Wahyu CF

- Januari 29, 2010

Windows XP selalu restart saat dinyalakan.

Windows XP yang sering restart sendiri kadangkala disebabkan oleh virus yang menyerang system. Tetapi bisa juga disebabkan oleh hilang/rusaknya file kernel32.dll yaitu ditandai dengan windows langsung restart saat baru muncul logo windows berlatar belakang hitam sebelum masuk jendela welcome screen layar biru.

Masalah yang sama juga terjadi saat masuk ke safemode yang selalu restart dan gagal booting ke windows sehingga anda tidak bisa masuk ke dalam windows.Anda dapat mengembalikan file kernel32.dll yang hilang/rusak dengan menggunakan CD Windows XP,jalankan cara dibawah ini:

Masukan CD Windows XP kedalam drive CdRoom anda.

Restart komputer dan booting dari CD Windows XP dengan memilih urutan boot prioritas pertama pada CdRoom.

Setelah masuk ke layar instalasi,tekan tombol [R] untuk menuju mode Recovery console.

Pilih lokasi instalasi Windows XP anda dan masukan password administrator.

Setelah muncul command prompt ketik:

cd system32 lalu

ren kernel32.dll kernel32.old lalu enter.

expand D:\i386\kernel32.dl_ tekan enter lagi.

exit

- Januari 28, 2010

This attachment type cannot be viewed on your device

If you are receiving this error message when you try to open an attachment to an email this might help. My problem was that I did not have the "Blackberry Attachment Service" loaded into my phone applications. Connected my phone to Desktop Manager and sure enough the Blackberry Attachment Service Box was unchecked. I checked the box and completed the add application through Desktop Manager and I was set. NOTE: The messages that I had received prior to adding the Attachment Service still gave the error message when I tried to open them. But all messages received after installing the Attachment Service opened without any problems. If this does not fix your problem search Blackberry.com forums they listed some other fixes for this problem. The one stated above solved my problem.

- Januari 28, 2010

NT Authority\System Error Message: "This system is shutting down. Windows must now restart because the Remote Procedure Call (RPC) service terminated unexpectedly."
Affected Products: Software, System CD/DVDs
Affected Operating Systems: Windows NT® 4.0, Windows® 2000, Windows® XPISSUE:
Note: If you have a Gateway Server, click here. When starting your computer, you may see the following error message:
System Shutdown
This system is shutting down. Please save all work in progress
and log off. Any unsaved changes will be lost. This shutdown
was initiated by NT AUTHORITY\SYSTEM
Time before shutdown:
Message:
Windows must now restart because the Remote Procedure Call
(RPC) service terminated unexpectedly

Note: If you disconnect your computer from its broadband connection, it does not shut down. Remove the cable from the network card or unplug the USB cable modem.
Note: This is in reference to issue number 2-976684501.
Note: There are currently, and may continue to be, variants to this worm virus. Your computer may also be infected with other viruses, yet this worm virus has made the issue known. Please check with your antivirus software manufacturer to obtain the latest updates for your antivirus software, as well as instructions for the removal of all viruses.
To help avoid these types of issues in the future, be sure to schedule regular updates for both your antivirus software and Windows critical updates. It is also recommended that on a regular basis you make a backup copy of all important data.
This document is intended for a computer that is not infected with any other viruses other than this worm virus. Gateway technical support does not normally support virus removal or any other virus issue. However, since this worm virus widely affects many computer users, we wanted to provide assistance as a courtesy.

RESOLUTION: Note: Gateway does not support viruses. All customers affected by this should be directed to Symantec or Answers by Gateway for support and resolution. We initially provided support for this virus because of the impact to our customers, however we now need to adhere to our virus policy. Note: Please read all information in this document before attempting to clean your computer. You may also want to print a copy of this document to have at your disposal when attempting to clean your computer. For best printing results, in your Internet browser, from the File menu, click Print.
There is a lot of information contained in the document on combating what you may see, including how to stop the shut down process so that you can complete the steps. Also, you must install the Microsoft patch to prevent this type of issue from reoccurring.
There are four resolution options available.
Note: Follow Resolution #1 first, and then proceed to either Resolution #2 or #3, depending on your antivirus software.

