International Journal of Human Capital Management (IJHCM)
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Mirizzi Syndrome in Gallstone Complication
No full textMirizzi syndrome is a rare complication of gallstone which is characterized by the presence of gallstone impaction in cystic duct that leads to inflammatory stricture in the biliary duct and results in obstructive jaundice. In this report, we highlighted the diagnostic approach and management of Mirizzi syndrome in a 58 year-old male complaining of nausea, vomiting, and appearing jaundice. The role of imaging such as abdominal ultrasonography in depicting the characteristics of Mirizzi syndrome was also discussed and compared the findings with the classification of the disease in the literature. In this patient, Mirizzi syndrome was suspected by the appearance acoustic shadow in the gallbladder with dilated cystic duct suggesting the impaction of common bile duct (CBD). We performed endoscopic retrograde cholangiopancreatography (ERCP) as both diagnostic and therapeutic modalities by which we allowed sphingterectomy to evacuate the gallstone. However, due to the risk of further stone evacuation, the procedure was followed by elective cholecystectomy. Keywords: gallstone, Mirizzi syndrome, complicatio
Approach for Diagnostic and Treatment of Achalasia
No full textAchalasia is a rare motor disorder of the esophagus and lower esophageal sphincter. The incidence is approximately 1/100,000 per year and the prevalence rate is 10/100,000. Achalasia is quite difficult to establishbecause the symptoms might be insidious and therefore not many people come to seek medical attention until it deteriorates to final stage of the disease. There are several modalities that can be used as diagnostic toolssuch as manometry, barium esophagogram, esophagoduodenoscopy, esophageal CT-scan, until the recent one, high-resolution manometry that can classify achalasia into three different types. The treatment options are the pharmacologic intervention, endoscopic treatment, minimal invasive surgery, and radical surgery.We reported a case of 20 year old female with achalasia who came with dysphagia symptom since three years before. The diagnosis was made by historytaking, physical examination and barium meal and esophagogastroduodenoscopy. The patient underwent pneumatic dilatation and since then the symptom was relieved.Keywords: achalasia, diagnostic, treatmen
Effect of Omeprazole to Dyspeptic Symptom on Ramadan Fasting Patient based on Dyspepsia Symptoms Severity Index Scores
No full textBackground: Dyspepsia is a symptoms collection of discomfort at the upper abdomen. Ramadan Fasting is a worship that must be run by all Moslems that do not eat and drink for ± 12 hours. Proton pump inhibitors are drugs commonly given to patients with dyspepsia with mechanism controlling gastric acid secretion. The aim of this study is to find the effect of omeprazole to the patient with dyspepsia and undergo Ramadan fasting.Method: Using analytic study design, conducted in outpatient in Koja Hospital Jakarta from June - July 2013, for patients with dyspepsia who will undergo Ramadan fasting. Subjects are divided into 2 groups; one group was given omeprazole while others were given a placebo. Before and after 2 weeks of fasting, dyspepsia symptoms severity index scores (DSSI) was taken which assessed changes in both groups and compared using student T-test.Results: DSSI scores on average before the intervention of both groups (n = 30) was not significant (p = 0.9). In the placebo group obtained increasing of DSSI score from 27.7 ± 14 to 36 ± 14.8 (p = 0.001), whereas in the omeprazole group obtained increasing of score only from 27.2 ± 9.4 to 30 ± 9.9 (p = 0.08). In the placebo group score worsened by 8.3 ± 7.2 but in the omeprazole group with only 2.7 ± 5.7 (p = 0.02).Conclusion: There was a significant decrease of DSSI scores in fasting patient with omeprazole. Therapy with omeprazole 20 mg twice daily during the month of fasting can reduce the abdominal complain in patient with dyspepsia.Keywords: dyspepsia, DSSI, fasting, Ramada
Update 2013: the Role of Probiotic in Non-alcoholic Fatty Liver Disease, an Evidence Based Approach
