subscapular liver hematoma
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Presentasi Referat
Subcapsular Liver Hematoma
Oleh :
Almirazada Zhes Putri
Pembimbing:
dr. Dean Wahjudy, Sp.OG (K)
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PENDAHULUAN
Sinrom HELLP hemolisis !H"#
pening$atan en%im hati !EL"# an
trombositopenia !LP" merupa$an salah satu
$ompli$asi pree$lamsia&e$lamsia'
Diper$ira$an ()&*) + pasien engan
pree$lamsia,e$lamsia berat a$an mengalami
gangguan paa hati- $ompli$asi sinrom
HELLP
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ANA.O/0 DAN 10S0OLO20
Leta$ :$uaran $anan atas rongga
perut i ba3ah iafragma'
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Hepar ibagi men4ai 5 lobus :lobus e6tra# lobus
cauatus# lobus sinistra an 7uaratus'
/emili$i lapisan 4aringan i$at tipis 8ang isebut $apsula
2lisson#
9agian luarn8a itutupi oleh peritoneum' Daerah tempat eluar masu$ pembuluh arah paa
hepar :hilus atau porta hepatis'
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Tinjaun pustaka
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Subcapsular Liver Hematomaaalah
$ompli$asi ari HELLP sinrom 8ang 4arang
tapi mengancam n8a3a'
Paa sebagian besar $asus ruptur hepar ter4ai
paa lobus bagian $anan
Diahului oleh terbentu$n8a hematoma
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Patofisiologi
un$no3n
erusa$anenotel an
a$tivasi
trombositintravas$uler
;asospasme
AglutinasiPem'arah
Agregasitrombosit
Smterfragmentasi
Depositfibrin $e
sinusoi
Nekrosis
periportal
Perarahan intrahepati$
Hematm su!"apsular hati
Ruptur hati
Hemolisis
trombositopenia
bl l b i di i S d
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Table 1. laboratory Findings in HELLP Syndrome
Hemolysis (at least two
of these) :
Elevated liver
enymes :
Low !latelets
("1##.###$mm%)
Peri!heral smear
(s&histo&ytes' brr&ells)
AST or ALT twice
upper level ornormal
Serm bilirbin (1.*
mg$+l
LDH twice upper
level or normal
Low serm
ha!toglobin
Severe anemia'
nrelated to blood
loss
Ptekie Ekimosis Gusi berra!
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#a!le $. Si%n and Symptms & Su!"apsular 'ier Hematma
Seere epi%astri" pain Seere nausea r mitin%
Shulderne"* pain
+espiratry di&&i"ulty r pain
n inspiratin A"ute nset & hyptensin and
ta"hy"ardia
Relapsing h8potension Disseminate intravascular
coagulopath8
Abrupt elevations in liver
en%8mes /assive ascites or pleural
effusions
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Diapat$an paa trimester $e ua a$hir atau
trimester $etiga $ehamilan'
Saat ruptur ari $apsul Glisson - hipotensi
an s8o$ hipovolemi$ '
Robe$an ari hematom 8ang inta$ apat
spontan atau apat ihubung$an engan
trauma ari luar !e6: palpasi abomen#
$onvulsi ataupun muntah'
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Diagnosis
#a!el . +adil%i"
-ma%in% in Su!"apsular
'ier Hematma
hest/0/ray
Pleural effusion
Elevate right iaphragm
1ltrasund
Hematoma
0ntraperitoneal flui
# s"an
2+-
=&ra8 US2
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ehamilan 8ang memili$i $ompli$asi seperti
subcapsular liver hematoma ihubung$an
engan ang$a $ematian maternal an perinatal
8ang sangat tinggi'
Resi$o paa 4anin biasan8a berhubunganen an rematuritas an hi o$sia'
.ing$at morbiitas bergantung paa:
(' Rupture atau tia$#
*' eterseiaan arah untu$ tranfusi#
>' .ina$an operasi 8ang
irencana$an
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Table ,. maternal and Perinatal -om!li&ations in He!ati& Hematoma
/aternal Perinatal 0eed for large volmes of
blood transfsions
Preterm eliver"
Prolonged hos!italiation in
intensive &are nit
#erebral pals"
Plmonary edema $ental retaration
2+S
%etal&neonatal eat! 2enal failre
He!ati& failre
Potential for liver trans!lant
Se!sis
+3-
3ntra&erebral hemorrhage
+eath
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&Suspecte subcapsularliver hematoma
&$onsul operasi ancross match bloo
unrupture
.ranfusi? perbai$i$oagulopati? serial
monitoring
0ncrease hematome si%e ?maternal conition
eteriorates
ruprute
>) U PR
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Pro'nosis
Ang$a $ehiupan ber$aitan gn :
Penega$an iagnosis ini
Penanganan meis
.ina$an operasi 8ang cepat'
Penelitian : B gn RPD: hematoma subcapsular hat0
prognosa bai$ paa $ehamilan beri$utn8a
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AS# 4 units ' (nrmal 5 64 units')
A'# >@ units, L !normal F G) units,L"
'DH () units, L !normal F *)) units,L"
Platelet "unt *))'))),mm> !normalF())'))),mm>"
Hem%l!in (*> g,Dl !normal () ,Dl
1SG janin : Presbo$# pertumbuhan normal# ica cu$up'
Prtein urin$6 j : *)() mg,hari'
DD : Pree$lamsia# pasien ira3at#erapi : Steroi untu$ pematangan paru 4anin'
5 4am setelah ira3at : tiba&tiba mengeluh$an n8eri epigastrium
berat#muntah#n8eri te$an paa $uaran $anan atas' Dila$u$an
pemeri$saan laboratorium ulang'
Hasil Lab(1)(
AS# 7$ units ' (nrmal 5 64 units')
A'# ()) units, L !normal F G) units,L"
'DH *@) units, L !normal F *)) units,L"
Platelet "unt B)'))),mm> !normalF())'))),mm>"
Hem%l!in > g,Dl !normal () ,L
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D=: Sinrom HELLP
S
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