International Journal of Human Capital Management (IJHCM)
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Dyspepsia and Depression, Anxiety, Stress Scales (DASS) Score
Get PDFBackground: Dyspepsia is a constellation of symptoms referable to the gastroduodenal region of the upper gastrointestinal tract. Emotional disturbances are often associated with dyspepsia and have been proposed as one of the possible causes of dyspepsia. This study was aimed to evaluate the difference between the severity of dyspepsia using porto alegre dyspeptic symptoms questionnaire (PADYQ) and emotional disturbances using depression, anxiety, stress scales (DASS).Method: This study was a cross-sectional analytical study. All the subjects were evaluated using PADYQ and DASS. PADYQ is classified into four categories (no, mild, moderate and severe dyspepsia symptoms). Data was analyzed using Independent t-test and Mann-Whitney test. A p < 0.05 was considered as statistically significant.Results: There were 90 subjects that enrolled in this study, consisted of 47 (52.2%) males and 43 (47.8%) females. Thirty three (36.7%) subjects had PADYQ score was < 6, while it was ≥ 6 in the other 57 (63.3%) subjects. DASS scores were significantly different in subjects without dyspepsia symptoms compared to subjects with dyspepsia symptoms. There is a difference in DASS scores between subjects with different categories of dyspepsia symptoms (p < 0.05). Conclusion: There was a difference in the severity of emotional disturbances among subjects with dyspepsia symptoms and without dyspepsia symptoms. The severity of emotional disturbances parallel with the severity of dyspepsia. Evaluation of emotional disturbances in case of dyspepsia will be helpful in the management of dyspepsia
Surgery in Liver Diseases: Perioperative Evaluation & Management
Get PDFMany patients with liver disease would have to undergo surgery. Surgery and anesthesia in patients with liver disease are associated with extremely high perioperative complications and mortality. Identification of the type of liver disease, stratification of risk factors, and management of preoperative, intraoperative, and postoperative complications are essential to reduce the morbidity and mortality. Surgical risk is increased in patients with liver cirrhosis. Child turchote pugh (CTP) and the model for end stage liver disease (MELD) are two scoring systems which are often used nowadays to stratify risk factors in patients with liver cirrhosis who will undergo surgery. Elective surgery is well tolerated in cirrhosis patients with CTP class A and permissible in patient with CTP class B with preoperative preparation, except for extensive liver resection surgery and cardiac surgery. Elective surgery is contraindicated in patients with CTP class C, acute viral hepatitis, alcoholic hepatitis, fulminant liver failure, and liver disease with severe extrahepatic complication such as hypoxemia, cardiomyopathy, and acute renal failure. Intensive monitoring in the postoperative period and early intervention of complications are also essential to reduce the morbidity and mortality
Recurrent Acute Pancreatitis as A Manifestation of Sphincter of Oddi Dysfunction
Get PDFRecurrent acute pancreatitis (RAP) is defined as two or more occurance of acute pancreatitis with no evidence of underlying chronic pancreatitis. Prevalence of RAP varied from 10-30%. One of the postulated mechanism of this condition is sphincter of Oddi dysfunction (SOD) which is a clinical biliary pain syndrome or acute pancreatitis (AP) due to pancreatobiliary obstruction at the level of sphincter of Oddi. We reported a 29-year-old female patient who came to Cipto Mangunkusomo Hospital regarding upper quadrant abdominal pain with previously well documented history of AP in the last six months before admission. Laboratory findings showed elevated pancreatic enzyme level which was consistent with AP. The patient underwent magnetic resonance cholangio-pancreatography (MRCP) and endoscopic ultrasound (EUS) examination and both of the results showed dilatation of pancreatic duct which suggested SOD. Due to the lack of further diagnostic modality, manometry was not performed on this patient. However, after excluding other possible etiology of SOD, the patient underwent endoscopic retrograde cholangio-pamcreatograhy (ERCP) and sphincterotomy was performed. The signs and symptoms of AP was relieved after sphincterotomy and not yet recurred