Note: If the computer attempts to shut down, use the following steps to prevent the forced shut down. This allows you to complete one of the resolutions without the computer restarting.

From the Start menu, click Run.
In the Run dialog box, type: shutdown -a. Click OK.

Resolution #1: Download and install the Symantec W32.Blaster.Worm Removal Tool.
Note: You need to be logged in with Administrative rights to run this tool in Windows 2000 or Windows XP.

Download the FixBlast.exe file from the Symantec Web site.
Save the file to a convenient location, such as the Downloads folder or the Windows Desktop, or to removable media that is known to be uninfected, if possible.
If you would like, check the authenticity of the digital signature. This step is optional.
Close all open windows and programs before running the tool.
If you are using Windows XP, disable System Restore. CAUTION: If you are running Windows XP, it is strongly recommend that you do not skip this step. The removal procedure may be unsuccessful if Windows XP System Restore is not disabled, as Windows prevents outside programs from modifying System Restore.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
  View Picture
Locate and double-click the FixBlast.exe file to start the removal tool.
In the Symantec W32.Blaster.Worm Fix Tool dialog box, click Start to begin the process.
Allow the tool to run. Note: When running the tool, if you see a message that the tool was unable to remove one or more files, run the tool in Safe mode. Shut down the computer, turn off the power, and wait 30 seconds. Restart the computer in Safe mode, and then run the tool again.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Run the FixBlast.exe removal tool again to ensure that the computer is clean of the virus.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run LiveUpdate to make sure that you are using the most current virus definitions.

When the tool has finished running, a message displays indicating whether W32.Blaster.Worm infected the computer. In the case of a worm removal, the program displays the following results:

Total number of the scanned files
Number of deleted files
Number of terminated viral processes
Number of fixed registry entries

Resolution #2: If you have a current subscription to Norton AntiVirus:
Note: Please see the Symantec Web site for additional information.

Disable System Restore.
Run LiveUpdate to update the virus definitions. Note: If you are unable to download the update, follow step number 2 in Resolution #3 below, and then attempt to run LiveUpdate again.
Restart the computer in Safe mode.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
  View Picture
Use Norton AntiVirus to scan for and delete any infected files.
- Run a full system scan.
- If any files are detected as infected with W32.Blaster.Worm, click Delete.
Delete the registry value.
- From the Start menu, click Run.
- In the Run dialog box, type: Regedit. Click OK.
- In the Registry Editor window, locate the following key: HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows\CurrentVersion\Run
- Delete the following entries, if present: Windows Auto Update and msblast.exe.
  - Click to select the registry name.
  - From the Edit menu, click Delete.
  - In the Confirm Value Delete dialog box, click Yes.
  - Repeat these steps for each registry name entry.
- If applicable, repeat steps c and d, this time checking for the following key: HKEY_CURRENT_USER\Software\Microsoft\Windows\CurrentVersion\Run. If this key is not found, you can skip this step.
- In the Registry Editor window, from the File menu, click Exit.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Use Norton AntiVirus again to scan for and remove any infected files.
- Run another full system scan.
- If any additional files are detected as infected with W32.Blaster.Worm, click Delete.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run Windows Update, and then download and install all critical updates. Note: You may need to run Windows Update more than once. Run this step until no more critical updates are listed.
Note: To make sure that your current is up to date with critical updates, run Windows Update on a regular basis. Also, be sure to regularly use an updated antivirus program, such as Norton AntiVirus.