No full textDuring the last two decades, non-alcoholic fatty liver disease (NAFLD) has been a topic in many discussions. The major risk factors for NAFLD is metabolic syndrome, which include obesity, insulin resistance andhypertension. Beside insulin resistance, oxidative stress has been linked with the disease. There is accumulating evidence that intestinal bacterial overgrowth plays an important role in NAFLD pathogenesis. Intestinal bacteria influence the progression of NAFLD through endogenous ethanol production and cytokine that would eventually induce hepatic oxidative stress. Probiotic intervene pathogenic intestinal flora so it is a potential treatment for NAFLD. Many animal studies documented the beneficial effect of probiotic in NAFLD. Probiotic reduce hepatic inflammation, reduce hepatic steatosis and improve insulin resistance. There is still limited human studies upon this topic. However, preliminary result showed potential role of probiotic in NAFLD treatment. Probiotic is safe, cheap and widely available therefore it is a promising new approach for NAFLD therapy. Upcoming study would hopefully provide firm foundation regarding the use of probiotic for NAFLD on human.Keywords: NAFLD, probiotic, metabolic syndrom
Proton Pump Inhibitors Therapy in Children with Gastroesophageal Reflux
No full textProton pump inhibitors (PPI) has been widely used by clinicians to treat diseases that require suppression of gastric acid. PPI work by inhibiting the proton pump in gastric parietal cells.In adult patients, PPI hasbeen widely studied and showed effective results and safe. This result make PPI positioning as the first choice medicine in the treatment of diseases that require suppression of gastric acid. As the primary choice therapy, PPI administration has been increased not only in adults but also in children.PPI is often administered to children with a diagnosis of gastroesophageal reflux disease (GERD) which defined as symptoms or complications caused by gastroesophageal reflux (GER). GERD diagnosis in children is quite difficult, so it is common to find that diagnosis is established only by the basis of clinical symptoms, resulting in overdiagnosis and over-treatment of GERD. The use of PPI in children still needs further study andcan not be inferred based on adult studies. Inappropropriate PPI prescription without indication will increase side effect, risk and also harm the children. Thus, it is important to know the indications, side effects and safety of PPI therapy in children.Keywords: proton pump inhibitor, children, gastroesophageal reflux diseas
Common Bile Duct Stricture Post Open Cholecystectomy
No full textCommon bile duct stricture is a common complication following open cholecystectomy. Approximately 80% of benign strictures occur following injury during a cholecystectomy. We report a female aged 70 years old, with a history of open cholecystectomy due to gallbladder stones. She was admitted to Cipto Mangunkusumo Hospital with symptoms and signs of obstructive jaundice. Endoscopy retrograde cholangio-pancreaticography (ERCP) examination revealed proximal common bile duct (CBD) stricture. She underwent open laparotomy, during which, a narrowing of proximal CBD was seen due to a fibrosis involving part of the duodenum. The patient then underwent a hepatic-duodenostomy bypass surgery. The symptoms and signs of obstructive jaundice were relieved after surgery.Keywords: CBD stricture, obstructive jaundice, open cholecystectomy, ERCP, hepatoduodenostomy bypass surger
Colonoscopic Findings in Patients with Chronic Diarrhea at Mohammad Hoesin Hospital Palembang
No full textBackground: Chronic diarrhea is a common problem encountered by clinicians. Colonoscopy is a tool with high accuracy and sensitivity to depict abnormalities and has the advantage in distinguishing the abnormalities that cause chronic diarrhea. Nevertheless, the colonoscopic findings in patients with chronic diarrhea vary by age. The objective of this study is to observe abnormalities found in lower gastrointestinal tract in patients withchronic diarrhea who underwent colonoscopy and its relationship with age.Method: An observational analytic study, data retrieved from medical record of outpatient and inpatient with chronic diarrhea at Mohammad Hoesin Hospital Palembang from January 2011 until December 2012. Chronic diarrhea diagnosis was based on clinical findings, laboratory result, and colonoscopy procedure. Patients were then divided into groups based on age ( 40). Data were analyzed with SPSS 12.0.Results: There were 92 patients consisted of 56 (60.9%) male and 36 (39.1%) female. Mean age was 47.67 ± 16.83 with age interval 15-85 years. Group I of 35 (38%) patients, whereas group II of 57 (62%) patients. The colonoscopic findings were ulcerative colitis 33 (35.9%), normal 27 (29.3%), colon tumor 20 (21.7%), colitis tuberculosis 5 (5.4%), Crohn’s disease 3 (3.3%) and polyp 4 (4.3%). Based on age, the incidence of ulcerative colitis was most frequently encountered in both groups, whereas normal colon and colon tumors were encountered most in group II. No correlation was found between age and colon abnormality (p = 0.87).Conclusion: The most common finding was ulcerative colitis followed by normal colon and colon tumor. There was no correlation between age and colon abnormalities.Keywords: chronic diarrhea, colonoscopy, ag