Comparison of Endoscopic Findings with Gastroesophageal Reflux Disease Questionnaires (GerdQ) and Reflux Disease Questionnaire (RDQ) for Gastroesophageal Reflux Disease in Medan
No full textBackground: There are many questionnaires that have been developed to diagnose gastroesophageal reflux disease (GERD), i.e. reflux disease questionnaire (RDQ), and the recently developed, gastroesophageal reflux disease questionnaires (GerdQ). In this study, we tried to compare GerdQ and RDQ in terms of sensitivity and specificity to diagnose GERD and its relationship with endoscopic findings.Method: This study was a cross sectional analytical study. Subsequently, all the subjects were evaluated using the GerdQ and RDQ, then underwent esophagogastroduodenoscopy examination. The severity of endoscopically observed reflux esophagitis was graded with the Los Angeles classification. All endoscopy was performed by well-trained doctor.Results: A total of 85 patients were examined, 34 (40%) patients had reflux esophagitis at endoscopy examination, including 15 (44.1%) cases of grade A, 11 (32.3%) cases of grade B, 4 (11.8%) cases of grade C, and 4 (11.8%) cases of grade D. Analysis study using sensitivity, specificity, and receiver operating characteristic (ROC) test showed that GerdQ had sensitivity (49%), specificity (91%), and an area under the ROC of 0.701 (p value = 0.002). RDQ had sensitivity (24%), specificity (91%), and an area under the ROC of 0.574 (p value = 0.253). Taking 11 as the cut off point for GerdQ, a maximal sensitivity of 73.5%, specificity of 82.4%, and an area under the ROC of 0.779 was achieved.Conclusion: GerdQ and RDQ can be used to help diagnose GERD, but GerdQ is more superior than RDQ in diagnosing GERD. A multi-center study with larger samples is needed to determine the best GerdQ’s cut off point in Indonesia
Coffee Consumption to Reduce Liver Fibrosis
No full textAs one of the most popular drink consumed daily, coffee is known to be good for health. One of the main substance found in coffee is caffeine. Several previous studies explained that caffeine found in coffee could act as hepatoprotective agents, and recently an antifibrotic agent. Since liver fibrosis is a fatal condition that could lead to liver cirrhosis and hepatocellular carcinoma, a lot of study were trying to find any alternatives to reduce fibrosis, one of them is coffee. Several studies have reported that coffee was significantly, able to reduce fibrosis process because of its caffeine which is found in coffee. Recently, some studies also reported that a non-caffeinated coffee also showed an antifibrotic effect. It is believed that several substances beside caffeine found in coffee were also played an important role in reduce liver fibrosis. By its cellular mechanism, coffee would be a new alternatives way to reduce liver fibrosis, and of course other chronic liver disease
Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer
No full textDespite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology
CD38+ Liver Stellate Cells in Chronic Hepatitis C Patients with Fibrosis
Get PDFBackground: Approximately 3% of the world population is infected with hepatitis C virus (HCV). Protein of hepatitis C virus modulates apoptosis and steatosis, liver cell injury, activates liver stellate cells and liver fibrosis. Hepatitis C virus infection will cause injury to the hepatocytes. This injury to the hepatocyte will activate liver stellate cells. Stellate cells have a huge role in the development of liver fibrosis. The objective of this study is to evaluate the difference of active CD38+ liver stellate cells in various degree of fibrosis as well as its relation with aspartate transaminase (AST), alanine transaminase (ALT), and quantitative amount of hepatitis c virus ribonucleic acid (HCV RNA) in chronic hepatitis C.Method: This study was a cross-sectional study performed in 32 patients with chronic hepatitis C who had undergone liver USG, did not suffer from hepatoma, had undergone liver biopsy. Paraffin block of patients’ liver tissue was further stained using Haematoxylin and Eosin technique to identify