan dapat segera dilakukan dengan cara men
cari }\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn1
r\pard\li1853\ri0\sl-373\slmult0 \fs20\cf0\f1\charscalex100 {sumber pendarahan,
kemudian mengikat pembuluh darah yang pecah }\par\pard\li1853\ri0\sl-240\slmult0
\fs20\cf0\f1\charscalex100 {(ligasi) atau disuntik dengan bahan kimia yang memb

uat pembuluh darah }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex1
00 {mengeras (skleroterapi endoskopi).}\par\pard\li1853\ri0\sl-240\slmult0 \fs20
\cf0\f1\charscalex100 {Sebelum teknologi ini ada, pendarahan dalam saluran pence
rnaan biasa }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {dih
entikan dengan cara operasi yang risikonya lebih besar atau dilakukan }\par\pard
\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {pemasangan balon yang ber
fungsi menahan pendarahan (SB Tube)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-280\slmult0 \fs20\cf5\f0\charscalex100\b {Mengangkat Po
lip Usus (Polipektomi)}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\char
scalex100 {Metode endoskopi dapat juga dipergunakan untuk mengeluarkan polip }\p
ar\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {yang sering tumbuh
di saluran pencernaan terutama usus besar dan }\par\pard\li1853\ri0\sl-240\slmu
lt0 \fs20\cf0\f1\charscalex100 {lambung. Walaupun demikian pada polip yang besar
, biasanya diangkat }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex
100 {dengan cara operatif, karena risiko pendarahan yang cukup besar.}\par\pard\
\f0\charscalex100\b {Mengeluarkan batu pada saluran empedu}\b0 \par\pard\li1853\
ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Dengan Endoskopi, adanya batu yan
g menyumbat saluran empedu }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\cha
rscalex100 {(biasanya menyebabkan pasien menjadi kuning) dapat diketahui dengan
}\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {langsung dan sa
at itu dapat dikeluarkan (ekstrasi) menggunakan alat }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f1\charscalex100 {tambahan, misalnya kawat penjepit atau mem
akai kateter berbentuk }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charsca
lex100 {basket.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-280\slmult0 \fs20\cf5\f0\charscalex100\b {Memasang Cincin Penyanggah Salura
n Empedu.}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {De
ngan peralatan duodenovideoskope, saluran empedu yang menutup }\par\pard\li1853\
ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {akibat tumor/keganasan dapat dibu
ka kembali dengan memasang cincin }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0
\f1\charscalex100 {penahan di dalam saluran empedu (stent) agar tidak menutup la
gi.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-280\slm
ult0 \fs20\cf5\f0\charscalex100\b {Mendeteksi kanker Usus Besar Secara Dini.}\b0
\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Dengan kolonosk
opi dapat dilakukan pemeriksaan saluran dinding usus }\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f1\charscalex100 {besar dengan teliti untuk mendeteksi adany
a tumor ataupun polip yang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\cha
rscalex100 {bila dibiarkan dengan berjalannya waktu bisa berubah menjadi tumor }
\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {ganas (kanker).
Di Negara-neara maju pemeriksaan kolonoskopi ini sangat }\par\pard\li1853\ri0\sl
-240\slmult0 \fs20\cf0\f1\charscalex100 {dianjurkan sebagai bagian dari uji kese
hatan (check up) untuk orang }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\c
harscalex100 {berusia di atas 40 tahun dan terutama yang berusia lebih dari 50 t
ahun }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {untuk dila
kukan setiap 3-5 tahun sekali.}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\
charscalex100 {Dengan dapat terdeteksi secara dini, dapat diambil tindakan sebel
um }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {tumor ganas
tersebut menyebar dan dapat membahayakan kehidupan }\par\pard\li1853\ri0\sl-240\
slmult0 \fs20\cf0\f1\charscalex100 {seseorang (kematian).}\par\pard\li1853\ri0\s
ex100\b {Apa Keunggulan Pemeriksaan Endoskopi?}\b0 \par\pard\li1853\ri0\sl-253\s
lmult0 \fs20\cf0\f1\charscalex100 {Pemeriksaan ini lebih akurat daripada pemerik
saan sinar X dalam deteksi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\cha
rscalex100 {peradangan, ulkus atau tumor di saluran pencernaan. Pemeriksaan ini
}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {dapat mendeteks
i kanker dini atau membedakan antara lensi kanker }\par\pard\li1853\ri0\sl-240\s
lmult0 \fs20\cf0\f1\charscalex100 {dengan bukan kanker dengan melalui biopsy pad
a tempat yang dicurigai.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-280\slmult0 \fs20\cf5\f0\charscalex100\b {Apakah Tindakan Endoskop
i Aman?}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Peme

riksaan pada dasarnya merupakan prosedur yang sangat aman. }\par\pard\li1853\ri0
\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Komplikasi biasanya jarang terjadi,
kecuali setelah biopsy atau }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\ch
arscalex100 {pengangkatan polip yang mungkin mengakibatkan pendarahan ringan }\p
ar\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {yang bisa berhenti
dengan sendirinya tanpa harus dilakukan transfuse.}\par\pard\li1853\ri0\sl-213\
{Paling penting adalah pasien mengenal adanya suatu komplikasi dan }\par\pard\li
1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {menyampaikannya pada dokter,
misalnya: sulit menelan, sakit }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f
1\charscalex100 {tenggorokan yang menetap, nyeri dada, nyeri perut hebat, menggi
gil, }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {atau penda
rahan dari usus yang lebih dari setengah gelas.}\par\pard\li1853\ri0\sl-213\slmu
ex100\b {JENIS PELAYANAN ENDOSKOPI YANG DAPAT DILAKUKAN DI RS }\b0 \par\pard\sec
t\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\marg
bsxn373\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmu
l-373\slmult0 \fs20\cf5\f0\charscalex100\b {Medistra }\b0 \par\pard\li1853\ri0\s
ex100\b {Endoskopi Diagnosis}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f
1\charscalex100 {Pemeriksaan Saluran Kerongkongan (Esofagoskopi)}\par\pard\li185
3\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Pemeriksaan Lambung dan Usus 12
Jari (Gatros-Duodenoskopi)}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\cha
rscalex100 {Pemeriksaan Saluran Empedu dan Pankreas (Endoskopic Retrograde }\par
\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Cholangio Pancreatog
raphy)}\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {Pemeriksa
an Saluruan Usus Besar (Kolonoskopi)}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\c
f0\f1\charscalex100 {Pemeriksaan Muara Usus Besar sampai Pangkal Dubur }\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {(Rektosigmoidoskopi)}\pa
r\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Pengambilan contoh
jaringan saluran pencernaan (biopsi)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-280\slmult0 \fs20\cf5\f0\charscalex100\b {Endoskopi Te
rapeutik}\b0 \par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Pen
gikatan Pembuluh darah pecah (Ligasi Varises Esofagus/Lambung)}\par\pard\li1853\
ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Pembuntuan Pembuluh darah yang pe
cah (Skleroterpi Endoskopi)}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\cha
rscalex100 {Melebarkan Saluran Menelan (Dilatasi Esofagus)}\par\pard\li1853\ri0\
sl-253\slmult0 \fs20\cf0\f1\charscalex100 {Mengeluarkan Batu Saluran Empedu (Eks
trasi Batu Empedu)}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex10
0 {Memasang cincin penyanggah saluran empedu (Stening Saluran Empedu)}\par\pard\
li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Mengangkat Polip di salura
n pencernaan (Polipoktomi Endoskopi)}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\c
f0\f1\charscalex100 {Mengikat Pembuluh darah yang pecah pada wasir (Ligasi Hermo
roid)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1853\ri0\sl-306\slmult0 \fs20\cf5\f0\charscalex100\b
{MEMPERSIAPKAN PASIEN YANG AKAN MENJALANI OPERASI}\b0 \par\pard\li1853\ri0\sl-2
00\b {Endoskopi Saluran Pencernaan}\b0 \par\pard\li1853\ri0\sl-253\slmult0 \fs20
\cf0\f1\charscalex100 {Lambung harus benar-benar kosong. Anda tidak boleh makan
atau minum }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {sela
ma 8 jam sebelum pemeriksaan. Dokter akan menginstruksikan kapan }\par\pard\li18
53\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {harus mulai puasa tergantung j
adwal pemeriksaan dilakukan.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1853\ri0\sl-280\slmult0 \fs20\cf0\f1\charscalex100 {Obat-obat yang dimakan
perlu disesuaikan, beberapa jenis obat harus }\par\pard\li1853\ri0\sl-240\slmul
t0 \fs20\cf0\f1\charscalex100 {dihindari.}\par\pard\li1853\ri0\sl-240\slmult0 \f
s20\cf0\f1\charscalex100 {Anda disarankan agar menginformasikan obat-obat yang d
iminum pada }\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f1\charscalex100 {dok

ter termasuk riwayat alergi obat. Konsultasikan ke dokter apabila anda }\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {mempunyai riwayat penyak
in jantung dan paru-paru, karena kemungkinan }\par\pard\li1853\ri0\sl-253\slmult
0 \fs20\cf0\f1\charscalex100 {memerlukan perhatian khusus selama tindakan.}\par\
0\cf0\f1\charscalex100 {Jangan mengemudikan kendaraan setelah tindakan. Harus di
upayakan }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {agar k
eluarga yang mendampingi pada saat pulang karena biasanya }\par\pard\li1853\ri0\
sl-253\slmult0 \fs20\cf0\f1\charscalex100 {diberikan obat penenang pada saat tin
dakan.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\
slmult0 \fs20\cf5\f0\charscalex100\b {Endoskopi Saluran Pencernaan Bawah}\b0 \pa
r\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {Untuk mendapatkan h
asil yang akurat, maka usus besar harus dibersihkan }\par\pard\li1853\ri0\sl-253
\slmult0 \fs20\cf0\f1\charscalex100 {dari sisa makanan sebelum tindakan. Dokter
akan melakukan instruksi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\chars
calex100 {mengenai jenis dan sumber makanan yang harus dikonsumsi agar dapat }\p
ar\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\charscalex100 {membantu membersih
kan saluran usus besar, anda akan diinstruksikan }\par\pard\li1853\ri0\sl-240\sl
mult0 \fs20\cf0\f1\charscalex100 {untuk minum larutan pencuci perut sebelum peme
riksaan. Patuhi instruksi }\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f1\char
scalex100 {tersebut secara cermat karena prosedur akan ditunda atau harus diulan
g }\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f1\charscalex100 {apabila usus
besar tidak bersih.}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
mult0 \fs24\cf0\f0\charscalex100 {Perdarahan Varises Gastroesofageal }\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pada Hipertensi Portal }\p
ar\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Myrna Justina}\b
0 \par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\m
argtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\i {Dokter Umum Rumah Sak
it Mitra Keluarga BekasiBarat, Jawa Barat }\i0 \par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100\b {PENDAHULUAN }\b0 \par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {Perdarahan varises gastroesofageal adalah sebu
ah }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {komplikasi m
ayor hipertensi portal akibat sirosis dengan angka }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {kejadian 10-30% dari seluruh perdarahan salu
ran cerna bagian }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{atas}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(1)}\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri
0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Perdarahan varises berhubungan deng
an kesakitan dan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{kematian yang lebih substansial daripada penyebab perdarahan }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {lain dengan biaya RS yang lebih
tinggi. Lebih dari 30%}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {episode perdarahan awal bersifat fatal dan 70% yang selamat }\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {akan mengalami perdarahan ul
ang. Selain itu angka }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {keselamatan setahun setelah perdarahan varises dapat buruk}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(32-80%)}\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100\b {LAPORAN KASUS }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\
cf0\f0\charscalex100\b {Riwayat penyakit }\b0 \par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {Seorang pasien laki-laki datang ke rumah sakit (RS
)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dengan keluhan
utama muntah 3 gelas yang disertai buang air}\par\pard\li1853\ri0\sl-266\slmult
0 \fs24\cf0\f0\charscalex100 {besar (bab) berdarah yang disertai rasa lemas. Riw

ayat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {perdarahan
saluran cerna dan sakit kuning sebelumnya }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {disangkal. Riwayat alkoholisme juga disangkal. Pasie
n}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {mempunyai riwa
yat asam urat tinggi dengan konsumsi obat }\par\pard\li1853\ri0\sl-266\slmult0 \
fs24\cf0\f0\charscalex100 {piroksikam, natrium diklofenak, dan alopurinol. }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Pemeriksaan fisik
}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Keadaan umu
m sakit sedang, tekanban darah 120/80}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\
cf0\f0\charscalex100 {mmHg, nadi 88 kali permenit, napas 18 kali permenit, suhu}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {afebris. }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Mata : Konjungtiva tid
ak pucat, sklera tidak }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {ikterik. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Paru : Perkusi sonor, Suara napas vesikuler, }\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {tanpa ronki.}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Jantung : Bunyi Jantung I dan II normal, tanpa }\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {bising. }\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Abdomen : Lemas, Hati dan
Limpa tidak teraba, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {pekak berpindah (+)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {Ekstremitas : Akral hangat, tanpa edema tungkai. }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Stigmata sirosis : Palmar eritema, he
moroid.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Pemeri
ksaan laboratorium dasar }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {Hemoglobin 9,1; Eritrosit 2,9 juta; Hematokrit 27; }\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Trombosit 60.000; Gula Darah 2
72}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Fungsi Hati
}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Nilai No
rmal }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Biliru
bin Total }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5,2}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {<1,5}\par\pard\li
1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Bilirubin Direk}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1,8}\par\pard\sect\sectd\sbk
page\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\par
t0 \fs24\cf0\f0\charscalex100 {<0,3}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {Bilirubin Indirek}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {3,4}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {Alanin Transaminase }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {43}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{<40}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Aspartat T
ransaminase }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {93}
\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {<35}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Fosfatase Alkali }\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {65}\par\pard\li1853\ri0\sl
-266\slmult0 \fs24\cf0\f0\charscalex100 {<165}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {Protein Total }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {7,3}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {6-8,5}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Albumin 3,0}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {3,5-5,5}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Globu
lin 4,6}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {2,5-3,5}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Ultrasonografi
abdomen }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ha
ti : Lobus kiri membesar, lobus kanan mengecil, tepi }\par\pard\li1853\ri0\sl-26
6\slmult0 \fs24\cf0\f0\charscalex100 {irreguler, Kaudal menumpul, tampak nodul }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {berukuran 1,5-1,
9 cm di lobus kanan sisi kaudal }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f

