The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Acute Tuberculous Appendicitis with Intestinal Obstruction
Full text linkTuberculosis (TB) can involve any organs. Tuberculous appendicitis is a rare case. Incidence of primary tuberculous appendicitis is 0.1-0.3% while incidence of secondary tuberculous appendicitis is 1.5-3%. Tuberculous appendicitis occurs in 0.08% of all appendectomy and 0.2% of all TB cases. We reported an acute tuberculous appendicitis with intestinal obstruction. Diagnosis was established based on histopathological findings. Treatments included appendectomy and first category of anti tuberculosis drugs (ATD) for 6 months. This case was reported to add our insight about possibility of TB as an etiology of many pathologic conditions in abdominal cavity
Inflammatory Bowel Disease in Young Adult
Full text linkInflammatory bowel disease is a chronic inflammatory disease that consist of Crohn’s disease and ulcerative colitis. A dramatic increase in the prevalence if inflammatory bowel disease (IBD) within developing countries including in Asia makes IBD a substantial global medical burden and modern refractory disease, and it is imperative that Asian healthcare systems especially physician are aware of this and familiar with the clinical manifestation and management. The aim of this case report is to present a case of IBD in young adult in Indonesia. Patient came with complaint of chronic diarrhea and had seen multiple doctor without improvement. Inflammatory bowel disease should always be considered in patient with chronic diarrhea with or without extraintestinal manifestation especially after poor response of usual antidiarrheal medication. Diagnosing of IBD is based on clinical manifestation, physical examination, laboratory result and endoscopy. Until now, ileocolonoscopy and biopsy is the most accurate diagnostic modality for IBD and can be used to differentiate between ulcerative colitis and Crohn’s disease. Treatment of IBD are drugs such as mesalazine until surgery based on the severity or complication of disease
Adult Ileocecal Intussusception: A Case Report and Review
Full text linkIntussusception is a rare cause of bowel obstruction in adult patients, it represents for five percent of all age intussusception. Several different aspects were found between adult and pediatric intussusception. We report a case of 39-year-old male with bowel obstruction due to ileocecal intussusception, which firstly diagnosed as acute appendicitis. Unlike pediatric intussusception which usually manifest as classical triad signs, unspecific symptoms of adult intussusception may become diagnostic challenge. Imaging modalities such as plain abdominal radiograph and ultrasonography may aid the preoperative diagnosis in the rural hospital setting. Prompt management which involved surgical approach is warranted to prevent further complications
Gastric Mucosa Plasma Cells is Unspecific for Diagnosing Helicobacter pylori Infection
Full text linkBackground: A high density of Helicobacter pylori is believed to trigger an accumulation of plasma cells in gastric mucosa as one of the inflammatory cells due to its high titer antibodies production circulated in blood system. We aimed to identify the correlation between total plasma cells and H. pylori density in gastric mucosa.Method: Endoscopic gastric biopsy tissues were stained by two different stains, Haematoxylin-Eosin and Modified Giemsa. The examination was performed by experienced pathologist.Results: The average age of chronic gastritis patients in this study was 48.80 years with standard deviation of 14.356. Out of 30 samples, 17 (56.7%) were female chronic gastritis patients. Female patients were dominating in most of categories of H. pylori density including 5 out of 9 patients (55.6%) in normal H. pylori density, 8 out of 14 patients (57.1%) in mild H. pylori density, and 3 out 5 patients (60.0%) in moderate H. pylori density. The average of total plasma cells in this study was 17.30 cells with standard deviation of 5.838. Importantly, there was no statistically significant correlation between total plasma cells and H. pylori density in gastric mucosa (p = 0.536). Although the distribution of total plasma cells was normal, there was no statistically significant difference of total plasma cells between positive and negative H. pylori density (p = 0.944).Conclusion: Plasma cells in gastric mucosa is unspecific for diagnosing H. pylori infection. Other causes associated with plasma cells are needed to be assessed for further study
Pancreatic Tuberculosis: A Rare Type of Extra Pulmonary Tuberculosis