Resolution #3: If you do not have a current Norton AntiVirus subscription:

Disable System Restore.
Enable the Microsoft Firewall. You should be able to complete this step without losing your current Internet connection.
- Open Control Panel.
  - From the Windows XP default Start menu, click Control Panel.
  - From the Windows XP classic Start menu, point to Settings, and then click Control Panel .
- In Control Panel, open Network Connections.
  - If the computer is in Category View, click Network and Internet Connections, and then click Network Connections.
  - If the computer is in Classic View, double-click the Network Connections icon.
- In the Network Connections window, click to select the local area connection.
- From the File menu, click Properties.
- In the Local Area Connection Properties window, click the Advanced tab.
- On the Advanced tab, click the Protect my computer and network by limiting or preventing access to this computer from the Internet check box, and then click OK.
- Close Control Panel.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Delete the registry value.
- From the Start menu, click Run.
- In the Run dialog box, type: Regedit. Click OK.
- In the Registry Editor window, locate the following key: HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows\CurrentVersion\Run
- Delete the following entries, if present: Windows Auto Update and msblast.exe.
  - Click to select the registry name.
  - From the Edit menu, click Delete.
  - In the Confirm Value Delete dialog box, click Yes.
  - Repeat these steps for each registry name entry.
- If applicable, repeat steps c and d, this time checking for the following key: HKEY_CURRENT_USER\Software\Microsoft\Windows\CurrentVersion\Run. If this key is not found, you can skip this step.
- In the Registry Editor window, from the File menu, click Exit.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
Delete msblast.exe.
- From the Start menu, point to Search, and then click For Files or Folders.
- In the Search Results window, in the What do you want to search for list, click All files and folders.
- In the All or part of the file name area, type: msblast.
- Verify that the Look in field lists Local Hard Drives.
- Click Search.
- When the msblast.exe file is found, click to select it, and then from the File menu, click Delete.
- In the Confirm File Delete dialog box, click Yes.
- In the Search Results window, from the File menu, click Exit.
- Empty the Recycle Bin.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run Windows Update, and then download and install all critical updates. Note: To make sure that your current is up to date with critical updates, run Windows Update on a regular basis. Also, be sure to regularly use an updated antivirus program, such as Norton AntiVirus.

Resolution #4:
This is to be used as a last resort when all other attempts have failed. Turn off the computer, and then disconnect the Internet connection from the computer. Write zeros to the hard drive, Fdisk, format, and then reload the computer. Enable the firewall before reconnecting to the Internet, and then immediately run Windows Update for critical updates and the virus scan updates.
Note: To make sure that your computer is up to date with critical updates, run Windows Update on a regular basis. Also, be sure to regularly use an updated antivirus program, such as Norton AntiVirus.
Note: You may need to run Windows Update more than once. Run this step until no more critical updates appear.
Note: Please read all information in this document before attempting to clean your computer. You may also want to print a copy of this document to have at your disposal when attempting to clean your computer. For best printing results, in your Internet browser, from the File menu, click Print.
There is a lot of information contained in the document on combating what you may see, including how to stop the shut down process so that you can complete the steps. Also, you must install the Microsoft patch to prevent this type of issue from reoccurring.
There are three resolution options available.
Note: Follow Resolution #1 first, and then proceed to either Resolution #2 or #3, depending on your antivirus software.

Note: If the computer attempts to shut down, use the following steps to prevent the forced shut down. This allows you to complete one of the resolutions without the computer restarting.

From the Start menu, click Run.
In the Run dialog box, type: shutdown -a. Click OK.

Resolution #1: Download and install the Symantec W32.Blaster.Worm Removal Tool.
Note: You need to be logged in with Administrative rights to run this tool in Windows 2000 or Windows XP.