0\charscalex100 {Limpa : Membesar.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Ginjal : Kiri dan Kanan normal. }\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf0\f0\charscalex100 {Asites : Positif. }\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100\b {Esofago-gastro-duodenoskopi }\b0 \par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Esofagus : Varises eso
fagus }\fs24\cf0\f0\charscalex100\i {grade}\i0 \fs24\cf0\f0\charscalex100 { II-I
II, tanpa tanda merah }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {endoskopik. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {Gaster : Kongesti seluruh mukosa, dan lesi erosi di }\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {antrum. }\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {Duodenum : Bulbus dan pars sekundum tidak ada
perdarahan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {baru
. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Saran : Ligas
i }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Masalah pad
a pasien ini adalah }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsc
alex100 {1. Hematemesis melena akibat pecahnya varises esofagus.}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2. Gastropati akibat obat. }\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {3. Nodul hati lobus
kanan sisi kaudal. }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100 {Pasien ditatalaksana dengan kumbah lambung, obat-obat }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hemostatik, dan obat-obat lain sesua
i indikasi. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {D
ISKUSI KASUS }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{Sirosis hati menahun merupakan penyebab terbanyak }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {hipertensi portal. Hipertensi portal ini te
rjadi akibat }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pe
ningkatan tahanan intrahepatik (pre-sinusoid, sinusoid, dan}\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pasca-sinusoid) yang sering terjadi
bersama dengan }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {
peningkatan aliran di dalam splanknik yang hiperdinamik. }\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Studi terakhir menyebutkan bahwa ketid
akseimbangan antara }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {endotelin-1 dan oksida nitrik dapat merupakan penyebab }\par\pard\li1853\ri
0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {terpenting peningkatan tahanan intr
ahepatik yang merupakan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {komponen kritis dari sebagian besar hipertensi portal}\par\pard\sect\se
ctd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn
400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0
3\slmult0 \fs24\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {Penentu utama perdarahan adalah tekanan dinding varises }\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(T) yang sesuai dengan modi
fikasi Frank's dari Hukum }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {Laplace: }\fs24\cf0\f0\charscalex100\b {T = TP X r X w}\b0 \par\pard\
li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {-1}\b0 \par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {- TP = Tekanan transmural, r = ja
ri-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {jari, dan w
= ketebalan dinding pembuluh. }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100 {Kombinasi penemuan klinis, endoskopik, kelas Child-Pugh}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {yang lanjut }\fs24\cf0\f0
\charscalex100\b {(Tabel 1)}\b0 \fs24\cf0\f0\charscalex100 {, fungsi hati yang b
uruk, dan varises yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {besar dengan tanda merah endoskopik sangat berhubungan }\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {dengan risiko perdarahan awal pad
a pasien sirosis}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Tabel 1: Klasifikasi Ch
ild-Pugh beratnya sirosis }\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\
charscalex100\b {Skor }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char

scalex100\b {Variabel }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100\b {1 2 3}\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Ensefalopati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {Tidak ada }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Ringan Sedang}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Be
rat Koma }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Asites
Tidak }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {ada }\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Sedikit }\par\pard\
li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Sedang }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Bilirubin }\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {(mg/dl) }\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {<2 2-3 >3}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {Albumin (g/l) }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {>3.5}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0
\charscalex100 {2.8 - 3.5}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {<2.8}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {W
aktu protrombin }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{1- 4}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {4 - 6}\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {>6}\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Jika jumlah skor 5-6, sirosis dik
lasifikasikan kelas A; jika }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {jumlah skor 7-9, kelas B; dan jika jumlah skor 10 atau lebih, }\par
\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {diklasifikasikan kel
as C. Prognosis secara langsung dikaitkan }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {dengan skor}\par\pard\li1853\ri0\sl-266\slmult0 \fs24
\cf0\f0\charscalex100 {(2)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Pan
duan tatalaksana pasien dengan varises gastroesofageal }\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {meliputi pencegahan episode perdarahan a
wal (profilaksis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{primer), pengendalian perdarahan aktif, dan pencegahan ulang }\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {setelah perdarahan awal (profila
ksis sekunder)}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(
2)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Panduan ini dapat dilihat p
ada }\fs24\cf0\f0\charscalex100\b {Tabel 2.}\b0 \par\pard\sect\sectd\sbkpage\pgw
sxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853
\cf0\f0\charscalex100\b {Tabel 2: Panduan tatalaksana varises gastroesofageal}\b
0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\b {Tujuan Terap
i }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Lini Pe
rtama }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Lin
i Alternatif}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Profilaksis }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Pr
imer }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penghambat
atau dengan kombinasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {isosorbid mononitrat }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {Ligasi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Perdarahan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{varises akut }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {
Octreotide (atau terlipressin) dan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {terapi endoskopik }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Tamponade }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {balon,TIPS }\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\ch
arscalex100 {Profilaksis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {sekunder}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {Ligasi atau dengan kombinasi dengan }\par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {penghambat beta dengan atau tanpa }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {isosorbid mononitrat }\par\pard\li185

3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {TIPS, terapi }\fs24\cf0\f0\char
scalex100\i {shunt}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100\b \i {Keterangan.}\b0 \i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100\i {1.}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100\i {TIPS = Transjugular Intrahepatic Portosystemic Shunt.}\i0 \par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {2. Penghambat beta propan
olol dengan dosis yang dititrasi sampai }\i0 \par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100\i {maksimum 320 mg perhari. Dosis awal penghambat be
ta nadolol 20 mg}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100\i {perhari yang dinaikkan sampai 80 mg perhari.}\i0 \par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100\i {3.}\i0 \par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100\i {Octreotide biasanya diberikan sebagai infusi
25-50 ug perjam (dengan }\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100\i {atau tanpa bolus). Dosis terlipressin adalah 3 mg setiap 4 jam un
tuk 24}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {jam
pertama, kemudian 1 mg setiap 4 jam. Bahan-bahan somatostatin ini }\i0 \par\par
d\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\i {menyebabkan konstriksi
arteriolar splanknik dan menghambat pelepasan }\i0 \par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100\i {peptida-peptida yang menyebabkan sindrom s
irkulasi hiperdinamik pada}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100\i {hipertensi portal. Penggunaan jangka panjang octreotide 2 x 50
ug}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {subkuta
n selama 6 bulan terbukti bermanfaat sebagai ajuvan skleroterapi }\i0 \par\pard\
li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\i {pada perdarahan varises
akut akibat hipertensi portal sirotik. }\i0 \par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100\i {4.}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100\i {Perdarahan terjadi sekitar dua pertiga pasien dalam satu
tahun pertama}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
\i {setelah perdarahan awal}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100\i {(2,3)}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100\i {.}\i0 \par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00\b {KEPUSTAKAAN }\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {1.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Laine
L. Upper gastrointestinal tract hemorrhage. West J Med 1991; 166: }\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {274-9.}\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {2. Sharara AL, Rockey DC. Gastroesopha
geal Variceal Hemorrhage. N }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {Engl J Med 2001; 345: 669-81.}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {3.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {Jenkins SA, Baxter JN, Kingsnorth AN, Makin CA, Ellenbogen S, Grim
e }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {JS, et al. Ra
ndomised trial of octreotide for long term management of}\par\pard\sect\sectd\sb
kpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pa
lt0 \fs24\cf0\f0\charscalex100 {cirrhosis after variceal hemorrhage. BMJ 1997; 3
15; 1338-41.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100\i {C
ermin Dunia Kedokteran No. 150, 2006}\i0 \fs24\cf0\f0\charscalex100 { 29}\par\pa
lt0 \fs24\cf0\f0\charscalex100\b {Hematemesis dan Melena}\b0 \par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Dr.}\b0 \par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100\b {Oey Tjeng Sien}\b0 \par\pard\li1853\ri0
\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Hematemesis adalah}\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {muntah darah dan melena adalah}\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {buang air besar be
rdarah seperti aspal, umumnya disebabkan}\par\pard\li1853\ri0\sl-266\slmult0 \fs
24\cf0\f0\charscalex100 {perdarahan saluran makan bagian atas (SMBA) mulai dari}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {esofagus sampai
duodenum.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penyeh

ab-penyebab dari perdarahan saluran makan bagian}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {alas antara lain :}\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf0\f0\charscalex100 {- Kelainan pada esofagus: varises, esofagiti
s, ulkus, sindroma}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {Mallory-Weiss, keganasan.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {- Kelainan pada lambung dan doudenum: gastritis hemora-}\par\pard\l
i1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {gika, ulkus peptikum ventri
kuli dan duodeni, keganasan,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {polip.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {- Penyakit darah: leukemia, DIC, trombositopeni.}\par\pard\li1853\ri0\sl-266
\slmult0 \fs24\cf0\f0\charscalex100 {- Penyakit sistemik: uremia.}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penyehab perdarahan SMBA yang
terbanyak dijumpai di}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Indonesia adalah pecahnya varises esofagus dengan rata-rata}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {40 - 55%, kemudian menyusul ga
stritis hemoragika dengan}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\chars
calex100 {20 - 25%. ulkus peptikum dengan 15 - 20%, sisanya oleh}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {keganasan, uremia dan sebagainy
a.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Unnunnya perd
arahan SMBA termasuk penyakit gawat}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {darurat yang memerlukan tindakan medik intensif yang segera}
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {di rumah-sakit/p
uskesmas karena angka kematiannya yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {tinggi, terutama pada perdarahan varises esofagus yang da
hulu}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {berkisar an
tara 40 - 85%.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {T
ingginya angka kematian pada perdarahan varises esofagus}\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {tergantung dari beberapa faktor, antara
lain :}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {- Sifat
dan lamanya perdarahan telah berlangsung.}\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {- Beratnya penyakit sirosis hati yang mendasarinya.}\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ketrampilan tenaga
medik dan paramedik yang menangani}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {penderita tersebut.}\par\pard\li1853\ri0\sl-266\slmult0 \fs2
4\cf0\f0\charscalex100 {- Tersedia tidaknya sarana diagnostik dan terapi di ruma
h-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sakit/puskesm
as tersebut.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Den
gan bertambah majunya teknologi kedokteran. ter-}\par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100 {utatna di bidang Endoskopi gastrointestinal. ak
hir-akhir ini}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {te
lah dikenal metoda-metoda baru dalam diagnostik dan}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {terapi yang memberi harapan dapat mengurangi
angka ke-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {matia
n yang tinggi, terutama pada perdarahan varises esofagus.}\par\pard\li1853\ri0\s
l-266\slmult0 \fs24\cf0\f0\charscalex100 {26 Cermin Dunia Kedokteran No. 40, 198
5}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Data-data dari
publikasi terakhir penulis-penulis Indonesia sen-}\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {diri juga menunjukkan penurunan angka kematia
n yang ber-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {makn
a di rumah-sakit tipe A/B sejak diikutinya protokol}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {penanggulangan seperti di luar negeri.}\par\
pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn
666\margbsxn666\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Berikut ini akan dibicarakan d
iagnosis dan penanganan}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charsca
lex100 {dari penderita-penderita dengan perdarahan saluran makan}\par\pard\li185
3\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {bagian atas.}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {DIAGNOSIS HEMATEMESIS DAN MELENA
}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Diagnosis p

ada gejala muntah darah dan buang air berdarah}\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {bertujuan mencari tahu tentang}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {-- kemungkinan penyebab utama dari
perdarahan SMBA}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{tersebut}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-- lok
asi yang tepat dari sumber perdarahannya}\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {-- sifat perdarahannya.(sedang atau telah berlangsung,
banyak}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {atau sedi
kit)}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-- derajat
gangguan yang ditimbulkan perdarahan SMBA pada}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {organ lain seperti syok. koma, anenti. kegagalan
fungsi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati/jant
ung/ginjal}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\b {Dia
gnosa perdarahan SMBA ditegakkan melalui}\b0 \par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100 {A. Anamnesis}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {B. Pemeriksaan fisik}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {C. Pemeriksaan penunjang diagnostik seperti}\par\
pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {I . Pemeriksaan labor
atorium}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {2. Pemer
iksaan radiologik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{3. Pemeriksaan endoskopik}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\cha
rscalex100 {4. Pemeriksaan ultrasonografi dan}{ }\fs24\cf0\f0\charscalex100\i {s
canning}\i0 { }\fs24\cf0\f0\charscalex100 {han}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100\i {Ana}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100\i {mnesis}\i0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Perlu dilakukan anamnesis yang teliti dan bila keadaan pen
-}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {derita lemah a
tau kesadarannya menurun dapat diambil allo}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {anamnesa dari pengantarnya.}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {Beberapa hal yang perlu ditanyakan antar
a lain :}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {-- Apak
ah penderita pernah menderita atau sedang dalam pe-}\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {rawatan karena penyakit hati seperti hepatit
is kronis, sirosis}\par\pard\sect\sectd\sbkpage\pard\sect\sectd\sbkpage\pgwsxn11
893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn426\pard\li1853\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\l
f0\charscalex100 {hati, penyakit lambung atau penyakit lain?}\par\pard\li1853\ri
0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {-- Apakah perdarahan ini yang perta
ma kali atau sudah pernah}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\chars
calex100 {mengalami sebelumnya?}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0
\charscalex100 {-- Apakah penderita minum obat-obat analgetik antipiretik}\par\p
ard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {atau kortison? Apakah
minum alkohol atau jamu-jamuan?}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0
\charscalex100 {-- Apakah ada rasa nyeri di ulu hati sebelumnya, mual-mual}\par\
pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {atau muntah?}\par\par
d\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-- Apakah timbulnya perd
arahan mendadak dan berapa ba-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\
charscalex100 {nyaknya atau terjadi terus menerus tetapi sedikit-sedikit?}\par\p
ard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {--Apakah timbul hemate
mesis dahulu baru diikuti melena}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f
0\charscalex100 {atau hanya melena saja?}\par\pard\li1853\ri0\sl-306\slmult0 \fs
26\cf0\f0\charscalex100\i {Pemeriksaan fisik}\i0 \par\pard\li1853\ri0\sl-320\slm
ult0 \fs26\cf0\f0\charscalex100 {Setibanya di rumah-sakit atau puskesmas, pender
ita perlu}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {segera
diperiksa keadaan umumnya yaitu derajat kesadaran,}\par\pard\li1853\ri0\sl-306\
slmult0 \fs26\cf0\f0\charscalex100 {tekanan darah, nadi, pernapasan, suhu badan
dan apakah ada}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {t
anda-tanda syok, anemi, payah jantung, kegagalan ginjal atau}\par\pard\li1853\ri
0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {kegagalan fungsi hati berupa koma.

