International Journal of Human Capital Management (IJHCM)
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Diagnosis, Management and Prevention of Colon Polyps
No full textColon polyps can be a predisposing factor for colon cancer; they should be immediately removed once they are found. Most of colon cancer arises from adenoma. Most adenoma cases are asymptomatic. It is frequently detected at the first time when someone undergoes screening for colorectal cancer with the ima- ging modalities in the medical check-up. Approximately, 10-40% of patients without any symptoms with the positive result of occult blood test suffer from adenoma. By using colonoscopy, we can detect for adenoma cancer and adenoma polyps, so colonoscopic procedure is recommended for individuals with the high risk for colorectal cancer. Excision and polyp removal during colonoscopy is a treatment choice to lower the risk for developing colon cancer. Surgical intervention is usually required in the management of adenoma polyps for those with an extremely large size which cannot be resected through endoscopy. There are some sugges- tions for preventing of adenoma growing such as vegetable and fruit diet, limit intake of meat and fatty food. And finally do physical activities regularly and stay away from alcohol and cigarettes Keywords: colon polyps, colonoscopy, polypectomi, vegetable and fruit die
Obstructive Jaundice Due to Bile Duct Tumor
No full textWe reported here a rare case of a 62 year old male patient with obstructive jaundice due to bile duct tumor. The main clinical features were yellowish eye and skin, followed by pruritus and clay-colored stool. Ultrasonography showed common bile duct dilatation and without evidence of stones. Computed Tomography Scan of upper abdomen showed a mass which were thought of head of pancreas origin. Endoscopic Retrograde Cholangio Pancreatograph revealed tight narrowing of the distal bile duct to a malignant tumor. A stent was inserted to allow biliary drainage. A surgical plan for billio digestive anastomosis was rejected by the patient and family. Keywords: bile duct tumor, CT scan abdomen, ERC
Management of Gastric Varices
No full textUpper gastrointestinal bleeding is one of the emergency conditions in the field of gastroenterology and variceal bleeding is the most common cause of it. Gastric varices accounts only 5% to 10% of all causes of upper gastrointestinal bleeding respectively, but it could be fatal and difficult to control despite provision of adequate therapy. Early diagnosis and appropriate management may decrease the morbidity and mortality of gastric variceal bleeding. Keywords: Gastric varices, upper gastrointestinal bleeding, endoscop
Gastric Mucosa Mucous Layer Thickness in Liver Cirrhosis with Portal Hypertensive Gastropathy Compare to Functional Dyspepsia
No full textBackground: This study aimed to investigate gastric mucosa mucous layer thickness in portal hypertensive gastropathy (PHG) compare to normal mucosa in functional dyspepsia and its correlation with several variables such as child class, severity of esophageal varices and gastropathy. Methods: Biopsy specimens were taken from the antrum and corpus from both group of patients with PHG and functional dyspepsia. The specimen was given cryometric for frozen section. Tissue were sliced by sagital section 11 µm, placed in object glass, fixed and stained to evaluate mucous thickness and giemsa stained to observe Helicobacter pylori. Measurement of mucous thickness was done upward muscularis mucosa started from upper epithelial layer from foveale tip until outer mucous layer on 15 points which were marked randomly and calculate the mean value by micrometer (µm). Results: Mean value of antral mucous thickness in PHG was 13.30 ± 6.5 µm, while in the functional dyspepsia it was 25.59 ± 5.66 µm. Statistical analysis for both kinds of mucous thickness was p<0.001. Mean corpus mucous thickness in PHG was 10.6 ± 6.81 µm, while mucous thickness in dyspepsia was 32.54 ± 6.51 µm. Statistical analysis revealed p<0.001. This result showed significant difference of mucous thickness of antrum and corpus statistically between PHG and dyspepsia as control group. Conclusion: The study had proven the presence of decreased gastric mucosa mucous layer thickness in corpus and antrum in PHG. Thus, therapeutic approach to increase mucous thickness must be considered in patients with PHG. Keywords: Gastric mucosa, PHG, liver cirrhosisemistr
Diagnostic Approach and Treatment of Choledocholithiasis
No full textCholedocolithiasis may cause acute cholangitis which is life-threatening condition. It has non specific clinical signs from mild to severe condition such as septicemia. Diagnostic and treatment modalities had developed a great deal recently. Therapeutic options include endoscopic retrograde cholangio pancreatography (ERCP),common bile duct exploration (CBDE), laparoscopic CBDE and stone retrieval. The important thing is to choose the appropriate method for each patient. We reported a case of choledocolithiasis in 40 years old, male patients who was clinically diagnosed as acute cholangitis. Diagnostic approach to find the etiology was done. Abdominal USG and CT were performed and showed multiple stones in gallbladder and intrahepatic biliary duct, suspected mass at caput of the pancreas and hepatomegaly. The ERCP showed dilatation of intra and extra hepatic biliary ducts with multiple stone in common bile duct (CBD), hepatic duct and gallbladder. The stent was placed for biliary drainage. The patient underwent cholecystectomy per laparoscopy, but further evaluation of the cholangiography still showed the presence of stones in intrahepatic biliary duct. Laparotomy exploration of CBD was done and it revealed multiple stones and dilatation of distal CBD. Surgical treatment selected for this case was choledocojejunostomy. Keywords: Choledocolithiasis, CBD, diagnostic approac
Risk Factors for Recurrent Upper Gastrointestinal Tract Bleeding after Esophageal Varices Ligation on Patients with Liver Cirrhosis