Download the FixBlast.exe file from the Symantec Web site.
Save the file to a convenient location, such as the Downloads folder or the Windows Desktop, or to removable media that is known to be uninfected, if possible.
If you would like, check the authenticity of the digital signature. This step is optional.
Close all open windows and programs before running the tool.
If you are using Windows XP, disable System Restore. CAUTION: If you are running Windows XP, it is strongly recommend that you do not skip this step. The removal procedure may be unsuccessful if Windows XP System Restore is not disabled, as Windows prevents outside programs from modifying System Restore.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
  View Picture
Locate and double-click the FixBlast.exe file to start the removal tool.
In the Symantec W32.Blaster.Worm Fix Tool dialog box, click Start to begin the process.
Allow the tool to run. Note: When running the tool, if you see a message that the tool was unable to remove one or more files, run the tool in Safe mode. Shut down the computer, turn off the power, and wait 30 seconds. Restart the computer in Safe mode, and then run the tool again.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Run the FixBlast.exe removal tool again to ensure that the computer is clean of the virus.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run LiveUpdate to make sure that you are using the most current virus definitions.

When the tool has finished running, a message displays indicating whether W32.Blaster.Worm infected the computer. In the case of a worm removal, the program displays the following results:

Total number of the scanned files
Number of deleted files
Number of terminated viral processes
Number of fixed registry entries

Resolution #2: If you have a current subscription to Norton AntiVirus:
Note: Please see the Symantec Web site for additional information.

Disable System Restore.
Run LiveUpdate to update the virus definitions. Note: If you are unable to download the update, follow step number 2 in Resolution #3 below, and then attempt to run LiveUpdate again.
Restart the computer in Safe mode.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
  View Picture
Use Norton AntiVirus to scan for and delete any infected files.
- Run a full system scan.
- If any files are detected as infected with W32.Blaster.Worm, click Delete.
Delete the registry value.
- From the Start menu, click Run.
- In the Run dialog box, type: Regedit. Click OK.
- In the Registry Editor window, locate the following key: HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows\CurrentVersion\Run
- Delete the following entries, if present: Windows Auto Update and msblast.exe.
  - Click to select the registry name.
  - From the Edit menu, click Delete.
  - In the Confirm Value Delete dialog box, click Yes.
  - Repeat these steps for each registry name entry.
- If applicable, repeat steps c and d, this time checking for the following key: HKEY_CURRENT_USER\Software\Microsoft\Windows\CurrentVersion\Run. If this key is not found, you can skip this step.
- In the Registry Editor window, from the File menu, click Exit.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Use Norton AntiVirus again to scan for and remove any infected files.
- Run another full system scan.
- If any additional files are detected as infected with W32.Blaster.Worm, click Delete.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run Windows Update, and then download and install all critical updates. Note: You may need to run Windows Update more than once. Run this step until no more critical updates are listed.
Note: To make sure that your current is up to date with critical updates, run Windows Update on a regular basis. Also, be sure to regularly use an updated antivirus program, such as Norton AntiVirus.

Resolution #3: If you do not have a current Norton AntiVirus subscription:
Note: If you would like to purchase a copy of Norton AntiVirus, please visit the Gateway Accessory Store.