Penderita dalam keadaan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsca
lex100 {umum yang buruk atau syok perlu segera ditolong dan diatasi}\par\pard\li
1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dahulu syoknya, sedangkan pe
meriksaan penunjang diagnosis}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\c
harscalex100 {ditunda dahulu sampai keadaan umum membaik. Bila dugaan}\par\pard\
li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {penyebab perdarahan SMBA a
dalah pecahnya varises esofagus,}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f
0\charscalex100 {perlu dicari tanda-tanda sirosis hati dengan hipertensi portal}
\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {seperti: hepatos
plenomegali, ikterus, asites, edema tungkai}\par\pard\li1853\ri0\sl-306\slmult0
\fs26\cf0\f0\charscalex100 {dan sakral,}\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100\i {spider nevi,}\i0 \par\pard\li1853\ri0\sl-293\slmult0 \
fs26\cf0\f0\charscalex100 {eritema palmarum, ginekomasti,}\par\pard\li1853\ri0\s
l-320\slmult0 \fs26\cf0\f0\charscalex100 {venektasi dinding perut. Bila pada pal
pasi ditemukan massa}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex
100 {yang padat di daerah epigastrium, perlu dipikirkan kemungkin-}\par\pard\li1
853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {an keganasan lambung atau keg
anasan hati lobus kiri.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charsca
lex100\i {Pemeriksaan penunjang}\i0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100\i {diagnosis}\i0 \par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf
0\f0\charscalex100 { Pemeriksaan laboratorik}\par\pard\li1853\ri0\sl-306\slmult0
\fs26\cf0\f0\charscalex100 {Pemeriksaan laboratorik dianjurkan dilakukan sedini
mung-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {kin, terga
ntung dari lengkap tidaknya sarana yang tersedia.}\par\pard\li1853\ri0\sl-306\sl
mult0 \fs26\cf0\f0\charscalex100 {Disarankan pemeriksaan-pemeriksaan seperti ber
ikut: golongan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {d
arah, Hb, hematokrit, jumlah eritrosit, lekosit, trombosit,}\par\pard\li1853\ri0
\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {waktu perdarahan, waktu pembekuan, m
orfologi darah tepi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex1
00 {dan fibrinogen.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex1
00 {Pemeriksaan tes faal hati bilirubin, SGOT, SGPT, fosfatase}\par\pard\li1853\
ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {alkali, gama GTkolinesterase, pro
tein total, albumin, globulin,}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\
charscalex100 {HBSAg, AntiHB}\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\ch
arscalex100 {S .}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100
{Pemeriksaan yang diperlukan pada komplikasi kegagalan}\par\pard\li1853\ri0\sl-3
20\slmult0 \fs26\cf0\f0\charscalex100 {fungsi ginjal, koma atau syok adalah: kre
atinin, ureum, elek-}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\margls
xn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\c
t0 \fs18\cf0\par\pard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\charscalex100 {trol
it, analisa gas darah, gula darah sewaktu, amoniak.}\par\pard\li1853\ri0\sl-306\
slmult0 \fs26\cf0\f0\charscalex100 { Pemeriksaan radiologik}\par\pard\li1853\ri0\
sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Pemeriksaan radiologik dilakukan sedi
ni mungkin bila per-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex
100 {darahan telah berhenti. Mula-mula dilakukan pemeriksaan}\par\pard\li1853\ri
0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {esofagus dengan menelan bubur bariu
m, diikuti dengan pe-}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscale
x100 {meriksaan lambung dan doudenum, sebaiknya dengan kon-}\par\pard\li1853\ri0
\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {tras ganda.}\par\pard\li1853\ri0\sl320\slmult0 \fs26\cf0\f0\charscalex100 {Pemeriksaan dilakukan dalam berbagai pos
isi dan diteliti ada}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex
100 {tidaknya varises di daerah 1/3 distal esofagus, atau apakah}\par\pard\li185
3\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {terdapat ulkus, polip atau tumo
r di esofagus, lambung, doude-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\
charscalex100 {num.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex1
00 { Pemeriksaan endoskopik}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\char
scalex100 {Pemeriksaan endoskopik dengan fiberpanendoskop dewasa}\par\pard\li185
3\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {ini juga sudah dapat dilakukan
di beberapa rumah-sakit besar}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\c

harscalex100 {di Indonsia. Dari publikasi pengarang-pengarang luar negeri}\par\p
ard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dan juga ahli-ahli di
Indonsia terbukti pemeriksaan endosko-}\par\pard\li1853\ri0\sl-320\slmult0 \fs24
\cf0\f0\charscalex100 {pik ini sangat penting untuk menentukan dengan tepat sumb
er}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {perdarahan SM
BA. Tergantung ketrampilan dokternya, endos}\par\pard\li1853\ri0\sl-320\slmult0
\fs26\cf0\f0\charscalex100 {kopi dapat dilakukan sebagai pemeriksaan darurat sew
aktu}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {perdarahan
atau segera setelah hematemesis berhenti.}\par\pard\li1853\ri0\sl-320\slmult0 \f
s26\cf0\f0\charscalex100 {Pada endoskopik darurat dapat ditentukan sifat dari pe
r-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {darahan yang
sedang berlangsung. Beberapa ahli langsung}\par\pard\li1853\ri0\sl-320\slmult0 \
fs26\cf0\f0\charscalex100 {melakukan terapi sklerosis pada varises esofagus yang
pecah,}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sedangka
n ahli-ahli lain melakukan terapi dengan laser endos-}\par\pard\li1853\ri0\sl-32
0\slmult0 \fs26\cf0\f0\charscalex100 {kopik pada perdarahan lambung dan esofagus
. Keuntungan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lai
n dari pemeriksaan endoskopik adalah dapat dilakukan}\par\pard\li1853\ri0\sl-320
\slmult0 \fs26\cf0\f0\charscalex100 {pengambilan foto slide, film atau video unt
uk dokumentasi,}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {
juga dapat dilakukan aspirasi serta biopsi untuk pemeriksaan}\par\pard\li1853\ri
0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sitologi.}\par\pard\li1853\ri0\sl-3
20\slmult0 \fs26\cf0\f0\charscalex100 { Pemeriksaan ultrasonografi dan scanning h
ati}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Pemeriksaan
ultrasonografi dapat menunjang diagnosa}\par\pard\li1853\ri0\sl-320\slmult0 \fs2
6\cf0\f0\charscalex100 {hematemesis/melena bila diduga penyebabnya adalah pecah}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {nya varises eso
fagus, karena secara tidak langsung memberi}\par\pard\li1853\ri0\sl-320\slmult0
\fs26\cf0\f0\charscalex100 {informasi tentang ada tidaknya hepatitis kronik, sir
osis hati}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dengan
hipertensi portal, keganasan hati dengan cara yang}\par\pard\li1853\ri0\sl-320\
slmult0 \fs26\cf0\f0\charscalex100 {non invasif dan tak memerlukan persiapan ses
udah perdarahan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {
akut berhenti.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {D
engan alat endoskop ultrasonografi, suatu alat endoskop}\par\pard\li1853\ri0\sl320\slmult0 \fs26\cf0\f0\charscalex100 {mutakhir dengan transducer ultrasonograf
i yang berputar}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {
di ujung endoskop, maka keganasan pada lambung dan pan-}\par\pard\li1853\ri0\sl320\slmult0 \fs26\cf0\f0\charscalex100 {kreas juga dapat dideteksi.}\par\pard\li
1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Pemeriksaan scanning hati ha
nya dapat dilakukan di rumah}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\ch
arscalex100 {sakit besar yang mempunyai bagian kedokteran nuklir. Dengan}\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {pemeriksaan ini diagnos
a sirosis hati dengan hipertensi portal}\par\pard\sect\sectd\sbkpage\pgwsxn11893
\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\
charscalex100 {atau suatu keganasan di hati dapat ditegakkan.}\par\pard\li1853\r
i0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\b {PENANGANAN PERDARAHAN SMBA}\b0 \
par\pard\li1853\ri0\sl-346\slmult0 \fs26\cf0\f0\charscalex100\b {Tindakan umum}\
b0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {1. Resusitasi
}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {2. Lavas lambun
g}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {3. Hemostatika
}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {4. Antasida dan
simetidin}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\b {Tin
dakan khusus}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100\
i { Medik intensif}\i0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscale
x100 {1. Lavas air es dan vasopresor/trombin intragastrik}\par\pard\li1853\ri0\s
l-306\slmult0 \fs26\cf0\f0\charscalex100 {2. Sterilisasi dan}{ }\fs26\cf0\f0\cha
rscalex100\i {lavement usus}\i0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0

\charscalex100 {3. Beta bloker}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\
charscalex100 {4. Infus vasopresin}\par\pard\li1853\ri0\sl-293\slmult0 \fs26\cf0
\f0\charscalex100\i {5. Balontamponade}\i0 \par\pard\li1853\ri0\sl-320\slmult0 \
fs26\cf0\f0\charscalex100 {6. Sklerosis varises endoskopik}\par\pard\li1853\ri0\
sl-320\slmult0 \fs26\cf0\f0\charscalex100 {7. Koagulasi laser endoskopik}\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {8. Embolisasi varises t
ranshepatik}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\i { Ti
ndakan bedah}\i0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100
{1. Tindakan bedah darurat}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\char
scalex100 {2. Tindakan bedah elektif}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\c
f0\f0\charscalex100\b {Tindakan Umum}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs
20\cf0\f0\charscalex100\b {RESUSITASI}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \f
s26\cf0\f0\charscalex100\b \i {Infus/Transfusi darah}\b0 \i0 \par\pard\li1853\ri
0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Penderita dengan perdarahan 500 -1000cc perlu diberi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex1
00 {infus Dextrose 5%, Ringer laktat atau Nacl 0,9%. Pada pen-}\par\pard\li1853\
ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {derita sirosis hati dengan asites
/edema tungkai sebaiknya}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsc
alex100 {diberi infus Dextrose 5%. Penderita dengan}{ }\fs26\cf0\f0\charscalex10
0\b {perdarahan }\b0 \fs26\cf0\f0\charscalex100 {yang}\par\pard\li1853\ri0\sl-32
0\slmult0 \fs26\cf0\f0\charscalex100 {masif lebih dari 1000 cc dengan Hb kurang
dari 8g%, perlu}\par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {
segera ditransfusi. Pada }\fs26\cf0\f0\charscalex100\b {hipovolemik }\b0 \fs26\c
f0\f0\charscalex100 {ringan diberi transfusi}\par\pard\li1853\ri0\sl-333\slmult0
\fs26\cf0\f0\charscalex100 {sebesar 25% dari volume normal, }\fs26\cf0\f0\chars
calex100\b {sebaiknya dalam bentuk}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24
\cf0\f0\charscalex100 {Cermin Dunia Kedokteran No. 40, 1985 27}\par\pard\sect\se
ctd\sbkpage\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn
133\margtsxn666\margbsxn386\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\charscalex100 {darah segar. Pada
hipovolemik berat/syok, kadangkala diperlu-}\par\pard\li1853\ri0\sl-306\slmult0
\fs26\cf0\f0\charscalex100 {kan transfusi sampai 40 -- 50%}\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dari}\par\pard\li1853\ri0\sl-306\slmu
lt0 \fs26\cf0\f0\charscalex100 {volume normal. Kecepatan}\par\pard\li1853\ri0\sl
-306\slmult0 \fs26\cf0\f0\charscalex100 {transfusi berkisar pada 80 -- 100 tetes
atau dapat lebih cepat}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsca
lex100 {bila perdarahan masih terus berlangsung, sebaiknya di bawah}\par\pard\li
1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {pengawasan tekanan vena sent
ral. Pada perdarahan yang tidak}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0
\charscalex100 {berhenti perlu dipikirkan adanya DIC, defisiensi faktor pem-}\pa
r\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {bekuan path sirosis
hati yang lanjut atau fibrinolisis primer.}\par\pard\li1853\ri0\sl-320\slmult0
\fs26\cf0\f0\charscalex100 {Bilamana darah belum tersedia, dapat diberi infus pl
asma}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {ekspander m
aksimal 1000 cc, selang seling dengan Dextrose}\par\pard\li1853\ri0\sl-320\slmul
t0 \fs26\cf0\f0\charscalex100 {5%, karena plasma ekspander dapat mempengaruhi ag
regasi}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {trombosit
.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Setiap pemberi
an 1000 cc darah perlu diberi 10 cc kalsium}\par\pard\li1853\ri0\sl-320\slmult0
\fs26\cf0\f0\charscalex100 {glukonas i.v. untuk mencegah terjadinya keracunan as
am}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sitrat.}\par\
pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\b {LAVAS LAMBUNG DENGA
N AIR}\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {ES}\
b0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Setelah keada
an umum penderita stabil, dipasang pipa}\par\pard\li1853\ri0\sl-306\slmult0 \fs2
6\cf0\f0\charscalex100 {nasogastrik untuk aspirasi isi lambung dan lavas air es,
mula-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {mula seti
ap 30 menit}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {1 ja
m. Bila air kurasan lambung tetap}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\

f0\charscalex100 {merah, penderita terus dipuasakan. Sesudah air kurasan men-}\p
ar\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {jadi merah muda at
au jernih, maka disarankan dilakukan pe-}\par\pard\li1853\ri0\sl-320\slmult0 \fs
26\cf0\f0\charscalex100 {meriksaan endoskopi yang dapat menentukan lokasi per-}\
par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {darahannya. Pada
perdarahan varises esofagus yang tidak}\par\pard\li1853\ri0\sl-306\slmult0 \fs26
\cf0\f0\charscalex100 {berhenti setelah lavas air es, diperlukan tindakan medik}
\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {intensif yang ak
an dibicarakan kemudian.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charsc
alex100 {Sedangkan pada perdarahan ulkus peptikum, gastritis}\par\pard\li1853\ri
0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {hemoragika dan lainnya, setelah per
darahan berhenti dapat}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscal
ex100 {mulai diberi susu}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {+}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {aqua
calcis 50 -- 100 cc/jam, dan secara}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf
0\f0\charscalex100 {bertahap ditingkatkan pada diit makanan lunak/bubur saring}\
par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dalam porsi kecil
setiap 1 -- 2 jam.}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex1
00\b {HEMOSTATIKA}\b0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscale
x100 {Yang dianjurkan adalah pemberian Vitamin K dalam dosis}\par\pard\li1853\ri
0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {10 -- 40 mg sehari parenteral, kare
na bermanfaat untuk mem-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsc
alex100 {perbaiki- defisiensi kompleks protrombin. Pemberian asam}\par\pard\li18
53\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {traneksamat dan karbazokrom da
pat pula diberikan.}\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex1
00\b {ANTASIDA DAN SIMETIDIN}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f
0\charscalex100 {Pemberian antasida secara intensif 10 -- 15 cc setiap jam di-}\
par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {sertai simetidin
200 mg tiap 4 -- 6 jam i.v. berguna untuk}\par\pard\li1853\ri0\sl-306\slmult0 \f
s26\cf0\f0\charscalex100 {menetralkan dan menekan sekresi asam lambung yang ber}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {lebihan, teruta
ma pada penderita dengan ulkus peptikum dan}\par\pard\sect\sectd\sbkpage\pgwsxn1
1893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0
\f0\charscalex100 {gastritis hemoragika. Bila perdarahan berhenti, antasida di-}
\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {berikan dalam do
sis lebih rendah setiap 3 -- 4 jam 10 cc, de-}\par\pard\li1853\ri0\sl-320\slmult
0 \fs26\cf0\f0\charscalex100 {mikian juga simetidin dapat diberi per oral 200 mg
tiap 4 -- 6}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {jam
.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Sebagai pengga
nti simetidin dapat diberikan :}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0
\charscalex100 {-- sucralfate sebanyak 1 -- 2 gram tiap 6 jam melalui pipa}\par\
pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {nasogastrik, kemudian
per oral.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-- pi
renzepin 20 mg tiap 8 jam i.v. atau 50 mg tablet tiap 12}\par\pard\li1853\ri0\sl
-306\slmult0 \fs26\cf0\f0\charscalex100 {jam.}\par\pard\li1853\ri0\sl-320\slmult
0 \fs26\cf0\f0\charscalex100 {-- somatostatin dilarutkan dalam infus NaCl 0,9% d
engan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dosis 250
ug/jam.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100\b {Tindak
an khusus}\b0 \par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {
MEDIK INTENSIF}\b0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex10
0\b \i {Lavas}\b0 \i0 \par\pard\li1853\ri0\sl-293\slmult0 \fs22\cf0\f0\charscale
x100\b \i {air es}\b0 \i0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\chars
calex100\b \i {dan vasopresor/trombin intragastrik}\b0 \i0 \par\pard\li1853\ri0\
sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Bila perdarahan tetap berlangsung, di
coba lavas lambung}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex10
0 {dengan air es ditambah 2 ampul Noradrenalin atau Aramine}\par\pard\li1853\ri0
\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {2 -- 4 mg dalam 50 cc air. Dapat pul
a diberikan bubuk trom-}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca

