hepatitis dan kholelithiasis.docx

7/23/2019 HEPATITIS dan KHOLELITHIASIS.docx

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BAB II

PEMBAHASAN

2.1 EMBRIOLOGI

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2.2 ANATOMI



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Hepar atau hati adaah !r"a# ter$e%ar &a#" tereta' di %e$eah

'a#a# ata% r!#""a a$d!(e#. Pada '!#di%i hidup hati $er)ar#a (erah tua



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*%ara- hepati4u% (e#"a#du#" %era$ut dari "a#"ia %i(pati% T=T10+ &a#"

$er%i#ap% daa( pe


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2. 3 HISTOLOGI HEPAR

Hepar (e(ii'i %a#"at %edi'it ari#"a# i'at u#tu' !r"a# &a#"

de(i'ia# $e%ar. Terdapat %eapi% ari#"a# i'at 7$r!%a &a#" (e#utupi#&a

%ete$a =0100>( &a#" di%e$ut 'ap%ua Gi%%!#. Ia pai#" te$a pada p!rta

hepati% da# dari %itu ari#"a# i'at $era#ut 'edaa( rua#" i#ter!$uari%

%a($i (e#u#a#" %i%te( 5a%'uar+ %aura# e(pedu da# pe($uuh i(e+

(e($a"i hati daa( !$u% da# !$uu%. ?ari#"a# i'at i#ter!$uari% %uit

diihat *%edi'it da# tipi%-+ 'e4uai pada $a$i (e(a#" (e(ii'i ari#"a# i'at

i#ter!$uari% &a#" te$a da# ea%.@e!(p!' dari arteri+ 5e#a+ pe($uuhi(e

da# %ara+ $eri'ut de#"a# ari#"a# i'at pe#u#a#"#&a+ di%e$ut triad p!rta

*p!rta 4a#a+ p!rta area-.

@!(p!#e# %tru'tur uta(a dari hepar adaah %e hepar atauhepat!%it. Hepat!%it ter%u%u# $erupa e(pe#"e(pe#" &a#" %ai#"

$erhu$u#"a# da# $er4a$a#" (e($e#tu' a#&a(a# ti"a di(e#%i. Hepat!%it

$er$e#tu' p!ihedra+ i#ti#&a $uat tereta' dite#"ah+ #u'e!u% dapat %atu

atau e$ih de#"a# 'r!(ati# &a#" (e#&e$ar. Seri#" ada#&a dua i#ti+ %e$a"ai

ha%i pe($a"ia# &a#" tida' %e(pur#a dari %it!pa%(a %eteah teradi

pe($eaha# i#ti. Sit!pa%(a#&a a"a' $er$utir+ tetapi ter"a#tu#" pada

peru$aha# #utri%i %erta u#"%i %euer. :ia#tara hepat!%it terdapat %aura#

%e(pit &aitu 'a#ai'ui $iiari%+ &a#" (e#"air 'e tepi !$uu% 'edaa( du'tu%

$iiari% *?u#9ueira+ 1;;-.

Hepat!%it (e(ii'i e#a( atau e$ih per(u'aa#+ da# ada ti"a

$e#tu' &a#" $er$eda 8

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a- Per(u'aa# &a#" $erhadapa# de#"a# rua#" peri%i#u%!id+ di(a#a pada

per(u'aa# $e$a%#&a tu($uh (i'r!5ii+

$- Per(u'aa# &a#" $er$ata%a# de#"a# 'a#ai'ui $iiari% da#

4- Per(u'aa# &a#" %ai#" $erhadapa# a#tar hepat!%it &a#" $er%e$eaha#

da# (e(ii'i "ap u#4ti!# *:e(a## Br!)#+ 1;;2-.

Hepar (e#dapat aira# darah "a#da. e#a p!rta (e($a)a darah

dari u%u% da# !r"a# terte#tu+ %eda#"'a# arteri hepati'a *dari a!rta-

(e($a)a darah $er%ih &a#" (e#"a#du#" !'%i"e#. e#a p!rta da# arteri

hepati'a $er4a$a#"4a$a#" (e#uu !$u%+ di%e$ut arteri atau 5e#a

i#ter!$ari%+ %eteru%#&a $er4a$a#"4a$a#" (e($e#tu' arteri da# 5e#a

i#ter!$uari% &a#" terdapat di daerah p!rta atau %e"iti"a @ier#a#. e#a

i#ter!$uari% (e(ii'i 4a$a#" 'e4i+ 'ada#"'ada#" di%e$ut 5e#a pe($a"i

&a#" (erupa'a# %u($u a%i#u% hati. e#ua pe#de' $era%a dari 5e#a

pe($a"i da# $era'hir a#"%u#" pada %i#u%!id *:e(a## Br!)#+ 1;;2-.

Se$a"ia# darah dari arteri i#ter!$uari% (e($e#tu' pe'%u% 'apier

di daerah p!rta da# di%erap !eh 4a$a#"4a$a#" 5e#a p!rta. Ha#&a

%e$a"ia# 'e4i darah (e#4apai %i#u%!id %e4ara a#"%u#" (eaui arteri!&a#" (erupa'a# 4a$a#" dari arteri i#ter!$uari% *:e(a## Br!)#+ 1;;2-.

Si#u%!id (erupa'a# pe($uuh darah 'apier &a#" (e#"i%i !$uu%+ &a#"

(e($a)a darah dari arteri da# 5e#a i#ter!$uari%+ (a%u' %i#u%!id da#

(e#uu 5e#a %e#trai%. Arteri da# 5e#a i#ter!$uari% didaa( !$uu%

$erte(u daa( %i#u%!id dia#tara e(pe#" hati. Su%u#a# per4a$a#"a# i#i

(e#a(i# hepat!%it (e(ii'i per(u'aa# &a#" $erhadapa# de#"a# %i#u%!id

&a#" ha#&a di$ata%i !eh rua#" peri%i#u%!id *Rua#" :i%%e-+ (erupa'a#

rua#" %e(pit dia#tara %i#u%!id da# %e%e hepar. Rua#" de(i'ia# tida'

ta(pa' daa( $i!p%i hepar (a#u%ia atau daa( hepar he)a# per4!$aa#.

Me%'ipu# $e"itu+ 'e$eradaa#&a 'i#i dapat dipa%ti'a# de#"a# (i'r!%'!p

ee'tr!# *:e(a## Br!)#+ 1;;2 ?u#9ueira+ 1;;-.

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:i#di#" %i#u%!id (e(ii'i $a#&a' 4eah+ 'are#a di#di#"#&a terdiri

dari e#d!te da# %e%e (a'r!a" $e%ar da# a'ti &a#" di%e$ut %e @upCer

&a#" $era%a dari (!#!%it. Se i#i terdapat di$er$a"ai te(pat %epa#a#"

%i#u%!id+ $ah'a# %eri#" (e#"iri( p%eud!p!dia pa#a#" (e#e($u% 4eah

e#d!te atau %e%e e#d!te *:e(a## Br!)#+ 1;;2 Da)4ett+ 2002-.

E#d!te pada %i#u%!id tida' (e(ii'i a(i#a $a%ai% %ehi#""a (e#!pa#"

a#"%u#" pada uu#" (i'r!5ii hepat!%it. ?adi r!#""a peri%i#u%!id ter$e#tu'

a#tara %e%e hepar da# e#d!te+ %ehi#""a (i'r!5ii dapat tere#da( daa(

pa%(a darah da# (e(u#"'i#'a# pertu'ara# a#"%u#" $aha#$aha# a#tara

darah da# %e%e hepar. :i%a(pi#" (i'r!5ii hepat!%it+ rua#" peri%i#u%!id

(e#"a#du#" %era$ut reti'uer di%a(pi#" %e peri%i#u%!id atau adip!%it. Se

%e ter%e$ut (e#&i(pa# 5ita(i# A da# ter'ait daa( 7$ri#!"e#e%i% de#"a#

%i#te%i% '!a"e# tipe II pada 'eru%a'a# hepar *:e(a## Br!)e#+ 1;;2-.

:arah (e#i#""a'a# !$uu% (eaui 5e#a %e#trai% atau 5e#ua

hepati'a ter(i#ai% &a#" diapi%i !eh e#d!te de#"a# a(i#a $a%ai% %erta

ad5e#ti%ia tipi%+ da# a#"%u#" $erhu$u#"a# de#"a# %i#u%!id. e#a %e#trai%

$erhu$u#"a# de#"a# 5e#a %u$!$uari% atau 5e#a i#ter'aatu% di tepi

!$uu%. @edua 5e#a ter%e$ut terdapat di%epa#a#" $a%i% !$uu%+ di(a#a

%e$a"ia# $er"a$u#" (e($e#tu' 5e#a pe#a(pa#" *4!e4ti#" 5ei#- &a#"

#a#ti#&a $er"a$u#" (e#adi 5e#a hepati'a *:e(a## Br!)#+ 1;;2-.

