Tugas

1. Pada kelainan traktus bilier parameter laboratorium apa saja yang meningkat
Jawab:
The presentation of acute obstruction of the common bile duct by a stone usually
includes biliary pain, similar to the pain of cystic duct obstruction, andif of
sufficient durationis followed by jaundice. Most patients with obstruction have
elevated liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase
[AST]) in the acute phase of obstruction. In the later course ALT and AST decrease
toward normal even if the obstruction persists, whereas alkaline phosphatase rises,
followed by bilirubin elevation and eventually jaundice.

sumber : lange current diagnosis and treatment gastroenterology hepatology and

endoscopy. 2009

liver function test

Liver function tests is a term frequently used to refer to measurement of the levels of a
group of serum markers for evaluation of liver dysfunction. Most commonly, levels of
aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase
(AP), -glutamyltranspeptidase (GGT), and bilirubin are included in this panel. This
term is a misnomer, however, because most of these tests measure not liver function
but rather cell damage. More accurate measurement of the livers synthetic function is
provided by serum albumin levels and prothrombin time (PT). Although measuring
liver enzyme levels is important in the assessment of a patients liver disease, these
test results can be nonspecific
sumber: schwartz

Oral Cholecystography
Once considered the diagnostic procedure of choice for gallstones, oral
cholecystography has largely been replaced by ultrasonography. It involves oral
administration of a radiopaque compound that is absorbed, excreted by the liver, and
passed into the gallbladder. Stones are noted on a film as filling defects in a
visualized, opacified gallbladder. Oral cholecystography is of no value in patients
with intestinal malabsorption, vomiting, obstructive jaundice, and hepatic failure.
sumber: schwartz

Cholesterol Stones.
Pure cholesterol stones are uncommon and account for <10% of all stones. They
usually occur as single large stones with smooth surfaces. Most other cholesterol
stones contain variable amounts of bile pigments and calcium, but are always >70%
cholesterol by weight. These stones are usually multiple, of variable size, and may be
hard and faceted or irregular, mulberry-shaped, and soft Most cholesterol stones are
radiolucent; <10% are radiopaque
sumber: schwartz

Oral bile acid dissolution

In selected patients who have symptomatic gallbladder stones without complications
and have mild and infrequent episodes of biliary pain, stone dissolution with UDCA
may be employed. The patient must, however, be informed about the high risk of
recurrent stones.UDCA reduces cholesterol saturation of bile and also produces a
lamellar liquid crystalline phase in bile that allows dispersion of cholesterol from
stones by physical-chemical means. In carefully selected patients with radiolucent
stones smaller than 510 mm in diameter in a functioning gallbladder, complete
dissolution can be achieved with UDCA in about 50% of patients. In general, 618
months of therapy are required to achieve complete dissolution of stones 510 mm in
diameter, as gallstone dissolution occurs at a mean rate of 0.7-mm decrease in
diameter per month. For good results within a reasonable time period, this therapy
should be limited to radiolucent stones smaller than 5 mm in diameter. The dose of
UDCA should be 1015 mg/kg/day. Stones larger than 15 mm in size rarely dissolve.
Pigment stones are not responsive to UDCA therapy. Recurrence of stones in 3050%
of patients within 35 years after stone dissolution have reduced the role of gallstone
dissolution to patients who want to avoid or are unfit for cholecystectomy.

sumber : lange current diagnosis and treatment gastroenterology hepatology and

endoscopy. 2009
URDAHEX

Komposisi:
Ursodeoxycholic acid 250 mg.

Bentuk Sediaan:
Kapsul.

Farmakologi:
Ursodeoxycholic acid adalah asam empedu tersier yang memiliki potensi untuk mengurangi tingkat
kejenuhan asam empedu, sehingga akan menekan pembentukan batu kolesterol dan memperbaiki
gangguan pada aliran asam empedu. Ursodeoxycholic acid menekan sintesis dan sekresi kolesterol
dari hati dan juga menghambat penyerapan kolesterol pada usus. Ursodeoxycholic acid juga memiliki
aktivitas penghambatan kecil pada sintesis dan sekresi asam empedu endogen, tanpa
mempengaruhi sekresi fosfolipid ke dalam empedu.

Indikasi:
Untuk pasien dengan batu empedu radiolusen tanpa kalsifikasi (diameter < 20 mm) sebelum
dilakukannya tindakan cholecystectomy elektif, kecuali pada pasien dengan penyakit sistemik, pasien
lanjut usia, reaksi idiosinkrasi terhadap anestesi umum, atau pasien yang menolak tindakan
pembedahan.

Dosis:
- Dosis umum : 8 10 mg / kg BB / hari dlm 2 3 dosis terbagi. Umumnya dosis 250 mg diberikan
pada pagi dan malam hari.
- Dosis dapat dibagi tidak rata dan dosis lebih besar diberikan sebelum tidur untuk menghalangi
peningkatan konsentrasi kolesterol empedu di malam hari.

Kontraindikasi:
- Batu kolesterol yang mengalami kalsifikasi, batu pigmen empedu yg radiolusen dan radioopak.
- Kolesistitis akut, kolangitis, obstruksi bilier, pankreatitis, fistula gastrointestinal bilier.
- Alergi asam empedu.
- Kehamilan.
- Gangguan fungsi ginjal.

Peringatan dan Perhatian:

- Terapi batu empedu dengan ursodeoxycholic acid butuh waktu beberapa bulan. Sehingga perlu
diberikan perhatian selama pengobatan dengan ursodeoxycholic acid dan terapi alternatif harus
dipertimbangkan.
- Disolusi batu empedu tidak terhadi pada semua pasien dan angka kekambhuan dalam 5 tahun
mencapai 50%.
- Disolusi batu empedu dengan ursodeoxycholic acid hanya untuk batu radiolusen saja pada pasien
dengan kandung empedu yang berfungsi. Kecepatan disolusi yang terbaik dicapai oleh batu empedu
yang kecil dan tergantung (diameter < 10 mm).
- Keamanan pemakaian ursodeoxycholic acid lebih dari 24 bulan belum diketahui.
- Keamanan dan efikasi pada anak-anak belum dapat dibuktikan.
Efek Samping:
Diare ringan biasanya terjadi dan akan membaik secara spontan. Efek samping yang jarang
dilaporkan seperti : kemerahan, rambut rontok, gatal-gatal, mual, muntah, gangguan saluran
cerna, metalic taste, nyeri abdomen, nyeri kandung empedu, cholecystitis, konstipasi, stomatitis,
kembung, sakit kepala, cemas, kelelahan, depresi, gangguan tidur, nyeri sendi, myalgia, nyeri
punggung, batuk, dan rhinitis.

Interaksi Obat:
- Menghambat absorpsi ursodeoxycholic acid: kolestiramin, kolestipol, aluminium hidroksida.
- Penggunaan bersama hormon estrogen dapat mempercepat pembentukan batu empedu.

Post Cholecystectomy diarhea

The aetiology of PCD is unknown and appears to be multifactorial. There are some so far
unknown factors, which can accelerate the colonic transit time significantly and lead to a
significant decrease of faecal consistency after cholecystectomy. These changes in some
cases are strong enough to develop PCD.

Sumber: Post Cholecystectomy DiarrhoeaA Systematic Review jurnal