International Journal of Human Capital Management (IJHCM)
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Peutz Jeghers Syndrome
No full textPeutz-Jeghers Syndrome (PJS) is a rare condition that tends to run in families. Diagnosis of PJS is made if a person has polyps in the gastrointestinal (GI) tract and at least two of the following: polyps in the small bowel, melanin spots, and/or a family history of PJS. The typical clinical manifestation of the disease is associated with complications secondary to intestinal polyps often requiring surgical treatment. A young woman, 29 years old with PJS had been hospitalized in Cipto Mangunkusumo hospital. She was suffering from GI complication secondary to her polyps such as abdominal pain, nausea, vomited every time she takes her meal and milk, anorexia, fatigue, weakness, chronic diarrhea with hematoschezia. Upper and lower endoscopy showed the multiple polyps along from esophagus, gaster, duodenum, and her colon. Histopathology examination confirmed the type of polyps is Peutz Jeghers with the unique morphology consisting of mucosa with interdigitating smooth muscle bundles that yield a characteristic branching tree appearance. We also found the family tree of this patient and it is a good evident how PJS can be inherited in a family. Keywords: Peutz-Jeghers syndrome, melanin spots, polypsr
Portal Hypertensive Enteropathy in Liver Cirrhosis
No full textBackground/Aim: Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method: Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result: In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion: There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords: portal hypertensive enteropathy, liver cirrhosi
Clinical Improvement of Dyspepsia Symptoms Following Eradication Treatment for Helicobacter pylori
No full textThe prevalence of Helicobacter pylori in patients with peptic ulcer in Indonesia is very high. It ranges between 90-100%. In general, patients with gastritis and peptic ulcer usually have dyspepsia symptoms. The pathophysiology of dyspepsia symptoms caused by Helicobacter pylori has not been clearly understood. However, it is assumed that the symptoms are correlated to various factors including inflammation, apoptosis damage, and increased secretion of gastric acid, atrophy and non-atrophy gastritis as well as the development of peptic ulcer. The main objective of treatment for Helicobacter pylori infection is elimination of Helicobacter pylori bacteria. Triple therapy has 80% success rate with no significant adverse events and minimal effect in inducing resistance to antibiotics. The success rate of eradication treatment in patients with peptic ulcer is 90%; while an evaluation on improvement of duodenal ulcus following eradication treatment with one month proton pump inhibitor treatment reveals 90% success rate. Keywords: Helicobacter pylori, improvement, dispepsi
Management of Complicated Colonic Diverticulosis
No full textPrevalence of diverticular disease has been increasing worldwide in concert with the development of industrial era and the alteration of diet pattern to low dietary fiber. Mean age of patients is 60 years; peak incidence at age more than 50 years, 20% less than 50 years, 2-8% less than 40 years. About 50 - 90% of diverticular disease are left-sided especially sigmoid, while in Asian people are mostly right sided. The usual complaint of patient is abdominal pain. Complications that may occur due to diverticulosis are diverticulitis, abscess, fistula, obstruction and bleeding. The presence of complicated diverticulosis can be evaluated by plain X-rays, CT-scan, barium with contrast, ultrasonography and colonoscopy in addition of laboratory examination. The management of complicated diverticulosis usually consists of combination of medical therapy and surgery. Proper and immediate treatment will influence the prognosis of patients. Keywords: diverticular diseases, diverticulitis, abscess, fistula, obstruction, bleedin
Adenoid Cystic Carcinoma of the Esophagus
No full textAdenoid cystic carcinoma is an extremely rare case of the esophagus. We present a female patient, aged 76 years who present with dysphagia and weight loss for the last three month. On endoscopy there was a luminal narrowing in the middle third of the esophagus. Diagnosis was challenging due to the stenosis and the tumor size. Histopathological confirmation was obtained by subcarinal fine-needle aspiration biopsy. This type of cancer is very aggressive with short survival time. Further studies are needed to define optimal treatment. Keywords: dysphagia, adenoid cystic carcinom
Non-Steroidal Anti-Inflammatory Drugs Prescribing in Patient with Gastrointestinal Risk