Disable System Restore.
Enable the Microsoft Firewall. You should be able to complete this step without losing your current Internet connection.
- Open Control Panel.
  - From the Windows XP default Start menu, click Control Panel.
  - From the Windows XP classic Start menu, point to Settings, and then click Control Panel .
- In Control Panel, open Network Connections.
  - If the computer is in Category View, click Network and Internet Connections, and then click Network Connections.
  - If the computer is in Classic View, double-click the Network Connections icon.
- In the Network Connections window, click to select the local area connection.
- From the File menu, click Properties.
- In the Local Area Connection Properties window, click the Advanced tab.
- On the Advanced tab, click the Protect my computer and network by limiting or preventing access to this computer from the Internet check box, and then click OK.
- Close Control Panel.
For Windows XP, download and install the "Blaster Worm: Critical Security Patch for Windows XP" patch from the Microsoft Web site to prevent this type of attack. Windows XP shipped with Gateway computers is a 32-bit operating system.
For Windows 2000, download and install the "Blaster Worm: Critical Security Patch for Windows 2000" patch from the Microsoft Web site to prevent this type of attack.
For Windows NT, download and install the "Blaster Worm: Critical Security Patch for Windows NT 4.0" patch from the Microsoft Web site to prevent this type of attack.
Delete the registry value.
- From the Start menu, click Run.
- In the Run dialog box, type: Regedit. Click OK.
- In the Registry Editor window, locate the following key: HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows\CurrentVersion\Run
- Delete the following entries, if present: Windows Auto Update and msblast.exe.
  - Click to select the registry name.
  - From the Edit menu, click Delete.
  - In the Confirm Value Delete dialog box, click Yes.
  - Repeat these steps for each registry name entry.
- If applicable, repeat steps c and d, this time checking for the following key: HKEY_CURRENT_USER\Software\Microsoft\Windows\CurrentVersion\Run. If this key is not found, you can skip this step.
- In the Registry Editor window, from the File menu, click Exit.
End task on msblast.exe.
- On your keyboard, press the CTRL+ALT+DELETE keys.
- In the Windows Security window, click Task Manager.
- In the Windows Task Manager window, click the Processes tab.
- On the Processes tab, click msblast.exe, and then click End Process.
Delete msblast.exe.
- From the Start menu, point to Search, and then click For Files or Folders.
- In the Search Results window, in the What do you want to search for list, click All files and folders.
- In the All or part of the file name area, type: msblast.
- Verify that the Look in field lists Local Hard Drives.
- Click Search.
- When the msblast.exe file is found, click to select it, and then from the File menu, click Delete.
- In the Confirm File Delete dialog box, click Yes.
- In the Search Results window, from the File menu, click Exit.
- Empty the Recycle Bin.
If you are running Windows XP, reenable System Restore if the computer is clean.
Run Windows Update, and then download and install all critical updates. Note: To make sure that your current is up to date with critical updates, run Windows Update on a regular basis. Also, be sure to regularly use an updated antivirus program, such as Norton AntiVirus.

- Januari 24, 2010

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- Januari 24, 2010

1. IRQL_NOT_LESS_OR_EQUAL (0X0000000A)
Ini merupakan biangnya kerok pada BsOD. Karena umumnya pada BsOD, pesan ini yang paling sering muncul. Pesan kesalahan ini disebabkan umumnya kerena ada ketidakcocokan driver yang terinstall di komputer.Daftar Penyebab:
- Masalah driver yang bentrok atau tidak cocok
- Masalah Video Card, hal ini mencakup video card yang di overclock melebihi batas atau Anda baru berganti Video card dan Anda belum menguninstall driver Video card lama dari chipset berbeda
- Masalah Audio Card, meliputi kesalahan konfigurasi atau bug dalam driver sound card

2. NTFS_FILE_SYSTEM atau FAT_FILE_SYSTEM (0X00000024) atau (0X00000023)
Nah, pesan ini setidaknya sudah sedikit “nyambung” memberikan gambaran di mana kerusakan berada, yaitu ada di partisi atau filesystemnya tetapi bukan di harddisknya. Kita bisa melakukan pengecekan dengan memeriksa kabel SATA atau PATA atau bisa mengecek partisi dengan tool chkdsk.

3. UNEXPECTED_KERNEL_MODE_TRAP (0X0000007F)
Bila Anda mendapatkan pesan seperti ini, dapat disebabkan karena:
- Overclock Hardware yang berlebihan
- Komponen komputer yang kepanasan
- BIOS yang korup
- Memory dan CPU yang cacat

4. DATA_BUS_ERROR
Pesan ini disebabkan karena adanya kemungkinan bahwa memory atau slot memory di motherboard rusak.

5. PAGE_FAULT_IN_NONPAGED_AREA
Disebabkan karena adanya kerusakan hardware, termasuk memory utama, memory video card, atau memory di processor (L2 Cache)

6. INACCESSIBLE_BOOT_DEVICE
Disebabkan karena adanya kesalahan dalam konfigurasi jumper harddisk yang salah, virus boot sector, driver IDE controller yang salah, atau kesalahan driver chipset.

