GRUP

DISCUSSION 14
Block Gastroentherohepatology
Muslim Indonesia Univercity
2015
 Grups name:
Aditya Prayoga Tanus 11020140007
Irma Nurwahyuningsih 11020140026
Ekarisma Faradita Wardihan 11020140038
Muh. Akbar 11020140051
St. Mardayanti Marzuki 11020140071
Citra Dewi11020140077
Muhammad Ishaq R. 11020140091
Fira Permata 11020140110
Fadillah 11020140128
Sesariah Fatimah Nur 11020140143
Della Pinka Pakaya 11020140152

Tutor :
dr. Arina F. Arifin
 Scenario
Womens 20 years comes to a doctor with complains of eye and skin
yellowish colored brass. Patient experience fever a few days earlier
accompanicd the nausea and pain in the right upper abdomen.
Sufferers about a week ago just get home from collage integrated in
Kab. Mamuju, an area endemic for malaria. In Mamuju, the patient
had undergone a slimy diarrhea. Whwn asked immunization history,
patients are not sure immunization ever received.
Difficult word
Immunization is a process where by a person is immunization
or resistant to an onfection disease, typically by administrasion
of a vacine.
Diarrhea is a passage of 3 or more loose or liquid stools per
dag, or more frequently than is normal for the individual
Malaria is a common and life theatmering disease in many
tropical and sub tropical/areas
Key word
Women 20 years
Complains of eye and skin yellowish colored brass
Fever a few days earlier accompanicd the nausea and pain in the upper
abdominal
A week ago just get home from college endemic malaria (Kab.Mamuju)
She had undergone slimy diarrhea
Not sure immunization ever received
Problem
1. How anatomy, histology and physiology of the scenario ?
2. How is the pathomechanism about formation of bilirubin ?
3. How is the mechanism of jaudice, nausea and pain?
4. What is the agent infections of jaudice?
5. What is required immunizations ?
6. What is the relations betwen malaria and jaundice ?
7. What is diagnose of the scenario ?
8. What is differential diagnose of scenario ?
1. anatomy, histology and physiology
Anatomy of liver
Anatomy of vessica billiaris
Histology of liver and vessica biliaris
Vessica billiaris (vessica fellea)
Function liver
1. Processing in merabolis three main categories of nutrients (carbohydrates,
protein, and fat) after zavzar is absorbed from the gastrointestinal tract.
2. detoxifies substances or decipher the rest of the body and hormones as
well as drugs and other foreign substances.
3. Establish a plasma protein, rermasuk proteins needed for blood clotting
and to transport the steroid and thyroid hormones and cholesterol in the
blood.
4. Storing glycogen, fat, iron, copper, and many viramin.
5. Enabling vitamin D, which performed the liver along with the kidneys.
6. Removing bacteria and old red blood cells, macrophages berkatadanya
residennya
7. excrete cholesterol and bilirubin, bilirubin is a decomposition product
derived from the destruction of old red blood cells
2. Formation of bilirubin
Destruction of erythrocytes Erythroid destruction in the
by reticuloendothelial cell spleen and bone marrow

Hemoglobin
Globin PRA
HEPATIK
Hem
Hem Oksigenase
Biliverdin
Biliverdin Reduktase
Unconjugated Bilirubin ~ Albumin
 Go to liver

uptake
Unconjugated Bilirubin let go
from Albumin
Glukuronosil
Transferase INTRA
HEPATIK
Bilirubin Diglukuronida
conjugation
(conjugated bilirubin,solulable water)

Excretion Through the excretion of bile

Go to gut

Intestinal POST
bacteria HEPATIC
Urobilinogen
 Urobilinogen

Excreted in feces Small partially absorbed by

the intestine Back

Strekobilin

Vena Porta POST

HEPATIK

Again excreted in bile Small portion Achieve

kidney

Excretion via urine

3. Mechanism of jaudice, nausea and pain

The mechanism of pain

Reference: Gottschalk A et al. Am Fam Physician.2001; 63 : 1981

Classification of pain abdominal

Reference: Gottschalk A et al. Am Fam Physician.2001; 63 : 1981

Reference :Vinay Kumar, Abul Abbas, Jon Aster Robbins Basic Pathology, 9th Edition. Page : 606
Mechanism Nausea
cause inflamation
Expend vasa active
Iritation and increased gaster
air
acid