lex100 {28 Cermin Dunia Kedokteran No. 40, 1985}\par\pard\li1853\ri0\sl-306\slmu
lt0 \fs26\cf0\f0\charscalex100 {bin (Topostasin) misalnya 1 bungkus tiap 2 jam m
elalui pipa}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {naso
gastrik. Ada ahli yang menyemprotkan larutan trombin}\par\pard\li1853\ri0\sl-320
\slmult0 \fs26\cf0\f0\charscalex100 {melalui saluran endoskop tepat di daerah pe
rdarahan di lam-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100
{bung, sehingga di bawah pengawasan endoskopik dapat meng-}\par\pard\li1853\ri0\
sl-320\slmult0 \fs26\cf0\f0\charscalex100 {ikuti langsung apakah perdarahannya b
erhenti dan apakah}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex10
0 {terbentuk gumpalan darah yang agak besar yang perlu aspirasi}\par\pard\li1853
\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dengan endoskop.}\par\pard\li185
3\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\b \i {Sterilisasi usus dan lavem
ent usus}\b0 \i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs26\cf0\f0\charscalex100
{Terutama pada penderita sirosis hati dengan perdarahan}\par\pard\li1853\ri0\sl306\slmult0 \fs26\cf0\f0\charscalex100 {varises esofagus perlu dilakukan tindaka
n pencegahan terjadi-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscale
x100 {nya koma hepatikum/ensefalopati hepatik yang disebabkan}\par\pard\li1853\r
i0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {antara lain oleh peningkatan produ
ksi amoniak pada pe-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex
100 {mecahan protein darah oleh bakteri usus.}\par\pard\li1853\ri0\sl-306\slmult
0 \fs26\cf0\f0\charscalex100 {Hal ini dapat dilakukan dengan jalan :}\par\pard\l
i1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-- Sterilisasi usus dengan
antibiotika yang tidak dapat diserap}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\c
f0\f0\charscalex100 {misalnya Neomisin 4 x 1 gram atau Kanamycin 4 x 1 gram/}\pa
r\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {hari, sehingga pemb
uatan amoniak oleh bakteri usus ber-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\c
f0\f0\charscalex100 {kurang.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\ch
arscalex100 {-- Dapat diberikan pula laktulosa atau sorbitol 200 gram/hari}\par\
pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dalam bentuk larutan
400 cc yang bersifat laksansia ringan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\
cf0\f0\charscalex100 {atau magnesiumsulfat 15g/400cc melalui pipa nasogastrik.}\
par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Selain itu perlu
dilakukan}{ }\fs26\cf0\f0\charscalex100\i {lavement usus }\i0 \fs26\cf0\f0\chars
calex100 {dengan air biasa se-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\
charscalex100 {tiap 12 -- 24 jam. Untuk pencegahan ensefalopati hepatik}\par\par
d\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dapat diberi infus Amino
fusin Hepar 1000 -- 1500 cc per hari.}\par\pard\sect\sectd\sbkpage\pgwsxn11893\p
ghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\pard\li1853\ri0\sl-21
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\ch
arscalex100 {Bila penderita telah berada dalam keadaan prekoma atau koma}\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {hepatikum, dianjurkan p
emberian infus Comafusin Hepar}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\
charscalex100 {1000 -- 1500 cc per hari.}\par\pard\li1853\ri0\sl-266\slmult0 \fs
22\cf0\f0\charscalex100\b \i {Beta}\b0 \i0 \par\pard\li1853\ri0\sl-333\slmult0 \
fs26\cf0\f0\charscalex100\b \i {Bloker}\b0 \i0 \par\pard\li1853\ri0\sl-333\slmul
t0 \fs26\cf0\f0\charscalex100 {Pemberian obat-obat golongan beta bloker non sele
ktif}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {seperti pro
panolol, oksprenolol, alprenolol ternyata dapat}\par\pard\li1853\ri0\sl-320\slmu
lt0 \fs26\cf0\f0\charscalex100 {menurunkan tekanan vena porta pada penderita sir
osis hati,}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {akiba
t penurunan curah jantung sehingga aliran darah ke}\par\pard\li1853\ri0\sl-306\s
lmult0 \fs26\cf0\f0\charscalex100 {hati dan gastrointestinal akan berkurang. Oba
t golongan beta}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {
bloker ini tidak dapat diberikan pada penderita syok atau}\par\pard\li1853\ri0\s
l-306\slmult0 \fs26\cf0\f0\charscalex100 {payah jantung, juga pada penderita asm
a dan penderita ganggu-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsca
lex100 {an irama jantung seperti bradikardi/AV Blok.}\par\pard\li1853\ri0\sl-306
\slmult0 \fs26\cf0\f0\charscalex100\b \i {Infus Vasopresin}\b0 \i0 \par\pard\li1
853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Vasopresin mempunyai efek kon

traksi pada otot polos}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscal
ex100 {seluruh sistem baskuler sehingga terjadi penurunan aliran}\par\pard\li185
3\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {darah di daerah splanknik, yang
selanjutnya menyebabkan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsc
alex100 {penurunan tekanan portal. Karena pembuluh darah arteri}\par\pard\li1853
\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {gastrika dan mesenterika ikut me
ngalami kontraksi, maka se-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\cha
rscalex100 {lain di esofagus, perdarahan dalam lambung dan doudenum}\par\pard\li
1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {juga ikut berhenti.}\par\par
d\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Vasopresin terutama dibe
rikan pada penderita perdarahan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0
\charscalex100 {varises esofagus yang perdarahannya tetap berlangsung setelah}\p
ar\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lavas lambung deng
an air es. Cara pemberian vasopresin ialah}\par\pard\li1853\ri0\sl-320\slmult0 \
fs26\cf0\f0\charscalex100 {20 unit dilartkan dalam 100 -- 200 cc Dextrose 5%, di
beri-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {kan dalam
10 -- 20 menit intravena.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\chars
calex100 {Efek samping pada pemberian secara cepat ini yang pernah}\par\pard\li1
853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dilaporkan adalah angina pekt
oris, infark miokard, fibrilasi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0
\charscalex100 {ventrikel dan kardiak arest pada penderita}\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-293\slmult0
\fs26\cf0\f0\charscalex100 {penderita jantung}\par\pard\li1853\ri0\sl-320\slmul
t0 \fs26\cf0\f0\charscalex100 {koroner dan usia lanjut, karena efek vaso kontrik
si}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dari}\par\par
d\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {vaso-}\par\pard\li1853\r
i0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {presin pada arteri koroner. Selain
itu juga ada penderita yang}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\ch
arscalex100 {mengeluh tentang kolik abdomen, rasa mual, diare. Beberapa}\par\par
d\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {ahli lain menganjurkan p
emberian infus vasopresin dengan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f
0\charscalex100 {dosis rendah, yaitu 0,2 unit vasopresin per menit untuk 16}\par
\pard\sect\sectd\sbkpage\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsx
0 \fs18\cf0\par\pard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\charscalex100 {jam p
ertama dan bila perdarahan berhenti setelah itu, dosis}\par\pard\li1853\ri0\sl-3
06\slmult0 \fs26\cf0\f0\charscalex100 {diturunkan 0,1 unit per menit untuk 8 jam
berikutnya. Pada}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100
{cara pemberian infus vasopresin dosis rendah lebih sedikit}\par\pard\li1853\ri
0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {efek sampingyang ditemukan.}\par\pa
rd\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Efek vasopresin dalam m
enghentikan perdarahan SMBA}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\cha
rscalex100 {berkisar antara 35 - 100%,}\par\pard\li1853\ri0\sl-320\slmult0 \fs26
\cf0\f0\charscalex100 {perdarahan ulang timbul pada}\par\pard\li1853\ri0\sl-320\
slmult0 \fs26\cf0\f0\charscalex100 {21 - 100% dan mortalitas berkisar pada 21 80%.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Balontampon
ade}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Tamponade de
ngan balon jenis Sengstaken Blakemore Tube}\par\pard\li1853\ri0\sl-306\slmult0 \
fs26\cf0\f0\charscalex100 {atau Linton Nachlas Tube diperlukan pada penderita -p
enderita}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {varises
esofagusyang perdarahannya tetap berlangsung setelah}\par\pard\li1853\ri0\sl-30
6\slmult0 \fs26\cf0\f0\charscalex100 {lavas lambung dan pemberian infus vasopres
in. Tindakan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {pem
asangan balon ini merupakan pilihan pertama pada pen-}\par\pard\li1853\ri0\sl-30
6\slmult0 \fs26\cf0\f0\charscalex100 {derita jantung koroner dan usia lanjut,}\p
ar\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {yang tidak dapat d
i-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {berikan infus
vasopresin.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Pri
nsip bekerjanya SB atau LN Tube adalah mengembang-}\par\pard\li1853\ri0\sl-320\s

lmult0 \fs26\cf0\f0\charscalex100 {kan balon di daerah kardia dan esofagus yang
akan menekan,}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {da
n dengan demikian menghentikan perdarahan}\par\pard\li1853\ri0\sl-320\slmult0 \f
s26\cf0\f0\charscalex100 {di esofagus}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\
cf0\f0\charscalex100 {dan kardia. SB Tube terdiri dari 2 balon, masing-masing un
tuk}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {lambung dan
esofagus, sedangkan LN Tube terdiri hanya dari}\par\pard\li1853\ri0\sl-306\slmul
t0 \fs26\cf0\f0\charscalex100 {1 balon yang mengkompresi daerah distal esofagus
dan kardia.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Prot
okol pemasangan SB Tube :}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\chars
calex100 {-- Penderita secara klinis menderita perdarahan varises esofa-}\par\pa
rd\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {gus, bila mungkin telah
diendoskopi.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-Keadaan umum cukup baik, tidak koma/syok/gelisah dan}\par\pard\li1853\ri0\sl-30
6\slmult0 \fs26\cf0\f0\charscalex100 {kooperatif.}\par\pard\li1853\ri0\sl-320\sl
mult0 \fs26\cf0\f0\charscalex100 {-- Pemasangan dilakukan sedini mungkin, kurang
dari 12 jam}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {set
elah dirawat.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-Sebelumnya dilakukan lavas lambung untuk mengeluarkan}\par\pard\li1853\ri0\sl-3
06\slmult0 \fs26\cf0\f0\charscalex100 {isi lambung terutama gumpalan darah.}\par
\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-- Pemasangan dilaku
kan oleh dokter atau perawat yang ber-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26
\cf0\f0\charscalex100 {pengalaman.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0
\f0\charscalex100 {-- Balon SB sebelum dipasang harus dites tidak bocor dan}\par
\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {kemudian diolesi den
gan salep zylocain atau parafin.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f
0\charscalex100 {--SB Tube dimasukkan secara perlahan-lahan melalui lubang}\par\
pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {hidung, sambil pender
ita disuruh menelan sampai SB Tube}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0
\f0\charscalex100 {masuk ke lambung, hingga garis ukuran pipa bagian luar}\par\p
ard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {menunjukkan 50 cm deka
t lubang hidung.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100
{-- Balon lambung dikembangkan dengan 30 - 50 cc udara dan}\par\pard\li1853\ri0\
sl-320\slmult0 \fs26\cf0\f0\charscalex100 {SB Tube ditarik perlahan-lahan ke lua
r sampai balon lam-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex1
00 {bung mencapai kardia dan terasa adanya tahanan}\par\pard\sect\sectd\sbkpage\
pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn426\pard\li1
s26\cf0\f0\charscalex100 {pada pe-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0
\f0\charscalex100 {narikan lebih lanjut. Angka pada garis ukuran SB}\par\pard\li
1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Tube di}\par\pard\li1853\ri0
\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lubang hidung berkisar antara 40 - 4
5 cm.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {-- SB Tube
difiksasi dengan plester, balon esofagus kemudian}\par\pard\li1853\ri0\sl-306\s
lmult0 \fs26\cf0\f0\charscalex100 {dikembangkan dengan 100 - 200 cc}\par\pard\li
1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {udara tergantung}\par\pard\l
i1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {ukuran SB Tube.}\par\pard\l
i1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {-- Penderita dipuasakan sel
ama SB}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Tube terp
asang. Lavas}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lam
bung dan pemberian obat -obatan dapat dilakukan me}\par\pard\li1853\ri0\sl-173\s
lmult0 \fs14\cf0\f0\charscalex100 {-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\c
f0\f0\charscalex100 {lalui pipa sentral. Sekret}\par\pard\li1853\ri0\sl-306\slmu
lt0 \fs26\cf0\f0\charscalex100 {di hipofaring perlu diaspirasi}\par\pard\li1853\
ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {secara berkala.}\par\pard\li1853\
ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {-- Pemasangan SB Tube berkisar an
tara 12 - 24 jam, kemudi-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\chars
calex100 {an dicoba dikempeskan dari dikontrol tiap-tiap jam dengan}\par\pard\li
1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lava lambung apakah terjadi

perdarahan ulang. Bila terjadi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\
charscalex100 {perdarahan ulang, balon SB Tube yang belum ditarik ke-}\par\pard\
li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {luar itu dapat segera dike
mbangkan kembali. SB}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex
100 {Tube di-}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {pa
sang maksimal48 jam.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex
100 {Menurut laporan peneliti -peneliti, pemasangan SB Tube dapat}\par\pard\li18
53\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {menghentikan 55 - 92%}\par\par
d\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {perdarahan varises esofa
gus, tetapi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {25 60%}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {penderita k
emudian mengalami perdarahan ulang,}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf
0\f0\charscalex100 {sedangkan mortalitas berkisar antara}\par\pard\li1853\ri0\sl
-306\slmult0 \fs26\cf0\f0\charscalex100 {20 - 60%.}\par\pard\li1853\ri0\sl-320\s
lmult0 \fs26\cf0\f0\charscalex100 {Komplikasi}\par\pard\li1853\ri0\sl-306\slmult
0 \fs26\cf0\f0\charscalex100 {pemasangan SB Tube adalah obstruksi laring serta a
sfiksi}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {akibat mi
grasi balonke hipofaring dan ulserasi esofagus, karena}\par\pard\li1853\ri0\sl-3
20\slmult0 \fs26\cf0\f0\charscalex100 {pemasangan terlalu lama.}\par\pard\li1853
\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100\b \i {Sklerosis varises endoskopi
k}\b0 \i0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Sejak
1970 ahli-ahli mencoba menghentikan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf
0\f0\charscalex100 {perdarahan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\
charscalex100 {varises esofagus dengan penyuntikan bahan-bahan sklerotik}\par\pa
rd\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {seperti etanolamin, pol
idokanol,}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sodium
morrhuate melalui}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex10
0 {esofagoskop kaku atau serat optik. Karena pemakaian eso-}\par\pard\li1853\ri0
\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {fagoskop kaku membutuhkan anestesi u
mum, dan sebagai}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100
{komplikasi dapat terjadi ruptur esofagus, maka metoda ini}\par\pard\li1853\ri0\
sl-320\slmult0 \fs26\cf0\f0\charscalex100 {telah ditinggalkan. Sekarang lebih ba
nyak digunakan endoskop}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charsca
lex100 {serat optik baik yang umum maupun yang khusus dengan 2}\par\pard\sect\se
ctd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn
666\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0
0\slmult0 \fs26\cf0\f0\charscalex100 {saluran, sehingga sewaktu penyuntikan dila
kukan melalui}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sa
luran pertama, penghisapan perdarahan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\
cf0\f0\charscalex100 {yang mungkin ter-}\par\pard\li1853\ri0\sl-306\slmult0 \fs2
6\cf0\f0\charscalex100 {jadi dapat dilakukan melalui saluran kedua. Teknik penyu
ntik-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {an dapat p
aravasal atau intravasal. Terapi ini dapat}\par\pard\li1853\ri0\sl-306\slmult0 \
fs26\cf0\f0\charscalex100 {dilakukan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\c
f0\f0\charscalex100 {segera setelah hematemesis berhenti, tetapi tergantung}\par
\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dari}\par\pard\li185
3\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {keahlian dokternya dapat dilaku
kan juga pada penderita yang}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\ch
arscalex100 {sedang mengalami perdarahan akut, bila tindakan medik in-}\par\pard
\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {tensif lainnya tidak berh
asil. Di sini perdarahan dapat dihenti-}\par\pard\li1853\ri0\sl-320\slmult0 \fs2
6\cf0\f0\charscalex100 {kan pada 80 - 100%, perdarahan ulang terjadi pada 10 - 4
0%}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {sedangkan mor
talitas selama dirawat mencapai 30%.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\c
f0\f0\charscalex100 {Bila perdarahan dapat dihentikan dengan SB}\par\pard\li1853
\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Tube atau}\par\pard\li1853\ri0\s
l-320\slmult0 \fs26\cf0\f0\charscalex100 {infus vasopresin, terapi sklerosis ini
dilakukan beberapa hari}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsc
alex100 {kemudian. Varises yang luas umumnya membutuhkan 2 - 3 x}\par\pard\li185

