HUBUNGAN TEMUAN HISTOPATOLOGI HATI PASCA KASAI DENGAN SIROSIS HATI PADA PASIEN ATRESIA BILIER DI RSUP DR. SARDJITO YOGYAKARTA

LEILA RAKHMA B, Dr. dr. Akhmad Makhmudi, Sp.B., Sp.BA ; dr. Gunadi, Ph.D, Sp. BA

2017 | Skripsi | S1 PENDIDIKAN DOKTER

INTISARI Latar Belakang:Atresia bilier merupakan sebuah peradangan kolangiopati pada bayi yang menghasilkan fibrosis progresif dan obliterasi pada saluran empedu ekstra hepatik dan menjadi penyebab utama terjadinya kolestatis neonatus. Apabila tidak ditangani, kelainan hati progresif yang disertai hipertensi portal, kegagalan hati, dan sirosis hati dapat terjadi dan menyebabkan kematian dalam 2 tahun pertama kehidupan. Diagnosis atresia bilier dapat dilakukan dengan mengenali tanda dan gejala, hasil pemeriksaan laboratorium, ultrasonografi, kolangiografi intraoperatif, dan biopsi hati. Gambaran histopatologi berperan dalam menentukan prognosis keberhasilan prosedur Kasai berupa angka kejadian sirosis. Tujuan Penelitian:Untuk mengetahui gambaran histopatologi pasien atresia bilier di RSUP Dr. Sardjito Yogyakarta dan mengetahui hubungan gambaran histopatologi pasien AB yaitu fibrosis, infiltrasi sel radang, proliferasi duktus bilier, kolestasis, dan transformasi giant cell dengan angka kejadian sirosis di RSUP Dr. Sardjito Yogyakarta. Metode: Jenis penelitian yang digunakan yaitu penelitian analisis retrospektif cross-sectional pada data rekam medik pasien AB serta review preparat hasil biopsi hati oleh ahli patologi anatomi di RSUP dr. Sardjito Yogyakarta pada tahun 2012-2016. Hasil: Terdapat 25 sampel yang dilakukan penilaian karakteristik dan didapatkan hasil 15 pasien laki-laki dan 10 pasien perempuan dengan gambaran fibrosis, infiltrasi sel radang, proliferasi duktus bilier, kolestasis, dan transformasi giant cell hepatosit. Sebanyak 14 (56%) diantaranya mengalami sirosis hati, dengan faktor yang berpengaruh adalah fibrosis, proliferasi duktus bilier, dan kolestasis (p<0.05). Kesimpulan: Gambaran histopatologi pasien AB di RSUP dr. Sardjito sebagian besar berupa adanya fibrosis, infiltrasi sel radang, dan proliferasi duktus bilier, serta didapati adanya kolestasis dan transformasi giant cell hepatosit. Terdapat hubungan yang signifikan antara fibrosis, proliferasi duktus bilier, dan kolestasis terhadap kejadian sirosis hati.

ABSTRACT Background : Biliary atresia is an inflammatory cholangiopathy of infancy that results in progressive fibrosis and obliteration of extrahepatic bile ducts and the main cause of neonatal cholestasis. If untreated, affected children show progressive liver disease, with development of portal hypertension, liver failure, and liver chirrosis, invariably resulting in death within the first 2 years of life. Diagnosis of biliary atresia could established by recognition of the disease, laboratory evaluation, ultrasonography, intraoperative cholangiography, and liver biopsy specimen. Histopathological features are important to determine Kasai's outcome i.e. cirrhosis events. Aim : To understand and acknowledge the histopathological characteristic of biliary atresia in RSUP Dr. Sardjito Yogyakarta and to understand the correlation between histopathological characteristics of biliary atresia i.e. fibrosis, inflammatory cell infiltration, bile duct proliferation, cholestasis, and giant cell transformation and cirrhosis event in biliary atresia patient in RSUP Dr. Sardjito Yogyakarta. Method : The type of the research used is cross-sectional analytical retrospective researchthat was conducted in patient's medical record and reviewed and re-evaluate biopsy specimen of biliary atresia patient by anatomical pathologist in RSUP Dr. Sardjito Yogyakarta in 2012-2016. Result: There were 25 samples evaluated for the characteristics. The results were, as follows, 15 patients were male and 10 were female with histopathological features were fibrosis, inflammatory cell infiltration, bile duct proliferation, cholestasis, and giant cell transformation.14 (56%) patients have cirrhosis appearance in their liver biopsy specimen, fibrosis, bile duct proliferation, and cholestasis (p<0.05) has the significant factors among the other histopathological characteristics of liver chirrosis event. Conclusion: The main histopathological characteristics of biliary atresia in RSUP Dr. Sardjito Yogyakarta are fibrosis, inflammatory cell infiltration, and bile duct proliferation. Other characteristics might be found are cholestasis and giant cell transformation and also there is a significant correlation between histopathological characteristics i.e. fibrosis, bile duct proliferation, and cholestasis with liver cirrhosis event.

Kata Kunci : atresia bilier, histopatologi, karakteristik, sirosis, Yogyakarta