The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient
No full textBackground: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p < 0.05. Results: During the period of May 1st - September 30th 2007, there were 36 eligible patients. The mean value of zinc serum levels was 63.70 ± 24.85 µg/dL. There were 24 (66.67%) patients with hypozincemia. The mean value of 24-hour-urinary zinc excretion was 787.52 ± 570.20 µg. There were 19 (52.8%) patients with urinary zinc excretion > 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume. Keywords: liver cirrhosis, serum zinc level, urinary zinc excretio
Cause of Upper Gastrointestinal Tract Bleeding in Dengue Hemorrhagic Fever Patient
No full textDengue fever is an acute mosquito-transmitted disease caused by the dengue fever virus which had clinical manifestations range from fever to severe hemorrhage, shock, and death.1 There were 500,000 cases of dengue hemorrhagic fever and 25,000 deaths due to dengue annually worldwide. Bleeding is one of the major problems encountered in dengue fever. The reported prevalence of upper gastrointestinal bleeding in dengue patients varies from 5% to 30%. The pathogenesis of hemorrhage could be multifactor and include vasculopathy, platelet deficiency, and dysfunction, and blood coagulation defects. We presented here a case of 27 years-old male patient who had clinical manifestation of hematemesis on his third day of fever. Keywords: GI tract, bleeding, DH
Endoscopic Findings and Histopathological Pattern in Patients with Chronic Dyspepsia at Panti Rapih Hospital Jogjakarta
No full textBackground: To determine the relationship between clinical manifestation of chronic dyspepsia and endoscopic findings along with histopathological pattern by descriptive analysis. Methods: This study was a retrospective study. Subjects were patients with chronic dyspepsia who underwent endoscopic examination and gastric biopsy between June 2005 and July 2006. Result: There are 10.17% normal endoscopic results of 79 patients with chronic dyspepsia and almost 90% show abnormal result in endoscopic examination. The histopathological pattern is normal in 2.53% and 97.47% demonstrate abnormal result. The prevalence of Helicobacter pylori due to gastric ulcer is 1.26% and chronic atrophic gastritis is 3.80%. Conclusion: Most of chronic dyspepsia patients have abnormal endoscopic and histopathologic result. Keywords: chronic dyspepsia, endoscopic findings, histopathological pattern, Helicobacter pylor
Upper Gastrointestinal Abnormalities in Esophagogastroduodenoscopy Examination: Descriptive Study in PSUPAU Endoscopic Unit
No full textBackground: The Endoscopy Unit of Indonesian Air Force Central Hospital Dr. Esnawan Antariksa, Jakarta, Indonesia, has just been established in late 2004 and it is still in developing process. This study was aim to depict the profile of patients who underwent esophagogastroduodenoscopy procedure in the unit. Method: This study was a retrospective study that analyzed data in endoscopic registry of patients who underwent esophagogastroduodenoscopy (EGD) examination from September 2004 to December 2007. Result: Total of 108 patients underwent EGD examination, comprised of 66 (61%) males and 42 (39%) females, with average age of 45.4 years old (range 16-77 years old). The most frequent indication for EGD was dyspepsia 63%, followed by hematemesis-melena 26% and dysphagia 5.5%. Among patients with dyspepsia, EGD revealed organic abnormalities in 71% patients, with descriptions of erosive gastritis 35%, gastritis 18%, bile reflux 7%, esophagitis 5% and gastric ulcer 3%. Among patients with hematemesis-melena, EGD revealed abnormalities, which were described as erosive gastritis 48%, esophageal varices bleeding 22%, gastric ulcer 18%, caustic injury 4%, and esophagitis 4%. Conclusions: EGD is an important procedure to ascertain the occurence of organic abnormalities in patient with gastrointestinal symptoms and signs e.g. dyspepsia and gastrointestinal bleeding. More than half of patients with dyspepsia showed organic abnormalities. Among patients with hematemesis-melena, erosive gastritis is more common than variceal bleeding. Keywords: esophagogastroduodenoscopy, dyspepsia, upper gastrointestinal bleeding, hematemesis melen
Colorectal Polyp Evaluation Management and Its Role in Gastrointestinal Tract Malignancy