7. VIDEO_DRIVER_INIT_FAILURE
Kesalahan terjadi pada instalasi driver video card yang kurang sempurna, restart pada saat instalasi atau juga dapat terjadi karena kesalahan dalam instalasi driver.

8. BAD_POOL_CALLER
Kesalahan ini dapat terjadi karena kesalahan atau driver yang tidak kompatibel. Sering terjadi saat melakukan instalasi XP dari upgrade, atau bukan dari instalasi baru.

9. PEN_LIST_CORRUPT
Pesan ini disebabkan karena adanya kerusakan RAM

10. MACHINE_CHECK_EXCEPTION
Disebabkan oleh cacatnya CPU, atau yang di overclock secara agresif, serta power supply yang kekurangan daya atau rusak.

- Januari 17, 2010

Kenali Gangguan Hati Melalui Warna Urin

Pengobatan Ust. Galih Gumelar - Salah satu organ vital dalam tubuh manusia adalah hati (liver). Dalam organ itu, terjadi proses-proses penting, yaitu proses penyimpanan energi, pembentukan protein dan asam empedu, pengaturan metabolisme kolesterol, dan penetralan racun/obat yang masuk dalam tubuh.

Jika terdapat kerusakan pada hati, otomatis akan mengganggu fungsi tubuh seseorang. Salah satu kerusakan pada hati yang dikenal adalah kolestasis.

Kolestasis terjadi akibat kegagalan hati memproduksi dan pengeluaran empedu. Seseorang yang menderita kolestasis mengalami kesulitan dalam penyerapan lemak dan vitamin A, D, E, K oleh usus. Selain itu kolestasis juga menyebakan adanya penumpukan asam empedu, bilirubin dan kolesterol di hati.

Gangguan aliran empedu bisa terjadi di sepanjang jalur antara sel-sel hati dan usus dua belas jari. Meskipun empedu tidak mengalir, tetapi hati terus mengeluarkan bilirubin, yaitu komponen empedu yang berwarna jingga. Bilirubin kemudian diendapkan di kulit dan dibuang ke air kemih, kejadian it menyebabkan sakit kuning (jaundice).

Untuk tujuan diagnosis dan pengobatan, penyebab kolestasis dibagi menjadi dua kelompok. Pertama, gangguan yang berasal dari hati, seperti hepatitis, penyakit hati alkoholik, akibat obat-obatan dan perubahan hormon selama kehamilan.

Kemudian, gangguan berasal dari luar hati, seperti batu di saluran empedu, penyempitan saluran empedu, kanker saluran empedu, kanker pankreas dan peradangan penkreas.

Gejala gangguan hati dapat dilihat dari bilirubin yang berlebihan di dalam kulit dan air kemih yang menyebabkan warna air kemih lebih gelap. Selain itu, perubahan dapat dilihat dari warna tinja.

Akibat adanya ganguan aliran empedu sehingga bilirubin tidak mengalir ke usus dan menyebabkan tinja tampak pucat. Tinja juga bisa mengandung banyak terlalu banyak lemak, karena di dalam usus tidak terdapat empedu untuk membantu proses pencernaan lemak dalam makanan.

Berkurangnya empedu dalam usus, juga menyebabkan berkurangnya penyerapan kalsium dan vitamin D. Jika kolestasis menetap, kekurangan kalsium dan vitamin D akan menyebabkan pengeroposan tulang sehingga penderita kolestasis merasakan nyeri di tulang hingga bisa menyebabkan patah tulang.

Selain itu, terjadi juga gangguan penyerapan bahan-bahan yang diperlukan untuk pembekuan darah, sehingga penderita cenderung mudah mengalami pendarahan.

Gejala lainnya tergantung dari penyebab kolestasis, bisa berupa sakit perut, hilangnya nafsu makan, muntah atau demam.

