HEPATITIS Suatu proses inflamasi pada hati dengan gambaran klinis dan histologis yang spesifik yaitu terdapatnya suatu keadaan nekrosis difus atau sebagian pada lobus hepatikus Etiologi Tiga penyebab utama hepatitis adalah virus hepatitis tipe A, tipe B, alkohol dan obat2an, juga virus C,D dan E Infeksi yang jarang terjadi oleh karena mononukleosis, yellow fever, cytomegalovirus, coxsachievirus, leptospirosis Infeksi parasit, schistosomiasis, amoebiasis, malaria, sasarannya adalah liver tetapi tidak menyebabkan hepatitis infeksi piogenic dan abses merupakan masalah juga tuberkulosis pada liver dan infiltrasi granulomatous lain disebut ‘ granulomatous hepatitis” , akan tetapi mempunyai gejala klinis, biokemis dan histologis yang berbeda

Systemic infection dan penyakit lain dapat menghasilkan nekrosis pada sebagian lobus liver dan proses peradangan, keadaan ini sifatnya non spesifik disebut “reactive hepatitis”, menyebabkan abnormalitas fungsi liver, biasanya asymptomatik. ACUTE VIRAL HEPATITIS Inflamasi difuus hepatoseluler, disebabkan oleh 2 macam agent virus Terdapat tipe A : serum hepatitis (SH), post transfusion hepatitis Tipe B : infeksi virus B (long incubation hepatitis) Etiologi virusA Virus B

Epidemiologi Virus A : terjadi oleh karena kontak fekal-oral , darah dan sekret lain yang infeksius. Merupakan “food- borne” epidemics, terutama di negara berkembang Secara sporadis terjadi oleh karena kontak “ person-to-person” Virus B : transmitted melalui parenteral Akibat transfusi darah Pemakaian jarum suntik secara bergantian pada pengguna narkoba Cuci darah (renal dialisis) Non parenteral juga dapat terjadi misalnya ok sex intercourse Inkubasi virus A : 2-6 minggu virus b : 6-25 minggu Dapat mengenai semua umur Hepatitis A lebih sering terjadi pada anak2 dan orang muda

Patologi Semua lobus pada liver dpt mengalami patchy nekrosis dan infiltrat mononuklear inflamasi Gambaran regresi histologik sering dijumpai, meskipun pada awal penyakit Symptom dan sign Bervariasi dari yang ringan seperti gejala flu s/d gejala fulminant yang sangat berat, sampai fatal Phase prodromal : - dimulai awal dengan gejala nausea, anorexia, malaise, panas. - dapat terjadi urticaria (gatal), arthralgia (nyeri sendi), khususnya pada hepatitis B - setelah 3-10 hari terjadi fase ikterik, sampai terdapat warna lebih gelap pada urin - diikuti dengan jaundice

Gejala klinis (penderita dengan ascites)

Chronic viral hepatitis (cirrhosis hepatis)

Jaundice mencapai puncak/peak dalam 1-2 minggu, kemudian terjadi fase recovery dalam 2-4 minggu Terdapat pembesaran hati, kadang2 keras, biasanya teraba lunak dan halus. Pembesaran limpa (splenomegali) terjadi pada 15-20% pasien Laboratorium Peningkatan transaminase, terjadi pada awal masa prodromal, puncaknya terjadi sebelum masa peak jaundice kemudian pelan2 turun pada fase recovery SGOT dan SGPT 1000-3000 u. Tidak terdapat hubungan dengan gejala klinis SGPT biasanya lebih meningkat dibanding SGOT Bilirubin pada urine terjadi sebelum jaundice Kenaikan alkali fosfatase terjadi apabila terdapat cholelithiasis berat Tidak terdapat kenaikan protrombine time

