SKENARIO 2

NYERI PERUT KANAN ATAS

KETUA : Dias Nuzulia Afriani 1102009080
SEKRETARIS : Anneu Rostiana 1102009036
AN!TA : A"it#o $i%&isono 1102009011
Alfis#a&rin 1102009023
'assa( 11020090)*
+&intia Nilna ,una 1102009062
-ulian .rata(a 110200812/
E0a Sur#a Set#a 110200/09/
Irfan Na"i#ans#a& .utra 1102008123
FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
SKENARIO 2
NYERI PERUT KANAN ATAS
Seoran0 1ar#a2an3 )* ta&un3 %ero%at 1e RS 4ARSI5 .asien (en0elu&1an n#eri 6a"a
6erut 1anan atas #an0 "iala(i se7a1 6 %ulan #an0 lalu3 1u(at81u(atan na(un "ua %ulan tera1&ir
n#eri se(a1in serin05 ,erasa (ual "an selera (a1an %er1uran0 se7a1 * %ulan #an0 lalu se&in00a
%erat %a"an %er1uran0 1) 105 Dari ana(nesis "i1eta&ui 6asien 6erna& ter1ena &e6atitis 1) ta&un
#an0 lalu "an serin0 (en01onsu(si al9o&ol5
.a"a 6e(eri1saan fisi1 "ite(u1an '' *)10 "en0an T' 16) 9(5 Te1anan "ara& "an tan"a
:ital lainn#a nor(al5 .e(eri1saan a%"o(en ;e6ato(e0ali3 "en0an 6er(u1aan &ati %erno"ul3
te6i tu(6ul "an n#eri te1an <=>5 .a"a 6e(eri1saaan la%oratoriu( "i"a6at1an 6enin01atan seru(
trans(inase S.T 110 U?@ "an S!T 60 U?@ "en0an %iliru%in nor(al3 Al6&a Aeto8.rotein
<AA.> 1000 U?@ <nor(al:310U?@>3 anti ;+B 6ositif5 Setela& "i%eri1an anal0eti1 "an
&e6ato6rote1tor n#eri (ere"a5 Setela& "ila1u1an 6e(eri1saan US "an %io6s# &ati 6asien
"i"ia0nosis 1arsino(a &e6atoseluler5 .asien "ian7ur1an untu1 (en7alani trans6lantasi &ati5
.asien (e(inta 2a1tu untu1 %er1onsultasi "en0an seoran0 ula(a5
STEP 1
SASARAN BELAJAR
LO I Memahami dan menjela!an "e#a$%&el'le( &a(&in%ma
LO II Memahami dan menjela!an #ena$ala!anaan "e#a$%&el'le( &&a(&in%ma
LO III Memahami dan menjela!an h%!'m $(an#lan$ai ha$i men'('$ a)ama ilam
LO I Memahami dan menjela!an "e#a$%&el'le( &a(&in%ma
1*1 DEFINISI
;e6ato9ellular +ar9ino(a <;++> atau "ise%ut 7u0a &e6ato(a atau 1an1er &ati 6ri(er atau
Karsino(a ;e6ato Selular <K;S> a"ala& satu "ari 7enis 1an1er #an0 %erasal "ari sel &ati5
;e6ato(a %iasa "an serin0 ter7a"i 6a"a 6asien "en0an sirosis &ati #an0 (eru6a1an
1o(6li1asi &e6atitis :irus 1roni15 ;e6atitis :irus 1roni1 a"ala& fa1tor risi1o 6entin0
&e6ato(a3 :irus 6en#e%a%n#aa"ala& :irus &e6atitis ' "an +.
1*2 EPIDEMIOLO+I
Karsino(a &e6atoseluler <&e6ato9elluler 9ar9ino(aC;++> a"ala& sala& satu 1e0anasan #an0
6alin0 u(u( "i seluru& "unia5 Insi"en 0lo%al setia6 ta&unn#a iala& se1itar 1 7uta 1asus3
"en0an 6er%an"in0an la1i8la1i "an 2anita se1itar *:15 Tin01at 1e7a"ian sa(a "en0an tin01at
1e(atian5 Di A(eri1a Seri1at3 ter"a6at 195160 1asus %aru "an 165/80 1e(atian #an0 ter9atat
6a"a ta&un 200/5 Tin01at 1e(atian 6a"a la1i8la1i "i ne0ara8ne0ara 1e7a"ian ren"a& se6erti
A(eri1a Seri1at a"ala& 139 6er 1005000 6er ta&unD "i "aera&8"aera& "en0an insi"ensi
(enen0a& se6erti Austria "an Afri1a Selatan3 an01a 1e(atian ta&unan %er1isar )3182030 6er
10050003 "an 6a"a "aera& "en0an insi"ensi #an0 tin00i se6erti "i Asia <+ina "an Korea>3
an01a 1e(atian 233181)0 6er 1005000 6er ta&un5 Daera& en"e(i1 ter"a6at "i +ina "an su%8
Sa&ara Afri1a3 #an0 %er&u%un0an "en0an "aera& en"e(i1 tin01at tin00i 9arrier &e6atitis '
"an 1onta(inasi (#9otoEin %a&an 6an0an3 %i7i8%i7ian #an0 "isi(6an3 air (inu(3 "an tana&5
Aa1tor8fa1tor lin01un0an a"ala& 6entin0D oran0 -e6an0 "i -e6an0 (e(ili1i insi"ensi le%i&
tin00i "ari6a"a (ere1a #an0 tin00al "i ;a2aii3 7u0a (e(ili1i insi"ensi #an0 le%i& tin00i
"ari6a"a (ere1a #an0 tin00al "i +alifornia5Di In"onesia <1&ususn#a -a1arta> ;++
"ite(u1an antara )0 "an 60 ta&un3 "en0an 6re"o(inasi 6a"a la1i8la1i5
1*, KLASIFIKASI
Sta"iu( I : Satu fo1al tu(or%er"ia(eter F &ati5
Sta"iu( II : Satu fo1al tu(or %er"ia(eter G 3 9(5 Tu(or ter%atas 6a"a se0(ent I
atau (ulti8fo1al tu(or ter%atas 6a"lo%us 1anan atau lo%us 1iri &ati5
Sta"iu( III : Tu(or6a"a se0(ent I (eluas 1e lo%us 1iri <se0(ent IB> atau 1e lo%us
1anan se0(ent B "an BIII atau tu(or"en0an in:asi 6eri6&eral 1e siste( 6e(%ulu& "ara&
<:as9ular> atau 6e(%ulu& e(6e"u <%iliar# "u9t> teta6i &an#a ter%atas 6a"a lo%us 1anan atau
lo%us 1iri &ati5
Sta"iu( IB :,ulti8fo1al atau "iffuse tu(or #an0 (en0enai lo%us 1anan "an lo%us 1iri
&ati5
8 atau tu(or "en0an in:asi 1e "ala( 6e(%ulu& "ara& &ati <intra &e6ati9:as1uler > atau6un
6e(%ulu& e(6e"u <%iliar# "u9t>
8 atau tu(or "en0an in:asi 1e 6e(%ulu& "ara& "i luar &ati <eEtra &e6ati9 :essel> se6erti
6e(%ulu& "ara& :ena li(6a <:ena lienalis>
8 atau :ena 9a:a inferior8atau a"an#a (etastase 1eluar "ari &ati <eEtra &e6ati9 (etastase>
Klasifkasi Cancer of the Liver Italian Program (CLIP)
P%in$
Va(ia-le . 1 2
i5 -u(la& Tu(or Sin0le ,ulti6le H
U1uran tu(or 6a"a ;e6ar #an0
(en00anti1an &e6ar nor(al <I>
a
J)0 J)0 G)0
ii5 Nilai +&il"8.u0& A ' +
iii5 K8Aeto6rotein le:el <n0?(@> J*00 *00 H
i:5 Tro(%osis Bena .orta <+T> No 4es H
a C @uas tu(or 6a"a &ati
Sta"iu( +@I. : +@I. 03 0 6ointsD +@I. 13 1 6ointD +@I. 23 2 6ointsD +@I. 33 3 6oints5
Ta%el 25) Klasifi1asi !1u"a
<1>
U!'(an T'm%(
a
A&i$e Al-'min /)0L1 Bili('-in /m)0dL1
)0I J)0 = L 3 G3 3 J3
<=> <L> <=> <L> <=> <L> <=> <L>
2 Sta"iu( !1u"a: Sta"iu( 1C se(ua <8>3 Sta"iu( 2C 1 atau 2 <=>3 Sta"iu( 3 C 3 atau * <=>5
3 a C @uas tu(or 6a"a &ati
1*2 ETIOLO+I
Vi(' "e#a$i$i
'ai1 1asus81ontrol (au6un stu"i 1o&ort (enun7u11an &u%un0an #an0 1uat antara tin01at
9arrier &e6atitis ' 1ronis "an 6enin01atan 1e7a"ian ;++5 .a"a 9arier la1i8la1i #an0
(e(6un#ai anti0en 6er(u1aan &e6atitis ' <;'sA0> 6ositif3 "ite(u1an %erisi1o 98 1ali li6at
le%i& %esar untu1 (en7a"i ;++ "i%an"in01an "en0an in"i:i"u "en0an ;%sA08ne0atif5