2., DISIOLOGI

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2. :EDINISI

Hepatiti% 5iru% adaah rada#" hati &a#" di%e$a$'a# !eh 5iru%.

:i'ata'a# a'ut apa$ia i#a(a%i *rada#"- hati a'i$at i#e'%i 5iru% hepatiti%

&a#" $era#"%u#" %ea(a 'ura#" dari 6 $ua#+ da# 'r!#i% apa$ia hepatiti%

&a#" tetap $ertaha# %ea(a e$ih dari 6 $ua#. @eadaa# 'r!#i% pada a#a'

a#a' e$ih %u'ar diru(u%'a# 'are#a peraa#a# pe#&a'it#&a e$ih ri#"a#

daripada !ra#" de)a%a. Pe#&a'it Hepatiti% adaah pe#&a'it &a#" di%e$a$'a#

!eh $e$erapa e#i% 5iru% &a#" (e#&era#" da# (e#&e$a$'a# perada#"a#

%erta (eru%a' %e%e !r"a# hati (a#u%ia. Hepatiti% di'ete"!ri'a# daa(

$e$erapa "!!#"a#+ dia#tara#&a hepetiti% A+B+F+:+E+D da# G. :i I#d!#e%ia

pe#derita pe#&a'it. Hepatiti% u(u(#&a 4e#deru#" e$ih $a#&a' (e#"aa(i

"!!#"a# hepatiti% B da# hepatiti% F.

Hepatiti% A

adaah "!!#"a# pe#&a'it Hepatiti% &a#" ri#"a# da# ara#" %e'ai

(e#&e$a$'a# 'e(atia#+ iru% hepatiti% A *HAiru% Hepatiti% A-

pe#&e$ara##&a (eaui '!t!ra#ti#a pe#derita &a#" pe#uara##&a (eaui

61112032 | HEPATITIS 10


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(a'a#a# da# (i#u(a# &a#" ter'!(ta(i#a%i+ $u'a# (eaui a'ti5ita% %e


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61112032 | HEPATITIS 13


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2.6 ETIOLOGI

Hepatitis A

Pe#&e$a$ pe#&a'it adaah 5iru% Hepatiti% A *HA-+ ter(a%u' a(ii

pi4!r#a5iridae $eru'ura# 2= #a#!(eter+ "e#u% hepat!5iru% &a#" di'e#a

61112032 | HEPATITIS 1,


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%e$a"ai e#ter!5iru% =2+ (e(pu#&ai 1 %er!t&pe da# , "e#!t&pe+ (erupa'a#

RNA 5iru%. iru% Hepatiti% A $er%iat ter(!%ta$i+ taha# a%a( da# taha#

terhadap e(pedu. iru% i#i di'etahui dapat $ertaha# hidup daa( %uhu

rua#"a# %ea(a e$ih dari 1 $ua#. Pea(u i#e'%i HA ha#&a ter$ata% pada

(a#u%ia da# $e$erapa $i#ata#" pri(ata. iru% dapat diper$a#&a' %e4ara i#

5itr! daa( 'utur %e pri(er (!#&et 'e4i atau %e4ara i#5i5! pada %i(pa#%e.

@ara'teri%ti' 5iru%8

G!!#"a# e#ter!5iru% RNA :ia(eter 2= #( :idete'%i pada a'hir (a%a i#'u$a%i da# a%e pre i'teri'

Hepatitis B

I#e'%i 5iru% hepatiti% B *HB- %e$eu(#&a di#a(ai hepatiti% %eru(J

di%e$a$'a# !eh 5iru% 'e!(p!' hepad#a5iru%. iru% ter%e$ut (e#"a#du#"

:NA.



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@ara'teri%ti' iru%8

iru% :NA

:ia(eter ,2 #(+ $er'ap%u "a#da

Me(ii'i api%a# per(u'aa# de#"a# i#ti didaa(#&a :ite(u'a# didaa( %eru(+ di%e$ut u"a de#"a# parti'e da#eJ :idaa( %eru( dite(u'a# parti'e ai# &a#" $er$e#tu' $uat da#

tu$uer+ (erupa'a# 5iru% &a#" tida' e#"'ap &aitu H$%A" *u#tu'

pe($uata# 5a'%i#- Repi'a%i ditu#u''a# !eh H$eA" *(e#u#u''a# ta#dai#e'ti5ita%

Pe#&e$a$ pe#&a'it adaah 5iru% Hepatiti% B *HB- &a#" ter(a%u'

a(ii Hepad#a5iru% da# $eru'ura# %a#"at 'e4i *,2 #(-. iru% Hepatiti% B

(erupa'a# 5iru% :NA da# %a(pai %aat i#i terdapat / "e#!tip HB &a#" teah

teride#ti7'a%i+ &aitu "e#!tip AH. HB (e(ii'i 3 e#i% (!r!!"i da# (a(pu

(e#"'!de , e#i% a#ti"e#+ &aitu HB%A"+ HBeA"+ HB4A"+ da# HB


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Hepatitis C

61112032 | HEPATITIS 1=


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@ara'teri%ti' 5iru%8

iru% RNA &a#" ter$u#"'u% e(a'

:ia(eter 3060 #(

Pe#&e$a$ pe#&a'it Hepatiti% F adaah 5iru% Hepatiti% F *HF- &a#"

ter(a%u' a(ii Da5i5iridea "e#u% Hepa4i5iru% da# (erupa'a# 5iru% RNA.

Setida'#&a 6 "e#!tip da# e$ih dari 0 %u$tipe HF &a#" $er$eda teah

dite(u'a#.

@ara'teri%ti' iru%8

iru% RNA :ia(eter 3 #( Me($utuh'a# HB%A" u#tu' $erpera# %e$a"ai api%a# uar parti'e

u#tu' (ea'u'a# repi'a%i

61112032 | HEPATITIS 1/


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Hepatiti% :

61112032 | HEPATITIS 1;


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Hepatiti% E

@ara'teri%ti' iru%8

iru% RNA

:ia(eter 32 3, #( Ma%a I#'u$a%i8 2; (i#""u

2.= EPI:EMIOLOGI

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2.=.1 S!%ia e'!#!(i8

:aerah de#"a# ti#"'at %!%ia e'!#!(i pe#dudu' &a#" re#dah+

(e(pu#&ai %a#ita%i i#"'u#"a# &a#" re#dah pua. P!a pe#uara# Hepatiti% A

da# Hepatiti% E &a#" (eaui !r!e4a %a#"at dipe#"aruhi 'uaita% %a#ita%i

i#"'u#"a# %ete(pat+ %ehi#""a pe#dudu' &a#" ti#""a di daerah e#de(i%

da# atau daerah de#"a# 'uaita% %a#ita%i &a#" re#dah a'a# (e(pu#&ai

ri%i'! e$ih $e%ar u#tu' (e#derita Hepatiti% A (aupu# Hepatiti% E.

Studi &a#" dia'u'a# !eh D@I di ?a'arta (e#u#u''a# $ah)a

ti#"'at %!%ia e'!#!(i re#dah (erupa'a# %aah %atu a't!r ri%i'! Hepatiti% B

da# Hepatiti% F+ &a#" dita#dai de#"a# ha%i pe(eri'%aa# HB%A" *Q- *OR

1/.0; ;K FI 2.313;.0-. Ha ai# &a#" dapat di'etahui adaah $ah)a

pe#dudu' 'e!(p!' ra% Fhi#e%e (e(pu#&ai ri%i'! 2.;= e$ih ti#""i u#tu'

teri#e'%i HB di$a#di#"'a# de#"a# 'e!(p!' ra% (ea&u *OR 2+;= ;K FI1+22=+/3-.

:ari %uatu %tudi &a#" dia'u'a# di @!rea dapat di'etahui $ah)a

pada 'e!(p!' (a%&ara'at de#"a# ti#"'at %!%ia e'!#!(i (e#e#"ah da#

ata% (e(pu#&ai 'e4e#deru#"a# !$e%ita% 'are#ap!a (a'a# &a#" %aah.

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O$e%ita% (e($eri'a# '!#tri$u%i &a#" #&ata pada per'e($a#"a# pe#&a'it

'r!#i% *%aah %atu#&a Hepatiti% B da# Hepatiti% F- (e#adi i5er 4irrh!%i%.

2.=.2 Da't!r Ri%i'!

Ri%i'! ti#""i terhadap Hepatiti% A da# Hepatiti% E+ terdapat pada 8

Ora#" &a#" (e#"u#u#"i atau ti#""a di #e"ara e#de(i% Hepatiti% A da#

Hepatiti% E. Ti#""a di daerah de#"a# '!#di%i i#"'u#"a# &a#" $uru' *pe#&ediaa# air

(i#u( da# air $er%ih+ pe($ua#"a# air i($ah+ pe#"e!aa# %a(pah+

pe($ua#"a# ti#a &a#" tida' (e(e#uhi %&arat-. Per%!#a h&"ie#e &a#" re#dah a#tara ai#8 pe#erapa# PHBS (a%ih

'ura#"+ 4ara (e#"!ah (a'a#a# &a#" tida' (e(e#uhi per%&arata#

'e%ehata#.

