International Journal of Human Capital Management (IJHCM)
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Left-Sided Portal Hypertension: A Case Series
Full text linkLeft-sided portal hypertension is rarely found, but this condition may cause gastrointestinal tract bleeding and can be life-threatening. The exact incidence of left-sided portal hypertension is unknown as it is rarely found, approximately 1-5%, and most cases were misdiagnosed. We reported 3 cases of left-sided portal hypertension in male patient aged 34 years old, female patient aged 29 years old, and female patient aged 35 years old. Most diagnosis was made based on the clinical findings by excluding the diagnosis of cirrhotic portal hypertension. Splenic vein angiography remains the gold standard in diagnosing left sided portal hypertension. Left-sided portal hypertension is difficult to differentiate from cirrhotic portal hypertension because in these both abnormalities, varices can be present. Left-sided portal hypertension can be considered as a diagnosis in patient with upper gastrointestinal tract bleeding due to oesophageal varices, gastric varices, or portal hypertension gastropathy, accompanied with hypersplenism without the presence of hepatic abnormality or cirrhosis
Unusual Case of Massive Obscure Gastrointestinal Bleeding: Ectopic Varices in Jejunum Caused by Arteriovenous Malformation
Full text linkSmall bowel ectopic varices is a rare etiology for obscure gastrointestinal bleeding. Ectopic varices in the absence of portal hypertension can be caused by congenital or familial conditions (e.g. malformation of vessel). Bleeding caused by ectopic varices can be massive and life threatening. Single Balloon Enteroscopy (SBE) is one of diagnostic modalities for obscure gastrointestinal bleeding. We report one case of obscure overt gastrointestinal bleeding with sub-acute onset. Previous esophagogastroduodenoscopy and colonoscopy cannot found the source of bleeding. On the enteroscopy we found varices at proximal jejunum with active bleeding during procedure. We applied hemostatic powder to stop the bleeding and proceed to surgery. Surgery was performed by enteroscopy guide. The jejunum section with varices was resected and the pathology confirmed the malformation of arteriovenous. Currently there is no available guideline or randomized study for the treatment of ectopic varices. Treatment options include ligation, sclerotherapy, surgery and interventional radiology. In this patient we choose surgery because of massive gastrointestinal bleeding
Red Cell Distribution Width to Platelet Ratio is not Inferior than Aspartate Aminotransferase to Platelet Ratio Index Score in Predicting Liver Fibrosis in Chronic Hepatitis B Patients at Sanglah General Hospital Denpasar
Full text linkBackground: Red cell distribution width to platelet ratio (RPR) is known to be associated with a degree of liver fibrosis in patients with hepatitis B. This study aims to compare the under curve area, sensitivity, specificity, positive predictive value, and negative predictive value between RPR and aspartate aminotransferase to platelet ratio index (APRI) score with degree of fibrosis.Method: This study is a retrospective study, data taken from medical records of all chronic hepatitis B patients examined by Fibroscan at Sanglah General Hospital Denpasar, Bali from January 2016 to February 2018.Results: Ninety eight patients with chronic hepatitis B, 81 patients were recovered after exclusion of patients with chronic kidney disease, malignancy, and dengue haemorrhagic fever (DHF). In receiver operating characteristic (ROC) analysis, obtained area under the ROC curve (AUC) at RPR of 0.816, and at APRI score 0.797. In RPR with cut off 0.066 the sensitivity was 76.9%, specificity 78.6%, PPV 79.5%, NPV 73.8%. While APRI score with cut off 0.85 got 69.2% sensitivity, specificity 76.2%, PPV 73.0%, and NPV 72.7%. According to Kappa test, we found kappa coefficient 0.653 (p < 0.05).Conclusion: In predicting severe liver fibrosis in chronic hepatitis B patients, RPR is not inferior than APRI score, and may be used as a diagnostic marker, with 65.3% conformity
The Comparison of Tnf α (Tumor Necrosis Factor α) Serum Levels Between Cytotoxin - Associated Gene A (Caga) Positive and Negative in Patients with Gastritis Helicobacter pylori