;e6atitis + :irus <;+B> 7u0a tela& "i1ait1an "en0an ter7a"in#a ;++5 Anti%o"i ter&a"a6
;+B tela& "ite(u1an se%an#a1 /6I "ari 6asien "en0an ;++ "i -e6an03 Italia3 "an S6an#ol
"an 36I "i A(eri1a Seri1at5;++ #an0 "ise%a%1an ole& :irus &e6atitis + 9en"erun0
(e(ili1i sirosis #an0 le%i& serin0 "an le%i& a2al3 teta6i "ala( ;++ #an0 "ise%a%1an
"en0an ;'B3 &an#a seten0a&n#a #an0 ter7a"i sirosisD sisan#a (en"erita &e6atitis a1tif
1ronis5Selain itu3 1e7a"ian ;++ 6a"a 9arier ;+B 1ronis "i6er1ira1an setin00i )I 6er ta&un3
"i%an"in01an "en0an 03)I 6er ta&un untu1 9arier ;'B5
Aa1tor Resi1o Karsino(a ;e6atoseluler5
Te(e(in) Ja(an)
Sirosis "ari 6en#e%a% a6a6un
Infe1si 1ronis &e6atitis ' atau +
Konsu(si etanol 1ronis
Non8Al1o&ol steato&e6atitis <NAS;>
Aflato1sin ' 1 atau (i1oto1sin lain
Sirosis %ilier 6ri(er
;e(o9&ro(atosis
Defisiensi antitr#6sin K81
Non8Al1o&ol steato&e6atitis <NAS;>
6en#a1it 6en#i(6anan 0li1o0en
+itrulline(ia
.orfiria 9utanea tar"a
Keturunan t#rosine(ia
$ilsonMs Disease
Si(%i "a$i
Sirosis &ati <S;> (eru6a1an fa1tor resi1o uta(a ;++ "i "unia "an (elatar%ela1an0i le%i&
"ari 80I 1asus ;++5 Setia6 ta&un ti0a sa(6ai li(a 6ersen "ari 6asien S; a1an (en"erita
;++3 "an ;++ (eru6a1an 6en#e%a% 1e(atian 6a"a S;5 !to6si 6a"a 6asien S;
(en"a6at1an 290880I "i antaran#a tela& (en"erita ;++5 .a"a 60880I "ari S;
(a1rono"uler "an ti0a sa(6ai se6ulu& 6ersen "ari S; (i1ronu"uler "a6at "ite(u1an
a"an#a ;++5 .re"i1tor uta(a ;++ 6a"a S; a"ala& 7enis 1ela(in la1i8la1i3 6enin01atan alfa
feto 6rotein <AA.> seru(3 %eratn#a 6en#a1it "an tin00in#a a1ti:itas 6roliferasi sel &ati5
Ka(in%)en Kimia
,un01in 1arsino0en 1i(ia ala(i #an0 6alin0 1uat "i (ana8(ana (eru6a1an 6ro"u1 "ari
7a(ur As6er0illus3 "ise%ut aflato1sin '15 .ro"u1 aflato1sin "a6at "ite(u1an "ala( %i7i8
%i7ian #an0 "isi(6an "i te(6at #an0 6anas3 te(6at8te(6at le(%a%3 1a9an0 "an nasi
"isi(6an ti"a1 "ala( le(ari es5 Aflato1sin '1 <AA'1> (eru6a1an (i1oto1sin #an0
"i6ro"u1si 7a(ur Aspergillus5 Dari 6er9o%aan %inatan0 "i1eta&ui %a&2a AA'1 %ersifat
1arsino0en5 ,eta%olit AA'1 182838 e6o1si" (eru6a1an 1arsino0en uta(a "ari 1elo(6o1
uta(a aflato1sin #an0 (a(6u (e(%entu1 i1atan "en0an DNA (au6un RNA5 Sala& satu
(e1anis(e 1arsino0enesisn#a iala& 1e(a(6uan AA'1 (en0in"u1si (utasi 6a"a 1o"on 2*9
"ari 0en su6resor tu(or 6)35
O-ei$a
Suatu 6enelitian 1o&ort 6ros6e1tif 6a"a le%i& "ari 9005000 in"i:i"u "i A(eri1a Seri1at
"en0an (asa 6en0a(atan sela(a 16 ta&un (en"a6at1an ter7a"in#a 6enin01atan an01a
(ortalitas se%esar li(a 1ali a1i%at 1an1er &ati 6a"a 1elo(6o1 in"i:i"u "en0an %erat %a"an
tertin00i <In"e1s ,assa Tu%u& <I,T> : 3)8*0 K0?(
2
> "i%an"in01an "en0an 1elo(6o1
in"i:i"u #an0 I,T8n#a nor(al5 Se6erti "i1eta&ui3 o%esitas (eru6a1an fa1tor resi1o uta(a
untu1 non-alchoholic fatty liver disease (NAFLD)3 1&ususn#a non alchoholic steatohepatis
(NASH) #an0 "a6at %er1e(%an0 (en7a"i sirosis &ati "an 1e(u"ian "a6at %erlan7ut (en7a"i
;++5
Dia-e$e Melli$' /DM1
D, (eru6a1an fa1tor resi1o %ai1 untu1 6en#a1it &ati 1roni1 (au6un untu1 ;++ (elalui
ter7a"in#a 6erle(a1an &ati "an steato&e6atis non al1o&oli1 <NAS;>5 Di sa(6in0 itu3 D,
"i&u%un01an "en0an 6enin01atan 1a"ar insulin "an insulin like growth factors <!Fs> #an0
(eru6a1an fa1tor 6ro(otif 6otensial untu1 1an1er5 In"i1asi 1uatn#a asosiasi antara D, "an
;++ terli&at "ari %an#a1 6enelitian antara D, (eru6a1an fa1tor resi1o ;++ tan6a
(e(an"an0 u(ur3 7enis 1ela(in "an ras3 "en0an an01a resi1o 23165
Al!%h%l
,es1i6un al9o&ol ti"a1 (e(ili1i 1e(a(6uan (uta0eni93 6e(inu( %erat al9o&ol <G)08/0
0?&ari "an %erlan0sun0 la(a> %erisi1o untu1 (en"erita ;++ (elalui sirosis &ati al1o&oli15
;an#a se"i1it %u1ti a"an#a efe1 1arsino0eni1 lan0sun0 "ari al1o&ol5 Al1o&olis(e 7u0a
(enin01at1an resi1o ter7a"in#a sirosis &ati "an ;++ 6a"a 6en0i"a6 infe1si ;'B atau ;+B5
Se%ali1n#a3 6a"a sirosis al1o&oli1 ter7a"in#a ;++ 7u0a (enin01at %er(a1na 6a"a 6asien
"en0an ;'sA086ositif atau anti ;+B86ositif5 Ini (enun7u11an a"an#a 6eran siner0isti1
al9o&ol ter&a"a6 infe1si ;'B (au6un infe1si ;+B5 A9a61ali 6en#ala&0unaan al1o&ol
(eru6a1an 6re"i1tor %e%as untu1 ter7a"in#a ;++ 6a"a 6asien "en0an &e6atitis 1roni1 atau
sirosis a1i%at infe1si ;'B atau ;+B5 Efe1 &e6atoto1si1 al1o&ol %ersifat dose-dependent3
se&in00a asu6an se"i1it al1o&ol ti"a1 (enin01at1an resi1o ter7a"in#a ;++5
Fa!$%( (ii!% lainn3a 'n$'! !an!e( ha$i4 $e(ma'!5
-enis 1ela(in <6ria?2anita>: 6ria le%i& %eresi1o tin00i 1an1er &ati "ari6a"a 2anita
'erat %a"an An"a: !%esitas "a6at (enin01at1an risi1o untu1 1an1er &ati
Ras An"a: 1an1er &ati u(u( ter7a"i 6a"a ras Asia N !9eania
.en00unaan steroi" ana%oli9: &or(on #an0 "isala&0una1an ole& 6ara atlet untu1
(en0e(%an01an otot ini3 se"i1it "a6at (enin01at1an risi1o 1an1er &ati "ala( 7an01a
6an7an05
Ri2a#at "ia%etes: stu"i tela& (en#ata1an a"an#a &u%un0an antara "ia%etes "an 1an1er
&ati5
.en#a1it (eta%oli1 #an0 "i2aris1an: ter%u1ti "a6at (enin01at1an risi1o 1an1er &ati
.en#a1it lan01a: .enelitian tela& (ene(u1an &u%un0an antara 1an1er &ati "an %e%era6a
6en#a1it lan01a se6erti "efisiensi alfa818antitr#6sin3 t#rosine(ia3 "an 6en#a1it $ilson5
1*6 PAT"OFISIOLO+I
Kan1er "ise%a%1an 6roliferasi sel #an0 ti"a1 ter1ontrol5 Kan1er a1an (un9ul %ila DNA sel
nor(al (en0ala(i 1erusa1an se&in00a (en#e%a%1an (utasi 0eneti15 Kan1er &ati a"ala&
tu(or (ali0na3 %ai1 "ala( 7arin0an itu sen"iri <6ri(ar# li:er 9an9er> (au6un se9on"ar#
li:er 9an9er <"a6at (en#e%ar 1e %a0ian tu%u& #an0 lain>5 Aun0si &ati se%a0ai 6en#arin0