3\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {terapi dengan jangka waktu 7 10 hari.}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Mortali
tas penderita yang diterapi dalam stadium interval}\par\pard\li1853\ri0\sl-306\s
lmult0 \fs26\cf0\f0\charscalex100 {ini lebih rendah 4 - 14%.}\par\pard\li1853\ri
0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Komplikasi metoda ini yang pernah d
ilaporkan adalah nyeri}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscal
ex100 {retrosternal, ulserasi, nekrosis, striktur dan stenosis}\par\pard\li1853\
ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {dari eso-}\par\pard\li1853\ri0\sl
-306\slmult0 \fs26\cf0\f0\charscalex100 {fagus, effusi pleura, mediastinitis.}\p
ar\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100\b \i {Koagulasi las
er e}\b0 \i0 \par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100\b \i
{ndoskopik}\b0 \i0 \par\pard\li1853\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex1
00 {Bila pemberian vasopresin, pemasangan SB Tube dan skle-}\par\pard\li1853\ri0
\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {rosis varises endiskopik gagal dalam
menghentikan perdarahan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsc
alex100 {varises esofagus, mungkin dapat diterapkan terapi koagulasi}\par\pard\l
i1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dengan Argon/Neodym Yag}\pa
r\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {Laser secara endosk
opik. Ada}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {ahli y
ang melaporkan keberhasilan sampai 91,3% (116 dari}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {Cermin Dunia Kedokteran}\par\pard\li1853\ri0\
sl-266\slmult0 \fs24\cf0\f0\charscalex100 {No. 40, 1985 29}\par\pard\sect\sectd\
sbkpage\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\
margtsxn666\margbsxn360\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
ard\li1853\ri0\sl-440\slmult0 \fs26\cf0\f0\charscalex100 {127 penderita). Hanya
alat ini sangat mahal.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscal
ex100 {Demikian juga perdarahan SMBA lainnya seperti pada ulkus}\par\pard\li1853
\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {peptikum dan keganasan ternyata
dapat dihentikan dengan}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charsca
lex100 {koagulasi laser endoskopik.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100\b \i {Embolisasi varises transhepatik}\b0 \i0 \par\pard\li185
3\ri0\sl-333\slmult0 \fs26\cf0\f0\charscalex100 {Caranya, dengan tuntunan ultras
onografi dimasukkan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex1
00 {jarum ke dalam hati sampai mencapai vena porta yang me-}\par\pard\li1853\ri0
\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lebar, kemudian disorong kateter mel
alui mandrin tersebut}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscale
x100 {sepanjang vena porta sampai mencapai vena koronaria gastrika}\par\pard\li1
853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {dan disuntikkan kontras angio
grafin. Pada transhepatik portal-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\
f0\charscalex100 {venografi ini akan terlihat vena-vena kolateral utama termasuk
}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {varises esofagu
s. Selanjutnya sebanyak 30 -- 50 cc Dextrose}\par\pard\li1853\ri0\sl-320\slmult0
\fs26\cf0\f0\charscalex100 {50% disuntikkan melalui kateter diikuti dengan sunt
ikan}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {trombin, di
tambah}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {gel foa
m}\i0 \par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {atau otole
in. Perdarahan varises}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscal
ex100 {esofagus umumnya segera berhenti.}\par\pard\li1853\ri0\sl-320\slmult0 \fs
26\cf0\f0\charscalex100 {Metoda ini belum banyak laporannya dalam kepustakaan,}\
par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {karena tekniknya
sukar dan sering mengalami kegagalan yang}\par\pard\li1853\ri0\sl-320\slmult0 \f
s26\cf0\f0\charscalex100 {disebabkan trombosis vena porta atau adanya asites. Ko
mpli-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {kasi yang
membahayakan adalah perdarahan intraperitoneal}\par\pard\li1853\ri0\sl-306\slmul
t0 \fs26\cf0\f0\charscalex100 {dari bekas tusukan jarum tersebut. Seorang peneli
ti melapor-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {kan
bahwa 5 bulan sesudah embolisasi timbul varises esofagus}\par\pard\li1853\ri0\sl
-306\slmult0 \fs26\cf0\f0\charscalex100 {yang baru.}\par\pard\li1853\ri0\sl-240\
slmult0 \fs20\cf0\f0\charscalex100\b {TINDAKAN BEDAH}\b0 \par\pard\li1853\ri0\sl

-333\slmult0 \fs26\cf0\f0\charscalex100 {Setelah usaha-usaha medik intensif di a
tas mengalami ke-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100
{gagalan dan perdarahan masih berlangsung, maka perlu di-}\par\pard\li1853\ri0\
sl-306\slmult0 \fs26\cf0\f0\charscalex100 {lakukan tindakan bedah darurat, seper
ti pintasan portosiste-}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charsca
lex100 {mik atau transeksi esofagus untuk perdarahan varises esofagus.}\par\pard
\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Perdarahan dari ulkus pep
tikum ventrikuli atau duodeni serta}\par\pard\li1853\ri0\sl-320\slmult0 \fs26\cf
0\f0\charscalex100 {keganasan SMBA yang tidak berhenti dalam 48 jam juga me-}\pa
r\pard\li1853\ri0\sl-320\slmult0 \fs26\cf0\f0\charscalex100 {merlukan tindakan b
edah.}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {Bila tidak
diperlukan tindakan bedah darurat, setelah ke-}\par\pard\li1853\ri0\sl-320\slmu
lt0 \fs26\cf0\f0\charscalex100 {adaan umum penderita membaik dan pemeriksaan dia
gnostik}\par\pard\li1853\ri0\sl-306\slmult0 \fs26\cf0\f0\charscalex100 {telah se
lesai dilakukan, dapat dilakukan tindakan bedah}\par\pard\li1853\ri0\sl-320\slmu
lt0 \fs26\cf0\f0\charscalex100 {elektif setelah 6 minggu.}\par\pard\li1853\ri0\s
l-240\slmult0 \fs20\cf0\f0\charscalex100\b {KEPUSTAKAAN}\b0 \par\pard\li1853\ri0
\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {1. Abdurachman}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {SA,}\par\pard\li1853\ri0\sl-266\slmul
t0 \fs24\cf0\f0\charscalex100 {Hematemesis dan Melena. Tinjauan kasus}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {di}\par\pard\li1853\ri0\sl
-280\slmult0 \fs24\cf0\f0\charscalex100 {Bagian Ilmu Penyakit Dalam}\par\pard\li
1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {RS}\par\pard\li1853\ri0\sl-2
80\slmult0 \fs24\cf0\f0\charscalex100 {Hasan Sadikin}\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Bandung,}\par\pard\li1853\ri0\sl-266\slmult
0 \fs24\cf0\f0\charscalex100 {selama}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pg
hsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
rscalex100 {1970 - 1974. Proceeding}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf
0\f0\charscalex100 {KOPAPDI}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {III di Bandung, 1975.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {2. Gross R. Die}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {akute Magen-Darmblutung}\par\pard\li1853\ri0\sl-266\slmult0 \f
s24\cf0\f0\charscalex100 {in Der}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {internistische Not-}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {fall, F.K. Sehattauer Verlag}\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {Stuttgart 1973,}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {haL}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {545 - 576.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f
0\charscalex100 {3. Fruhmorgen}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {P.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Neue Verfahren zur Blutstillung dalam}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {Operative}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\
f0\charscalex100 {Endoskopie. Acron Verlag}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {1979,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {haL}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100 {83 - 90.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {4.
Hadi}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {S.}\par\pa
rd\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Hematemesis Melena dala
m Gastroenterologi.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {Alumni}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Bandu
ng 1981,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hal}\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {161- 191.}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5. Hadi}\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {S.}\par\pard\li1853\ri0\sl-266\sl
mult0 \fs24\cf0\f0\charscalex100 {Langkah pendekatan penatalaksanaan perdarahan
saluran}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {makan ba
gian atas. Makalah pada pertemuan Ilmiah PPHI ke}\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {3.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf

0\f0\charscalex100 {Kongres PGI/PEGI}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {Palembang 1 -- 3}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Agustus}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
harscalex100 {1985.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex1
00 {6. Hernomo}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {K
.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Terapi medik p
erdarahan hipertensi}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex
100 {portal.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Buk
u}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ilmu Penyakit
Dalam Jilid}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {I,}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {th.}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1984}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {hal}\par\pard\li1853\ri0\sl-266\slmult0
\fs24\cf0\f0\charscalex100 {795 - 807.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {7. Kiefhaber}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {P.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscal
ex100 {Endoskopische Blutstillung blutender Osophagus und}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Magenvarizen mit Neodym-Yag-Laser dala
m}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\m
argtsxn666\margbsxn560\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100 {Operative}\par\pard\li1
853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Endoskopie}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {haL}\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {19 - 26.}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {8. Paquet KJ. Wandsklerosierung bei Osophagusvarizen
dalam}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Opera-}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {tive}\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Endoskopie. Acron Verlag,}\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Berlin,}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hal}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {33 - 46.}\par\pard\li1853\ri0\sl-266\slm
ult0 \fs24\cf0\f0\charscalex100 {9. Soehendra}\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {N.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {Sclerotherapy}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {of Oesophageal}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {Varices}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {by Means of}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Fibreendoscopy}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100
{in Clinical}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hep
atology.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Springe
r}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Verlag}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Berlin}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1983.}\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {10. Tondobala}\par\pard\li1853\ri0\sl-266\
slmult0 \fs24\cf0\f0\charscalex100 {TH.}\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {Hematemesis dan Melena. Buku Ilmu Penyakit}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Dalam}\par\pard\li1853\ri0\sl
-266\slmult0 \fs24\cf0\f0\charscalex100 {1984,}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {haL}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {737 - 743.}\par\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\c
harscalex100 {11. Westaby}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\chars
calex100 {D, Macdougall B, Williams R. New Approaches to the}\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Management of Portal Hypertension a
nd}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Variceal}\par
\pard\li1853\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Haemorrhage}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {in Clinical}\par\pard\li
1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hepatology.}\par\pard\li1853
\ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {Springer.}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Verlag}\par\pard\li1853\ri0\sl-280\slm

ult0 \fs24\cf0\f0\charscalex100 {Berlin 1983.}\par\pard\li1853\ri0\sl-266\slmult
0 \fs24\cf0\f0\charscalex100\i {Dibawakan pada Simposium Penyakit Hati}\i0 \par\
pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {Kalimantan}\i0 \par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {Timur,}\i0 \par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {Samarinda}\i0 \par\pa
rd\li1853\ri0\sl-213\slmult0 \fs20\cf0\f0\charscalex100\i {20}\i0 \par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {Oktober}\i0 \par\pard\li1853
\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100\i {1985}\i0 \par\pard\sect\sectd\
sbkpage
7;32768}}
3\margtsxn666\margbsxn360\cols2\colno1\colw8573\colsr-0\colno2\colw2520\pard\li1
f0\f0\charscalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li1853
\ri0\sl-360\slmult0 \fs30\cf0\f0\charscalex100 {11}\par\column\pard\li0\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100\b {Page 11}\b0 \par\pard\s
ect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Kardel dan Nielsen melaporkan bahwa
pada 34 pasien penyakit hati kronik }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha
rscalex100 {berat dijumpai adanya kelainan saraf perifer baik secara klinis maup
un secara}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {elektr
ofisiologis ataupun keduanya pada 31 orang pasien. Dilaporkan bahwa }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {gangguan}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {metabolik yang menyebabkan tergang
gunya fungsi membran akson. Penelitian }\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {lain}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {mendapatkan bahwa kejadian portosistemik shunt merupakan penyebab }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {terjadinya }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {kelainan saraf.}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Seneviratne dan Peir
is meneliti fungsi saraf perifer secara elektrofisiologis }\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pada }\par\pard\li1853\ri0\sl-293\slm

ult0 \fs24\cf0\f0\charscalex100 {50 pasien penyakit hati kronik. Dijumpai sebany
ak 34 pasien menunjukkan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {adanya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{peningkatan keadaan laten atau pengurangan amplitudo}{ }\fs24\cf0\f0\charscale
x100\i {evoked sensory }\i0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100\i {potential of }\i0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100\i {the median nerve}\i0 \fs24\cf0\f0\charscalex100 {. Secara kin
is gejala neuropati hanya terdeteksi pada 4 pasien }\par\pard\li1853\ri0\sl-280\
slmult0 \fs24\cf0\f0\charscalex100 {.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {Beberapa peneliti mendapatkan adanya hubungan antara disfu
ngsi autonomik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {d
engan penyakit hati menahun. Dimana juga didapatkan disfungsi autonomik }\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {baik}\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pada penyakit hati menahun alkohol
ik atau non alkoholik. Chaudry dkk }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {melaporkan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {disfungsi autonomik yang terjadi pada penderita sirosis hati meru
pakan bagian }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {da
ri }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {generalize
d sensory-motor polineuropathy}\i0 \fs24\cf0\f0\charscalex100 {. Dimana sebagian
besar penderita }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{disfungsi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {aut
onomik juga terbukti memiliki neuropati perifer.}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {Trevisani dkk melaporkan 30 penderita sirosis h
ati, 80% menunjukkan adanya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {disfungsi autonomik, dimana disfungsi autonomik ini berhubungan den
gan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {beratnya }\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sirosis hati (ber
dasarkan kriteria Child-Pugh) dan tidak berhubungan dengan }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {etiologi }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {penyakit hati.}\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {Dari uraian di atas penulis ingin meneliti
apakah ada hubungan beratnya}\par\pard\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\ch
arscalex100 {penyakit hati dengan disfungsi autonomik dan neuropati perifer pada
penderita }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {siro
sis }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hati , sepe
ngetahuan kami belum pernah dilakukan di Medan.}\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100\b {3.2. PERUMUSAN MASALAH}\b0 \par\pard\li1853\ri
0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {3.2.1. Apakah ada hubungan beratnya
disfungsi autonomik dengan beratnya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {sirosis }\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16
840\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage
7;32768}}