No full textConventional NSAID treatment has been consistently associated with gastrointestinal complications including dyspepsia syndrome, gastric ulcer, and upper gastrointestinal tract bleeding. There are some risk factors correlated to these complications, i.e. elderly age, previous history of gastric ulcer, concomitant use with steroid, multiple NSAID administration, high-dose NSAID and concomitant use with anticoagulant. NSAID prescribing with consideration of patient’s risk factor is necessary in order to decrease gastrointestinal complications. Combination therapy of NSAID and mucoprotector agent may be considered to prevent or to treat the NSAID- induced gastrointestinal ulcer Keywords: prescribing, NSAID, gastrointestinal ris
Endoscopic Features of Patients with Bronchial Asthma and Gastroesophageal Reflux Symptoms
No full textBackground: Studies evaluating endoscopic results in patients with bronchial asthma and Gastroesophageal Reflux Disease (GERD) in Gatot Soebroto hospital have never been undertaken. It leads an idea to further study, in order to find a more accurate and rapid management as solution for anticipating asthma attack and complications of bronchial asthma to upper gastrointestinal tract. Methods: A retrospective study was aimed to evaluate endoscopic result of upper gastrointestinal tract in bronchial asthma patients who had GERD symptoms as appropriate to the criteria of 4 major GERD symptoms of Talley 2002. Data was collected in one year period starting from November 2004 to October 2005. Results: Subject characteristics in this study indicated that there were more female patients compared to male with a ratio approaching 3:1 who had such symptoms. Mean age was 38.5 years and ratio of body weight to body height indicated normal weight result and the mean value for duration of asthma was 27 years. Clinical symptoms of GERD found in the present study was in accordance with four majors symptoms of GERD i.e. 32 (100.00%) cases of regurgitation, 29 (90.63%) cases for each of heartburn and non-cardiac chest pain symptom, and 7 (21.88%) cases of difficult / painful swallowing or dys/odinophagia. The endoscopic result of upper gastrointestinal tract had figured of: (1) 4 (12.50%) cases of normal esophagus, (2) 11 (34.40%) cases of non-erosive esophagitis known as Non Erosive Reflux Disease (NERD), and (3) erosive esophagitis which regarding to Los Angeles classification: 15 (46.90%) cases of grade A and 2 (6.20%) cases of grade B. Conclusion: The incidence of esophagitis in accordance with LA classification is extremely high although no severe damage (grade C and grade D) was found. Early anticipation of reflux associated respiratory symptoms and anti-reflux treatment should be considered in order to shorten or to discontinue the asthma attack cycle. Keywords: bronchial asthma, GERD, endoscopy, NER
Recurrent Abdominal Pain in Children
No full textRecurrent abdominal pain is one of the most common symptoms found in children. Description of abdominal pain is important in determining the etiologic cause. Organic pain must be ruled out first before suspecting psychogenic cause of pain. However, Children and infant are likely having difficulties in describing abdominal pain. Referred pain may lead to misdiagnosis. Alarm symptoms of abdominal pain are important indices and must be recognized. Careful and complete anamnesis and physical examination play critical role in management approach of recurrent abdominal pain in children and determine whether medical therapy only or combination with surgical intervention is considered necessary. Keywords: recurrent abdominal pain, children, alarm sympto
Colonic Tuberculosis: a high Index of Suspicion
No full textTuberculosis remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tract. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to nonspecific sign and symptoms. In endemic areas, correct diagnoses were made only 50% of the time. Without a high index of suspicion of the disease, it has been rarely diagnosed correctly. We reported a case of colonic tuberculosis in 18 years old female patient with lung tuberculosis.Endoscopic examination showed ulcerative mucosa, ‘halo lesion’, and pseudopolyp while PPD skin test, sputum smear and histopathological examination of endoscopic biopsy revealed negative for tuberculosis infection. The presence of lung tuberculosis had made high index of suspicion of colonic tuberculosis. Standard regimen of antituberculosis therapy was given and the patient showed good clinical response. Keywords: high index suspicion, colonic tuberculosi
Leptospirosis and Pancreatitis Complication
No full textLeptospirosis is a wide-spread zoonosis in the world, especially in the tropical countries. Ninety percent of cases are characterized by abrupt fever and have good prognosis, but in 10% of cases, exacerbation will occur and the mortality rate is about 10%. Leptospirosis may strike the entire organ, including gastrointestinal tract. Pancreatitis in leptospira is characterized by increased serum amylase levels, with mean values of five times normal. Early diagnosis and prompt treatment will engender good prognosis. Treatment of acute pancreatitis caused by leptospira is similar with other acute pancreatitis treatment caused by other agents. The pathophysiology of leptospira infection includes endotoxin, hemolysis and lipase. Keywords: Leptospirosis, pancreatitis, diagnosi