ra9un "an sa(6a& lainn#a "ala( "ara& (en7a"i1ann#a san0at 6entin05 A1an teta6i3 %ila
1an1er (en#eran0 &ati3 &ati ti"a1 (e(6un#ai 1e(a(6uan terse%ut5
P(%e &a(in%)eni
+arsino0enesis (eru6a1an ta&a6an 6e(%entu1an sel8sel 1an1er (ulai "ari ta&a6an inisiasi
sa(6ai 6a"a 6ro0resi:itas 6ertu(%u&an sel 1an1er5 Ta&a6 inisiasi "i(ulai "en0an 6eru%a&an
0eneti1 sel8sel #an0 (en0a1i%at1an rusa1n#a DNA sel nor(al5 Selan7utn#a 6eru%a&an
0eneti1 "ari sel8sel #an0 a"a %erlan7ut (en7a"i ta&a6 6ro(otion "i(ana sel8sel terinisiasi
(en7a"i a0en #an0 (enin01at 6ertu(%u&ann#a (en7a"i (assa #an0 le%i& %esar5 Karena
itula& fun0si sel8sel atau 7arin0an #an0 "iseran0 (en7a"i ter0an00u5 Ta&a6an #an0
%eri1utn#a a"ala& ta&a6 transfor(asi "i(ana sel8sel #an0 (en0ala(i (ulti6li1asi ini
%ertransfor(asi (en7a"i sel (ali0nant "an (en0ala(i 6eru%a&an 0eneti1 "i "ala(n#a5
Ta&a6an #an0 tera1&ir a"ala& ta&a6 6ro0ression "i(ana sel (ali0nant #an0 (ulai ter%entu1
6a"a fase transfor(ation %eru%a& (en7a"i (ali0nant tu(or5 ,ali0nant tu(or a"ala& sel
(ali0nant #an0 (ulai (en00anas "an 9en"erun0 6a"a tu(or 0anas atau 1an1er5
Me$a$ai
Sel nor(al "a6at %eru%a& (en7a"i sel 1an1er "ise%a%1an 1arena e1s6resi on1o0en5 !n1o0en
%erasal "ari 6roto on1o0en #an0 %er6eran "ala( a1ti:itas 6ertu(%u&an sel eu1arioti1
nor(al #an0 %er(utasi5 -i1a on1o0en a1tif (a1a sel a1an (en0ala(i 6eru%a&an
6ertu(%u&an #an0 ti"a1 ter1en"ali5
.en#e%a% 1an1er &ati sa(6ai se1aran0 %elu( "i1eta&ui se9ara 6asti5 Na(un 1an1er &ati
"a6at "i1enali "ari fa1tor8fa1tor #an0 %isa "ii"entifi1as3 6en#a1it #an0 6erna& atau se"an0
"i"erita5 ,eli6uti:
15;e6atitis ' 1ronis
25Terinfe1si &e6atitis +
35+irr&osis 6a"a li:er
*5Dia%etes (ellitus
)5Terinfe1si ra9un3 se6erti 7a(ur aflatoEin3 :in#l 9&lori"e3 ana%oli9 steroi"s3 "an arseni1
65A1i%at (ero1o1
Pa$%)enei m%le!'la( "77
,e1anis(e 1arsino0enis ;++ <&e6ato9ellular 9ar9ino(a> %elu( se6enu&n#a "i1eta&ui
se9ara 6asti5 A6a6un a0en 6en#e%a%n#a3 transfor(asi (ali0na &e6atosit "a6at ter7a"i (elalui
6enin01atan 6er6utaran <turn o:er> sel &ati #an0 "iin"u1si ole& 9e"era <in7ur#> "an re0enerasi
1roni1 "ala( %entu1 infla(asi "an 1erusa1an o1si"atif DNA5 ;al ini "a6at (eni(%ul1an
6eru%a&an 0eneti1 se6erti 6eru%a&an 1ro(oso(3 a1ti:asi on1o0en seluler atau ina1ti:asi 0en
su6resor tu(or3 #an0 (un01in %ersa(a "en0an 1uran0 %ai1n#a 6enan0anan DNA (is(at9&3
a1ti:asi telo(erase3 serta in"u1si fa1tor8fa1tor 6ertu(%u&an "an an0io0eni15 ;e6atitis :irus
1roni13 al1o&ol "an 6en#a1it &ati (eta%oli1 se6erti &e(o1ro(atosis "an "efisiensi
antitri6sin8alfa13 (un01in (en7alan1an 6eranann#a teruta(a (elalui 7alur ini <9e"era 1roni13
re0enerasi3 "an sirosis>5 Dila6or1an %a&2a ;'B "an (un01in 7u0a ;+B "ala( 1ea"aan
tertentu 7u0a %er6eran lan0sun0 6a"a 6ato0enesis (ole1ular ;++5 Aflato1sin "a6at
(en0in"u1si (utasi 6a"a 0en su6resor tu(or 6)3 "an ini (enun7u11an %a&2a fa1tor
lin01un0an 7u0a %er6eran 6a"a tin01at (ole1ular untu1 %erlan0sun0n#a 6roses &e6ato
1arsino0enesis5
;ilan0n#a &eterozi0ositas <@!;C lost of &eterozi0#0osit#> 7u0a "i&u%un01an "en0an
ina1ti:asi 0en su6resor tu(or5 @!; atau "elesi aleli1 a"ala& &ilan0n#a satu salinan <1o6i>
"ari %a0ian tertentu suatu 0eno(5 .a"a (anusia3 @!; "a6at ter7a"i "i %an#a1 %a0ian
1ro(oso(5 Infe1si ;'B "i&u%un01an "en0an 1elainan "i 1ro(oso( 1/ atau 6a"a lo1asi "i
"e1at 0en 6)35 .a"a 1asus ;++3 lo1asi insersional non8sele1tif5 Inte0rasi a9a6 1ali
(en#e%a%1an ter7a"in#a %e%era6a 6eru%a&an "an selan7utn#a (en0a1i%at1an 6roses
translo1asi3 "u6li1asi ter%ali13 6en0&a6usan <"elesi> "an re1o(%inasi5 Se(ua 6eru%a&an ini
"a6at %era1i%at &ilan0n#a 0en80en su6resi tu(or (au6un 0en80en selular 6entin0 lainn#a5
Den0an analisis sout&ern %lot3 6oton0an <se1uen> ;'B #an0 tela& terinte0rasi "ite(u1an "i
"ala( 7arin0an tu(or?;++3 ti"a1 "ite(u1an "i luar 7arin0an tu(or5 .ro"u1 0en O "ari ;'B3
lazi( "ise%ut ;'E "a6at %erfun0si se%a0ai transa1ti:ator tranns1ri6sional "ari %er%a0ai 0en
seluler #an0 %er&u%un0an "en0an 1ontrol 6ertu(%u&an5 Ini (eni(%ul1an &i6otesis %a&2a
;'E (un01in terli%at 6a"a &e6ato1arsino0enesis ole& ;'B5
Di 2ila#a& en"e(i1 ;'B "ite(u1an &u%un0an #an0 %ersifat "ose8"e6en"ent antara 6e7anan
AA'1 "ala( "iet "en0an (utasi 6a"a 1o"on 2*9 "ari 6)35 ,utasi ini s6esifi1 untu1 ;++
"an ti"a1 (e(erlu1an inte0rasi ;'B 1e "ala( DNA tu(or5 ,utasi 0en 6)3 ter7a"i 6a"a
se1itar 30I 1asus ;++ "i "unia3 "en0an fre1uensi "an ti6e (utasi #an0 %er%e"a (enurut
2ila#a& 0eo0rafi1 "an etiolo0i tu(orn#a5
Infe1si 1roni1 ;+B "a6at %eru7un0 6a"a ;++ setela& %erlan0sun0 6ulu&an ta&un "an
u(u(n#a "i"a&ului ole& ter7a"in#a sirosis5 Ini (enun7u11an 6eranan 6entin0 "ari 6roses
9e"era &ati 1roni1 "ii1uti ole& re0enerasi "an sirosis 6a"a 6roses &e6ato1arsino0enesis ole&
;+B5 Selain #an0 "ise%ut1an "i atas3 (e1anis(e 1arsino0enesis ;++ 7u0a "i1ait1an "en0an
6eran "ari telo(erase3 insulin8li1e 0ro2t& en"ot&elial <IAs> "an insulin re9e6tor su%strate
<IRS1>5 Untu1 6roliferasi ;++ #an0 "i"u0a %er6eran 6entin0 a"ala& :as9ular en"ot&elial
0ro2t& fa9tor <BEA> "an %asi9 fi%ro%last 0ro2t& fa9tor <%EA>3 %er1at 6eran 1e"uan#a
6a"a 6roses an0io0enesis5<!%erfiel"31989>
1*8 MANIFESTASI KLINIS
e7ala 6a"a 6asien ;++ ter(asu1 9a9&eEia3 n#eri 6a"a 6erut3 6enurunan %erat %a"an3
1ele(a&an3 a%"o(inal fullness "an %en01a13 6en#a1it 1unin03 "an (ual #an0 %er&u%un0an
"en0an 0e7ala5Ke(un9ulan asites3 1e(un01inan 6er"ara&an3 #an0 (enun7u11an tro(%osis
:ena 6ortal atau &ati "en0an tu(or atau 6en"ara&an "ari tu(or ne1roti15 .erut %en01a1