Hepatiti% A

I#di5idu &a#" $erper"ia# 'e daerah &a#" (e#"aa(i 'eadia# Hepatiti%

A

Te#a"a 'e%ehata# Hu$u#"a# %e'%ua de#"a# i#di5idu &a#" teri#e'%i

Hepatiti% B

A#a' &a#" diahir'a# dari i$u pe#derita Hepatiti% B. Pa%a#"a# Pe#derita Hepatiti% B. Ora#" &a#" %eri#" $er"a#ti pa%a#"a# %e


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Pa%ie# &a#" (e#aa#i H: daa( a#"'a )a'tu a(a Pe#eri(a d!#!r *$ai' darah+ ari#"a#+ !r"a#- %e$eu( tahu# 1;/0a# Te#a"a 'e%ehata# I#di5idu &a#" teri#e'%i HI ?a#i# &a#" di'a#du#" atau $a&i &a#" diahir'a# !ehi$u &a#" teri#e'%i

Hepatiti% Pe#""u#a aru( %u#ti' tida' %teri *#ar'!$a+ tat!+ ti#di'- Pe'era &a#" $erhu$u#"a# de#"a# darah da# pr!du' darah pe#derita

HF.

Hepatiti% :

Ora#" &a#" '!#ta' a#"%u#" de#"a# darah pe#derita Hepatiti% :. Pe#derita Hep. B 'r!#i' *4arrier-

I#di5idu &a#" $eu( per#ah teri#e'%i atau di$eri'a# i(u#i%a%i Hep. B I:

2.=.3 I#%ide#+ Pre5ae#%i+ d

Hepatiti% A

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Hepatiti% B

Hepatiti% B adaah pe#&a'it i#e'%i 5iru% hati &a#" (e#urut

per'e($a#"a##&a apa$ia tida' dita#"a#i de#"a# $ai' dapat $er'e($a#"

(e#adi %ir!%i% hati+ 'ar%i#!(a hepat!%euer $ah'a# tida' ara#"

(e#&e$a$'a# 'e(atia#. Me#urut HO+ %edi'it#&a 30 uta pe#derita 4arrier

hepatiti% B terdapat di %euruh du#ia+ =K#&a $erada di A%ia Pa%i7'.

:iper'ira'a# %etiap tahu##&a terdapat 2 uta pa%ie# (e#i#""a 'are#a

hepatiti% B. Hepatiti% B (e#4a'up 13 'a%u% pada a#a'. I#d!#e%ia ter(a%u'

#e"ara e#de(i' hepatiti% B de#"a# u(ah &a#" tera#"'it a#tara 2+K

hi#""a 36+1=K dari t!ta u(ah pe#dudu' *Ria E.M.+ 200;-. Ra(ai

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pe($a)a 5iru% hepatiti% B tida' (e#"etahui i(pi'a%i pe#&a'it i#i+ da#

(e(pu#&ai per%ep%i &a#" $er$eda$eda.

:aa( pe#eitia# terhadap 320 pe#dudu' @e($!a A(eri'a+

(edia# %'!r ti#"'at pe#"etahua# (ere'a adaah ha#&a ,./ daripada

(a'%i(a 12*Ta&!r M+ 200-. :aa( pe#eitia# &a#" ha(per %a(a

terhadap 1,= )a#ita Fi#a @a#ada+ re%p!#de# ha#&a (e#a)a$ 6+; dari 12

%!aa# &a#" $e#ar *Th!(p%!# M?+ 200,-.



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Hepatiti% F

61112032 | HEPATITIS 26


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61112032 | HEPATITIS 2=


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Hepatiti% :

61112032 | HEPATITIS 2/


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Hepatiti% E

2./ PATOGENESIS

61112032 | HEPATITIS 2;


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@u(a# i#i (a%u' 'e daa( tu$uh de#"a# pera#tara (a'a#a# atau

air &a#" ter4e(ar. :i daa( %aura# pe#4era#a'a# 'u(a# ter%e$ut dapat

$er'e($a#" $ia' de#"a# 4epat+ 'e(udia# dia#"'ut (eaui aira# darah 'e

daa( hati+ di(a#a ti#""a di daa( 'apier'apier darah da# (e#&era#"

ari#"a#ari#"a# %e'itar#&a %ehi#""a (e#&e$a$'a# rada#" hati. *Ma#%!er

A+ 2000+ p.22/-

61112032 | HEPATITIS 31


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HEPATITIS B

Pe#uara# Hepatiti% B

:ari i$u 'e $a&i %aat (eahir'a# Hu$u#"a# %e'%ua Tra#%u%i darah ?aru( %u#ti' Ti#di' tei#"a Pe#""u#aa# aat 'e$er%iha# diri *%i'at "i"i+ ha#du'+ pi%au 4u'ur-

%e4ara $er%a(a%a(a.

61112032 | HEPATITIS 32


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Hepatiti% B dapat (e#&era#" %iapa%aa+ a'a# tetapi u(u(#&a $a"i (ere'a

&a#" $eru%ia pr!du'ti a'a# e$ih $ere%i'! ter'e#a pe#&a'it i#i.

Ma%a i#'u$a%i

Pada u(u(#&a i#e'%i 5iru% hepatiti% B teradi e$ih a($at di$a#di#"'a#

de#"a# i#e'%i 5iru% hepatiti% A. Hepatiti% B 4e#4eru#" reati e$ih ri#"a#

pada $a&i da# a#a'a#a' %erta (u#"'i# tida' di'etahui. Be$erapa pe#derita

i#e'%i teruta(a #e!#atu% a'a# (e#adi 'arier 'r!#i%. Ma%a i#'u$a%i

hepatiti% B di(uai %ea' pe(apara# hi#""a a)ita# i'teru% %ea(a 2

$ua#. Pada pe#&a'it i#i tida' terdapat pre5ae#%i &a#" $erhu$u#"a# de#"a#

(u%i( *Hetti+ 200;-.

Ber'i%ar a#tara 301/0 hari de#"a# ratarata 60;0 hari. La(a (a%a i#'u$a%i

ter"a#tu#"8

1. $a#&a'#&a 5iru% &a#" ada daa( tu$uh pe#derita2. 4ara pe#uara# da#

3. a't!r pea(u

?u(ah 5iru% da# u%ia (erupa'a# a't!r pe#ti#" &a#" $erhu$u#"a# de#"a#

'eparaha# a'ut atau 'r!#i' Hepatiti% B

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HEPATITIS F

Pe#uara#

Pare#tera

Se< F!#ta4t Per%ai#a# dari i$u &a#" teri#e'%i Hep. F Farrier State

Ma%a i#'u$a%i8

226 (i#""u *rerata8 60120 hari-

HEPATITIS :

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Fara Pe#uara#8

Per4uta#eu%per(u4!%a Pare#tera Se< F!#ta4t :arah atau pr!du' darah ai# (erupa'a# %u($er pe#uara#

Ma%a I#'u$a%i8 2160 hari

Su($er ai# (e#"ata'a#8 2/ (i#""u

HEPATITIS E

Fara Pe#uara#8 %a(a de#"a# pe#uara# HA

!!#!ti4 i#e4ti!#

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I#'u$a%i 2; (i#""u

2.; PATODISIOLOGI

Hepatiti% B

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Hepatiti% F

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Hepatiti% :

2.10 PATOLOGI

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Hepatiti% A

Hepatiti% F

Hepatiti% :

2.11 MANIDESTASI @LINIS

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Hepatiti% A

Pada (i#""u perta(a+ i#di5idu &a#" dia#"'iti a'a# (e#"aa(i

%a'it %eperti 'u#i#"+ 'eetiha#+de(a(+ hia#" %eera (a'a#+ (u#tah

(u#tah+ pu%i#" da# 'e#4i#" &a#" $er)ar#a hita( pe'at. :e(a( &a#"

teradi adaah de(a( &a#" teru% (e#eru%+ tida' %eperti de(a( &a#"

ai##&a &aitu pada de(a( $erdarah+ t$4+ th&pu%+ d

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Geaa a)a i#e'%i 5iru% Hepatiti% A %a#"at $er5aria%i da# $er%iat

