Karakteristik Klinik dan Laboratorik Kolestasis Intrahepatal dan Ekstrahepatal di Bangsal Perawatan Anak RSU Dr. Saiful Anwar Malang

Abstract

Clinical and laboratory characteristics of intrahepatic and extrahepatic cholestasis in pediatric ward of Dr. Saiful Anwar General Hospital Malang

Introduction: Clinical examination in determining intrahepatic and extrahepatic cholestasis in children and infant remains invasive and difficult. There is a need of simple and aplicative method on clinical practice. The objective of this review is to find the cause of cholestasis based on clinical and laboratory examination. Subject and Methode: Sixty nine medical records from pediatric patients who suffered from prolonged conjugated jaundice between January 2008 and March 2011 in the Department of Pediatrics of Dr. Saiful Anwar General Hospital, Malang, Indonesia were reviewed with regard to the clinical examinations, laboratory parameters and ultrasound. Liver ultrasound was used to classify patients into two groups: intra or extrahepatic cholestasis. Unpaired t-test was performed to compare numerical data. P value less than 0.05 were considered as to indicate statistical significant.

Results: Leucocytes count (mean 2.649/mm3, 95%CI 1.556 to 12.141/mm3, p=0.012), ALT (mean 155 IU/L, 95%CI 66.9 to 245 IU/L, p=0.043), cholesterol (mean 243 mg/dl, 95%CI 31 to 455 mg/dl, p=0.026) and triglyseride (mean 219 mg/dl, 95%CI 40 to 398 mg/dl, p=0.018) were significantly higher in patients with extrahepatic cholestasis than intrahepatic group, but potassium level (mean 1.18 mEq/L, 95%CI 0.22 to 2.14 mEq/L, p=0.017) were significantly lower in intrahepatic group. Pale stool color had 75%
sensitivity and 80% spesificity in determining extrahepatic cholestasis.

Conclusion: Elevated leucocyte count, increased ALT serum level, cholesterol, triglyseride and decreased of potassium and acholic stool can be used as determinant factors in classifying intra or extrahepatic cholestasis in children.

Keywords: Acholic stool, leucocyte, ALT, cholesterol, triglyseride, potassium, cholestasis

ABSTRAK

Latar belakang: Diagnosis pasti kolestasis intrahepatal dan ekstrahepatal pada bayi dan anak membutuhkan pemeriksaan yang invasif dan sulit. Dibutuhkan metode yang sederhana dan aplikatif untuk praktek klinis. Penelitian ini bertujuan untuk menentukan jenis kolestasis intrahepatal berdasarkan pemeriksaan klinis dan laboratoris.
Metode: Enam puluh sembilan rekam medis pasien yang pernah dirawat di bangsal anak RSU Dr. Saiful Anwar Malang dengan kolestasis selama periode Januari 2008 sampai Maret 2011 dianalisis. USG digunakan untuk menentukan ada tidaknya sumbatan ekstrahepatal dan menentukan kelompok kolestasis intrahepatal atau ekstrahepatal. Identitas, keluhan, riwayat penyakit dan hasilhasil pemeriksaan laboratorium dibandingkan antara dua kelompok penelitian. Unpaired t-test digunakan untuk membandingkan
data numerik dari dua kelompok yang diteliti.

Hasil: Leukosit (rerata 2,649/mm3, 95%CI 1.556-12,141/mm3, p=0,012), ALT (rerata 155 IU/L, 95%CI 66,9-245 IU/L, p=0,043), kolesterol (rerata 243 mg/dl, 95%CI 31-455 mg/dl, p=0,026) dan trigliserida (rerata 219 mg/dl, 95%CI 40-398 mg/dl, p=0,018) lebih tinggi pada pasien dengan kolestasis ekstrahepatal dibandingkan dengan intrahepatal, namun kadar kalium (rerata 1,18 mEq/L, 95% CI 0,22-2,14 mEq/L, p=0,017) lebih rendah. Warna tinja pada kedua jenis kolestasis juga berbeda. Warna tinja yang pucat memiliki sensitivitas 75% and spesifisitas 80% dalam menentukan kolestasis ekstrahepatal.

Simpulan: Peningkatan jumlah leukosit, ALT, kolesterol, trigliserida dan penurunan kadar kalium darah serta warna