the Metavir degree which is categorized into mild-moderate or severe degree. Special staining is performed to evaluate liver stellate cells that were then counted in averagely in five fields of view.Results: In this study, we found significant difference in the amount of CD38+ stellate liver cells between severe and mild-moderate fibrosis (p < 0.001), there was no association between CD38+ stellate liver cells with AST (p = 0.2) or ALT (p = 0.7), and there was association between CD38+ stellate liver cells with quantitative HCV RNA (r = -0.372).Conclusion: Total amount of CD38+ stellate liver cells in severe fibrosis was higher compared to the total amount of CD38+ liver stellate cells in mild-moderate fibrosis. There was no association between the value of AST, ALT, and quantitative HCV RNA with the number of CD38+ stellate liver cells
Correlation Between Serum Thrombopoietin Level and Cirrhosis Clinical Stage in Liver Cirrhosis Patients in Mohammad Hoesin Palembang Hospital and Palembang BARI Hospital
No full textBackground: Thrombopoietin (TPO) is a cytokine mainly produced in the liver that regulate humoral control mechanism of thrombopoesis. Presumably, TPO production is decrease in patients with liver cirrhosis which interfere platelet production. The aim of this study was to identify the correlation between serum TPO levels and the clinical stage of liver cirrhosis.Method: With analytical cross sectional design, this sudy analyzed the correlation between the serum TPO level and the clinical stage of liver cirrhosis according to Child-Pugh classification in 32 liver cirrhosis patients and 30 healthy subjects from March 2015 to August 2015. The serum level of TPO was examined using the Quantikine human TPO immunoassay.Results: There were 13 females and 19 males patients aged 19 to 67 years old. Serum TPO level were lower in patients with liver cirrhosis (65.65 ± 28.97 pg/mL) than in healthy subjects (98.16 ± 41.25 pg/mL, p < 0.005). Serum TPO levels were negatively correlated with clinical stage of liver cirrhosis in a moderate strength of correlation (r = -0.516, p = 0.002). There were no correlation between serum TPO level and platelet count (r = 0.186; p = 0.309), but a significant negative correlation between the clinical stage of liver cirrhosis and platelet counts (r = - 0.361; p = 0.042).Conclusion: There was a significant negative correlation between serum TPO levels and the clinical stage of liver cirrhosis according to Child-Pugh classification
Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly
Get PDFLemmel’s syndrome, also known as duodenal diverticulum obstructive jaundice, is a rare cause of benign obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when PAD is present, in the absence of cholelithiasis or other detectable obstacle. Diagnosing Lemmel’s syndrome could be challenging, but being aware of this condition is important to avoid mismanagement and it begins with identification of PAD, while interpreting any bile duct imaging. It can be misinterpreted as periampullary tumors, biliary stones, or pancreatic pseudocyst. Symptomatic patients can be successfully managed endoscopically in many cases but surgical management would be necessary in selected cases.We present a patient with benign obstructive jaundice caused by Lemmel’s syndrome who was successfully treated with endoscopic sphicterectomy. A 67 years old female presented to the emergency department with chief complaint of jaundice. The patient was assesed to have obstructive jaundice cause by a duodenal mass, elevation of transaminase enzime supected caused by drug induced liver injury, hypertension (controlled), and anterior extensive coronary ischemia. Endoscopic retrograde cholangiopancreatografi (ERCP) showing mutiple giant diverticle in second part of duodenum, stenosis of the distal CBD with compression of diverticular extra luminal as a differential diagnosis. Endoscopic ultrasound (EUS) was performed to exlude a periampullary tumor, resulting distal CBD stenosis due to compression of multiple periampullary diverticula (PAD). We performed an endoscopic sphinterectomy (EST) and the stent was removed. A further evaluation of the tuberculous lymphadenitis was planned as outpatient setting. One month follow-up, no recurence of jaundice was observed