tida' %pe%i7'. :e(a(+ 'eeaha#+ a#!re'%ia *tida' #a%u (a'a#- da#

"a#""ua# pe#4er#aa# *(ua+ (u#tah+ 'e($u#"- dapat dite(u'a# pada

a)a pe#&a'it. :aa( )a'tu 1 (i#""u+ $e$erapa pe#derita dapat (e#"aa(i

"eaa 'u#i#" di%ertai "ata *i'teru%-+ $ua#" air 'e4i $er)ar#a %eperti teh+

da# ti#a $er)ar#a pu4at. I#e'%i pada a#a' $eru%ia di$a)ah tahu#

u(u(#&a tida' (e($eri'a# "eaa &a#" ea% da# ha#&a 10K &a#" a'a#

(e($eri'a# "eaa i'teru%. Pada a#a' &a#" e$ih tua da# de)a%a+ "eaa

&a#" (u#4u $ia%a#&a e$ih $erat da# i'teru% teradi pada e$ih dari =0K

pe#derita

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Hepatiti% B+ F+ :+ E + G

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Hepatiti% B

Se$eu( ti($u#&a i'teru% $ia%a#&a didahuui !eh %uatu (a%a

pr!d!r(a %eperti

(aai%e+ a#!re'%ia+ da# %eri#" "eaa "a%tr!i#te%ti#ai%+ di%ertai #&eri perut

ata%. Pe(eri'%aa# a$!rat!riu( (e#u#u'a# hiper$iiru$i#e(ia+ 'e#ai'a#

'adar tra#%a(i#a%e %eru(. Pada te% %er!!"i% didapat'a# HB%A" *Q-+ I" M

A#ti HB4 *Q-. Berda%ar'a# "eaa 'i#i% da# petu#u' %er!!"i%+ (a#ie%ta%i

'i#i% hepatiti% B di$a"i 2 &aitu 8

1. Hepatiti% B a'ut &aitu (a#ie%ta%i i#e'%i 5iru% hepatiti% B terhadap

i#di5idu &a#" %i%te( i(u#!!"i#&a (atur %ehi#""a $era'hir de#"a#

hia#"#&a 5iru% hepatiti% B dari tu$uh 'r!pe%.

Hepatiti% B a'ut terdiri ata% 3 &aitu 8

a. Hepatiti% B a'ut &a#" 'ha%

$. Hepatiti% Du(i#a#

4. Hepatiti% Su$'i#i'

2. Hepatiti% B 'r!#i%+

&aitu (a#ie%ta%i i#e'%i 5iru% hepatiti% B terhadap i#di5idu de#"a# %i%te(

i(u#!!"i 'ura#" %e(pur#a %ehi#""a (e'a#i%(e+ u#tu' (e#"hia#"'a#

HB tida' ee'ti da# teradi '!e'%i%te#%i de#"a# HB.

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Se%e!ra#" &a#" teri#e'%i HB $i%a (e#"aa(i Hepatiti% B a'ut.

Pe#derita &a#" (e#"aa(i Hepatiti% B a'ut a'a# (e#"aa(i "eaa

pr!dr!(a &a#" %a(a de#"a# Hepatiti% a'ut u(u(#&a+ &aitu8

'eeaha#+ 'ura#"#&a #a%u (a'a#+ (ua+ (u#tah+ da#



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#&eri %e#di.

Geaa"eaa pr!dr!(a i#i a'a#(e($ai' 'eti'a perada#"a# hati+ &a#"

u(u(#&a dita#dai de#"a# "eaa 'u#i#" ti($u. aaupu# $e"itu+ =0K

pe#derita Hepatiti% a'ut ter#&ata tida' (e#"aa(i 'u#i#".

Se$a"ia# dari pe#derita Hepatiti% B a'ut au a'a# (e#"aa(i

'e%e($uha# %p!#ta#+ %e(e#tara %e$a"ia# a"i a'a# $er'e($a#" (e#adi

Hepatiti% B 'r!#i'. @e(u#"'i#a# (e#adi %ir!%i% atau 'a#'er hati+ %eri#"'ai

tida' (e#u#u''a# "eaa apapu# da# tida' (e#"aa(i pe#uru#a#

'e(a(pua# $e'era. Ma'a pe#&a'it Hepatiti% B %eharu%#&a tida'

(e#"ha($at ha' %e%e!ra#" u#tu' $e'era atau $er%e'!ah.

Sa&a#"#&a pada pra'te'#&a %eri#"'ai didapat'a# di%'ri(i#a%i

terhadap !ra#" &a#" %udah di'etahui (e(ii'i %tatu% Hepatiti% B *Q-.

@e$a#&a'a# di%'ri(i#a%i i#i di%e$a$'a# 'ura#"#&a pe#"etahua# pu$i'

(e#"e#ai Hepatiti% B. Aa%a# &a#" u(u( &a#" di'e(u'a'a# adaah

'eta'uta# a'a# ri%i'! pe#uara# di te(pat 'era da# 'etida'(a(pua# !ra#"

&a#" $er%a#"'uta# u#tu' $e'era de#"a# #!r(a. @edua ha i#i %e$e#ar#&a

'ura#" ree5a# u#tu' diadi'a# aa%a#+ (e#"i#"at i#e'%i Hepatiti% B ha#&a

$i%a teradi (eaui '!#ta' 4aira# tu$uh &a#" ara#" %e'ai teradi pada

ha(pir %e"aa e#i% pe'eraa# da# %iat Hepatiti% B &a#" ta#pa "eaa %a(pai

ti($u '!(pi'a%i.

aaupu# $e"itu+ $e$erapa pe#&e%uaia# u"a haru% dia'u'a# pada

pe#derita Hepatiti% B. Pe#derita tida' diper$!eh'a# $e'era de#"a# paa#a#

ti#""i $e#da$e#da &a#" $er%iat hepat!t!'%i' *pe'era pa$ri' 4at atau

$aha# 'i(ia ai#-. Aa%a# ai# u#tu' tida' (e(pe'era'a# pe#derita

Hepatiti% B adaah (a%aah a%ura#%i. #tu' (a%aah i#i+ 'eputu%a#

pe#eri(aa# a'a# di$uat 'e$ia'a# 'hu%u% &a#" tida' (eru"i'a# da#

(ei#du#"i pe#derita u#tu' (e#dapat'a# ha'ha'#&a %e$a"ai )ar"a

#e"ara. Pe#derita Hepatiti% B u"a haru% (e#dapat a'%e% &a#"

%eua%ua%#&a u#tu' pe#didi'a# daa( $ida#" apapu#. #tu' (e#"hapu%



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per$edaa# pera'ua# pada pe#derita Hepatiti% B+ $e$erapa a#"'ah '!#'ret

haru% %e"era dia($i. La#"'aha#"'ah i#i (e#4a'up pe#&uuha# 'epada

piha'piha' pe($eri 'era+ %e'!ah+ (aupu# u#i5er%ita% (e#"e#ai Hepatiti%

B+ da# '!!rdi#a%i de#"a# pe($uatpe($uat 'eputu%a# u#tu' (eahir'a#

'e$ia'a#'e$ia'a# &a#" (ei#du#"i ha'ha' pe#derita Hepatiti% B di

I#d!#e%ia.

Hepatiti% F



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Pe#derita Hepatiti% F %eri#" 'ai !ra#" &a#" (e#derita Hepatiti% F tida'

(e#u#u''a# "eaa+ )aaupu# i#e'%i teah teradi $ertahu#tahu# a(a#&a.

Na(u# $e$erapa "eaa &a#" %a(ar dia#tara#&a adaah8

Leah+ Hia#" %eera (a'a#+ Sa'it perut+ ri# (e#adi "eap da# @uit atau (ata (e#adi 'u#i#" &a#" di%e$ut au#di4e *ara#"

teradi-.Pada $e$erapa 'a%u% dapat dite(u'a#8

pe#i#"'ata# e#&(e hati pada pe(eri'%aa# uri#e+ #a(u# de(i'ia#

pada pe#derita Hepatiti% F u%tru ter'ada#" e#&(e hati u'tua%i

$ah'a# #!r(a.



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Hepatiti% :

@i#i% : Hepatiti% A

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Hepatiti% E

1. Da%e Pr!dr!(a *Pre I'teri'-8

Ti($u 1 ("" %e$eu( i'teru%8

Maai%e

A#!re'%ia

Sa'it 'epaa

:e(a(

Athra"ia

Arthriti%

Rua( 'uit

:&%4!(!rt perut 'a#a# ata%

Le(ah

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2. Da%e I'teri'8

Bera#"%u#" 2, (i#""u8

?au#di4e I'teri'

:e(a(

Pruritu%

Na%u (a'a# (a%ih (e#uru#

:ar' 4!!r uri#e

Fa& 4!!r %t!!

Hepat!(e"ai *'ada#"-

Spe#!(e"ai

3. Da%e Pe#&e($uha#8

Pada 'a%u% &a#" tida' (e#"aa(i '!(pi'a%i di(uai 12 (i#""u %eteah

a%e i'teru%. Bera#"%u#" %ea(a 26 (i#""u8

@euha# (udah eah

True e4e% 4!!r

I'teru% $er'ura#"

ri#e $er)ar#a UU (uda

Spe#!(e"ai (e#"e4i+ hepat!(e"ai #!r(a daa( $$rp ("" 'e(udia#

LDTa$#!r(a (e#etap %ea(a 36 $ua#



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2.12 :IAGNOSIS



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Hepatiti% A

:i%a(pi#" "eaa da# ta#da 'i#i% &a#" 'ada#" tida' (u#4u+ dia"#!%i%

Hepatiti% A dapat dite"a''a# $erda%ar'a# ha%i pe(eri'%aa# I"Ma#tiHA

%eru( pe#derita.