Full text linkTuberculosis is a serious health problem not only in Indonesia, but worldwide. Each year, it occurs in nearly 9.7 million people and claims about 2 million lives worldwide. Pancreatic tuberculosis is a rare type of extra pulmonary tuberculosis that only occur less than 4.7% worldwide. The most common symptoms is abdominal pain and most of the patients shows abdominal tenderness on palpation. Diagnosis of pancreatic tuberculosis consist of tuberculin skin test, ultrasonography, computed tomography-scan, magnetic resonance imaging and biopsy. Diagnosing pancreatic tuberculosis is a challenge because of its rarity and it has similar symptoms as more common pancreatic condition such as pancreatic malignancy. Understanding of pancreatic tuberculosis will increased the clinical awareness that may guide clinicians to avoid unnecessary diagnostic or therapeutic procedures and early diagnosis
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
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
Long Term Risks of Proton Pump Inhibitor Administration: A Literature Review
No full textProton pump inhibitor (PPI) has become drug of choice for acid related disease. However, PPI tend to be overprescribed and becoming one of the highest burden for health cost. Some studies showed that PPI are prescribed unnecessarily. Recent evidences showed raised concerns over long term effects of PPI consumption. Several long term side effects such as increased incidence of gastric polyps, micronutrient absorption disorders, infections, and osteoporosis have been yearly discussed. In recent years there has been increased attention to new side effects such as dementia, chronic renal failure, and cardiovascular disorders. Therefore, some health associations had issued warning and guidance regarding long term PPI prescription
Efficacy of Combination Sofosbuvir, Pegylated-Interferon, and Ribavirin for Treatment of Hepatitis C Virus Genotype 1 Infection in Indonesia
Full text linkBackground: The presence of direct-acting antiviral (DAA) has improved the treatment of HCV infection and making it more preferable than Pegylated-interferon (PegIFN) and Ribavirin (RBV) based treatment. However, treatment with all DAA combination regimen is limited and expensive in low health care affordability country including Indonesia. The appearance of generic sofosbuvir (SOF) facilitate the utilization of SOF plus PegINF with or withour RBV combination. Therefore, in this study we assessed the efficacy of SOF+RBV and SOF+RBV+PegINF combination for treatment of chronic hepatitis C infections patient with genotype 1 in IndonesiaMethod: We performed retrospective study comprising 128 patients in Cipto Mangunkusumo Hospital with chronic hepatitis C, genotype 1, infection. 36 patients was treated with PegINF+SOF+RBV and 92 patients was treated with SOF+RBV with the duration of therapy was 12 and 24 weeks in both arms. The primary endpoint was sustained virologic response after treatment completion (SVR12)Results: In the end of treatment, 99.2% patients achieved undetected HCV RNA in 12 weeks and 24 weeks duration of therapy (100% in PegINF+SOF+RBV group and 98.9% in SOF+RBV group). The SVR12 of PegINF+SOF+RBV reach 100% meanwhile The SVR12 of SOF+RBV reach 88%. No different in SVR12 between cirrhotic and non-cirrhotic patient in PegINF+SOF+RBV group while in SOF+RBV group, the SVR12 was lower in cirrhotic patients (82.9%) compared to non-cirrhotic patients (92.2%). In multivariate analysis, HIV co-infection is associated with lower SVR12 in SOF+RBV group.Conclusion: 12 weeks and 24 weeks of PegINF+SOF+RBV and SOF+RBV is effective in the treatment of genotype 1 chronic hepatitis C infectio
Case Report: A 31-year-old Post Cesarean Section Women with Intrahepatic Cholestasis of Pregnancy and Post Partum Bell’s Palsy
Full text linkIntrahepatic cholestasis of pregnancy (ICP) is cholestasis condition characterized by pruritus, elevated serum aminotransferase and bile acid levels with onset in the second or third trimester of pregnancy. Estimated of ICP prevalence only 0.001% to 0.3%. Bell's Palsy is a neurological disorder that causes facial muscles on one side of the face to suddenly weaken or become paralyzed. Bell's Palsy is more common in young adults, older people, diabetics and pregnant women. A 31-year-old women with major complaint is yellow eyes. She got itching in all over the body. Patient was in second pregnancy with gestational age was 39-40 weeks. She suffered from unable to close her eyelid or blink. Patient was diagnosed with cholestasis intrahepatal in pregnancy and Bell’s palsy post partum. Diagnosis was established concluded from anamnesis, physical examination and hepar biopsy. The result of a liver biopsy showed intrahepatic cholestasis. From Fibroscan examination was visible with F2 category or Moderate Fibrosis. The main management of this patient is cesarean section with UDCA and corticosteroid therapy. Patient was administrated with antiviral therapy for her Bell’s Palsy condition. After 1 week hospitalization, patient was discharged with improvement of her major complaint