ter7a"i se%a0ai a1i%at "ari asites 1arena 6en#a1it &ati 1ronis #an0 (en"asarin#a atau
(un01in 1arena tu(or #an0 %er1e(%an0 "en0an 6esat5 Ka"an081a"an03 ne1rosis 6usat atau
6er"ara&an a1ut 1e "ala( ron00a 6eritoneu( (en#e%a%1an 1e(atian5.en#a1it 1unin0
%iasan#a 1arena 0an00uan 6a"a saluran intra&e6ati9 ole& 6en#a1it &ati #an0 (en"asarin#a5
;e(ate(esis ter7a"i (un01in "ise%a%1an 1arena a"an#a :arises oeso6&a0us a1i%at
&i6ertensi 6ortal5 N#eri tulan0 terli&at 6a"a 3812I 6asien5 .asien (un01in "a6at ti"a1
(enun7u11an 0e7ala5
1*9 DIA+NOSIS
Den0an 1e(a7uan te1nolo0i #an0 se(a1in 9an00i& "an (a7u6esat3 (a1a %er1e(%an0 6ula
9ara89ara "ia0nosis "an tera6i #an0 le%i& (en7an7i1an "e2asa ini5 Kan1er &ati selular #an0
1e9il 6un su"a& %isa "i"ete1si le%i& a2al teruta(an#a "en0an 6en"e1atan ra"iolo0i #an0
a1urasin#a /0 L 9)I13*38 "an 6en"e1atan la%oratoriu( alphafetoprotein #an0 a1urasin#a 60
L /0I5
<9>
Kriteria "ia0nosa ;++ (enurut ..;I .er&i(6unan .eneliti ;ati In"onesia>3 #aitu:
15 ;ati (e(%esar %er%en7ol8%en7ol "en0an?tan6a "isertai %isin0 arteri5
25 AA. (Alphafetoprotein) #an0 (enin01at le%i& "ari )00 (0 6er (l5
35 "ltrasonography <US>3 Nuclear #edicine3 $o%puted &o%ography Scann <$& Scann>3
#agnetic 'esonance %aging <,RI>3 Angiography3 atau6un (ositron )%ission &o%ography
<.ET> #an0 (enun7u11an a"an#a ;++5
*5 (eritoneoscopy "an %io6si (enun7u11an a"an#a ;++5
)5 ;asil %io6si atau as6irasi %io6si 7aru( &alus (enun7u11an ;++5
Dia0nosa ;++ "i"a6at1an %ila a"a "ua atau le%i& "ari li(a 1riteria atau &an#a satu #aitu
1riteria e(6at atau li(a5
.e(eri1saan Alfa Aeto .rotein <AA.> san0at %er0una untu1 (ene0a11an "ia0nosis 6en#a1it
&e6ato(a ini5 .en00unaan ultrasono0rafi <US>3 $o%puted &o%ographic Scannin0 ($&
Scan)* #agnetic 'esonance %aging <#'> 6entin0 untu1 (ene0a11an "ia0nosis "an
(en0eta&ui u1uran tu(or5Ke%an#a1an 6asien "en0an 1arsino(a &e6atoseluler <;++>
(enin00al "ala( 2a1tu 1 ta&un setela& "i"ia0nosis5 Kelan0sun0an &i"u6 ter0antun0 6a"a
u1uran tu(or "an 6en#a1itn#a saat "i"ia0nosis5 .asien "en0an sirosis (e(ili1i
1elan0sun0an &i"u6 #an0 le%i& 6en"e15 .enatala1sanaan se9ara %e"a& "a6at (en#e(%u&1an
&an#a 1uran0 "ari )I 6asien5 .en#e%a% 1e(atian iala& 6er"ara&an <:arises3 intra6eritoneal>
"an 9a9&eEia5
Ka"ar alfa8feto6rotein "ara& 6a"a 6en"erita &e6ato(a tin00i5 Ka"an0 6e(eri1saan "ara&
(enun7u11an 1a"ar 0ula "ara& #an0 ren"a& atau 6enin01atan 1a"ar 1alsiu(3 le(a1 atau sel
"ara& (era&5 .a"a a2aln#a3 0e7ala #an0 a"a ti"a1 9u1u6 untu1 (en0ara& 6a"a "ia0nosis5
Teta6i 7i1a tera%a 6e(%esaran &ati3 6atut "i9uri0ai suatu &e6ato(a3 teruta(a 7i1a ter"a6at
sirosis (ena&un5 .a"a 6e(eri1saan "en0an stetoskop3 1a"an0 ter"en0ar suara %isin0 <+ruit
hepatik> "an suara 0ese1an <friction ru+s>5 US "an +T S9an 6erut 1a"an0 "a6at
(ene(u1an 1an1er #an0 %elu( (eni(%ul1an 0e7ala5 Di %e%era6a ne0ara3 "i(ana %an#a1
ter"a6at :irus &e6atitis ' <(isaln#a "i -e6an0>3 US "i0una1an untu1 (en#arin0 6en"erita
infe1si ter&a"a6 1an1er &ati5
Arteriografi hepatik %isa (enun7u11an &e6ato(a "an teruta(a "ila1u1an se%elu(
6e(%e"a&an3 untu1 (e(%antu (enentu1an lo1asi #an0 6asti "ari 6e(%ulu& "ara& &ati5
'io6si 7arin0an &ati "a6at (e(6er1uat "ia0nosis5 Resi1o ter7a"in#a 6er"ara&an atau 9e"era
lainn#a 6a"a saat (ela1u1an %io6si 6a"a u(u(n#a ren"a&5
1*: PEMERIKSAAN PENUNJAN+
Penanda T'm%(
Alfa-fetoprotein <AA.> a"ala& 6rotein seru( nor(al #an0 "isintesis ole& sel &ati fetal3 sel
#ol1 sa9 "an se"i1it se1ali ole& saluran 0astrointestinal fetal5 Rentan0 nor(al AA. seru(
a"ala& 0820 n0?(l5 Ka"ar AA. (enin01at 6a"a 60I 8/0I "ari 6asien ;++3 "an 1a"ar le%i&
"ari *00 n0?(l a"ala& "ia0nosti1 atau san0at su0estif untu1 ;++5 Nilai nor(al 7u0a "a6at
"ite(u1an 7u0a 6a"a 1e&a(ilan5 .enan"a tu(or lain untu1 ;++ a"ala& des-ga%%a car+o,y
prothro%+in <D+.> atau .IBKA823 #an0 1a"arn#a (enin01at 6a"a &in00a 91I "ari 6asien
;++3 na(un 7u0a "a6at (enin01at 6a"a "efisiensi :ita(in K3 &e6atitis 1ronis a1tif atau
(etastasis 1arsino(a5 A"a %e%era6a la0i 6enan"a ;++3 se6erti AA.8@3 <suatu su%fra1si
AA.>3 alfa-L-fucosidase seru(3 "ll3 teta6i ti"a1 a"a #an0 (e(ili1i a0re0at sensiti:itas "an
s6esifitas (ele%i&i AA.3 AA.8@3 "an .IBKA825
Ul$(a%n%)(a;i /US+1
.e(eri1saan US &ati (eru6a1an alat s1rinin0 #an0 san0at %ai15 Dua 1ara1teristi1 1elainan
:as1ular %eru6a &i6er:as1ularisasi (assa tu(or <neo:as1ularisasi> "an tro(%osis ole& in:asi
tu(or5 .er1e(%an0an #an0 9e6at "ari gray-scaleultrasono0rafi (en7a"i1an 0a(%aran
6aren1i( &ati le%i& 7elas5 Keuntun0an &al ini (en#e%a%1an 1ualitas stru1tur e1o 7arin0an
&ati le%i& (u"a& "i6ela7ari se&in00a i"entifi1asi lesi8lesi le%i& 7elas3 %ai1 (eru6a1an lesi
lo1al (au6un 1elainan 6aren1i( "ifus5 .a"a &e6ato(a?1arsino(a &e6atoselular serin0
"i1ete(u1an a"an#a &e6ar #an0 (e(%esar3 6er(u1aan #an0 %er0elo(%an0 "an lesi8lesi
fo1al intra&e6ati1 "en0an stru1tur e1o #an0 %er%e"a "en0an 6aren1i( &ati nor(al5
7%m#'$ed T%m%)(a#h3 /7T1 S&an
Di sa(6in0 US "i6erlu1an$& scan se%a0ai 6elen01a6 #an0 "a6at (enilai seluru& se0(en
&ati "ala( satu 6oton0an 0a(%ar #an0 "en0an US 0a(%ar &ati itu &an#a %isa "i%uat
se%a0ian8se%a0ian sa7a- $& scan #an0 saat ini te1nolo0in#a %er1e(%an0 6esat tela& 6ula
(enun7u11an a1urasi #an0 tin00i a6ala0i "en0an (en00una1an te1ni1 &elli9al$&
scan3 %ultislice #an0 san00u6 (e(%uat irisan8irisan #an0 san0at &alus se&in00a 1an1er #an0
6alin0 1e9il 6un ti"a1 terle2at1an5
Untu1 (enentu1an u1uran "an %esar tu(or3 "an a"an#a in:asi :ena 6ortal se9ara a1urat3 +T ?