Diagnosis Pada fase prodromal didapatkan gejala seperti influenza dan susah didiagnose Apabila jaundice sudah tampak, dapat didiagnosa Hepatitis ok obat atau toxic dapat diperoleh ketr mell riwayat penyakit Gejala prodromal sakit tenggorokan, adenopati diffus Atipical limfositosis Alkoholik hepatitis ditanyakan melalui riwayat, terdapat spider nevi Keadaan ekstra hepatik obstruksi dan neoplasma kadang sulit dibedakan Prognosis Hepatitis sembuh spontan pada sebagian besar kasus, selama 6-12 mg Hepatitis B lebih jelek dibanding hepatitis A, khususnya pada orang2 tua, mortalitas sebesar 10-15%

Prophilactie Personal hygiene Isolasi faeces, urine dan darah dari penderita2 hepatitis A, hendaknya diperlakukan sbg bahan infeksius Isolasi dari penderita hanya dapat menghindari pyebaran hepatitis B Mma 0globulin 0,02 ml/kg BB Transfusi darah - hati2 terhadap kontaminasi hepatitis B vaksinasi

What can you do to prevent hepatitis A? Get vaccinated against hepatitis A if your travel plans, job, health, or lifestyle puts you at risk. Make sure your children get vaccinated. The U.S. Centers for Disease Control and Prevention recommends the vaccine for all children starting at age 1 year. It's also important for children adopted from other countries to get the vaccine. Talk to your doctor if you've been around someone who you know has hepatitis A. The hepatitis A vaccine or an injection of immunoglobulin (IG) within 2 weeks of exposure may prevent you from getting sick.1

Practice good hygiene habits. Wash your hands well after using the toilet, after changing a diaper, and before you prepare or eat food. Wash dishes in hot, soapy water or in a dishwasher. Discourage children from putting objects in their mouths. Don't eat or drink anything that you think may have been prepared in unclean conditions.

Don't eat raw or undercooked shellfish. If you plan to travel to a part of the world where sanitation is poor or where hepatitis A is a known problem: Ask your doctor about getting the hepatitis A vaccine, a shot of immunoglobulin (IG), or the combination hepatitis A and B vaccine. Always drink bottled water or boil water before drinking it. Avoid drinks with ice cubes. Don't eat raw foods, such as unpeeled fruits or vegetable

People with jaundice

Alcoholic hepatitis

Key facts about Hepatitis B Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person. An estimated 240 million people are chronically infected with hepatitis B (defined as hepatitis B surface antigen positive for at least 6 months). Approximately 780 000 persons die each year from hepatitis B infection -- 650 000 from cirrhosis and liver cancer due to chronic hepatitis B infection and another 130 000 from acute hepatitis B.1 Hepatitis B is an important occupational hazard for health workers. However, it can be prevented by currently available safe and effective vaccine.

Geographical distribution Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia, where between 5–10% of the adult population is chronically infected. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, an estimated 2–5% of the general population is chronically infected. Less than 1% of the population in western Europe and North America is chronically infected.

Transmission The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B.

In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission), or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is very common in infants infected from their mothers or before the age of 5 years.

Hepatitis B is also spread by percutaneous or mucosal exposure to infected blood and various body fluids, as well as through saliva, menstrual, vaginal, and seminal fluids. Sexual transmission of hepatitis B may occur, particularly in unvaccinated men who have sex with men and heterosexual persons with multiple sex partners or contact with sex workers. Infection in adulthood leads to chronic hepatitis in less than 5% of cases. Transmission of the virus may also occur through the reuse of needles and syringes either in health-care settings or among persons who inject drugs. In addition, infection can occur during medical, surgical and dental procedures, tattooing, or through the use of razors and similar objects that are contaminated with infected blood.

All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine if they live in countries where there is low or intermediate endemicity. In those settings it is possible that more people in high risk groups may acquire the infection and they should also be vaccinated. They include:

people who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations; people interned in prisons; people who inject drugs; household and sexual contacts of people with chronic HBV infection; people with multiple sexual partners; health-care workers and others who may be exposed to blood and blood products through their work; and travellers who have not completed their hepatitis B vaccination series, who should be offered the vaccine before leaving for endemic areas.

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