Perbedaan Manifestasi Klinis dan Laboratorium Kolestasis Intrahepatal dengan Ekstrahepatal pada Bayi

Abstract

Ikterus fisiologis sering didapatkan pada bayi dan kebanyakan gejalanya ringan. Gejala ikterik biasanya akan menghilang dalam 2 minggu setelah lahir. Pada ikterus yang terkonjugasi terjadi defek produksi intrahepatal, transpor transmembran dari empedu, yaitu kolestasis intrahepatal (IH) atau obstruksi kolestasis ekstrahepatal (EH) yang mengakibatkan hambatan empedu. Penelitian ini dilakukan untuk melihat perbedaan manifestasi klinis dan laboratorium kolestasis IH dengan EH pada bayi. Studi potong lintang dilakukan pada 72 bayi dengan kolestasis yang datang ke Rumah Sakit Dr. Hasan Sadikin Bandung, periode Januari 2014–Desember 2015. Analisis data dilakukan dengan uji Pearson Chi-kuadrat dan Mann-Whitney. Subjek terdiri atas 43 (60%) laki-laki dan 29 (40%) perempuan, kolestasis IH sebanyak 61 orang (85%), dan EH sebanyak 11 (15%). Pada penelitian ini didapatkan perbedaan bermakna manifestasi klinis asites antara kolestasis IH dan EH (p=0,047), sedangkan venektasi, hepatomegali, dan splenomegali tidak didapatkan perbedaan bermakna. Pada pemeriksaan warna feses tidak didapatkan perbedaan bermakna (p=0,936), demikian juga hasil laboratorium bilirubin total, bilirubin direk, glutamat oksaloasetat transaminase, glutamat piruvat transaminase, alkali fosfatase, dan gama glutamil transferase serum tidak berbeda bermakna. Simpulan, didapatkan perbedaan manifestasi klinis asites, sedangkan manifestasi klinis yang lain dan hasil laboratorium tidak didapatkan perbedaan antara kolestasis IH dan EH. [MKB. 2016;48(1)45–50]

Kata kunci: Kolestasis ekstrahepatal, kolestasis intrahepatal, laboratorium, manifestasi klinis

Differences of Clinical Manifestation and Laboratory Findings in Intra-Hepatic and Extra-Hepatic Cholestasis in Infants

Abstract

Physiological jaundice found in infants and most symptoms are often mild. Jaundice symptoms usually disappear within 2 weeks after birth. In conjugated jaundice defects in intra-hepatic production, transmembran transport from bile, i.e. cholestasis intra hepatic (IH), or extra-hepatic (EH) obstruction/cholestasis occur, resulting in bile barriers. This study was conducted to look at the differences in the clinical and laboratory manifestations of IH and EH cholestasis in infants. A cross-sectional study was performed on 72 infants with cholestasis who came to Dr. Hasan Sadikin General Hospital Bandung, during the period of January 2014–December 2015. Data analysis was performed with Pearson Chi-square test and Mann-Whitney. Subjects consisted of 43 (60%) infant boys and 29 (40%) infant girls, IH cholestasis were 61 (85%) and EH cholestasis were 11 (15.3%). Significant differences in the clinical manifestations of acites with IH and EH cholestasis were found (p=0.047), whereas insignificant differences in venectation, hepatomegaly and splenomegaly were observed. On examination of stool color, no significant difference was found (p=0.936). The same was true for laboratory results of total bilirubin, direct bilirubin, serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and gamma glutamyl transferase. In conclusion, we found differences in clinical manifestation of acites, while for other clinical manifestations and laboratory results no differences were found between IH and EH cholestasis. [MKB. 2016;48(1)45–50]

Key words: Clinical manifestation, extra-hepatic cholestasis, intra-hepatic colestasis, laboratory