No full textBackground: Helicobacter pylori (H. pylori) infection is the common cause of chronic gastritis in the world that is around 80% in addition to other causes such as autoimmune diseases, drugs, idiopathic and others. The pathogenesis of H. pylori associated with virulence factors consisting of cytotoxin - associated gene A (CagA) and vacuolating cytotoxin A (Vaca). In the case of gastritis occurred acute and chronic inflammatory responses and activation cytokines that cause inflammation of mucous which TNF-α levels increased in patients gatritis H. pylori. Levels of serum TNF-α was found higher in patients infected with H. pylori with CagA positive. The purpose of this study is to investigate the comparison between TNF-α serum level in H. pylori gastritis patients with Cag A (+) and CagA (-).Method: The study was conducted with a cross-sectional design in 30 patients with dyspepsia, using PADYQ score. We performed gastroscopy, biopsy, and CLO test to prove the existence of H. pylori. Furthermore, we used PCR to assess CagA (+) and CagA (-), and ELISA method to measure TNF-α serum level.Results: From 30 subjects, 18 men (60%), 12 women (40%), and the mean age was 53.5 years, the majority of the ethnic was Bataknese (53.3%), patients with H. pylori gastritis with CagA (+) were 21 (70%) and patients with H. pylori gastritis with CagA (-) were 9 (30%). We found the mean serum levels of TNF-α was higher (3.48) in H. pylori gastritis with CagA (+) than the CagA (-) (1.29) with p value was 0.001.Conclusion: We found increased serum levels of TNF-α in patients with CagA (+) compared to Cag A (-) H. pylori gastritis
Nutritional Support in Critically Ill Patients
Full text linkCritically ill patient is at risk of malnutrition. The aim of nutritional support is to prevent malnutrition and its complication, and also fulfill macro- and micronutrient, reduce nitrogen deficit, and improve inflammaroty response. In critica patient with stable hemodynamic, enteral nutrition should be started early at 24-48 hours while patient not in ebb/resuscitation phase. Parenteral nutrition is not recommended in the first 24 hours of ICU care if enteral feeding is feasible. Parenteral nutrition is considered after 5-7 days, except poor enteral condition. Delay of parenteral nutrition for 7 days reduce risk of infection, increase recovery time, and reduce cost. On the first day, calorie should reach one third of actual need, increased to half to two third on second day, and full calorie on the third day. Total calorie need is 25-35 kcal/ideal bodyweight. Source of calorie is 60-70% carbohydrate and 30-40% lipid. Daily fluid need is 30-40 mL/kgBW/day or 1.0 – 1.5 mL/kcal calorie intake. Several important micronutrients to fulfill is sodium, potassium, calcium, phosphate, and magnesium. Three main consideration of nutritional support is route, type of formula, and when to start nutritional support
Alcoholic Liver Cirrhosis in Young Female: Diagnostic and Therapeutic Challenge
Full text linkAlcoholic liver cirrhosis is a disease due to excessive alcohol consumption that manifest as fatty liver, alcoholic hepatitis, and chronic hepatitis with fibrosis or liver cirrhosis. Alcohol consumption as much as 60-80 g per day for 20 years or more in male, or 20 g/day (approximately 25 mL/day) in female significantly increases the risk of hepatitis and fibrosis as much as 7-47%. The aim of this case report was to explore the diagnostic and therapeutic challenge of alcoholic liver disease in young aged female. A female, 24 years old, came with complaints of bloody vomiting, blacktarry stool, abdominal distention and history of alcohol consumption (canned beer 5%, equal to 56-70 g/day) for 9 years. Physical examination revealed anaemic conjunctiva (Hb 2.9 g/dL), ascites, hepatosplenomegaly, and bilateral legs oedema. Laboratory examinations showed thrombocytopenia (125000/uL) and hypalbuminaemia (2.65 gr/dL). AST and ALP were increased with the value of 175 U/L and 456 U/L, respectively. Albumin-globulin ratio was 0.93 g/dL with serum ascites albumin-gradient was 2.20 g/dL (ascites fluid albumin level was 0.45 gr/dL and serum albumin level was 2.65 gr/dL). Abdominal USG revealed hepatomegaly with coarse heterogenic ecoparenchyma, portal vein dilatation, and splenomegaly. Diagnosis of alcoholic liver cirrhosis was made based on clinical, laboratory, and radiologic findings, while biopsy result did not confirm the pathology. Patients condition improved with education of stop alcohol consumption and was given supportive therapy