&eli1s trifasi1 s9an 6erut "an 6an00ul "en0an te1ni1 %olus 1ontras se9ara 9e6at &arus
"ila1u1an untu1 (en"ete1si lesi :as1ular 1&as 6a"a ;++5 In:asi :ena 6ortal %iasan#a
ter"ete1si se%a0ai &a(%atan "an e1s6ansi "ari 6e(%ulu& "ara&5 +T s9an "a"a "i0una1an
untu1 (en0&ilan01an "ia0nosis a"an#a (etastasis5
An)i%)(a;i
.a"a setia6 6asien #an0 a1an (en7alani o6erasi rese1si &ati &arus "ila1u1an 6e(eri1saan
an0io0rafi- Den0an an0io0rafi ini "a6at "ili&at %era6a luas 1an1er #an0 se%enarn#a5 Kan1er
#an0 1ita li&at "en0an US #an0 "i6er1ira1an 1e9il sesuai "en0an u1uran 6a"a US %isa
sa7a u1uran se%enarn#a "ua atau ti0a 1ali le%i& %esar5 An0i0rafi %isa (e(6erli&at1an u1uran
1an1er #an0 se%enarn#a5
Ma)ne$i& Re%nan&e Ima)in) /MRI1
.e(eri1saan "en0an ,RI ini lan0sun0 "i6ili& se%a0ai alternatif %ila a"a 0a(%aran $&
scann #an0 (era0u1an atau 6a"a 6en"erita #an0 a"a risi1o %a&a#a ra"iasi sinar O "an 6a"a
6en"erita #an0 a"a 1ontrain"i1asi <risi1o %a&a#a> 6e(%erian zat contrast se&in00a
6e(eri1saan $& angiography ta1 (e(un01in1an 6a"a&al "i6erlu1an 0a(%ar 6eta 6e(%ulu&
"ara&5
LO II Memahami dan menjela!an #ena$ala!anaan "e#a$%&el'le( &a(&in%ma
2*1 FARMAKOLO+I
Kem%$e(a#i i$emi!
Se7u(la& %esar stu"i 1linis ter1en"ali "an ti"a1 ter1en"ali tela& "ila1u1an 6a"a se%a0ian
%esar 1elo(6o1 uta(a 1e(otera6i 1an1er5 Ti"a1 a"a o%at tun00al atau o%at 1o(%inasi #an0
"i%eri1an se9ara siste(i1 %er6en0aru& %ai13 %a&1an &an#a (en0ara& 1e tin01at res6ons
se%esar 2)I atau &an#a se"i1it %er6en0aru& 1e6a"a 1elan0sun0an &i"u65
Kem%$e(a#i Re)i%nal
'er%e"a "en0an &asil %uru1 6a"a 1e(otera6i siste(i13 %er%a0ai a0en #an0 "i%eri1an (elalui
arteri &e6ati1 (e(ili1i a1ti:itas #an0 ter%atas 6a"a ;++5Dua u7i ter1ontrol a9a1 tela&
(enun7u11an 1eun00ulan untu1 %erta&an &i"u6 untu1 TA+E "ala( su%set #an0 "i6ili&
6asien5 Satu "i0una1an "oEoru%i9in "an lainn#a (en00una1an 9is6latin5 Terle6as "ari
1en#ataan %a&2a ter7a"i 6enin01atan e1stra1si &e6ati1 "ari 1e(otera6i untu1 o%at san0at
se"i1it3 %e%era6a o%at se6erti 9is6latin3 "oEoru%i9in3 + (ito(#9in3 "an (un01in
neo9arzinostatin (en0&asil1an res6on #an0 9u1u6 %esar %ila "i%eri1an se9ara re0ional5
;an#a se"i1it "ata #an0 terse"ia 6e(%eriann#a (elalui infus arteri se9ara terus8(enerus
untu1 ;++3 (es1i6un stu"i uta(a "en0an 9is6latin tela& (enun7u11an res6on #an0 %ai15
Karena la6oran 1elan0sun0an &i"u6 ti"a1 "i%uat %er"asar1an %er"asar1an sta"iu( TN,3
sulit untu1 (en0eta&ui 6ro0nosis 7an01a 6an7an0 "ala( &u%un0ann#a "en0an %atas tu(or5
Se%a0ian %esar 6enelitian tentan0 1e(otera6i arteri &e6ati1 re0ional 7u0a (en00una1an a0en
e(%olisasi se6erti et&io"ol3 0elatin 6arti1el s6ons <elfoa(>3 6ati <S6&ereE>3 atau (i1rosfer5
Dua 6ro"u1 #an0 ter"iri "ari (i1rosfer "i"efinisi1an "en0an u1uran %er1isar8E(%os6&eres
<%ios6&ere> "an Sensual SE8(en00una1an 6arti1el *081203 10083003 3008)003 "an )0081000
( u1urann#a5 Dia(eter o6ti(al 6arti1el untu1 TA+E %elu( "i"efinisi1an5.en00unaan
se9ara luas "ari %e%era6a %entu1 e(%olisasi "i sa(6in0 1e(otera6i tela& (ena(%a& efe1
to1sisitas5 ;al ini (eli6uti "e(a( #an0 serin0 ter7a"i teta6i transient3 sa1it 6erut3 "an
anore1sia <se(ua "ala(G 60I 6asien>5 Selain itu3 6a"a G 20I 6asien ter7a"i 6enin01atan
asites atau ele:asi transien enzi( transa(inase5 To1sisitas &ati #an0 "ise%a%1an ole&
e(%olisasi "a6at "i%antu "en0an 6en00unaan (i1rosfer 6ati #an0 "a6at "i"e0ra"asi3 "en0an
tin01at res6on )0860I5 Se%ua& (asala& %esar "ala( (enun7u11an 1eun00ulan &ara6an
&i"u6 6a"a 6asien (enan00a6i TA+E a"ala& %a&2a %an#a1 6asien (enin00al a1i%at sirosis
#an0 (en"asari (ere1a3 %u1an tu(or5 Na(un3 (enin01at1an 1ualitas &i"u6 6asien a"ala&
tu7uan uta(a "ari tera6i re0ional5
2*2 NON FARMAKOLO+I
Tin"a1an non8%e"a& (eru6a1an 6ili&an untu1 6asien #an0 "atan0 6a"a sta"iu( lan7ut5
Tin"a1an non8%e"a& "ila1u1an ole& "o1ter a&li ra"iolo0i5 Ter(asu1 "ala( tin"a1an non8
%e"a& ini a"ala&:
a5 E(%olisasi Arteri ;e6ati1a <&rans Arterial )%+olisasi C TAE>
.a"a 6rinsi6n#a sel #an0 &i"u6 (e(%utu&1an (a1anan "an o1si0en #an0 "atan0n#a
%ersa(a aliran "ara& #an0 (en#u6lai sel terse%ut5 .a"a 1an1er ti(%ul %an#a1 sel8sel %aru
se&in00a "i6erlu1an %an#a1 (a1anan "an o1si0en3 "en0an "e(i1ian ter7a"i %an#a1
6e(%ulu& "ara& %aru (neovascularisasi> #an0 (eru6a1an 9a%an089a%an0 "ari 6e(%ulu&
"ara& #an0 su"a& a"a "ise%ut 6e(%ulu& "ara& 6e(%eri (a1anan (feeding artery) Tin"a1an
TAE ini (en#u(%at feeding artery- +aran#a "i(asu11an 1ateter (elalui 6e(%ulu& "ara& "i
6a&a (arteri fe%oralis) #an0 seterusn#a (asu1 1e 6e(%ulu& na"i %esar "i 6erut (aorta
a+do%inalis) "an seterusn#a "i(asu11an 1e 6e(%ulu& "ara& &ati (artery hepatica> "an
seterusn#a (asu1 1e "ala( feeding artery- @alu feeding artery ini "isu(%at <"ie(%olisasi>
"en0an suatu %a&an se6erti 0el foa( se&in00a aliran "ara& 1e 1an1er "i&enti1an "an "en0an
"e(i1ian su6lai (a1anan "an o1si0en 1e selsel 1an1er a1an ter&enti "an sel8sel 1an1er ini