Hepatiti% B

:ia"#!%i% dite"a''a# $erda%ar'a# "eaa 'i#i' &a#" dite(ui da# didu'u#"

!eh pe(eri'%aa# a$!rat!riu(. Ri)a&at i'teru% pada para '!#ta' 'euar"a+

'a)a#'a)a# %e'!ah+ pu%at pera)ata# $a&i+ te(a#te(a# atau peraa#a#

'e daerah e#de(i dapat (e($eri'a# petu#u' te#ta#" dia"#!%i%. Hepatiti%

B 'r!#i% (erupa'a# pe#&a'it #e'r!i#a(a%i 'r!#i% hati &a#" di%e$a$'a#

!eh i#e'%i 5iru% hepatiti% B per%i%te#. Hepatiti% B 'r!#i% dita#dai de#"a#

HB%A" p!%iti *U 6 $ua#- di daa( %eru(+ ti#""i#&a 'adar HB :NA da#

$era#"%u#"#&a pr!%e% #e'r!i#a(a%i 'r!#i% hati. Farrier HB%A" i#a'ti

diarti'a# %e$a"ai i#e'%i HB per%i%te# hati ta#pa #e'r!i#a(a%i. Seda#"'a#

hepatiti% B 'r!#i% e'%a%er$a%i adaah 'eadaa# 'i#i% &a#" dita#dai de#"a#

pe#i#"'ata# i#ter(ite# ALTU10 'ai $ata% ata% #iai #!r(a *BANN-.

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:ia"#!%i% i#e'%i hepatiti% B 'r!#i% dida%ar'a# pada pe(eri'%aa# %er!!"i+

peta#da 5ir!!"i+ $i!'i(ia)i da# hi%t!!"i.

Se4ara %er!!"i pe(eri'%aa# &a#" dia#ur'a# u#tu' dia"#!%i% da#

e5aua%i i#e'%i hepatiti% B 'r!#i% adaah 8 HB%A"+ HBeA"+ a#ti HBe da# HB

:NA. Ada#&a HB%A" daa( %eru( (erupa'a# peta#da %er!!"i% i#e'%ihepatiti% B. Titer HB%A" &a#" (a%ih p!%iti e$ih dari 6 $ua# (e#u#u''a#

i#e'%i hepatiti% 'r!#i%. Mu#4u#&a a#ti$!di terhadap HB%A" *a#ti HB%-

(e#u#u''a# i(u#ita% da# atau pe#&e($uha# pr!%e% i#e'%i. Ada#&a HBeA"

daa( %eru( (e#"i#di'a%i'a# ada#&a repi'a%i a'ti 5iru% di daa(

hepat!%it. Titer HBeA" $er'!rea%i de#"a# 'adar HB :NA. Na(u# tida'

ada#&a HBeA" *#e"ati- $u'a# $erarti tida' ada#&a repi'a%i 5iru%+ 'eadaa#

i#i dapat diu(pai pada pe#derita teri#e'%i HB &a#" (e#"aa(i (uta%i

*pre4!re atau 4!re (uta#t-. Pe#eitia# (e#u#u''a# $ah)a pada %e%e!ra#"

HBeA" #e"ati ter#&ata (e(ii'i HB :NA U104!pie%(. Pa%ie# hepatiti%

'r!#i% B de#"a# HBeA" #e"ati &a#" $a#&a' teradi di A%ia da# Meditera#ea

u(u(#&a (e(pu#&ai 'adar HB :NA e$ih re#dah *$er'i%ar 10,10/

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4!pie%(- di$a#di#"'a# de#"a# tipe HBeA" p!%iti. Pada e#i% i#i (e%'ipu#

HBeA" #e"ati+ re(i%i da# pr!"#!%i% reati ee'+ %ehi#""a peru diterapi.

Se4ara %er!!"i i#e'%i hepatiti% per%i%te# di$a"i (e#adi

hepatiti% B 'r!#i% da# 'eadaa# 4arrier HB%A" i#a'ti. Va#" (e($eda'a# 'edua#&a adaah

titer HB :NA+ deraat #e'r!i#a(a%i da# ada#&a %er!'!#5er%i HBeA".

Seda#"'a# hepatiti% 'r!#i% B %e#diri di$eda'a# $erda%ar'a# HBeA"+ &aitu

hepatiti% B 'r!#i% de#"a# HBeA" p!%iti da# hepatiti% B 'r!#i% de#"a# HBeA" #e"ati.

Pe(eri'%aa# 5ir!!"i u#tu' (e#"u'ur u(ah HB :NA %eru(

%a#"at pe#ti#" 'are#a dapat (e#""a($ar'a# ti#"'at repi'a%i 5iru%. Ada

$e$erapa per%!aa# $er'aita# de#"a# pe(eri'%aa# 'adar HB :NA.

Perta(a+ (et!de &a#" di"u#a'a# u#tu' (e#"u'ur 'adar HB :NA. Saat i#i

ada $e$erapa e#i% pe(eri'%aa# HB :NA+ &aitu 8

Bra#4hed :NA+ H&$rid 4apture+ Li9uid h&$ridiati!# da# PFR.

:aa( pe#eitia#+ u(u(#&a titer HB :NA diu'ur (e#""u#a'a# a(pi7'a%i+

%eperti (i%a#&a PFR+ 'are#a dapat (e#"u'ur %a(pai 1001000 4!pie%(.

@edua+ $e$erapa pa%ie# de#"a# hepatiti% B 'r!#i% (e(ii'i 'adar HB :NA

u'tuati. @e ti"a+ pe#e#tua# a($a#" $ata% 'adar HB :NA &a#"

(e#4er(i#'a# ti#"'at pr!"re%i7ta% pe#&a'it hati. Saah %atu 'epe#ti#"a#

ai# pe#e#tua# 'adar HB :NA adaah u#tu' (e($eda'a# a#tara 4arrier

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hepatiti% i#a'ti de#"a# hepatiti% B 'r!#i% de#"a# HBeA" #e"ati 8 'adar

W10 4!pie%( e$ih (e#u#u''a# 4arrier hepatiti% i#a'ti. Saat i#i teah

di%epa'ati $ah)a 'adar HB :NAU104!pie%( (erupa'a# $ata% pe#e#tua#

u#tu' hepatiti% B 'r!#i%.

Saah %atu pe(eri'%aa# $i!'i(ia)i &a#" pe#ti#" u#tu' (e#e#tu'a#

'eputu%a# terapi adaah8

@adar ALT

Pe#i#"'ata# 'adar ALT (e#""a($ar'a# ada#&a a'ti7ta%

#e'r!i#a(a%i. Oeh 'are#a itu pe(eri'%aa# i#i diperti($a#"'a# %e$a"ai predi'%i

"a($ara# hi%t!!"i Pa%ie# de#"a# 'adar ALT &a#" (e#i#"'at (e#u#u''a# pr!%e%

#e'r!i#a(a%i e$ih $erat di$a#di#"'a# pada ALT &a#" #!r(a. Pa%ie# de#"a# 'adar ALT #!r(a (e(ii'i re%p!# %er!!"i &a#" 'ura#"

$ai' pada terapi a#ti5ira. Oeh %e$a$ itu pa%ie# de#"a# 'adar ALT #!r(a diperti($a#"'a#

u#tu' tida' diterapi+ 'e4uai $ia ha%i pe(eri'%aa# hi%t!!"i

(e#u#u''a# pr!%e% #e'r!i#a(a%i a'ti.

Tuua# pe(eri'%aa# hi%t!!"i adaah u#tu'8

o (e#iai ti#"'at 'eru%a'a# hati+o (e#&i%ih'a# dia"#!%i% pe#&a'it hati ai#+o pr!"#!%i% da#o

(e#e#tu'a# (a#ae(e# a#ti 5ira.

'ura# %pe%i(e# $i!p%i &a#" repre%e#tati adaah 13 4( *u'ura# pa#a#"-

da# 1+22 (( *u'ura# dia(eter- $ai' (e#""u#a'a# aru( Me#"hi#i atau

Tru4ut. Saah %atu (et!de pe#iaia# $i!p%i &a#" %eri#" di"u#a'a# adaah

de#"a# Hi%t!!"i4 A4ti5it& I#de< %4!re.Pada %etiap pa%ie# de#"a# i#e'%i HB

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peru dia'u'a# e5aua%i a)a. Pada pa%ie# de#"a# HBeA" p!%iti da# HB

:NA U 104!pie%( da# 'adar ALT #!r(a &a#" $eu( (e#dapat'a# terapi

a#ti5ira peru dia'u'a# pe(eri'%aa# ALT $er'aa da# %'ri#i#" terhadap

ri%i'! @HS+ i'a peru dia'u'a# $i!p%i hati. Seda#"'a# $a"i pa%ie# de#"a#

'eadaa# 4arrier HB%A" i#a'ti peru

dia'u'a# pe(a#taua# 'adar ALT da# HB :NA *Suhar! ?.B.+2006-.