Increased
permeabilitation
capiler

Stimulation receptor
Nausea Gaster edem
in hypotalamus

Referensi
Bacon, B.R., 2010, Cirrhosis and its Complication, in Longo, L., Fauci, A.S., (eds) Harrisons Gastroenterology and Hepatology, The McGraw-Hill
Companies.
4. Agents infection
Plasmodium
Plasmodium is agent infection of Malaria. Plasmodium
infects red blood cells, so that the increased breakdown of red blood
cells, with the rapid release of bilirubin in the blood. This hemolysis
occurs in the formation phase of pre hepatic bilirubin in the hepar.

Hepatitis Virus
Hepatitis virus is an infectious agent causing icterus in hepatitis. Hepatitis
virus infects liver cells. Resulting in liver cell damage and unconjugated
bilirubin can not be converted into a conjugated bilirubin. So that the amount of
bilirubin mundane can not be excreted into the digestive tract.

Reference: Guyton and Hall. Buku Ajar Fisiologi Kedokteran. Edisi 11. Jakarta: EGC. 2008 Page 907.
 Leptospira
Leptospira is the infectious agent causing icterus on leptospirosis. Leptospira
can cause hepar damage. Hepar damage that occurs will result in the onset of icterus,
although there are some experts expressed icterus among others caused by hemolysis
and biliary obstruction.

Reference : Setiadi, Bobby, Andi Setiawan, Daniel Effendi, Sri Rezeki S Hadinegoro. Leptospirosis. Online (21 December 2015) Available from
URL : http://saripediatri.idai.or.id/pdfile/3-3-10.pdf
5. Required Immunization
BCG Immunization
DPT Immunization
Polio Immunization
Immunization against measles
Hepatitis B Immunization (HIB)
 6. Relation of malaria and jaudice
Infection by female
Liver cant change
Anopheles
Bilirubin I to Bilirubin II
musquito
JAUDICE

Bilirubin 1
in serum

ANEMIA
HEMOLITIK

Sporozoid replicated In sirculation :

Erythrocyte
To morozoid in hepatosit Morozoid infection
cell To eritrocyt rupture
 7. Diagnose of the scenario
Hepatitis A
Hepatitis A is a viral infection of hepatitis A (VHA) in acute liver. Globally and in Indonesia,

Definision Hepatitis A is a liver disease most commonly reported. Seroprevalence of anti-VHA generally
found in areas with high health standards, especially hygiene, are still low.

Risk factor VHA deployment occursfaecal-oral, either direct contact or food / drink contaminated. No
evidence of perinatal transmission (mother to fetus) in this disease.

anorexia, nausea and vomiting, malaise, fatigue, arthralgia, myalgia, headache, photophobia,

Symptoms pharyngitis or cough. Nausea, vomiting, and anorexia are often associated with changes in
smelling and tasting

Supporting Investigation Serology Hepatitis A, Biochemical LiverBiochemical Liver, Abdominal ultrasound

8. Differensial diagnose
Abses Hepatis Entamoeba
Amoebic liver abscess is hoarding or accumulation of debris necro -
Definision inflammatory purulent in the parenchyma of the liver caused by
amoebas , especially Entamoeba hytolitica

Parasitic amoeba , which is the most common , namely Entamoeba

Etiology Hystolotica

Age : 20-40 years old

Demography Gender : male>female (>10:1)

The Biggest Risk Factor Traveling or living in an endemic area

Hyperthermia, pain in the right upper abdomen, Nausea, Vomitting,

Symptoms Anorexia, Malaise, Myalgia, Artralgia, Hepatomegali, Jaundice
Malaria
Malaria is a disease of the blood that is caused by the
Definision Plasmodium parasite, which is transmitted from person
to person by a particular type of mosquito.

Etiology plasmodium falciparum, plasmodium vivax, plasmodium malariae, plasmodium

ovale

Symptoms begin 10 days to 4 weeks after infection, although a person may feel ill

symptoms as early as 7 days later.

Symptoms include fever, headache and vomiting.

The most common antimalarial drugs include, Chloroquine (Aralen), Quinine

Treatment sulfate (Qualaquin), Hydroxychloroquine (Plaquenil) , Mefloquine , Combination

of atovaquone and proguanil (Malarone)