IKTERUSIkterusAdalah suatu peningkatan bilirubin direk / indirek > 3, sehingga berwarna kuning (jaundice)Ikterus : bedah --> obstruksi IPD- Hepar- Kandung empedu- Saluran empeduFirst steps in the diagnostic of the jaundice patientTanda-tanda ikterus (sirosis)- Oedema- Clubbing finger- Ascites- Splenomegali- VenektasiJaundiceS. bilirubin + Hepato-cellularGillbertshemolysis Cholestasis Acute ChronicDilated Undilatedduct ductCholestasis :- Intra hepatic- Ekstra hepatic Extra hepatic Intra hepaticHistory Fever, pain, frequent Drugs, onset as for hepatitisLiver size ++ +-Hepatic hstologyBile necrosis + (sometimes) 0Portal zones +Polymorps + 0Eosinophyl 0 FrequentLiver cell damage +- +USGIntrahepatic ducts Dilated Not dilatedPercutnaeus / endoscopic cholangiography Block shown No dilated bile ducts foundHistoryPhysicalCoagulation screenUSG LFTDilated ductsPTCBiliodigestive anastomosis :Cholecysto - jejunostomyCholedocho - jejunostomyCholedocho - duodenostomyBatu TumorKadang-kadang hilang timbul koliknya Nyeri terus menerusBilirubin tidak pernah naik terus menerus (naik turun) Bilirubin naik progresifVesika velea tetap kecil Vesika velea membesarPemeriksaan : USG sensitivitas tinggi