7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {hati (berdasarkan kr
iteria Child-Pugh)}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {3.2.2. Apakah ada hubungan neuropati perifer (sensorimotor) dengan beratnya }
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sirosis }\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati (berdasarkan krite
ria Child-Pugh)}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
3.2.3. Apakah ada korelasi antara disfungsi autonomik dengan neuropati }\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {perifer}\par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(sensorimotor) pada penderita si
rosis hati.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.
3. HIPOTESA}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {
3.3.1. Ada hubungan beratnya disfungsi autonomik dengan beratnya sirosis }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati}\par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {(berdasarkan kriteria Child-Pugh)
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3.3.2. Ada hubu
ngan neuropati perifer (sensorimotor) dengan beratnya sirosis }\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {(berdasarkan kriteria Child-Pugh)}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3.3.3. Ada korelasi }\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {antara disfungsi auto
nomik dengan neuropati perifer}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {(sensorimotor) pada penderita sirosis hati.}\par\pard\li1853\ri0\
sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.4.}\b0 \par\pard\li1853\ri0\sl-30
6\slmult0 \fs24\cf0\f0\charscalex100\b {TUJUAN PENELITIAN}\b0 \par\pard\li1853\r
i0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {3.4.1. Menilai adanya hubungan dis
fungsi autonomik pada penderita sirosis }\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {hati}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {3.4.2. Menilai adanya hubungan neuropati perifer (sensorimotor) pa
da }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita si
rosis }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {hati}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3.4.3. Mencari korel
asi antara disfungsi autonomik dan neuropati perifer pada}\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita sirosis hati.}\par\pard\li85
73\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 12}\b0 \par\pard\li1853
\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital l
ibrary}\i0 \par\pard\li1853\ri0\sl-360\slmult0 \fs30\cf0\f0\charscalex100 {12}\p

ar\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.5.}\b0 \par\pa
rd\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {MANFAAT PENELITIAN}\b
0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dengan ditemuk
annya disfungsi autonomik sebagai faktor resiko yang penting }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {terhadap mortalitas pada penderita
sirosis hati. Hasil ini dapat digunakan }\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {untuk}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {menentukan prognosa penyakit yang jelek.}\par\pard\li1853\ri0\sl
-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.}\b0 \par\pard\li1853\ri0\sl-306\
slmult0 \fs24\cf0\f0\charscalex100\b {BAHAN DAN CARA PENELITIAN}\b0 \par\pard\li
1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.1. Disain Penelitian}\
b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Penelitian in
i bersifat studi cross sectional.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\
f0\charscalex100\b {3.6.2. Waktu dan Tempat Penelitian}\b0 \par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Penelitian ini dilakukan mulai bulan
Juni 2001 sampai April 2002.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {Tempat penelitian Rumah Sakit Haji Adam Malik Medan.}\par\pard\li18
53\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.3. Subjek}\b0 \par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Kelompok kasus adalah pend
erita sirosis hati yang berobat jalan dan rawat }\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {inap,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {dilakukan pemeriksaan laboratorium: darah rutin, KGD N/2P
P, SGOT, SGPT,}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {a
lkalin fosfatase, gamma GT, bilirubin total, bilirubin direk, serum protein}\par
\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}

\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {elektroforesis, prot
rombin time, viral marker, USG hati, endoskopi,}\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {elektrokardiografi, dan EMG (elektromiografi).}\
par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.4. Kriteria
yang Diikutkan dalam Penelitian}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {Penderita sirosis hati yang ditegakkan berdasarkan klinis,
laboratorium, dan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{USG.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.5.
Kriteria yang Dikeluarkan}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\c
harscalex100 {Penderita sirosis hati dengan diabetes mellitus, ensefalopati, ane
mia berat (Hb }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {<
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {6 gr/dl), riwa
yat perdarahan 2 bulan sebelumnya, sedang diterapi dengan beta }\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {bloker.}\par\pard\li1853\ri0\sl306\slmult0 \fs24\cf0\f0\charscalex100\b {3.6.6. Jumlah Sampel}\b0 \par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Sampel yang diikutkan dalam p
enelitian adalah semua penderita sirosis hati}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {yang berobat jalan maupun yang opname di Rumah Sak
it Haji Adam Malik }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {Medan yang}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {m
emenuhi kriteria penelitian dan sesuai waktu penelitian.}\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {Prevalensi disfungsi autonomik pada pen
derita sirosis hati 80%.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {n = 27,31}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {30 orang}\par\pard\li1853\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100 {Dima
na: Z}\fs24\cf0\f3\charscalex100 {\uc1\u9001X }{ }\fs24\cf0\f0\charscalex100 {=1
,96; P: proporsi (80% atau 0,8); Q=(1-P)= 0,2 dan d : presisi }\par\pard\li1853\
ri0\sl-266\slmult0 \fs24\cf0\f0\charscalex100 {atau}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {besar penyimpangan pengukuran yang masih dap
at ditolerir = 15%.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {a : taraf signifikansi sebesar 5%.}\par\pard\li1853\ri0\sl-360\slmult0 \fs30
\cf0\f0\charscalex100 {Z a}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\char
scalex100 {2}\par\pard\li1853\ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100 {PQ}
\par\pard\li1853\ri0\sl-360\slmult0 \fs30\cf0\f0\charscalex100 {d}\par\pard\li18
slmult0 \fs30\cf0\f0\charscalex100 {1,96}\par\pard\li1853\ri0\sl-226\slmult0 \fs
scalex100 {X 0,8 X 0,2}\par\pard\li1853\ri0\sl-360\slmult0 \fs30\cf0\f0\charscal
ex100 {0,15}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {2}\p
ar\pard\li1853\ri0\sl-360\slmult0 \fs30\cf0\f0\charscalex100 {Besar sample }\par
ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100 {: n = }\par\pard\li1853\ri0\sl-36
0\slmult0 \fs30\cf0\f0\charscalex100 {=}\par\pard\li8573\ri0\sl-346\slmult0 \fs2
4\cf0\f0\charscalex100\b {Page 13}\b0 \par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li185
slmult0 \fs24\cf0\f0\charscalex100\b {3.6.7. Analisa Data}\b0 \par\pard\li1853\r
i0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Uji Signifikansi dengan Chi-square
test.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Uji korel
asi dengan Spearman Rank correlation.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\
cf0\f0\charscalex100\b {3.7. Persiapan Penderita}\b0 \par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {Tidak ada persiapan khusus untuk penderita.
Hanya diperlukan penerangan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c

harscalex100 {yang }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {baik kepada pasien bahwa akan dilakukan pemeriksaan saraf perifer dan }\par\
pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn
666\margbsxn400\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {ototnya. Untuk}\par\pard\li185
3\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {memproleh hasil yang sempurna d
iperlukan kerjasama yang baik antara pasien }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {pemeriksa untuk melakukan kontraksi otot yang akan diperiksa
. Perlu }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {diberit
ahukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {bahwa pem
eriksaan dilakukan dengan menggunakan stimulasi listrik dan }\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {kadang-}\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {kadang dengan jarum. Diterangkan bahwa peme
riksaan EMG tidak berbahaya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {sehingga }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {tidak perlu takut untuk diperiksa.}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100\b {3.8. PEMERIKSAN DISFUNGSI AUTONOMIK}\b0 \par\pard\li
1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Merupakan pemeriksaan test k
husus yang sederhana dan tidak invasif yang}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {dipakai untuk mendeteksi adanya disfungsi autonomik.
}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.8.1. Test M
enguji Kerusakan Saraf Parasimpatis}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs2
4\cf0\f0\charscalex100\b {3.8.1.1.Respon denyut jantung terhadap manuver valsava
}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Pasien meni
up melalui manometer aneroid atau spigmomanometer yang}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {dimodifikasi hingga tekanan 40 mmHg, dan
dipertahankan selama 15 detik. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0
\charscalex100 {Denyut }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca
lex100 {jantung diukur dengan rekaman EKG. Hasil ditunjukkan dengan rasio valsav
a }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {yaitu}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {perbandingan R-R terpan
jang setelah manuver dengan RR terpendek selama }\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {manuver.}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {Hasil normal jika rasio valsava > 1,21, border line 1,
11 \uc1\u8211X 1,20, abnormal < }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {1,10.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscal
ex100\b {3.8.1.2.}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscale
x100\b {Variasi denyut jantung (R-R interval) selama bernafas}\b0 \par\pard\li18
53\ri0\sl-333\slmult0 \*\tx2813\fs24\cf0\f0\charscalex100\b {dalam(}\b0 \fs24\cf
0\f0\charscalex100 {\uc1\u8710X}\tab \fs24\cf0\f0\charscalex100\b {R6)}\b0 \par\
pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Cara pemeriksaan: Pen
derita duduk atau berbaring dengan tenang dan }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {bernafas }\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {dalam sebanyak 6 kali per menit (5 detik inspirasi dan
5 detik ekspirasi). }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {Bersamaan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {d
engan itu dilakukan EKG. Dihitung selisih denyut jantung maksimal dengan }\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {denyut }\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {jantung minimal. Interpretasi
hasil: normal, selisih > 14 x/menit; border line, }\par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100 {selisih}\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {11 \uc1\u8211X 14 x/menit; abnormal, selisih < 11 x p
er menit.}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.8.
1.3.}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Respo
n denyut jantung setelah penderita berdiri (RR 30/15)}\b0 \par\pard\li1853\ri0\s
l-306\slmult0 \fs24\cf0\f0\charscalex100 {Cara pemeriksaan: Penderita berbaring
dengan tenang lebih kurang tiga menit, }\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {kemudian berdiri tanpa bantuan. Pantauan denyut jantung

dengan EKG }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dila
kukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sampai 15
denyut , kemudian tanpa berhenti dilanjutkan sampai dengan 30 }\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {denyut }\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {setelah berdiri. Dihitung panjang R-R ant
ara denyut 30 dan 15, lalu }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha
rscalex100 {bandingkan.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {Perbandingan antara denyut 30 dan 15 disebut dengan rasio 30/15. Interpr
etasi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hasil: }\
par\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {normal, rasio 30/15
: > 1.03; border line, rasio 30/ 15: 1.01 \uc1\u8211X 1.03; abnormal, }\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {rasio }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {30/15: < 1.01.}\par\pard\li8573\ri
0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 14}\b0 \par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital librar
y}\i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100 {14}\par\pa
rd\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.9. Test Menguji Ker

usakan Saraf Simpatis}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\chars
calex100\b {3.9.1.}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscal
ex100\b {Respon tekanan darah dari berbaring lalu berdiri}\b0 \par\pard\li1853\r
i0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Perubahan posisi dari posisi berba
ring ke berdiri akan menyebabkan terjadinya }\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {akumulasi sebagian besar darah di ekstremitas bawah
dan daerah splangnikus,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {sehingga terjadi penurunan curah jantung dan penurunan tekan darah. Pad
a }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {orang }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {normal keadaan ini aka
n menyebabkan terjadinya kompensasi sistim saraf }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {simpatis }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {melalui refleks baroreseptor . Adanya kegagalan sist
im simpatis oleh karena }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {neuropati }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {akan menyebabkan menurunnya tekanan darah sistolik maupun diastolik.}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Cara pemeriksaan: Pasie
n berbaring tenang dan diukur tekanan darah sistolik.}\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {Kemudian pasien disuruh berdiri tanpa bant
uan dan diukur tekanan darahnya. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {Tentukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {penurunan tekanan sistolik dari berbaring ke berdiri. Normal < 10 mmH
g, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {border line
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {11 \uc1\u8211X
29 mmHg, abnormal > 30 mmHg. Uji ini disebut dengan Schelong test.}\par\pard\li1
853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {3.9.2.}\b0 \par\pard\li1853
\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {Respon tekanan darah terhadap
Handgrip}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Tes
ini menggunakan alat Handgrip dinamometer dengan membuat tegangan}\par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sampai 30% dari maksimal sela
ma 5 menit, tekanan darah diukur 3 kali yaitu }\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {sebelum }\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {interval 1 menit selama beban handgrip. Hasilnya berupa
perbedaan di antara }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {tingginya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
tekanan diastolik selama beban handgrip dengan rata-rata tekanan diastolik }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sebelum }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dimulai handgrip. Respon no
rmal jika dijumpai peningkatan tekanan darah }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {diastolik > }\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {16 mmHg. border line: 11 \uc1\u8211X 15 mmHg, abnorma
l < 10 mmHg. Pemeriksaan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {ini}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {me
merlukan peralatan handgrip dinamometer untuk membuat pergerakan }\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {tangan dan}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dipertahankan dengan tekanan 30% da
ri tekanan maksimal.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100\b {4.}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {
Alat Pemeriksaan/ Pengukuran }\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\
f0\charscalex100 {4.1 Pemeriksaan Disfungsi Autonom :EKG \uc1\u8220XLogos serie
8821\uc1\u8221X}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
Early disfungsi autonom : Ditemukan 1 dari uji diatas hasil abnormal atau 2}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {borderline}\par\pard
\li1853\ri0\sl-280\slmult0 \fs22\cf0\f0\charscalex100 {Definite disfungsi autono
m: Ditemukan 1 abnormal dengan 2 borderline atau 2 }\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {uji abnormal.}\par\pard\sect\sectd\sbkpage

7;32768}}
7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {4.2. Pemeriksaan Ele
ktroneurografi : EMG \uc1\u8220XMedelec / TECA Sapphire II\uc1\u8221X}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dilakukan pemeriksaan untu
k menilai neuropati perifer secara objektif. }\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {Pemeriksaan dilakukan di Instalasi Diagnostik Terp
adu RS. H.Adam Malik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex
100 {Medan, oleh dokter ahli saraf.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {KHS motorik n. Median, abn < 48, n. Peroneus, abn < 40, n. T
ibialis < 40}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {KHS
sensorik n. Median abn < 40, n. Peroneus < 35, n. Suralis < 36 m/detik.}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {4.8.HASIL PENELITIAN}
\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Dari 30 oran
g penderita sirosis hati yang masuk penelitian terdiri dari 27 orang }\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {laki laki dan 3 orang pere
mpuan dengan umur rata rata 49,1 19,9 tahun, }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {dimana }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {umur termuda 23 tahun dan tertua 70 tahun.}\par\pard\li185
3\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dari 30 orang penderita sirosis
hati, dimana 8 (26,6%) termasuk dalam}\par\pard\li1853\ri0\sl-280\slmult0 \fs24
\cf0\f0\charscalex100 {klasifikasi Child -Pugh A, 12 (40 %) Child- Pugh B dan 10
(33,3%) Child- }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{Pugh C. Dari }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3

0 penderita 17 ( 56,6 %) dengan asites dan 13 (40,3 %) tanpa asites.}\par\pard\l
i8573\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 15}\b0 \par\pard\li1
853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digita
l library}\i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100 {15
}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {4.8.1. Hasil
Pemeriksaan Fungsi Autonom}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\
charscalex100 {Tabel.2 Uji fungsi autonom pada penderita sirosis hati}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Uji Fungsi autonom}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Normal}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Borderline}\par\pard\li1853\ri0\
sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Abnormal}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {? R6}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
{11}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {4}\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {RR 30/15}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {13}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
alex100 {2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {30}\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {TD Berbaring-berdi
ri}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {24}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {1}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {Dari tabel diatas tampak 13,3 % pemeriksaan fungsi autonom ? R6 abn
ormal }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {, 6,7 % R
R 30/15 dan hanya 3,3 % TD Berbaring-berdiri. Kerusakan lebih }\par\pard\li1853\
ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {sering pada }\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {saraf parasimpatis daripada simpatis
.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 3. Hubun
gan Beratnya Disfungsi Autonom dengan Beratnya Sirosis }\par\pard\li1853\ri0\sl280\slmult0 \fs24\cf0\f0\charscalex100 {Hati }\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {Child -Pugh}\par\pard\sect\sectd\sbkpage\pgwsxn118
93\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn400\pard\li1853\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
0\charscalex100 {Disfungsi Autonom}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {A}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {B}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {C}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Normal}\par\pard\li1853\ri0\sl-28
4\cf0\f0\charscalex100 {6}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {4}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {18}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Early}\par\pard\l
scalex100 {10}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {De
finite}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {0}\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {0}\par\pard\li1853\ri0\
\fs24\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {8}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {12}\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {10}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\sl-280\slmu
lt0 \fs24\cf0\f0\charscalex100 {Chi-Square . X}\par\pard\li1853\ri0\sl-173\slmul
t0 \fs14\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f