a1an (ati5 A6ala0i se%elu( "ila1u1an e(%olisasi "ila1u1an tin"a1an trans arterial
che%otherapy #aitu (e(%eri1an o%at 1e(otera6i (elalui feeding artery itu (a1a sel8sel
1an1er 7a"i "ira9uni "en0an o%at #an0 (e(ati1an5 'ila 1e"ua 9ara ini "i0a%un0 (a1a sel8sel
1an1er %enar8%enar ter7a(in (ati "an ta1 %er1e(%an0 la0i5
Den0an "asar inila& e(%olisasi "an in7e1si 1e(otera6i intra8arterial "i1e(%an01an "an
na(6a1n#a (e(%eri &ara6an #an0 le%i& 9era& 6a"a 6en"erita #an0 teran9a( (aut ini5
An01a &ara6an &i"u6 6en"erita "en0an 9ara ini 6er li(a ta&unn#a %isa (en9a6ai sa(6ai
/0I "an 6er se6ulu& ta&unn#a %isa (en9a6ai )0I5
%5 Infus Sitostati1a Intra8arterial5
,enurut literatur /0I nutrisi "an o1si0enasi sel8sel &ati #an0 nor(al %erasal "ari :ena 6orta
"an 30I "ari arteri &e6ati1a3 se&in00a sel8sel 0anas (en"a6at nutrisi "an o1si0enasi
teruta(a "ari siste( arteri &e6ati1a5 'ila Bena 6orta tertutu6 ole& tu(or (a1a (a1anan "an
o1si0en 1e sel8sel &ati nor(al a1an ter&enti "an sel8sel terse%ut a1an (ati5 Da6atla&
"i(en0erti 1ena6a 6asien 9e6at (enin00al %ila su"a& a"a 6en#u(%atan :ena 6orta ini5
Infus sitostati1a intra8arterial ini "i1er7a1an %ila :ena 6orta sa(6ai 1e 9a%an0 %esar tertutu6
ole& sel8sel tu(or "i "ala(n#a "an 6a"a 6asien ti"a1 "a6at "ila1u1an tin"a1an trans6lantasi
&ati ole& 1arena 1etia"aan "onor3 atau 1arena 6asien (enola1 atau 1arena 1eti"a1(a(6uan
6asien5
Sitostati1a #an0 "i6a1ai a"ala& (ito(#9in + 10 L 20 ,0 1o(%inasi "en0an a"ri%lastina 108
20 ,0 "i9a(6ur "en0an Na+l <saline> 100 L 200 995 Atau "a6at 7u0a 9is6latin "an )AU <)
Aluoro Ura9il>5 ,eto"a +allon occluded intra arterial infusion a"ala& (o"ifi1asi infuse
sitostati1a intra8arterial3 &an#a 1ateter #an0 "i6a1ai a"ala& dou+le lu%en +allon catheter
#an0 "i8insert ("i(asu11an> 1e "ala( arteri &e6ati1a5 Setela& +allon "i1e(%an01an ter7a"i
su(%atan aliran "ara&3 sitostati1a "iin7e1si1an "ala( 1ea"aan +allon (en0e(%an0 sela(a
10 L 30 (enit3 tu7uann#a a"ala& (e(6erla(a 1onta1 sitostati1a "en0an tu(or5 Den0an 9ara
ini (a1a &ara6an &i"u6 6asien 6er li(a ta&unn#a (en7a"i *0I "an 6er se6ulu& ta&unn#a
30I "i%an"in01an "en0an tan6a 6en0o%atan a"ala& 20I "an 10I5
95 In7e1si Etanol .er1utan ((ercutaneus )tanol n.eksi / ())
.a"a 1asus81asus #an0 (enola1 untu1 "i%e"a& "an 7u0a (enola1 se(ua tin"a1an atau
6asien ti"a1 (a(6u (e(%ia#ai 6e(%e"a&an "an ta1 (a(6u (e(%ia#ai tin"a1an lainn#a
(a1a tin"a1an .EI8la& #an0 (en7a"i 6ili&an satu8satun#a5 Tin"a1an in7e1si etanol 6er1utan
ini (u"a& "i1er7a1an3 a(an3 efe1 sa(6in0 rin0an3 %ia#a (ura&3 "an &asiln#a 6un 9u1u6
(e(%eri1an &ara6an5 .EI &an#a "i1er7a1an 6a"a 6asien sta"iu( "ini sa7a "an ti"a1 6a"a
sta"iu( lan7ut5 Se%a0ian %esar 6eneliti (ela1u1an 6en0o%atan "en0an 9ara ini untu1 1an1er
%er0aris ten0a& sa(6ai ) 9(3 2alau6un 6en0o%atan 6alin0 o6ti(al "i1er7a1an 6a"a 0aris
ten0a& 1uran0 "ari 3 9(5
.e(eri1saan &isto6atolo0i setela& tin"a1an (e(%u1ti1an %a&2a tu(or (en0ala(i ne1rosis
#an0 len01a65 Se%a0ian %esar 6eneliti (en#unti11an etanol 6er1utan 6a"a 1asus 1an1er ini
"en0an 7u(la& lesi ti"a1 le%i& "ari 3 %ua& nodule3 (es1i6un "ila6or1an %a&2a lesi tun00al
(eru6a1an 1asus #an0 6alin0 o6ti(al "ala( 6en0o%atan5 $alau6un 1eli&atann#a 9ara ini
(u01in "a6at (enolon0 teta6i ti"a1 %an#a1 6enelitian #an0 (e(a"ai "ila1u1an se&in00a
&an#a "i1ata1an (e(%a2a tin"a1an ini (e(%eri &asil #an0 9u1u6 (en00e(%ira1an5
"5 Tera6i Non8%e"a& @ainn#a
Tera6i non8%e"a& lainn#a saat ini su"a& "i1e(%an01an "an &an#a "ila1u1an %ila tera6i
%e"a& rese1si "an &rans Arterial )%+olisasi (&A)) atau6un &rans Arterial
$he%oe%+olisation atau6un &rans Arterial $he%otherapy ta1 (un01in "ila1u1an la0i5 Di
antaran#a #aitu tera6i 'adio Fre0uency A+lation &herapy ('FA)* (roton 1ea% &herapy3
&hree Di%entional $onfor%al 'adiotherapy (2D$'&)* $ryosurgery #an0 1ese(uan#a ini
%ersifat palliatif <(e(%antu> %u1an kuratif <(en#e(%u&1an> 1eseluru&ann#a
Ka(in%ma "e#a$%el'le( S$adi'm I dan II
Tu(or ta&a6 a2al "a6at %er&asil "io%ati "en0an (en00una1an %er%a0ai te1ni13 ter(asu1
rese1si %e"a&3 a%lasi lo1al <t&er(al atau ra"iofre1uensi>3 "an tera6i in7e1si lo1al <etanol atau
asa( asetat>5 'an#a1 7u0a #an0 (e(ili1i 6en#a1it &ati #an0 si0nifi1an #an0 (en"asari "an
ti"a1 "a6at (entolerir tera6i %e"a& 1arena 1e&ilan0an 6aren1i( &ati3 na(un (un01in
(ere1a (e(enu&i 6ers#aratan untu1 trans6lantasi &ati ort&oto6i9 <ort&oto6i9 li:er trans6lant
C !@TO> "i (asa #an0 a1an "atan05 .rinsi6 6entin0 "ala( 6era2atan ta&a6 a2al ;++
a"ala& "en0an (en00una1an 6era2atan &ati8&e(at "an %erfo1us 6a"a 6en0o%atan %ai1
tu(or (au6un sirosis5
E!ii Bedah
Risi1o &e6ate9to(i uta(a a"ala& tin00i <(ortalitas )810I> "ia1i%at1an ole& 6en#a1it &ati
#an0 (en"asari "an 6otensi untu1 (en7a"i 0a0al &ati5 !1lusi :ena 6ortal 6reo6erati:e
1a"an081a"an0 "a6at "ila1u1an untu1 (en#e%a%1an atrofi lo%us ;++ #an0 terli%at "an
&i6ertrofi 1o(6ensasi "ari &ati #an0 (asi& nor(al5.a"a 6asien sirosis3 o6erasi &ati %esar
