HEPATITIS A

OLEH
AYU RAHAYU
NIM: 0608120857

Supervisor:
dr. Muhammad Nur, SpA

Definition
Hepatitis viral infection at hepar
Hepatitis A hepatitis caused by HAV (RNA
viral -Family Picornavirus.)

CLINICAL MANIFESTATION
>90% asimptomatik
preicterik phase : prodromal (fever, malaise,
nausea, vomit, anoreksia, abdominal pain,
diarre)
icterik (30%) 10 days after that patient had
abdominal pain at upper right quadran,
hepatomegali, yellow urine, stool feces, yellow
skin and sclera, anoreksia, nausea, vomit.

Patophysiologi
HAV enter to hepar and GIT through blood,
and replication at hepatosit
From hepar HAV eliminated at sinusoid ,
kanalikuli and go to the intestine after clinical
manifestation and laboratorium result
appearance

Support examination
IgM anti-HAV examination can stay in body 3-6
month
IgG anti-HAV can detection in 5-6 weeks after
infection
Polymerace Chain Reaction (PCR)
Protrombin Time (PT) elevate
urinalisis ; bilirubin urin dan urobilinogen,
bilirubin serum, alkalifosfatase.

Management
Bed rest
Avoid hepatotoksik material
vaksination

CASE ILUSTRATION

Identity: An. S, perempuan, 13 years old,

Admitted to hospital : 7 -04-2014
Alloanamnesis: mother
Chief complain: eye becoming yellow since 1
week

Present Historical Disease

10 days, fever, nausea, vomit 2x contains food
Decrease of apetite, headache, abdominal
pain at umbilical, brown feces, normal urine
1 week yellow eye, then skin become yellow,
fever (-), abdominal pain at umbilical, yellow
feces

Past historical disease and family :

Same complain (-)
Imunitation : complete
Home and environment :
Living in semipermanent house,
environment,

clean

Physical examination
General condition : mild
Counciusness : compomentis
Vital sign
Blood pressure: 120/80 mmHg
temperatured : 36,5 C
Heart rate
: 98
Respiration
20 x/i

nutrition:
height : 157 cm
weight : 50 kg
Arm sircum: 25,5 cm
Head sircum : 54 cm

Nutrition status : normal

Head
: normocephali
Hair
: black
Eye
: Konjungtiva anemis (-/-),
Sklera ikterik (+/+) bright
yellow,isokhor,diameter 3mm/ 3mm, lamp
Reflek : direct +/+, undirect +/+
Nose, mouth : normal

Neck : enlargement limf(-), Kaku kuduk (-)

Paru : normal
Jantung
: normal
Abdomen
:supel, hepatomegali 1/3
1/3,licin, press pain(+) at regio hipokondrium
dextra

 Genitalia :normal
Ekstremity : warm, CRT < 2 detik, edem (),ekstremitas jaundice (-)
Sistem neurologis : Reflek fisiologis (+/+)
normal, Reflek patologis (-/-)

PEMERIKSAAN PENUNJANG
07 April 2014 :
Darah rutin
Hb : 12.7 g/dl, Ht
: 32.3 %, Leu
:
9700/
mm, Trom
: 308.000/ mm
Kimia darah
Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88
mg/dl, AST : 180 IU/L, ALT : 807 IU, Ureum : 15
mg/dl, Creatinin : 0,40 mg/dl, BUN : 7,0 mg/dl,
Albumin : 4, 31 gr/dl

Pemeriksaan Koagulasi Darah :

FIB (PT PLUS) : 2, 761 g/L
PT HS Plus : 13,9
APTT : 34,0
Pemeriksaan Imunoserologi :
Anti HAV IgM : Reaktif 3,05
HbsAg kualitatif : Non Reakif

10 April 2014
Urin :
Makroskopis :
Warna kuning pekat
Mikroskopis :
Eritrosit 3-4 /LPB, Leukosit : 5-6 /LPB, Epitel +,
Hialin +, Epitel lilin +, Bilirubin urin +

Important thing in anamnesis

High fever, countinious

Decrease of appetite, nausea(+), vomit(+)
Headache,
Yellow urine
Yellow eye

Important thing in physical

examination
Nutrition status normal
eye: sklera ikterik +/+ bright yellow
Palpation of abdomen : hepatomegali

Important thing in supporting

examination
Bil D : 6,12 mg/dl, Bil T : 8 mg/dl, Bil I : 1,88
mg/dl, AST : 180 IU/L, ALT : 807 IU
FIB (PT PLUS) : 2, 761 g/L, PT : 13,9. APTT :
34,0, Anti HAV IgM : Reaktif 3,05, HbsAg
kualitatif : Non Reakif

Urinalisis
Makroskopis : yellow
Mikroskopis : Eritrosit 3-4 / LPB, Leukosit urin :
1-2 / LPB, Epitel : +
Kimia Urin
Bilirubin urin : +

 DIAGNOSIS : Hepatitis virus A

NUTRITION DIAGNOSIS :Normoweight
THERAPY
Medikamentosa : IVFD D5 NS 20 tpm (makro)
Domperidon syrup 3x 1cth
Curcuma 2x 1 tab
Nutrition: 1840 kkal

PROGNOSIS
Quo ad vitam
: bonam
Quo ad fungsionam : bonam

FOLLOW UP & PEMBAHASAN

7/4/2014.
nausea, fever(-), vomit(-), epigastric pain (+).
BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T
37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:
hepatomegali, yellow skin of all body.
Urinalisis: deep yellow urine, Bilirubin urin : +

 Lab: leu 9.700/mm; Hb 12,7 mg/dl; Ht 35,4 %;

platelet 308.000/mm, Bil D : 6,12 mg/dl, Bil T :
8 mg/dl, Bil I : 1,88 mg/dl, AST : 180 IU/L, ALT :
807 IU, Anti HAV IgM : Reaktif 3,05.
Assessment: Hepatits A. IVFD D5 NS 20 tpm
(makro), Domperidon syrup 3x 1cth, Curcuma
2x 1 tab.

 This patien had been diagnosed with hepatitis A,

because :
Have prodromal sign like : fever, nausea, vomit,
headache, epigastric pain, decrease of appetitude
Icteric phase : deep yellow urine because of
problem at transportation, konjugation and
ekscretion of bilirubin.
Icteric sklera +/+, kadar bilirubin direk (6,12
mg/dl) and bilirubin indirek up to (1,88 mg/dl).

 Icterus happen because obstruction of bile

flow and damaged of hepatosit
Sklera become ikterik if blood bilirubin 22.5 mg/dl or more.
Hepatomegali happen because compensation
damaged of hepatosit

9/4/2014.
nausea, fever(-), vomit(-), epigastric pain (+).
BP= 110/80 mmHg. HR 80 x/i. RR 18 x/i. T
37,20C. BB 50 kg. Sclera ikterik +/+, Abdomen:
hepatomegali, yellow skin of all body
Assessment: Hepatits A. IVFD D5 NS 20 tpm
(makro), Curcuma 2x 1 tab.