Penggobatan paling rasional untuk kolestasis adalah perbaikan aliran empedu ke dalam usus. perbaikan aliran empedu secara medis dapat dengan pemberian pemberian fenobarbital dan kolestiramin, ursodioxy cholic acid (UDCA).

Penyumbatan di luar hati biasanya dapat diobati dengan pembedahan. Sementara itu, jika penyumbatan terjadi di dalam hati bisa diobati dengan berbagai cara, tergantung dari penyebabnya.

Jika penyebabnya adalah obat, maka pemakaian obat dihentikan dan jika penyebabnya adalah hepatitis, Biasanya kolestasis dan sakit kuning akan menghilang sejalan dengan membaiknya penyakit.

- Januari 17, 2010

Kolestasis Pada Bayi

Sjamsul Arief, Boerhan Hidajat, Bagus Setyoboedi

BATASAN

Kolestasis adalah gangguan pembentukan, sekresi dan pengaliran empedu mulai dari hepatosit, saluran empedu intrasel, ekstrasel dan ekstra-hepatal. Hal ini dapat menyebabkan perubahan indikator biokimia, fisiologis, morfologis, dan klinis karena terjadi retensi bahan-bahan larut dalam empedu. Dikatakan kolestasis apabila kadar bilirubin direk melebihi 2.0 mg/dl atau 20% dari bilirubin total.

PATOFISIOLOGI

Kolestasis pada bayi dibagi dalam dua golongan besar yaitu hepato-seluler dan bilier, intra dan ekstra hepatal. Penyebab terbanyak kolestasis pada neonatus adalah kerusakan jaringan hati akibat infeksi virus intra uterin, terutama TORCH. Penyebab lain diantaranya gangguan metabolik, genetik, autoimun, dan gangguan embrional. Secara klinis maupun laboratoris sangat sukar untuk membedakan kolestasis intra dan ekstra hepatal, sehingga diperlukan langkah diagnostik yang kompleks.

GEJALA KLINIS

� Kuning

� Gatal-gatal di kulit

� Urin berwarna gelap

� Tinja pucat seperti dempul

� Pembesaran perut

DIAGNOSIS

A. Anamnesis

Riwayat kehamilan dan kelahiran: infeksi ibu pada saat hamil atau melahirkan, berat lahir, lingkar kepala, pertumbuhan janin (kolestasis intrahepatik umumnya berat lahirnya <>

Riwayat keluarga : riwayat kuning, tumor hati, hepatitis B, hepatitis C, hemokro-matosis, perkawinan antar keluarga. Resiko hepatitis virus B/C (transfusi darah, operasi, dll) paparan terhadap toksin/obat-obat.

B. Pemeriksaan fisik

1. Pertumbuhan (berat badan, lingkar kepala)

2. Kulit : ikterus, spider angiomata, eritema palmaris, edema

3. Abdomen :

a. Liver : pembesaran/ukuran, konsistensi, permukaan.

b. Splenomegali.

c. Vena kolateral, asites.

4. Mata : ikterik

Lain-lain : jari tabuh, asteriksis, foetor hepaticus

C. Pemeriksaan penunjang

1. Gambaran darah tepi

2. Biokimia darah

� Serum bilirubin direk dan indirek

� ALT (SGPT), AST (SGOT)

� Gamma Glutamil Transpeptidase (GGT)

� Masa protrombin

� Albumin, globulin

� Kolesterol, trigliserida

� Gula darah puasa

� Ureum, kreatinin

� Asam empedu

3. Urin : rutin (leukosit urin, bilirubin, urobilinogen, reduksi) dan kultur urin

4. DAT (aspirasi cairan duodenum)

5. Pemeriksaan etiologi : TORCH (toksoplasma, rubella, CMV, herpes simpleks), hepatitis virus B, C, skrining sederhana penyakit metabolik (gula darah, trigliserida).