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Sa(pai %aat i#i terdapat $e$erapa i#di'at!r a$!rat!ri% &a#" $i%a

di"u#a'a# u#tu' (e#iai i#e'%i Hepatiti% B. Pada i#e'%i a'ut+ a#ti$!di

terhadap HB4A" adaah &a#" pai#" perta(a (u#4u+ dii'uti de#"a#

(u#4u#&a HB%A" da# HBeA" %eru(. Bia pe#derita (e#"aa(i 'e%e($uha#

%p!#ta# %eteah Hepatiti% B a'ut+ (a'a a'a# teradi %er!'!#5er%i HB%A" da#

HBeA"+ &a#" dita#dai 'adar 'edua pe#a#da ter%e$ut tida' a'a# dapat

terdete'%i a"i di %eru( %e(e#tara a#tiHB% da# a#tiHBe u%tru (uai

terdete'%i. Se$ai'#&a+ pada Hepatiti% B 'r!#i'+ HB%A" da# HBeA" a'a# teru%

terdete'%i di %eru( pe#derita. Pada pe#derita de#"a# Hepatiti% B 'r!#i'+

:NA HB %e$ai'#&a diperi'%a u#tu' (e(a#tau peraa#a# pe#&a'it. Pada

$e$erapa e#i% 5iru% (uta#+ HBeA" $i%a tida' terdete'%i di %eru( )aaupu#

pr!%e% perada#"a# hati (a%ih teradi da# 'adar :NA HB %eru( (a%ih

ti#""i.



66/136

61112032 | HEPATITIS 66


67/136

Hepatiti% F

61112032 | HEPATITIS 6=


68/136

Hepatiti% :

61112032 | HEPATITIS 6/


69/136

Hepatiti% E

2.13 :IAGNOSIS BAN:ING

61112032 | HEPATITIS 6;


70/136

Hepatiti% A

61112032 | HEPATITIS =0


71/136

61112032 | HEPATITIS =1


72/136

Hepatiti% B+ F+ :

Lihat pe#ea%a# Hep A

:: Hep B da# F

2.1, TATA LA@SANA

61112032 | HEPATITIS =2


73/136

61112032 | HEPATITIS =3


74/136

61112032 | HEPATITIS =,


75/136

Dar(a'!!"i8

o Ster!ido I((u#!"!$ui#o A#ti Lip!(i4 A"e#to A#ti irao Terapi %i(t!(ati' ai#o N! hepat!t!


76/136

Pada %aat i#i terdapat (a4a( !$at u#tu' Hepatiti% 'r!#i' &a#" teah

di%etuui !eh D:A &a#" ter(a%u' daa( Nu4e!%ide A#a!"*NA-8

o La(i5udi#e+o Ade!5ir+o E#te4a5ir+o Te$i5udi#e+o Te#!!5ir

Seda#"'a# !$at #!# NA &a#" di$eri'a# %e4ara pare#tera8

I#terer!# aa2$ &a#" %udah di"a#ti !ehPe"i#terer!#aa2a.

61112032 | HEPATITIS =6


77/136

61112032 | HEPATITIS ==


78/136

61112032 | HEPATITIS =/


79/136

61112032 | HEPATITIS =;


80/136

61112032 | HEPATITIS /0


81/136

Hepatiti% F

Dar(a'!!"i

Pe"&ated i#ter5er!# Q Ri$a5iri#

I#terer!# '!#5e#%i!#a Q Ri$a5iri#

:iet8

61112032 | HEPATITIS /1


82/136

Ti#""i 'ar$!hidrat

Re#dah e(a'

Re#dah pr!tei# *ter"a#tu#"

'a%u%-

N! a4!h!

Hepatiti% :

61112032 | HEPATITIS /2


83/136

Hepatiti% E

61112032 | HEPATITIS /3


84/136

61112032 | HEPATITIS /,


85/136



86/136

T?AN :IET

Tuua# diet pe#&a'it hati da# 'a#du#" e(pedu adaah u#tu' (e#4apai da#

(e(pertaha#'a# %tatu% "ii !pti(a ta#pa (e($erat'a# u#"%i hati. Tuua#

diet pada pe#derita Hepatiti% adaah u#tu'8

1. Me#i#"'at'a# re"e#era%i ari#"a# hati da# (e#4e"ah 'eru%a'a#

e$ih a#ut da#atau (e#i#"'at'a# u#"%i ari#"a# hati &a#" ter%i%a

2. Me#4e"ah 'ata$!i%(e pr!tei#

3. Me#4e"ah pe#uru#a# $erat $ada# atau (e#i#"'at'a# $erat $ada# $ia

'ura#"

,. Me#4e"ah atau (e#"ura#"i a%ite%+ 5ari%e% e%!a"u% da# hiperte#%i p!rta

. Me#4e"ah '!(a hepati'

6. Me#"ata%i a#!re'%ia

=. :i$eri'a# (a'a#a# &a#" dapat (e(e#uhi %eera pe#derita ta#pa

(e#"e#&a(pi#"'a# terapi diet &a#" haru% diaa#i pe#derita

61112032 | HEPATITIS /6


87/136


88/136

ita(i# da# (i#era di$eri'a# %e%uai de#"a# ti#"'at de7%ie#%i. Bia

peru+ di$eri'a# %upe(e# 5ita(i# B '!(pe'%+ F da# @ %erta (i#era %e#"

da# at $e%i $ia ada a#e(ia

6. Re#dah "ara( atau 4aira# di$ata%i $ia teradi pe#i($u#a# "ara(air

Natriu( di$eri'a# re#dah+ $er"a#tu#" ti#"'at ede(a da# a%ite%. Bia

pa%ie# (e#dapat'a# diureti'a+ "ara( #atriu( dapat di$eri'a# e$ih eua%a

=. Mudah di4er#a da# tida' (era#"%a#".

/. Baha# (a'a#a# &a#" (e#"a#du#" "a% dihi#da'a#.

;. Faira# di$eri'a# e$ih dari $ia%a+ 'e4uai $ia ada '!#trai#di'a%i

10. Be#tu' (a'a#a# u#a' $ia ada 'euha# (ua da# (u#tah atau

(a'a# $ia%a

%e%uai 'e(a(pua# %aura# 4er#a.

Be$erapa pa#ta#"a#VANG HARS :IHIN:ARIa#tara ai# 8

1. Se(ua (a'a#a# &a#" (e#"a#du#" e(a' ti#""i%eperti da"i#" 'a($i#" da# $a$i+ er!ha#+ !ta'+ e% 'ri(+ %u%u u

4rea(+ 'eu+ (e#te"a(ar"ari#e+ (i#&a' %erta (a'a#a# $er%a#ta#

%eperti "uai+ 'are+ atau "ude".

2. Ma'a#a# 'ae#" %eperti %arde# da# '!r#ed.

3. @ue atau 4a(ia# $ere(a'+ %eperti 'ue tart+ "!re#"a#+ a%t !!d.

,. Baha# (a'a#a# &a#" (e#i($u'a# "a%+ %eperti u$i+ 'a4a#" (erah+

'!+ %a)i+ !$a'+ (e#ti(u#+ duria#+ #a#"'a.

. Bu($u &a#" (era#"%a#"+ %eperti 4a$e+ $a)a#"+ (eri4a+ 4u'a+ ahe.

6. Mi#u(a# &a#" (e#"a#du#" a'!h! da# %!da.

61112032 | HEPATITIS //


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Baha# (a'a#a# &a#" BAI@di'!#%u(%i pe#derita hepatiti% 8

1. Su($er hidrat ara#" %eperti #a%i+ ha5er(!ut+ r!ti putih+ u($iu($ia#.

2. Su($er pr!tei# a#tara ai# teur+ i'a#+ da"i#"+ a&a(+ te(pe+ tahu+ 'a4a#"

hiau+ %a&ura# da# $uah$uaha# &a#" tida' (e#i($u'a# "a%.

3. Ma'a#a# &a#" (e#"a#du#" hidrat ara#" ti#""i da# (udah di4er#a

%eperti "ua"ua+ %ari $uah+ %eai+ %irup+ (a#i%a#+ da# (adu.

Ba"i pe#derita hepatiti%+ terapi diet %a#"at pe#ti#" u#tu'

dia'u'a#. @a#du#"a# "ii pada terapi diet pe#derita hepatiti% $er$eda

$eda ter"a#tu#" pada '!#di%i pe#derita.

T!ta 'a!ri &a#" di$eri'a# u"a $er$eda+ ter"a#tu#" $e%ar

$ada# da# a'ti7ta% pe#derita.

Seai# itu+ pada u(u(#&a 'ura#" $ai' i'a terau $a#&a'

(e#"ura#"i e(a' 'e4uai $ia ada "eaa 'u#i#" pada (ata atau 'uit.