0\charscalex100 {= 10.8 df 4 p= 0.029}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Dari tabel diatas tampak 12 (40%) yang didapatkan disfungs
i autonomik ,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {di
mana 10 early (6 Child B dan 4 Child C) dan 2 definite Child C. Dengan uji }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {statistik }\par\pard
\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {didapat p< 0.05. Ada hubu
ngan beratnya disfungsi autonomik dengan beratnya }\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {sirosis }\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {hati}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100\b {4.8.2. Hasil Pemeriksaan Kecepatan Hantaran Saraf}\b0 \par\pa
rd\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 4. Hasil Pemeriks
aan Kecepatan Hantaran Saraf pada Penderita Sirosis }\par\pard\li1853\ri0\sl-280
\slmult0 \fs24\cf0\f0\charscalex100 {Hati}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {Neuropati Perifer (Sensorimotor)}\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Abnormal}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {Motorik n. Median}\par\pard\li1853\ri0\sl-28
0\slmult0 \fs24\cf0\f0\charscalex100 {16,7%}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {Motorik n. Peroneus}\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {23,3%}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {Motorik n. Tibialis}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {23,3 %}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {Sensorik n. Median}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf
0\f0\charscalex100 {56,7%}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {Sensorik n. Suralis }\par\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}

\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {66,7%}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Sensorik n. Ulnaris }\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {33,3%}\par\pard\li1853\ri
0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Dari tabel diatas pada penderita si
rosis yang terbanyak neuropati perifer }\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {sebanyak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {66,7% mengenai saraf sensorik Suralis, 56,7% mengenai sensorik
Median dan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {33,3
%}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sensorik Ulnar
is, 23,3%}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {masing
masing saraf motorik Tibia dan Peroneus , hanya }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {16,7% mengenai motorik Media.}\par\pard\li8573
\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 16}\b0 \par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital lib
rary}\i0 \par\pard\li1853\ri0\sl-360\slmult0 \fs30\cf0\f0\charscalex100 {16}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 5.Hub.Neuropat
i Perifer (motorik n. Median ) dengan Beratnya Sirosis }\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {Hati }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {Child Pugh}\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {A}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {B}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {C}\
par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Motorik n. Median: Normal}\
slmult0 \fs24\cf0\f0\charscalex100 {9}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
alex100 {Abnormal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {8}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{12}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {10}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Chi-Square . X}\par\pard\li1853\ri0\s
l-173\slmult0 \fs14\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {=13,3 df 2 p=0.004}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Dari tabel diatas ada 5 (16,5 %) yang mendapatkan
neuropati perifer pada }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {saraf}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {m
otorik Median dan dengan uji statistik didapat p<0,05. Didapat ada }\par\pard\li
1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hubungan}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {neuropati perifer ( motorik n.Media
n ) dengan beratnya sirosis hati.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\
f0\charscalex100 {Tabel 6. Hub.Neuropati Perifer ( Motorik n.Peroneus) dgn Berat
nya Sirosis }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Hat
i }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Child -Pugh}\
par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {A}\par\pard\li185
3\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {B}\par\pard\sect\sectd\sbkpage\
pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn373\pard\li1
s24\cf0\f0\charscalex100 {C}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha

rscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{Motorik n.Peroneus Normal}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {6}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {8}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {9}\par\pard\li18
\slmult0 \fs24\cf0\f0\charscalex100 {Abnormal}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {4}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{1}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {7}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {12}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {10}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex1
00 {30}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Chi-Squar
e . X}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {2}\par\par
d\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {=8,53 df 2 p=0,03}\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dari tabel diatas ada
7 (23,3%) neuropati perifer ( motorik n.Peroneus ) dan}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {dengan uji statistik didapat p<0,05 . Ada
hubungan neuropati perifer ( motorik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {n.Peroneus ) dengan beratnya beratnya hati.}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 7. Hub.Neuropati Perifer
(Motorik n.Tibialis) dengan Beratnya Sirosis }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {Child -Pugh}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {A}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {B}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {C}\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Motorik n. Tibialis: Normal}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\ri0\
\fs24\cf0\f0\charscalex100 {9}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
{Abnormal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3}\pa
r\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {3}\par\pard\li1853\
ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {1}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {7}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0
\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {8}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {12}\p
slmult0 \fs24\cf0\f0\charscalex100 {Chi-Square . X}\par\pard\li1853\ri0\sl-173\s
lmult0 \fs14\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {=8,53 df 2 p=0,03}\par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {Dari tabel diatas ada 7 (23,3%) neuropati perifer ( motor
ik n. Tibialis ) dan}\par\pard\sect\sectd\sbkpage
7;32768}}

7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {dengan uji statistik
didapat p <0,05 . Ada hubungan neuropati perifer ( motorik}\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {n.Tibialis ) dengan beratnya sirosis
hati.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 8.H
ub.Neuropati Perifer ( Sensoris n. Median ) dgn Beratnya Sirosis }\par\pard\li18
53\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Hati }\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {Child- Pugh}\par\pard\li1853\ri0\sl-293\
slmult0 \fs24\cf0\f0\charscalex100 {A}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\
cf0\f0\charscalex100 {B}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca
lex100 {C}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Total}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Sensorik n.Media
n: Normal}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {3}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\ri0\sl-293\slmu
lt0 \fs24\cf0\f0\charscalex100 {13}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {Abnormal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha
rscalex100 {5}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {7}
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5}\par\pard\li18
\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {8}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {12}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
10}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {30}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Chi-Square . X}\par\pard\l
80\slmult0 \fs24\cf0\f0\charscalex100 {= 0,53 df 2 p= 0,465}\par\pard\li8573\ri0
\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Page 17}\b0 \par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU digital library
}\i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100 {17}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Dari tabel diatas didapa
t 17 (56,7%) neuropati perifer( sensorik n. Median ) }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {dan }\par\pard\li1853\ri0\sl-293\slmult0 \

fs24\cf0\f0\charscalex100 {dengan uji statistik diadapat p >0,05. Tidak ada hubu
ngan antara neuropati }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscal
ex100 {perifer}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {(
sensorik n. Median ) dengan beratnya sirosis hati.}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {Tabel 9. Hub.Neuropati Perifer(Sensorik n. Su
ralis) dengan Beratnya Sirosis }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {Hati }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Child- Pugh}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{A}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {B}\par\pard\
li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {C}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {Sensorik n.Suralis : Normal}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {2}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {5}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {3}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
10}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Abnormal}\par
\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsx
n666\margbsxn426\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl
\slmult0 \fs22\cf0\f0\charscalex100 {7}\par\pard\li1853\ri0\sl-293\slmult0 \fs22
\cf0\f0\charscalex100 {7}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {20}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Tota
l}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {8}\par\pard\li
93\slmult0 \fs24\cf0\f0\charscalex100 {10}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {30}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\ch
arscalex100 {Chi-Square . X}\par\pard\li1853\ri0\sl-160\slmult0 \fs14\cf0\f0\cha
rscalex100 {2}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {=3
,33 df 2 p=0,680}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Dari tabel diatas didapat 20 (66,7%) neuropati perifer (sensorik n.Suralis ) da
n }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dengan uji st
atistik didapat p>0,05. Tidak ada hubungan neuropati perifer }\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {( sensorik}\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {n.Suralis) dengan beratnya sirosis hati
.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Tabel 10.Hub.N
europati Perifer (Sensorik n. Ulnaris) dgn Beratnya Sirosis }\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Hati }\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {Child- Pugh}\par\pard\li1853\ri0\sl-280\slmul
t0 \fs24\cf0\f0\charscalex100 {A}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {B}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex10
0 {C}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Total}\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Sensorik n. Ulnaris :
Normal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {4}\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {9}\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {7}\par\pard\li1853\ri0\sl-293\slmult
0 \fs24\cf0\f0\charscalex100 {20}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {Abnormal}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {4}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3}\p
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {10}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {Total}\par\pard\li1853\ri0\sl-280\slmult0 \fs
scalex100 {12}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {10
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {30}\par\pard\li
1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Chi-Square . X}\par\pard\li1
\slmult0 \fs24\cf0\f0\charscalex100 {= 3,33 df 2}\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {p=0,680}\par\pard\li1853\ri0\sl-293\slmult0 \fs
24\cf0\f0\charscalex100 {Dari tabel diatas didapat 10 ( 33 %) neuropati perifer

( sensorik n. Ulnaris )}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsca
lex100 {dengan uji statistik didapat p>0,05. Tidak ada hubungan neuropati perife
r }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {( sensorik}\p
ar\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {n.Ulnaris ) dengan
beratnya sirosis hati.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca
lex100\b {4.8.3. Korelasi }\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\
charscalex100\b {Antara Disfungsi Autonomik dengan Neuropati Perifer}\b0 \par\pa
rd\sect\sectd\sbkpage
7;32768}}
7;32768}}
\pard\li1853\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b {(Sensorimotor) pad
a Penderita Sirosis Hati}\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\ch
arscalex100 {Neuropati autonomik yang merupakan bagian dari }\fs24\cf0\f0\charsc
alex100\i {generalized sensori-motor }\i0 \par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100\i {polineuropathy}\i0 \fs24\cf0\f0\charscalex100 {, pen
derita dengan disfungsi autonomik juga mengalami }\par\pard\li1853\ri0\sl-280\sl
mult0 \fs24\cf0\f0\charscalex100 {neuropati}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {perifer ( sensorimotor ). Pada penelitian ini dari 1
2 penderita yang didapati }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {disfungsi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale

x100 {autonomik, 11 diantaranya juga didapati neuropati perifer ( sensorimotor )
. }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Pada}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {pemeriksaan uji fungsi a
utonom , variasi denyut jantung selama bernafas }\par\pard\li1853\ri0\sl-306\slm
ult0 \fs24\cf0\f0\charscalex100 {dalam (}{ }\fs24\cf0\f0\charscalex100 {\uc1\u87
10X}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {R6 ) dengan
neuropati perifer ( sensorik n. Suralis ) pada uji }\fs24\cf0\f0\charscalex100\b
{korelasi }\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b
{Spearman}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100 {d
engan}{ }\fs24\cf0\f0\charscalex100\b {r = 0,527 p= 0,003}\b0 { }\fs24\cf0\f0\ch
arscalex100 {. Ini menyatakan adanya korelasi yang kuat antara }\par\pard\li1853
\ri0\sl-320\slmult0 \*\tx5893\fs24\cf0\f0\charscalex100 {variasi denyut jantung
bernafas dalam (}\fs24\cf0\f0\charscalex100 {\uc1\u8710X}\tab \fs24\cf0\f0\chars
calex100 {R6 ) dengan neuropati perifer. }\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {Begitu juga }\par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {dengan respon denyut jantung dari berbaring ke berdiri (
RR 30/15 ) dengan }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex10
0 {neuropati }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {pe
rifer ( sensorik n. Suralis ) ,}{ }\fs24\cf0\f0\charscalex100\b {r = 0,456 p = 0
,010}\b0 \fs24\cf0\f0\charscalex100 {. Ini menyatakan ada }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {korelasi }\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {antara RR 30/15 dengan neuropati perifer (
sensorik n. Suralis ). Respon }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {tekanan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscal
ex100 {darah dari berbaring ke berdiri dengan neuropati perifer ( sensorik n. Su
ralis ), }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {r =}
\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {0,275 p= 0
,142.}\b0 { }\fs24\cf0\f0\charscalex100 {Tidak didapat korelasi antara respon TD
Berbaring-berdiri }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex1
00 {dengan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {neuro
pati perifer ( sensorik n. Suralis ). Juga tidak didapat adanya korelasi }\par\p
ard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {antara }\par\pard\li18
53\ri0\sl-306\slmult0 \fs22\cf0\f0\charscalex100 {disfungsi autonomik dengan neu
ropati perifer ( sensorik n Suralis ) ,}{ }\fs22\cf0\f0\charscalex100\b {r = 0.2
53 }\b0 \par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {p = }\
b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {0,505}\b0 \
fs24\cf0\f0\charscalex100 {.}\par\pard\li8573\ri0\sl-346\slmult0 \fs24\cf0\f0\ch
arscalex100\b {Page 18}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li1853\ri0\sl-34
24\cf0\f0\charscalex100\b {BAB IV}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\
cf0\f0\charscalex100\b {PEMBAHASAN}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24
\cf0\f0\charscalex100 {Pada tahun 1967 Dayan dan Williams melaporkan ditemukan d
emielinisasi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {da
n }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {remielinisasi
segmental pada 10 bahan biopsi nervus suralis pada pasien }\par\pard\li1853\ri0
\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {berbagai penyakit hati kronik. Beberapa penel
iti mendapatkan adanya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsca
lex100 {hubungan antara }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charsc
alex100 {disfungsi autonomik dengan penyakit hati menahun, baik pada penyakit ha
ti }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {menahun}\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {alkoholik atau non a
lkoholik.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Trevis
ani dkk melaporkan 80% dari 30 penderita sirosis hati menunjukkan}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {adanya disfungsi autonomik, di
mana disfungsi autonomik berhubungan }\par\pard\sect\sectd\sbkpage\pgwsxn11893\p
ghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn386\pard\li1853\ri0\sl-21
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\ch

arscalex100 {dengan berat }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {sirosis hati ( berdasarkan kriteria Child-Pugh ) dan tidak berhubunga
n dengan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {etiolo
gi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penyakit hat
i. Chaudry dkk dengan pemeriksaan elektrofisiologi pada }\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita sirosis }\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hati mendapatkan hasil yang sesuai d
engan \uc1\u8220X length-dependent axonal }\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {neuropathy\uc1\u8221X }\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {atau \uc1\u8220X dying back neuropathy\uc1\u82
21X. Dimana sebagian besar penderita sirosis hati }\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {dengan}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {disfungsi autonomik juga terbukti mengalami neuropati
perifer.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Neuropa
ti yang terjadi tidak tergantung kepada etiologi penyakit hati, ada }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hubungan yang bermakna anta
ra beratnya neuropati terhadap beratnya }\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {penyakit hati.}\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {Hasil penelitian ini menyimpulkan bahwa disfungsi metabo
lik oleh karena }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{kegagalan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {fungs
i hati menyebabkan terjadinya neuropati.}\par\pard\li1853\ri0\sl-280\slmult0 \fs
24\cf0\f0\charscalex100 {Pada penelitian ini pemeriksaan fungsi autonom variasi
denyut jantung selama }\par\pard\li1853\ri0\sl-320\slmult0 \*\tx3760\fs24\cf0\f0
\charscalex100 {bernafas dalam (}{ }\fs24\cf0\f0\charscalex100 {\uc1\u8710X}\tab
\fs24\cf0\f0\charscalex100 {R6 ) sebanyak 17,3%, respon segera denyut jantung }
\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {setelah}\par\par
d\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {penderita berdiri ( RR 3
0/15 ) 6,7% dan respon tekanan darah dari berbaring }\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {ke berdiri }\par\pard\li1853\ri0\sl-280\slm
ult0 \fs24\cf0\f0\charscalex100 {( TD Berbaring-berdiri ) 3,3%. Hendrickse}\par\
pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {11}\par\pard\li1853\r
i0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {mendapatkan 45%}\par\pard\li1853\r
i0\sl-306\slmult0 \*\tx2093\fs24\cf0\f0\charscalex100 {\uc1\u8710X}\tab \fs24\cf
0\f0\charscalex100 {R6, 5% TD}\par\pard\li1853\ri0\sl-320\slmult0 \*\tx6746\fs24
\cf0\f0\charscalex100 {Berbaring \uc1\u8211X berdiri, Oliver mendapatkan 36,6%}{
}\fs24\cf0\f0\charscalex100 {\uc1\u8710X}\tab \fs24\cf0\f0\charscalex100 {R6 da
n}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {3,3 % RR 30/15
yang abnormal.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Penelitian ini mendapatkan uji fungsi parasimpatis lebih sering dari pada}\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {simpatis ( tabel.5 ),
menggambarkan kerusakan lebih awal pada vagal }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {kemungkinan}\par\pard\li1853\ri0\sl-280\slmult0 \
fs24\cf0\f0\charscalex100 {besar lebih mudahnya kerusakan serabut parasimpatis k
emudian berikutnya }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {simpatis.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Ur
utan kerusakan menunjukkan uji disfungsi parasimpatis lebih sensitif dari }\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {pada uji }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {simpatis. Keresztes dkk, di
dapat perbaikan yang signifikan disfungsi }\par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100 {autonomik setelah}\par\pard\li1853\ri0\sl-280\slmult0
\fs24\cf0\f0\charscalex100 {transplantasi hati, dimana perbaikan terjadi lebih
awal pada fungsi }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{parasimpatis,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {
kemudian perbaikan simpatis.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\ch
arscalex100 {Disfungsi autonomik yang didapat pada penelitian ini sebanyak 12 (4
0%)}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dimana 10 ea
rly ( 6 Child B dan 4 Child C ) dan 2 definite( 2 Child C) ( tabel. }\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {6 ).}\par\pard\li1853\ri0\s
l-280\slmult0 \fs24\cf0\f0\charscalex100 {Trevisani mendapatkan 80% disfungsi au