6. Pencitraan :

� USG dua fase (puasa 4-6 jam dan sesudah minum)

� CT scan, MRI

� Skintigrafi

7. Kolangiografi intraoperatif untuk kasus kolestasis ekstrahepatik

8. Biopsi hati

Gambaran laboratoris kolestasis intrahepatis dan ekstrahepatis secara kasar

	Intrahepatis	Ekstrahepatis
ALT/AST	+++	+
GGT	+	++++
Bilirubin serum	+++	++

DIAGNOSIS BANDING

� Anatomi : atresia bilier, kista koledokal, hipoplasia bilier

� Infeksi : toksoplasma, rubella, sitomegalovirus, simplek herpes, sipilis

� Metabolik : galaktosemi, tirosinemi

� Endokrin : hipotiroit, hipokortisol

� Genetik : sindrom Alagille, PFIC

� Lain-lain : infeksi bakteri

TERAPI

A. Terapi operasi untuk kolestasis ekstrahepatik

B. Terapi medikamentosa untuk kolestasis intrahepatik yang diketahui penyebabnya

C. Terapi suportif

1. Asam ursodeoksikolat 10-20 mg/kg dalam 2-3 dosis

2. Kebutuhan kalori mencapai 130-150% kebutuhan bayi normal dan mengandung lemak rantai sedang (Medium chain trigliseride-MCT), misalnya panenteral, progrestimil

3. Vitamin yang larut dalam lemak

- A : 5000-25.000 IU

- D : calcitriol 0,05-0,2 ug/kg/hari

- E : 25-200 IU/kk/hari

- K₁ : 2,5-5 mg : 2-7 x/ minggu

4. Mineral dan trace element : Ca, P, Mn, Zn, Se,Fe

5. Terapi komplikasi lain: misalnya hiperlipidemia/xantelasma: Obat HMG-coA reductase inhibitor contohnya kolestipol, simvastatin

6. Pruritus :

- Atihistamin : difenhidramin 5-10 mg/kg/hati, hidroksisin 2-5 mg/kg/hati

- Rifampisin : 10 mg/kg/hari

- Kolestiramin : 0,25-0,5g/kg/hari

PEMANTAUAN

A. Terapi

Dilihat progresifitas kondisi klinis seperti ikterus (berkurang, tetap, semakin kuning), besarnya hati, limpa, asites, vena kolateral. Kadar bilirubin direk dan indirek, ALT, AST, GGT, albumin, tes koagulasi dan pencitraan.

B. Tumbuh Kembang

Pertumbuhan pasien dengan kolestasis intrahepatik menunjukkan perlambatan sejak awal. Pada pasien dengan kolestasis ekstrahepatik umumnya bertumbuh dengan baik pada awalnya tetapi kemudian akan mengalami gangguan pertumbuhan sesuai dengan perkembangan penyakit. Pasien dengan kolestasis perlu dipantau pertumbuhannya dengan membuat kurva pertumbuhan berat badan dan tinggi badan bayi/anak.

DAFTAR PUSTAKA

1. Balisteri WF. Cholestasis. In: Berhman RE, Kliegman RM, Jenson HB, eds. Nelson Text Book of Pediatrics, 17^th ed. Philadelphi : WB Saunders, 2004; 1203-7.

2. Emerick KM, Whitington PF. Molecular Basis of Neonatal Cholestasis. Pediatrics Clinics of North America 2002; 49 (1) : 1-3.

3. Haefelin DN, Griffiths P, Rizetto M. Systemic Virosis Producing Hepatitis. In: Bircher J, et al, eds. Oxford textbook of clinical hepatology, 2^nd ed. Oxford: Oxford University Press, 1999; 955-63.

4. Rosenthal P. Neonatal Hepatitis and Congenital Infections. In: Suchy FJ, ed. Liver disease in children, 1^st ed. St. Louis : Mosby year book, 1994; 414-24.

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