Le(a' &a#" (e#"a#du#" $a#&a' a%a( e(a' e%e#%ia %eperti

(i#&a' #a$ati atau (i#&a' i'a# $!eh di$eri'a# %eperti $ia%a.

@are#a "eaa pe#&a'it $er%iat %a#"at i#di5idua+ diet di%u%u#

%e4ara i#di5idua pua de#"a# (e#&ata'a# $erapa 'e$utuha# pr!tei#

da# #atriu( &a#" di$utuh'a# di daa( diet. Ma4a((a4a( diet u#tu'

pe#derita Hepatiti% 8

61112032 | HEPATITIS /;


90/136

:iet Hati 1

:iet Hati I di$eri'a# $ia8

pa%ie# daa( 'eadaa# a'ut atau $ia pre'!(a %udah dapat diata%i

da# pa%ie# %udah (uai (e(pu#&ai #a%u (a'a#.

Meihat 'eadaa# pa%ie#+ (a'a#a# di$eri'a# daa( $e#tu'

4i#4a#" atau u#a'.

Pe($eria# pr!tei# di$ata%i *30 "hari- da# e(a' di$eri'a#

daa( $e#tu' (udah di4er#a. D!r(ua e#tera de#"a# a%a( a(i#!

ra#tai 4a$a#" *Bra#4hed Fhai# A(i#! A4idBFAA- &aitu eu%i#+ i%!eu%i#da# 5ai# dapat di"u#a'a#. Bia ada a%ite% da# diure%i% $eu( %e(pur#a+

pe($eria# 4aira# (a'%i(a 1 iterhari.

Ma'a#a# i#i re#dah e#er"i+ pr!tei#+ 'a%iu(+ at $e%i da# tia(i#

'are#a itu %e$ai'#&a di$eri'a# %ea(a $e$erapa hari %aa.

Me#urut $erat#&a rete#%i "ara( atau air+ (a'a#a# di$eri'a#

%e$a"ai :iet Hati I Gara( Re#dah. Bia ada a%ite% he$at da# ta#da

ta#da diure%i% $eu( (e($ai'+ di$eri'a# :iet Gara( Re#dah I.

#tu' (e#a($ah 'a#du#"a# e#er"i+ %eai# (a'a#a# per !ra

u"a di$eri'a# (a'a#a# pare#tera $erupa 4aira# "u'!%a.

61112032 | HEPATITIS ;0


91/136

61112032 | HEPATITIS ;1


92/136

:iet Hati II

:iet Hati II di$eri'a# %e$a"ai (a'a#a# perpi#daha# dari :iet

Hati I 'epada pa%ie# &a#" #a%u (a'a##&a 4u'up.

Me#urut 'eadaa# pa%ie#+ (a'a#a# di$eri'a# daa( $e#tu' u#a'

atau $ia%a. Pr!tei# di$eri'a# 1 "@" BB da# e(a' %eda#" *202K dari

'e$utuha# e#er"i t!ta- daa( $e#tu' &a#" (udah di4er#a.

Ma'a#a# i#i 4u'up (e#"a#du#" e#er"i+ at $e%i+ 5ita(i# A+ F

tetapi 'ura#" 'a%iu( da# tia(i#.


%e$a"ai :iet Hati II Gara( Re#dah. Bia a%ite% he$at da# diure%i% $eu(

$ai'+ diet (e#"i'uti p!a diet Gara( Re#dah I.

61112032 | HEPATITIS ;2


93/136

:iet Hati III

:iet Hati III di$eri'a# %e$a"i (a'a#a# perpi#daha# dari :iet

Hati II atau 'epada pa%ie# hepatiti% a'ut *Hepatiti% I#e'%i!%aA da#

Hepatiti% Seru(B- da# %ir!%i% hati &a#" #a%u (a'a##&a teah $ai'+ teah

dapat (e#eri(a pr!tei#+ da# tida' (e#u#u''a# "eaa %ir!%i% hati a'ti.

61112032 | HEPATITIS ;3


94/136

Me#urut 'e%a#""upa# pa%ie#+ (a'a#a# di$eri'a# daa( $e#tu'

u#a' atau $ia%a.

Ma'a#a# i#i (e#"a#du#" 4u'up e#er"i+ pr!tei#+ e(a'+

(i#era da# 5ita(i# tapi ti#""i 'ar$!hidrat.


%e$a"ai :iet Hati II Gara( Re#dah I.

61112032 | HEPATITIS ;,


95/136

@e!(p!' (a'a#a# %eharihari %e4ara pra'ti%+ (a'a#a# %eharihari

dapat di$a"i

(e#adi 3 'e!(p!' 8

1. @e!(p!' 'u#i#"

Ma'a#a# &a#" di"u#a'a# %e$a"ai %u($er e#er"i %eperti #a%i+ 'e#ta#"+

(i#&a'+

"ua+ da# 'ue. A%upa# (a'a#a# dari 'e!(p!' i#i haru% ditetap'a#

u(ah#&a

perhari.

2. @e!(p!' hiau

@e!(p!' (a'a#a# &a#" haru% di(a'a# %e%uai 'e$utuha#. F!#t!h#&a

%a&ur%a&ura# da# $uah$uaha#. @are#a (e#"a#du#" %erat+ (a'a#a# i#i

$i%a (e#4e"ah

%e($eit. Ma'a#a# i#i (e#"a#du#" pua 5ita(i# da# (i#era.

3.@e!(p!' (erah



96/136

Terdiri ata% (a'a#a# $a#&a' pr!tei# (i%a#&a da"i#"+ teur+ i'a# da#

ai#ai#.

@!#%u(%i (a'a#a# 'e!(p!' i#i haru% $erhatihati 'are#a $ia di'!#%u(%i

daa(

u(ah $ere$ih a'a# (e#"a'i$at'a# pe#i#"'ata# 'adar a((!#ia daa(

darah

Terapi Bedah

Hep B da# F

Hepatiti% A

1. Bedre%t2. Ade'ua%i Nutri%i Ade'ua%i Nutri%i :iet Lu#a'3. Faira#

,. Medi'a%i Se%uai @euha# *de(a(+ a#!re'%ia-

Hepatiti% B

61112032 | HEPATITIS ;6


97/136

Tuua# terapi hepatiti% B 'r!#i% adaah u#tu' (e#"ei(i#a%i %e4ara

$er(a'#a repi'a%i HB da# (e#4e"ah pr!"re%i pe#&a'it hati (e#adi %ir!%i%

&a#" $erp!te#%ia (e#uu "a"a hati+ da# (e#4e"ah 'ar%i#!(a

hepat!%euar.

Sa%ara# pe#"!$ata# adaah (e#uru#'a# 'adar HB :NA %ere#dah

(u#"'i#+ %er!'!#5er%i HBeA" da# #!r(ai%a%i 'adar ALT*Suhar! ?.B.+2006-.

Pe#derita &a#" didu"a Hepatiti% B+ u#tu' 'epa%tia# dia"#!%a &a#"

dite"a''a# (a'a a'a# dia'u'a# peri'%aa# darah. Seteah dia"#!%a

dite"a''a# %e$a"ai Hepatiti% B+ (a'a ada 4ara pe#"!$ata# u#tu' hepatiti%

B+ &aitu pe#"!$ata# tea# *!rada# %e4ara i#e'%i.

a. Per Ora

La(i5udi#e:ari 'e!(p!' #u'e!%ida a#a!"+ &a#" di'e#a de#"a# #a(a 3TF.O$at i#i di"u#a'a# $a"i de)a%a (aupu# a#a'a#a'. Pe(a'aia# !$at

i#i 4e#deru#" (e#i#"'at'a# e#&(e hati *ALT- u#tu' itu pe#derita

a'a# (e#dapat (!#it!r $er%i#a($u#"a# dari d!'ter.

Ade!5ir dipi5!


98/136

&a#" (e#"a#du#" parti'e radi!a'ti pe(a#4ar %i#ar X &a#" a'a#

(e#"ha#4ur'a# %e 'a#'er hati ta#pa (eru%a' ari#"a# %ehat di

%e'itar#&a.o Aa I#terer!#*de#"a# #a(a 4a$a#" INTRON A+ INDERGEN+ RODERON-

di$eri'a# %e4ara %u$'uta# de#"a# %'aa pe($eria# 3 'ai daa(%e(i#""u %ea(a 1216 (i#""u atau e$ih.Ee' %a(pi#" pe($eria# !$at i#i adaah depre%i+ teruta(a pada

pe#derita &a#" (e(i'i ri)a&at depre%i %e$eu(#&a.Ee' ai##&a adaah tera%a %a'it pada !t!t!t!t+ 4epat etih da# %edi'it

(e#i($u'a# de(a( &a#" ha i#i dapat dihia#"'a# de#"a#

pe($eria# para4eta(!.