How to Negotiate Difficult Colonoscopy to Optimize Cecal Intubation Rate
No full textColonoscopy is the current standard method for evaluating colon. Cecal intubation rate is an important indicator of colonoscopy quality. In up to 10–20% colonoscopies, cecal intubation may be considered difficult.There are several consequences of low cecal intubation rate: it limits the efficacy of colonoscopy, increasing risk of complications and cost, and missing in detecting adenoma colorectal or other abnormal mucosa lesion.Failure to intubate the cecal can be a result of: (1) patients factors (female, older, diverticular disease, history of abdominal surgery, low body mass index, history of constipation, laxative use); (2) endoscopist factors (prior experience, the specific techniques and instrument used; (3) or some combination thereof. In an effort to solve these problems endoscopist should increase their technical manoeuvres (minimizing inflation and looping, using water–aided method, appropriate use of positional changes and abdominal pressure) and use various accessories methods (inserting a biopsy forceps through the biopsy channel, pediatric colonoscopy, variable stiffness colonoscopy).Keywords: cecal intubation rate, difficult colonoscopy, colonoscopy quality, water–aided colonoscop
Current Diagnosis and Management of Helicobacter pylori
No full textHelicobacter pylori (H. pylori) is a microbe which cause chronic infection in human. Currently, the prevalence in developed countries continue to decrease, but the same does not happen in developing countries. Orofecal transmission and its connection with environmental condition is assumed to be its cause.Impact of H. pylori infection in gastric mucosa is influenced by the bacteria pathogenesis which is able to survive in acid condition and causes inflammatory reaction. The diagnosis is differentiated through endoscopy or non-endoscopy depends on the alarm symptoms, local prevalence, pre-test probability, availability, cost and aim of examination.Management of H. pylori depends on the high rate of clarithromycin resistence. In area with resistency prevalence below 20% triple therapy can still be used, while in increasing resistency area, use of four times daily therapy or other antibiotics such as levofloxacin and furazolidone can be considered.Keywords: Helicobacter pylori, diagnosis, alternative therap
Ultrasound-Diagnosed Non-Alcoholic Fatty Liver Disease among Medical Check Up Patients
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is recognised as one of the most important causes of chronic liver disease and has become an important health issue in many countries. The aim of the study wasto evaluate the prevalence and risk factors of NAFLD patients based on ultrasound diagnosed in medical check up setting.Method: In this study, of 2,105 patients undergoing medical check up in Charitas Hospital, Palembang between January 2011 to August 2013, 115 NAFLD patients and 113 non-NAFLD patients as controls were included. Diagnosis of NAFLD was based on ultrasound appearance, patients did not consume alcohol, with negative HBsAg and hepatitis C virus antibodies.Results: The prevalence of NAFLD in medical check up patients was 7.9% whereas 39% patients had normal body mass index (BMI) (< 25 kg/m2). Patients with NAFLD compared with non-NAFLD patients had higher values of BMI (p < 0.001), triglycerides (p = 0.001), aspartate aminostransferase (AST) (p < 0.001), alanine aminotransferase (ALT) (p < 0.001), fasting glucose (p = 0.002), and lower HDL cholesterol (p = 0.001). Obesity was the strongest associated factor for NAFLD (95% CI = 1.87-7.85; OR = 3.83; p < 0.001), followed by high glucose levels (95% CI = 1.38 - 8.31; OR = 3.83; p = 0.008) and hypertriglyceridemia (95% CI = 1.38 - 4.11;OR = 2.38; p = 0.002).Conclusion: About 7.9% patients suffered from NAFLD. Approximately 39% medical check up patients had NAFLD with normal BMI. Obesity, hypertriglyceridemia and high glucose levels were the risk factors for NAFLD.Keywords: non-alcoholic liver disease, body mass index, prevalence, metabolic syndrom