tonomik , definite sebanyak 40 %,. }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf
0\f0\charscalex100 {Chaudry}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\cha
rscalex100 {mendapatkan disfungsi autonomik 48%, Fleckenstein 67 %, early 31 % ,
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {definite }\par
\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {36%}\par\pard\li1853
\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Pada penelitian ini didapatkan a
danya hubungan antara beratnya disfungsi}\par\pard\sect\sectd\sbkpage
7;32768}}
7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {autonomik dengan ber
atnya keparahan penyakit hati ( Child-Pugh ) p< 0.05}\par\pard\li1853\ri0\sl-293
\slmult0 \fs24\cf0\f0\charscalex100 {( tabel.6 ) , sesuai dengan yang dilaporkan
Trevisani, Oliver, Hendrickse, }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {Chaudry, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {Thuluvath, Kempler.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {Pada pemeriksaan kecepatan hantaran saraf untuk menilai neuropati
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {perifer(sensori
motor), pada penelitian ini didapatkan motorik n.median yang }\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {abnormal }\par\pard\li1853\ri0\sl-
293\slmult0 \fs24\cf0\f0\charscalex100 {16,7%, n. peroneus 23,3% dan n. tibialis

23,3% sedangkan sensorik n. suralis }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {66,7%,}\par\pard\li8573\ri0\sl-333\slmult0 \fs24\cf0\f0\ch
arscalex100\b {Page 19}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100\i {2003 Digitized by USU digital library}\i0 \par\pard\li1853\ri0\sl-34
24\cf0\f0\charscalex100 {n. ulnaris 33,3% dan n. median 56,7%. ( tabel.7 ) Saraf
sensori neuropati lebih }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\chars
calex100 {banyak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{dijumpai daripada saraf motorik neuropati. Oliver pada motorik n. median }\par\
pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {13,3%,}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sensorik n. suralis 16,6 %, se
nsorik n. median 6,6%., Chaudry}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
\charscalex100 {mendapatkan}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\cha
rscalex100 {neuropati perifer sebanyak 24% pada motorik n. peroneus, Kardel 67,6
%, }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Knill- Jones
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {14,2%, dan Haki
m 73,9%.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Penelit
ian ini mendapatkan adanya hubungan antara neuropati perifer dengan}\par\pard\li
1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {beratnya penyakit }\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hati, motorik}\par\pard\l
i1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {n. median, peroneus dan tib
ialis p<0,05}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {(ta
bel.8,9,10 ), Sama yang didapatkan Trevisani, Oliver dan Hakim, }\par\pard\li185
3\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sedangkan dengan}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {sensorik n. median, suralis da
n ulnaris tidak didapat adanya hubungan, p > }\par\pard\li1853\ri0\sl-280\slmult
0 \fs24\cf0\f0\charscalex100 {0,05}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {(tabel.11,12,13 )}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\c
f0\f0\charscalex100 {Pada kepustakaan terdapat variasi prevalensi neuropati peri
fer berkisar antara }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex
100 {0-90%. Perbedaan ini disebabkan karena beragamnya kriteria yang digunakan }
\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {dalam}\par\pard\
li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {mendeteksi neuropati dan b
eratnya neuropati yang digunakan untuk }\par\pard\li1853\ri0\sl-280\slmult0 \fs2
4\cf0\f0\charscalex100 {menentukan}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {neuropati perifer.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\
cf0\f0\charscalex100 {Neuropati autonomik yang merupakan bagian dari }\fs24\cf0\
f0\charscalex100\i {generalized sensori-motor }\i0 \par\pard\li1853\ri0\sl-280\s
lmult0 \fs24\cf0\f0\charscalex100\i {polineuropathy }\i0 \fs24\cf0\f0\charscalex
100 {, penderita dengan disfungsi autonomik juga mengalami }\par\pard\li1853\ri0
\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {neuropati}\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {perifer ( sensorimotor ). Pada penelitian
ini dari 12 penderita disfungsi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f
0\charscalex100 {autonomik, 11}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {diantaranya juga dijumpai neuropati perifer , 84%. Chaudry mendap
atkan }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {91%. Pada
}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {penelitian ini
}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {didapatkan ada
nya korelasi antara variasi denyut jantung selama}\par\pard\li1853\ri0\sl-306\sl
mult0 \*\tx3693\fs24\cf0\f0\charscalex100 {bernafas dalam (}\fs24\cf0\f0\charsca
lex100 {\uc1\u8710X}\tab \fs24\cf0\f0\charscalex100 {R6 ) dengan sensorik n. sur
alis ; r= 0,057; p < 0,05, RR }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\
charscalex100 {30/15 r= }\par\pard\sect\sectd\sbkpage

7;32768}}
7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {0,456 ; p < 0,05 sed
angkan dengan respon tekanan darah berbaring ke berdiri, }\par\pard\li1853\ri0\s
l-293\slmult0 \fs24\cf0\f0\charscalex100 {r=}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {0,275 ; p > 0,05. Oliver}\par\pard\li1853\ri0\sl-17
24\cf0\f0\charscalex100 {mendapatkan}\par\pard\li1853\ri0\sl-320\slmult0 \*\tx35
60\fs24\cf0\f0\charscalex100 {korelasi antara }\fs24\cf0\f0\charscalex100 {\uc1\
u8710X}\tab \fs24\cf0\f0\charscalex100 {R6 dengan sensorik n.}\par\pard\li1853\r
i0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {median r =0,35 ; p < 0,05, RR 30/1
5 dengan motorik n. peroneus }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {r= 0,50; p < 0,01.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {Pada penelitian ini tidak didapat adanya korelasi antara disfun
gsi autonomik}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {de
ngan neuropati perifer sensorik n. suralis r =0,253 ; p> 0,05 .}\par\pard\li1853
\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {BAB V}\b0 \par\pard\li1853\ri0
\sl-306\slmult0 \fs24\cf0\f0\charscalex100\b {KESIMPULAN DAN SARAN}\b0 \par\pard
\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {5.1 KESIMPULAN }\b0 \pa
r\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {5.1.1. Pada penderi
ta sirosis hati dijumpai adanya disfungsi autonomik dan}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {beratnya disfungsi autonomik ini berhubu
ngan dengan beratnya sirosis hati.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {5.1.2. Pada penderita sirosis hati dijumpai prevalensi yang t
inggi untuk }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {ter
jadinya }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {neuropa
ti perifer ( sensorimotor ) dan berhubungan dengan beratnya sirosis }\par\pard\l

i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hati, terutama saraf motori
k.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {5.1.3 Tidak d
ijumpai adanya korelasi antara disfungsi autonomik dengan }\par\pard\li1853\ri0\
sl-293\slmult0 \fs24\cf0\f0\charscalex100 {neuropati }\par\pard\li1853\ri0\sl-29
3\slmult0 \fs24\cf0\f0\charscalex100 {perifer ( sensorimotor ) pada penderita si
rosis hati.}\par\pard\li8573\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b {Pa
ge 20}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003
Digitized by USU digital library}\i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs30\c
f0\f0\charscalex100 {20}\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charsca
lex100\b {5.2}\b0 \par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100
\b {SARAN}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Pe
rlu penelitian lanjutan dengan cara kohort dengan penderita yang lebih}\par\pard
\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {banyak agar disfungsi aut
onomik dapat dipakai sebagai prediktor prognostik }\par\pard\li1853\ri0\sl-293\s
lmult0 \fs24\cf0\f0\charscalex100 {mortalitas pada penderita sirosis hati.}\par\
pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\b {BAB VI}\b0 \par\par
d\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {KEPUSTAKAAN}\b0 \par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Abergel A, Braillon A,
Gaudin C, Kleber G, Lebrec D. Persistence of a }\par\pard\li1853\ri0\sl-293\slm
ult0 \fs24\cf0\f0\charscalex100 {hyperdynamic }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {circulation in cirrhotic rats following removal o
f the sympathetic nervous }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\char
scalex100 {system. }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex1
00 {Am J Gastroenterology 1992; 102:616-60.}\par\pard\li1853\ri0\sl-293\slmult0
\fs24\cf0\f0\charscalex100 {Asbury AK. Hepatic neuropathy. In: Dick PJ, Thomas P
K, Lambert EH, }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Bunge R.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Periphe
ral neuropathy. 2}\par\pard\li1853\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100
{th}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Ed. WB Saun
ders company, Philadelphia, 1984; }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0
\f0\charscalex100 {1826-1831.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\c
harscalex100 {Chari VR, Katiyar BC, Rastogi BL, Bhattacharya SK. Neuropathy in h
epatic }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {disorder
s: a }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {clinical,
electrophysiological and histopathological appraisal. Journal of the}\par\pard\l
i1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Neurological Sciences,1977,
31:93-111.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Chaud
hry V, Corse AM, O\uc1\u8217XBrien R, Cornblath DR, Klein AS, Thuluvath PJ. }\pa
r\pard\sect\sectd\sbkpage
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\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {Autonomic and}\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {peripheral (sensorimot
or) neuropathy in chronic liver disease: a clinical and}\par\pard\li1853\ri0\sl293\slmult0 \fs24\cf0\f0\charscalex100 {electrophysiology study. Hepatology 1999
; 29:1689-1703.}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
Chopra JS, Samantha AK, Murthy JM et al. Role of porta systemic shunt and}\par\p
ard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {hepatocellular damaged
in the genesis of hepatic neuropathy. Cin Neurol}\par\pard\li1853\ri0\sl-293\sl
mult0 \fs24\cf0\f0\charscalex100 {Neurosurg 1980;82;37-44. abstrak}\par\pard\li1
853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {Consensus statement. Standari
zed measures in diabetic neuropathy. Diabetes }\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Care.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\c
f0\f0\charscalex100 {Suppl 1995;18: 59-82}\par\pard\li1853\ri0\sl-293\slmult0 \f
s24\cf0\f0\charscalex100 {Darmansjah I, Setiawati A, Gan S. Susunan saraf otonom
dan transmisi }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
neurohumoral.}\par\pard\li1853\ri0\sl-293\slmult0 \fs22\cf0\f0\charscalex100 {Da
lam: Gan S. Ed, Farmakologi Terapi, Ed. IV. Jakarta,Balai Penerbit FKUI,}\par\pa
rd\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {1995; 25}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Daube JR. Electrophysiologik t

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t0 \fs24\cf0\f0\charscalex100 {hyponatraemia of alcoholic cirrosis, Br Med J 198
6; 293:1534-36}\par\pard\li8573\ri0\sl-333\slmult0 \fs24\cf0\f0\charscalex100\b
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scalex100 {Ewing DJ, Clarke BF. Diagnisis and management of diabetic autonomic }
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ion and liver disease. In: Liver and nervous }\par\pard\li1853\ri0\sl-293\slmult
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\cf0\f0\charscalex100 {Disampaikan pada: Part III of the liver week freiburg. Fa
lk symposium no. }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{103,}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Freiburg
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tes, The Johns Hopkins University 1997.}\par\pard\li1853\ri0\sl-293\slmult0 \fs2
4\cf0\f0\charscalex100 {Groszmann RJ. de Francis R,}{ }\fs24\cf0\f0\charscalex10
0\b {Portal}\b0 \fs24\cf0\f0\charscalex100 { hypertension. In: Schiff ER, Sorell
MF, }\par\pard\li1853\ri0\sl-306\slmult0 \fs24\cf0\f0\charscalex100 {Madrey}\pa
r\pard\sect\sectd\sbkpage
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7;32768}}
\pard\li1853\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100 {WC.Eds .Schiff disea
se of the liver. Lippincot Raven Publisher. Philadelphia}\par\pard\li1853\ri0\sl
-293\slmult0 \fs24\cf0\f0\charscalex100 {1999:1:387-93}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {Groszmann RJ. Hyperdynamic circulation of
liver disease 40 years later:}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\
charscalex100 {Pathophysiology and clinical consequences. Hepatology 1994; 20:13
59-63.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Hadi S. S
irosis Hati. Dalam : Gastroenterologi. Edisi I, Bandung. Alumni ,}\par\pard\li18
53\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {1991:494-}\par\pard\li1853\ri0
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rita penyakit hati kronis. Acta }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
0\charscalex100 {Medica }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charsc
alex100 {Indonesiana 1994, XXVI; 111-119.}\par\pard\li1853\ri0\sl-280\slmult0 \f
s24\cf0\f0\charscalex100 {Hakim M, Wibowo BS, Purba JS, Husodo UB. Peripheral ne
uropathy in }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {cir
rhosis patient: }\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100
{Correlation between the severity of liver dysfunction and the degree of}\par\pa
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ASNA ,Kuala Lumpur 22-24 Maret 2001.abstrak}\par\pard\li1853\ri0\sl-293\slmult0
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ory of autonomic }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100
{neuropathy in}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscalex100 {
chronic liver disease. Lancet 1992; 332:1462-4}\par\pard\li1853\ri0\sl-293\slmul
t0 \fs24\cf0\f0\charscalex100 {Hendrickse MT, Triger DR. autonomic dysfunction i
n chronic liver disease.. }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\char
scalex100 {Clin Auton}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\charscale
x100 {Res 1993;3:227-31.abstrak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0
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ervous }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {system i
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97. abstrak}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Kemp
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0\charscalex100 {Keresztes K, Marton A, Hermanyi ZS, et al. Improvement of cardi
ovascular }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {auton
omic }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {and periph
eral sensori nerve function after orthotopic liver transplantation. In: }\par\pa
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\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100\i {2003 Digitized by USU di
gital library}\i0 \par\pard\li1853\ri0\sl-346\slmult0 \fs30\cf0\f0\charscalex100
{22}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {Liver and n
ervous system. Disampaikan pada: Part III of the liver week }\par\pard\li1853\ri
0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {freiburg.}\par\pard\li1853\ri0\sl-2
93\slmult0 \fs24\cf0\f0\charscalex100 {Falk symposium no. 103, Freiburg (Germany
), 4-5 Oktober, 1997. abstrak}\par\pard\li1853\ri0\sl-280\slmult0 \fs24\cf0\f0\c
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ic }\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f0\charscalex100 {liver diseas
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93\slmult0 \fs24\cf0\f0\charscalex100 {sample. Dalam: }\par\pard\li1853\ri0\sl-2
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ar metodologi penelitian klinis.}\par\pard\li1853\ri0\sl-293\slmult0 \fs24\cf0\f
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7;32768}}

7;32768}}
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ge\pard\sect\sectd\sbkpage}

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