A@T8

Ta#pa Medi'a%i

Th Supp!rti *Bedre%t+ Ade'ua%i Nutri%i+ Faira#-

@RONIS8

M!#it!ri#" Du#"%i Hepar

A#ti5ira

Pe#&uit

61112032 | HEPATITIS ;/


99/136

Hepatiti% F

Saat i#i pe#"!$ata# Hepatiti% F dia'u'a# de#"a# pe($eria#

!$at %eperti I#terer!# aa+ Pe"&ated i#terer!# aada# Ri$a5iri#.

Adapu# tuua# pe#"!$ata# dari Hepatiti% F adaah

(e#"hia#"'a# 5iru% dari tu$uh a#da %edi#i (u#"'i# u#tu' (e#4e"ah

per'e($a#"a# &a#" (e($uru' da# %tadiu( a'hir pe#&a'it hati.

61112032 | HEPATITIS ;;


100/136

Pe#"!$ata# pada pe#derita Hepatiti% F (e(eru'a# )a'tu &a#"

4u'up a(a $ah'a# pada pe#derita terte#tu ha i#i tida' dapat (e#!!#"+

u#tu' itu peru pe#a#"a#a# pada %tadiu( a)a#&a.

a'ut8

a#ti 5ira

th %upp!rti *$edre%t+ ade'ua%i #utri%i+ 4aira#-

'r!#i%8

(!#it!ri#" u#"%i hepar

a#ti 5ira

2.1 @OMPLI@ASI Hepatiti% @r!#i' Per%i%te#

Peraa#a# pe#&a'it &a#" (e(a#a#" %a(pai ,/ $ua#+ $ia%a#&a pada

Hep. B da# Hep.F Hepatiti% Du(i#a#

@e(u#dura# &a#" he$at %a(pai e#%epha!phat&+ a%4ite% da# au#di4e

&a#" #&ata.Teradi pe#4iuta# hati+ pe(a#a#"a# )a'tu pr!tr!($i# da# $iiru$i#

%eru( (e#i#"'at 4epat Hepatiti% @r!#i' A'ti

Hepar (e#"aa(i 'eru%a'a# %eperti di"er!"!ti *pie4e (ea-

61112032 | HEPATITIS 100


101/136

61112032 | HEPATITIS 101


102/136

61112032 | HEPATITIS 102


103/136

61112032 | HEPATITIS 103


104/136

61112032 | HEPATITIS 10,


105/136

61112032 | HEPATITIS 10


106/136

Hepatiti% A

61112032 | HEPATITIS 106


107/136

Hepatiti% B

61112032 | HEPATITIS 10=


108/136

Hepatiti% F

Hepatiti% :

61112032 | HEPATITIS 10/


109/136

PENFEGAHAN

Hepatiti% A

Seda#"'ah a#"'aha#"'ah &a#" dapat dia($i %e$a"ai u%aha pe#4e"aha#

adaah de#"a#

(e#4u4i ta#"a# de#"a# teiti+ da# %u#ti'a# i(u#i%a%i dia#ur'a# $a"i

%e%e!ra#" &a#" $erada

di%e'itar pe#derita.

61112032 | HEPATITIS 10;


110/136

Per%!#a h&"ie#e #i5er%a Pre4auti!#% ater h&"ie#e D!!d h&"ie#e re%taura#t I(u#i%a%i AOI:YYY !ra a#a %e


111/136

61112032 | HEPATITIS 111


112/136

61112032 | HEPATITIS 112


113/136

61112032 | HEPATITIS 113


114/136

61112032 | HEPATITIS 11,


115/136

Hepatiti% B

61112032 | HEPATITIS 11


116/136

61112032 | HEPATITIS 116


117/136

61112032 | HEPATITIS 11=


118/136

61112032 | HEPATITIS 11/


119/136

61112032 | HEPATITIS 11;


120/136

61112032 | HEPATITIS 120


121/136

61112032 | HEPATITIS 121


122/136

61112032 | HEPATITIS 122


123/136

61112032 | HEPATITIS 123


124/136

La#"'aha#"'ah pe#4e"aha# a"ar terhi#dar dari pe#&a'it

Hepatiti% B adaah pe($eria# 5a'%i# teruta(a pada !ra#"!ra#" &a#"

$ere%i'! ti#""i ter'e#a 5iru% i#i+ %eperti (ere'a &a#" $erpria'u %e< 'ura#"

$ai' *"a#ti"a#ti pa%a#"a#h!(!%e


125/136

1. Pe#derita haru% (e#"hi#dari a'!h! %a(a %e'ai da# (e#"ura#"i

(a'a#a# &a#" (e(ii'i 'e(u#"'i#a# $er%iat hepat!t!'%i'.2. Pe#derita haru% $erhatihati daa( (e#"'!#%u(%i a(u+ %upe(e#+

atau !$at &a#" diua $e$a%.

3. Pe#derita haru% (e($eritahu'a# %tatu% Hepatiti% B#&a apa$ia$er!$at 'e d!'ter u#tu' (e#"hi#dari pe($eria# terapi &a#" $er%iat

hepat!t!'%i'.,. Pe#derita &a#" $eru%ia di ata% ,0 tahu# haru% (e#aa#i pe(eri'%aa#

SG da# ADP %etiap 6 $ua# %e'ai u#tu' dete'%i di#i 'a#'er hati.. Peru dia'u'a# i(u#i%a%i pada pa%a#"a# %e'%ua.6. Peru#&a pe#""u#aa# '!#d!( %ea(a $erhu$u#"a# %e'%ua de#"a#

pa%a#"a# &a#" $eu( dii(u#i%a%i.=. Pe#derita tida' diper$!eh'a# $ertu'ar %i'at "i"i ataupu# pi%au 4u'ur.

/. Peru#&a (e#utup u'a &a#" ter$u'a a"ar darah tida' '!#ta' de#"a#!ra#" ai#.

;. Pe#derita tida' diper$!eh'a# (e#d!#!r'a# darah+ !r"a#+ ataupu#

%per(a. Terapi %e4ara ri#4i a'a# di$aha% daa( petu#u' te'#i%

%4ree#i#" di#ire'!(e#da%i8 A pre"#a#t )!(a#

I#a#t% )h! )a% $!r# r!( p!%iti5e (!ther Me# )h! ha5e %e< )ith (e#

I: Pa%ie# de#"a# pe#i#"'ata# u#"%i hepar ta#pa

%e$a$ &a#" ea% Pa%ie# &a#" (e#aa#i H: Ped!#!r *$ai' darah+ ari#"a#+ !r"a#- Pa%ie# &a#" a'a# di$eri'a# !$at2

i(u#!%upre%a# atau terapi %it!t!'%i' I#di5idu &a#" teri#e'%i HI

I(u#i%a%i

AOI:YYY Se< )ith (uti part#er

Medi4a i#%tru(e# %terii%ati!#

B!!d pr!du4t

61112032 | HEPATITIS 12


126/136

Hepatiti% F

Re'!(e#da%i %'ri#i#"8

A#a' &a#" terahir dari i$u &a#" p!%iti da# a#a' $eu( per#ah diperi'%a

%e$eu(#&a

Me# )h! ha5e %e< )ith (e#

I:

Pa%ie# de#"a# ta#da da# "eaa (e#"aa(i "a#""ua# u#"%i hepar

Pa%ie# &a#" (e#aa#i H: a(a

Ped!#!r *$ai' darah+ ari#"a#+ !r"a#-

Pe#eri(a d!#!r *$ai' darah+ ari#"a#+ !r"a#- %e$eu( tahu# 1;/0a#

Te#a"a 'e%ehata#

61112032 | HEPATITIS 126


127/136

I#di5idu &a#" teri#e'%i HI

61112032 | HEPATITIS 12=


128/136

Hepatiti% :

Pre5e#ti!#8

B!!d Pr!du4t Medi4a I#%tru(e#t Sterii%ati!#

61112032 | HEPATITIS 12/


129/136

Hepatiti% E

61112032 | HEPATITIS 12;


130/136

61112032 | HEPATITIS 130


131/136

61112032 | HEPATITIS 131


132/136

61112032 | HEPATITIS 132


133/136

61112032 | HEPATITIS 133


134/136

61112032 | HEPATITIS 13,


135/136

:ADTAR PSTA@A

Rep!%it!r&.u%u

Li$rar&.up#5.a4.id

au&.(h%.u#i(u%.a4.id

#er%.u#air.a4.id

Hepatiti% iru% B ed 2 Pr! S!e)i"#!

Terapi "ii da# diet r% ed 2

ppp.dep'e%."!.id

ei$.'.u)'%.a4.id

di"ii$.u#i(u%.a4.id

I@A NELSON E:. 1 OL 2

Api'a%i @i#i% Pat!7%i!!"i

Bu'u Sa'u @ep Pediatri Ed.

@ie# GG Hati %eri A%'ep

Ga)ar :arurat di Bida#" Pe#&a'it :aa(

61112032 | HEPATITIS 13


136/136

hepatitis dan kholelithiasis.docx

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