No full textBackground: Upper gastrointestinal tract (GIT) bleeding on liver cirrhosis patients will increase morbidity and mortality. Recurrent bleeding’s risk rise after the first episode of variceal bleeding. The mortality risk also rises on each bleeding. Purpose: This study was done in order to identify the risk factors for the first episode of recurrent bleeding of upper GIT on liver cirrhosis patient. Evaluation of risk factors was based on preliminary data prior to ligation. Method: Evaluation of the upper GIT bleeding was done using anamnesis on the patients or their relatives by letter, home visits or telephone. The data on recurrent bleeding was obtained from medical records. They were evaluated on the 3rd month then 1st year after ligation. This study was a cross sectional study with retrospective data and a consecutive sampling method. Result: Bivariate analysis revealed the 3rd month’s risk factors for first episode of upper GIT bleeding were ascites, total bilirubin level of > 2 mg/dL, hepatoma, Child-Pugh C classification of the liver function and red color sign on esophageal varices. The risk factors for the first episode of upper GIT bleeding on first year were age £ 60 years old, hepatoma, and red color sign (RCS) on esophageal varices. The differences between risk factors on upper GIT bleeding on the 3rd month and 1st year were likely due to intervention, collateral para-esophageal varices, medication that irritated GIT, physical activities, and differences on variceal obliteration rate related to variceal ligation. Conclusion: Risk factors for recurrent upper GIT bleeding that could be minimized were ascites, total bilirubin level, Child-Pugh classification and RCS. It was expected with parascentesis, diuretics, hepatoprotector medications and drugs that lowers portal hypertension (such as propranolol and isosorbid mononitrate), might improve those risk factors thus decreasing the risk for recurrent upper GIT bleeding. Keywords: Upper gastrointestinal tract, esophageal varices, liver cirrhoti
Pathogenesis in Portal Hypertensive Gastropathy Due to Liver Cirrhosis
No full textThe recent advances of endoscopic examination had proven that source of upper gastrointestinal bleeding in liver cirrhosis is not always caused by esophageal varices rupture but also gastric mucosal lesion. The prevalence of gastric ulcer in patients with liver cirrhosis is higher than healthy individuals. Imbalance of defensive and aggressive factors of gastric mucosa may involve in development of portal hypertensive gastropathy (PHG). Several studies reported hemodynamic changes associated wuth portal hypertension causing decreased mucus layer thickness as one of mechanism of PHG. Other etiologic factors of PHG were hypoacidity, hypergastrinemia, reduced hexosamin concentration, mucus metabolic function associated with decreased prostaglandin E2 (PGE2), and increased nitric oxyde (NO) which had caused mucus wall thickness changes. Gastric mucus damage induced by portal hypertension has important role in the pathogenesis of gastric ulcer in liver cirrhosis. Keywords: Pathogenesis, PHG, liver cirrhosi
Specific Subjective Symptoms for Gastroesophageal Reflux Disease in Ulcer Like Dyspepsia
No full textBackground: The Aim of study is to identify specific subjective symptoms for gastroesophageal reflux disease (GERD), GERD proportion in ulcer like dyspepsia and the correlation between specific subjective symptoms for GERD and endoscopic examination Result in ulcer like dyspepsia Methods: A cross-sectional study was conducted in 67 patients with ulcer like dyspepsia. The patient’s history of illness was taken, and physical and endoscopic examinations were performed. A questionnaire on dyspepsia symptoms was completed. Data analysis was performed to identify the correlation between subjective symptoms and endoscopic examination results using chi-square test. T test was performed to determine the correlation between dyspepsia scores and endoscopic results. Result: Subjective symptoms that correlated with endoscopic results were severe epigastric pain (p=0.080) and the absence of bloating (p=0.055). Dyspepsia scores did not correlate with endoscopic examination results (p=0.725). Conclusion: Specific subjective symptoms for GERD in clinical dyspepsia-like ulcer were severe epigastric pain and absence of bloating. The proportion of such symptoms in ulcer like dyspepsia could assist clinical diagnosis of GERD. Keywords: GERD, symptom, dyspepsi
Helicobacter pylori, Induced Gastric Cells Apoptosis
No full textGastric epithelial cells apoptosis induced by Helicobacter pylori depends on microbial and host factors. Apoptosis on mitochondrial level by Bcl2 family protein is the main pathway for Helicobacter pylori induced gastric epithelial cells apoptosis, though there are roles for apoptosis through Fas receptors or TNF. Imbalance between proliferation and apoptosis gastric epithelial cells determines the risk for neoplastic transformation. Increase of gastric epithelial cells apoptosis seems to have an obligation for initiating secondary hyperproliferative response. If altruistic cellular death fails to oppose this process, uncontrollable cellular growth leading to neoplastic transformation will occur. Keywords: Helicobacter pylori, gastric cells, apoptosi
Paralytic Ileus in Vegetarian with Pneumonia Infection
No full textParalytic ileus which is commonly found in clinical practice is referred to clinical syndrome of transportation disturbance of the intestinal lumen content due to various etiology and underlying condition. It has been considered a transient gastrointestinal syndrome with good prognosis. Most cases respond well to conservative management. However, inappropriate diagnostic approach and management will result in severe complication leading to death such as septicemia and perforation. We reported a case of paralytic ileus in young male who is vegetarian with pneumonia infection as the suspected underlying etiology. Radiological examination of the abdomen in three position (upright, supine and lateral) showed dilated gaster and duodenum with minimal air fluid level, no herring bone appearance and absent of free intraperitoneal air. The laboratory result also showed low level of vitamin B12 which might be due to his lactovegetarian diet habit. Management including supportive therapy such as decompression, fasting, adequate parenteral nutrition, fluid balance and treatment of pneumonia as the underlying cause of paralytic ileus had been resulted in good clinical response. Keywords: Paralytic ileus, pneumonia, treatmen