Signet-Ring Cell Carcinoma of the Ampulla of Vater
Full text linkSignet-ring cell carcinoma (SRCC) of the ampulla of Vater is a very rare case and only 28 cases have beed reported in the English literature. Herein, we report a 59-year-old woman with SRCC of the ampulla of Vater. She developed symptoms of obstructive jaundice at early stage of disease and underwent pylorus-preserving Whipple procedure as definitive treatment. Histopathology examination showed numerous tumor cells with intracytoplasmic mucin and eccentric nuclei. Her tumor has already invaded the serosa of duodenum, but no infiltration to the stomach, pancreas, and lymphovascular structure. Her surgical margins and regional lymph nodes were free of tumor. She was diagnosed with T2N0M0 SRCC of the ampulla of Vater. No adjuvant treatment was given and she has been doing well for five months after surgery
The Comparision of Serum Malondialdehyde Level Between H. pylori Positive and H. pylori Negative Gastritis Patients
Full text linkBackground: Helicobacter pylori is the most common cause of chronic gastritis in the world, meanwhile gastritis caused by NSAIDs is the most encountered type of gastritis. Increased free radicals caused by Helicobacter pylori can cause damage in gastric mucous. Tissue damage due to free radicals can be examined by measuring malondialdehyde compound. There are many studies that proves the increased malondialdehyde in gastritis, but those studies commonly done in animal experimentation and malondialdehyde examination in gastric mucous.Method: This is a cross-sectional study of 40 dyspepsia patients who came to endoscopic unit of Adam Malik General Hospital Medan and networking hospitals by using Rome III criteria. Further examination with gastroscopy and biopsy was done to determine gastritis. H. pylori examination was done by using Campylobacter-like organism test (CLO) test. Serum malondiasldehyde level was examined with high performance liquid chromatography (HPLC) method.Results: From total of 40 patients,24 (60%) were men and 16 (40%) were women with an average age of 47 years, the majority of the ethnic was Bataknese (57.5%). From 20 patients with H.pylori (+), the average level of malondialdehyde was 1.58 umol/mL while in 20 other patients with H.pylori (-), malondialdehyde level was 1.19 umol/mL with p value 0.013.We found the mean serum levels of malondialdehyde was higher in H. pylori positive gastritis than H. pylori negative.Conclusion: Serum Malondialdehyde level was significantly higher in patient with positive H.pylori gastritis compared to H. pylori negative gastritis.
Eosinophilic Colitis Presenting with Chronic Diarrhea
Full text linkEosinophilic colitis (EC) is a rare disease which characterized by infiltration of eosinophil in colon and peripheral eosinophilia. Other causes of peripheral eosinophilia need to be excluded before assumed EC such as food allergy, inflammatory bowel disease, or parasites. It has bimodal distribution, peaked at neonates and young adult.A 24-year-old man was admitted with abdominal pain and chronic diarrhea. He has no any disease, food, pollen, or drug allergy in his medical history. Leukocyte: 29,000/mm3 (neutrophil: 43.4%, eosinophil: 44.4%, lymphocyte: 8.2%), platelet: 453,000/mm3, total eosinophil: 17,582.1/µL (normal range: 50-300), immunoglobulin E: 1000 IU/mL (normal range < 100 IU/mL) was counted in his blood examination. The colon biopsy was reported as eosinophilic colitis. We applied methylprednisolone 24 mg/day. With this treatment, the patient’s symptoms regressed.EC may involve any part of the gastrointestinal tract. An intense inflammatory infiltrate, consisting predominantly of eosinophils penetrates into one or more layers of the gastrointestinal tract. In 1937, Kaijser described this disorder. EC is classified into mucosal, submucosal or muscular, and serosal types. The endoscopic findings may vary from normal mucosa to frank ulceration. Our patient had chronic diarrhea and peripheral eosinophilia which are typical features of the mucosal types. It should be put in differential diagnosis in patients with chronic diarrhea