"a6at (en0a1i%at1an 1e0a0alan &ati5 Klasifi1asi +&il"8.u0& "ari 0a0al &ati "a6at
(enentu1an 6ro0nosis untu1 toleransi o6erasi &ati #an0 "a6at "ian"al1an3 "an &an#a +&il"
A #an0 "a6at "i6erti(%an01an untu1 rese1si %e"a&5 .asien "en0an +&il" ' "an + "en0an
ta&a6 I "an II ;++ &arus "iru7u1 untu1 !@TO 7i1a sesuai3 se6erti 6a"a 6asien "en0an asites
atau ri2a#at 6en"ara&an :arises5 ,es1i6un tera6i %e"a& e1sisi ter%u1a (eru6a1an tera6i
#an0 6alin0 "a6at "ian"al1an3 na(un 6asien (un01in le%i& %ai1 "ita2ar1an "en0an
6en"e1atan se9ara la6aros1o6i untu1 rese1si3 (en00una1an RAA atau in7e1si etanol 6er1utan
<6er9utaneous et&anol in7e9tionC.EI>5
S$(a$e)i A-lai L%!al
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tu(or5 U1uran (a1si(u( "ari arra# 6ro%e "a6at "ila1u1an untu1 zona ne1rosis /89(3 #an0
a1an 9u1u6 untu1 tu(or %eru1uran 38* 9(
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untu1 te1ni1 ini5 RAA "a6at "ila1u1an se9ara 6er1utan "en0an 6an"uan +T atau US3 atau
"en0an la6aros1o6i "en0an 6an"uan US5
Te(a#i Inje!i L%!al
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6alin0 serin03 et&anol <.EI>5 ;++ luna1 relatif "en0an ri2a#at sirosis &ati 1eras
(e(un01in1an untu1 "ila1u1an in7e1si etanol :olu(e %esar 1e "ala( tu(or tan6a ter7a"i
"ifusi 1e "ala( 6aren1i( &ati atau 1e%o9oran 1eluar "ari &ati5 .EI (en#e%a%1an 1erusa1an
lan0sun0 "ari sel8sel 1an1er3 teta6i 7u0a a1an (en0&an9ur1an sel8sel nor(al "i se1itarn#a5
;al ini %iasan#a (e(erlu1an %e%era6a sunti1an <rata8rata ti0a>3 %er%e"a "en0an satu untu1
RAA5 U1uran (a1si(u( tu(or ter6er9a#a "i6erla1u1an a"ala& 3 9(3 %a&1an "en0an
%e%era6a sunti1an5
T(an#lan$ai "e#a(
Se%ua& 6ili&an #an0 la#a1 untu1 ;++ Sta"iu( I "an II 6a"a tu(or "en0an sirosis a"ala&
!@TO3 "en0an 1elan0sun0an &i"u6 (en"e1ati 6a"a 1asus81asus non1an1er5 !@TO "a6at
"i0una1an 6a"a 6asien "en0an lesi tun00al ) 9( atau 3 no"ul atau 1uran03 setia6 3 9(3
(en0&asil1an 1elan0sun0an &i"u6 #an0 %a0us tan6a tu(or </0I sela(a ) ta&un>5 Untu1
;++ lan7ut3 !@TO tela& "itin00al1an 1arena a"an#a tin01at 1e1a(%u&an tu(or #an0 tin00i5
.rioritas s1orin0 untu1 !@TO se%elu(n#a (en#e%a%1an 6asien ;++ (enun00u terlalu
la(a untu1 "ila1u1an !@TO3 se&in00a %e%era6a tu(or (en7a"i le%i& 6ara& sela(a 6asien
(enun00u &ati #an0 "isu(%an01an5 'er%a0ai tera6i #an0 "i0una1an se%a0ai P7e(%atanP
untu1 !@TO3 iala& RAA3 .EI3 "an 9&e(oe(%olization transarterial <TA+E>5
Te(a#i Adj'<an$
.eran 1e(otera6i a7u:an %a0i 6asien setela& rese1si atau !@TO (asi& %elu( 7elas5 Tela&
"ite(u1an %a&2a ti"a1 a"a (anfaat #an0 7elas "ala( 1elan0sun0an &i"u6 "ala( 1ea"aan
%e%as 6en#a1it atau se9ara 1eseluru&an %ai1 untu1 6en"e1atan a"7u:ant (au6un
neoa"7u:ant3 (es1i6un suatu (eta8analisis %e%era6a 6er9o%aan (enun7u11an 6enin01atan
#an0 si0nifi1an "ala( 1ea"aan %e%as 6en#a1it "an se9ara 1eseluru&an5 Analisis "ari u7i 9o%a
1e(otera6i a7u:an 6as9a o6erasi siste(i1 ti"a1 (enun7u11an (anfaat 1eta&anan &i"u6
"ala( 1ea"aan %e%as 6en#a1it atau se9ara 1eseluru&an3 na(un stu"i tun00al TA+E "an
neoa"7u:ant
131
I8et&io"ol tela& (enun7u11an 6enin01atan 1elan0sun0an &i"u6 setela&
"ila1u1an rese1si5
2*, PRO+NOSIS
) #ear sur:i:al sete1a& rese1si 1uratif se1itar 33I86* I5 ) #ear sur:i:al setela&
trans6lantasi se1itar 19I8/0I5 -i1a ti"a1 "a6at "ila1u1an rese1si 6ro0nosis &i"u6 a1an
se(a1in %uru1 #aitu se1itar *86 %ulan sa7a5
2*2 PEN7E+A"AN
.en9e0a&an 6ri(er "ila1u1an se%elu( ter7a"i 1an1er #aitu :
a5 Ba1sinasi &e6atitis
%5 ,en7a0a 6ola &i"u6 se&at "en0an ti"a1 (ero1o1 "an (inu( al1o&ol
95 ,en7a0a 6ola (a1an #an0 ren"a& 0lu1osa a0ar ti"a1 "ia%etes (elitus se&in00a a1an
(en7a"i fa1tor resi1o ter7a"i ;++
"5 ,en7a0a 6ola (a1an a0ar ti"a1 o%esitas a6ala0i "iusia #an0 su"a& &a(6ir lansia
.en9e0a&an se1un"er #aitu "en0an (en9e0a& ter7a"in#a re1urensi
LO III Memahami dan menjela!an h%!'m $(an#lan$ai ha$i men'('$ a)ama ilam
1* Pen)e($ian T(an#lan$ai
Trans6lantasi %erasal "ari %a&asa In00ris to transplant3 #an0 %erarti to %ove fro% one place
to another* %er0era1 "ari satu te(6at 1e te(6at lain5 A"a6un 6en0ertian (enurut a&li il(u
1e"o1teran3 trans6lantasi itu iala& : .e(in"a&an 7arin0an atau or0an "ari te(6at satu 1e
te(6at lain5 4an0 "i(a1su" 7arin0an "i sini iala& : Ku(6ulan sel8sel <%a0ian ter1e9il "ari
in"i:i"u> #an0 sa(a (e(6un#ai fun0si tertentu5
4an0 "i(a1su" or0an iala& : Ku(6ulan 7arin0an #an0 (e(6un#ai fun0si %er%e"a se&in00a
(eru6a1an satu 1esatuan #an0 (e(6un#ai fun0si tertentu3 se6erti 7antun03 &ati "an lain8lain5
Se"an01an trans6lantasi "ala( literatur Ara% 1onte(6orer "i1enal "en0an istila& na0l al-
a3d4a3 atau 7u0a "ise%ut "en0an 5ar3u al-a3d4a3- Kalau "ala( literatur Ara% 1lasi1
trans6lantasi "ise%ut "en0an istila& al-was6l <6en#a(%un0an>5 A"a6un 6en0ertian
trans6lantasi se9ara ter6erin9i "ala( literatur Ara% 1lasi1 "an 1onte(6orer sa(a &aln#a
"en0an 1eteran0an il(u 1e"o1teran "i atas5 Se"an0 trans6lantasi "i In"onesia le%i& "i1enal
"en0an istila& 6en9an01o1an5
2* Pem-a)ian T(an#lan$ai
,eli&at "ari 6en0ertian "i atas3 D7a(alu""in ,iri (e(%a0i trans6lantasi itu 6a"a "ua
%a0ian :
15 Trans6lantasi 7arin0an se6erti 6en9an01o1an 1ornea (ata5
25 Trans6lantasi or0an se6erti 6en9an01o1an or0an 0in7al3 7antun0 "an se%a0ain#a5
,eli&at "ari &u%un0an 0eneti1 antara "onor <6e(%eri 7arin0an atau or0an #an0
"itrans6lantasi1an> "ari resi6ien <oran0 #an0 (eneri(a 6in"a&an 7arin0an atau or0an>3 a"a
ti0a (a9a( 6en9an01o1an :
15 Auto transplantasi* #aitu trans6lantasi "i (ana "onor resi6ienn#a satu in"i:i"u5 Se6erti
seoran0 #an0 6i6in#a "io6erasi3 untu1 (e(uli&1an %entu13 "ia(%il1an "a0in0 "ari %a0ian
%a"ann#a #an0 lain "ala( %a"ann#a sen"iri5
25 Ho%o transplantasi* #a1ni "i (ana trans6lantasi itu "onor "an resi6ienn#a in"i:i"u #an0
sa(a 7enisn#a3 <7enis "i sini %u1an 7enis 1ela(in3 teta6i 7enis (anusia "en0an (anusia>5
.a"a ho%o transplantasi ini %isa ter7a"i "onor "an resi6ienn#a "ua in"i:i"u #an0 (asi&
&i"u63 %isa 7u0a ter7a"i antara "onor #an0 tela& (enin00al "unia #an0 "ise%ut cadaver
donor3 se"an0 resi6ien (asi& &i"u65
15 Hetero transplantasi iala& #an0 "onor "an resi6ienn#a "ua in"i:i"u #an0 %erlainan
7enisn#a3 se6erti trans6lantasi #an0 "onorn#a a"ala& &e2an se"an01an resi6ienn#a (anusia5
.a"a auto transplantasi &a(6ir selalu ti"a1 6erna& (en"atan01an rea1si 6enola1an3
se&in00a 7arin0an atau or0an #an0 "itrans6lantasi1an &a(6ir selalu "a6at "i6erta&an1an ole&
resi6ien "ala( 7an01a 2a1tu #an0 9u1u6 la(a55
.a"a ho%o transplantasi "i1enal ti0a 1e(un01inan :
15 A6a%ila resi6ien "an "onor a"ala& sau"ara 1e(%ar #an0 %erasal "ari satu telur3 (a1a
trans6lantasi &a(6ir selalu ti"a1 (en#e%a%1an rea1si 6enola1an5 .a"a 0olon0an ini &asil
trans6lantasin#a seru6a "en0an &asil trans6lantasi 6a"a auto transplantasi5
25 A6a%ila resi6ien "an "onor a"ala& sau"ara 1an"un0 atau sala& satun#a a"ala& oran0
tuan#a3 (a1a rea1si 6enola1an 6a"a 0olon0an ini le%i& %esar "ari6a"a 0olon0an 6erta(a3
teta6i (asi& le%i& 1e9il "ari6a"a 0olon0an 1eti0a5
35 A6a%ila resi6ien "an "onor a"ala& "ua oran0 #an0 ti"a1 a"a &u%un0an sau"ara3 (a1a
1e(un01inan %esar trans6lantasi selalu (en#e%a%1an rea1si 6enola1an5
.a"a 2a1tu se1aran0 ho%o transplantasi 6alin0 serin0 "i1er7a1an "ala( 1lini13 terle%i&8
le%i& "en0an (en00una1an cadaver donor3 1arena :
15 Ke%utu&an or0an "en0an (u"a& "a6at "i9u1u6i3 1arena "onor ti"a1 sulit "i9ari5
25 Den0an 6er1e(%an0an il(u 6en0eta&uan #an0 san0at 6esat3 teruta(a "ala( %i"an0
i((unolo0i3 (a1a rea1si 6enola1an "a6at "ite1an se(ini(al (un01in5
.a"a hetero transplantasi &a(6ir selalu (e#e%a%1an ti(%uln#a rea1si 6enola1an #an0
san0at &e%at "an su1ar se1ali "iatasi5 ,a1a itu3 6en00unaan#a (asi& ter%atas 6a"a %inatan0
6er9o%aan5 Teta6i 6erna& "i%erita1an a"an#a 6er9o%aan (entrans6lantasi1an 1ulit %a%i #an0
su"a& "i i#o6&ilisasi untu1 (enutu6 lu1a %a1ar #an0 san0at luas 6a"a (anusia5
Se1aran0 &a(6ir se(ua or0an tela& "a6at "itrans6lantasi1an3 se1ali6un se%a0ian (asi&
"ala( taraf (en00una1an %inatan0 6er9o%aan3 1e9uali ota13 1arena (e(an0 te&nisn#a a(at
sulit5 Na(un "e(i1ian 6erna& "i%erita1an %a&2a "i Rusia su"a& 6erna& "ila1u1an
6er9o%aan (entrans6lantasi1an 1e6ala 6a"a %inatan0 "en0an &asil %ai15
,* Penda#a$ Ulama Ten$an) T(an#lan$ai
.ara ula(a fiQ& <6a1ar &u1u( Isla(> 1lasi1 se6a1at %a&2a (en#a(%un0 or0an tu%u&
(anusia "en0an or0an (anusia %ole& sela(a or0an lainn#a ti"a1 "i"a6at1an5 Se"an01an
6a1ar &u1u( Isla( 1onte(6orer %er%e"a 6en"a6at a1an %ole& "an ti"a1n#a trans6lantasi
or0an tu%u& (anusia5 'eri1ut ini 6ern#ataan 6ara 6a1ar &u1u( Isla( 1lasi1 "an
1onte(6orer:
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sa& s&olatn#a "en0an tulan0 na7is terse%ut5 Ke9uali3 7i1a "ala( 6en#a(%un0an itu ti"a1 a"a
unsur 1e%utu&an atau a"a tulan0 lain #an0 su9i selain tulan0 (anusia (a1a ia 2a7i%
(e(%u1a <(en9a%ut> 1e(%ali tulan0 na7is terse%ut 2alau6un su"a& tertutu6 ole& "a0in05
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7i1a #an0 lain (asi& a"a 2alau6un tulan0n#a &e2an #an0 na7is se6erti 9elen0 "an an7in05
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DAFTAR PUSTAKA
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De6arte(en I.D AKUI5
.ri9e3 S#l:ia A3 199) (atofisiologi ;konsep klinis proses-proses penyakit* e" *3 E+3 -a1arta5
Ku(6ulan 1ulia& il(u %e"a& AKUI3 199)3-a1arta5
De -on032i(5 199/5 l%u 1edah3 e"5re:isi5 -a1arta:E+
A%u Da2u"5 Sunan A+i Dawud3 :ol5 II5 tt5 Dar al8Ai1r3 tt5
Al8AnsRaGriG3 a1ari#aG 5 Fathu al-<ahha+ Sharh #anha. al-&6ulla7+* :ol5 15 @e%anon: DaGr
al8Ai1r3 19985
Al8'u7a#ra(iG3 Sula#(aGn- Ha7shiyah Sharh #anha. al-&6ulla7+* :ol5 15 @e%anon: DaGr al8
Ai1r3 19985
Al8'uGtRiG3 ,u&a((a"5 #a3a al-Na7s3 :ol5 15 @e%anon: Dar al8Ai1r3 19985
Al8AaQiG&3 A%" Alla&5 #arka5 al-Fatwa "ala( al8,a1ta%a& al8S&a(ila&5
Al8;aita(iG3 I%nu ;a7r5 &uhfah al-#uhta7. "ala( al8,a1ta%a& al8S&a(ila&5
Al8Na2a2iG3 4a&#a5 #inha7. al-&6a7li+i7n5 @e%anon : Dar al8Ai1r3 19925