No full textColorectal polyp is one of important factors that have roles in developing malignancy of lower gastrointestinal tract. Adenomatous polyp is the most common colorectal polyps and it has been known as a lesion precursor for transformation process in developing gastrointestinal malignancy. Such transformation is known as adenocarcinoma sequence, a long-term process which usually does not elaborate any symptoms and remains asymptomatic. Since most colorectal polyps are asymptomatic, they are usually undiscovered at the time of diagnosis and results to the increasing case of malignancy especially the colorectal cancer. Considering that colorectal cancer still becomes one of the most common causes of death and morbidity worldwide, early detection and elimination of colorectal polyp may have a significant role in preventing lower gastrointestinal tract malignancy. Keywords: polyp, colorectal polyp, adenomatous poly
Prevalence of Hapatitis Prevalence of Hepatitis C Virus and Human Immunodeficiency Virus Co-infection in Dr. Mintohardjo Navy Hospital, Jakarta
No full textBackground: Today HIV/AIDS has become a major global health problem due to high rate of morbidity and mortality. Epidemiological data showed that many HIV-infected patients were co infected by hepatitis C virus (HCV) since both of these viruses share similar routes of transmission, with the most frequent modes of acquiring the infections are by sexual, parenteral, and perinatal transmission. The objective was to describe the profiles of HCV and HIV co-infection patients in Mintohardjo hospital Jakarta. Methods: This was a cross-sectional study in HIV patients who were treated in Internal Medicine Department of Mintohardjo hospital Jakarta from January 2006 to July 2007. Patient’s record was retrieved from Medical Record Department and we sought event rate of hepatitis C co-infection. Results: There were 114 patients were diagnosed as HIV positive in a several clinical staging treated during period of 1st January 2006 to 31st July 2007, 80.7% were men and their median age was 27 years old. The peak age group was 26-30 years old. Intravenous drug users (IDUs) were found in 73.7% of cases. Anti-HCV total antibody was found in 31.6% cases, including 1 non-IDUs. Sex was significantly correlated with the risk factor of HIV infection (r = 0.580, p < 0.01), and educational background was also significantly correlated with the risk factor of HIV infection (r = 0.229, p < 0.05). Conclusion: The prevalence of HCV and HIV co-infection in Dr. Mintohardjo Navy Hospital was 31.6%. There were a correlation between HCV infection and IDU, sex and risk factors, and also between educational background and risk factors. Keywords: HIV infection, hepatitis C infection, IDU
Profile of Colorectal Cancer Patients in Endoscopic Unit at Dr. Pirngadi Hospital - Medan
No full textBackground: Colorectal cancer is the third most prevalent cancer and the second leading cause of cancer death worldwide every year. Rates of this malignancy vary by country. In Indonesia, the prevalence is estimated to have an increased tendency. The objectives of this sudy was to examine the prevalence and profile of colorectal cancer, which are diagnosed by endoscopic examination. Method: The study was conducted retrospectively, by examining the Result of endoscopic findings of patients with rectal bleeding, altered bowel habit, chronic diarrhea, unexplain abdominal pain, and other signs and symptoms at The Endoscopic Unit Department of Internal Medicine, Dr. Pirngadi hospital from January 2004 to June 2008. Results: We found 197 patients with colorectal cancer (CRC) from 760 patients examined by colonoscopy (25.9%). One hundred and one patients (51.3%) out of 197 CRC patients were female. Most were in the group of age 51-60 years (28.9%). The most frequent ethnic of the patients were Bataknese (46.2%). The most common symptom was rectal bleeding (70.6%). The most common location of CRC was in the rectum (74.6%). Histopathologic Result was adenocarcinoma. Conclusion: The prevalence of colorectal cancer in this study were twenty six percents. Rectal bleeding appeared to be the most common sign in this study. Rectum was the most common site of the cancer. Most of patients were Bataknese. Patients were at advanced stage and most of them were having well-differentiated adenocarcinoma. Keywords: colorectal cancer, rectal bleeding, altered bowel habits, colonoscop
The Role of Esophageal pH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis
No full textGastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal endoscopic result but still having refractory reflux symptoms against proton pump inhibitor medication; detecting refractory reflux in patients chest pain following the heart evaluation; evaluating patients with otolaryngologic manifestations (laryngitis, pharyngitis, chronic cough) of the esophageal reflux disease after therapeutic failure of 4-weeks proton pump inhibitor treatment; and looking for correlation between adult onset gastro-esophageal reflux disease and non-allergic asthma. Keywords: gastro-esophageal reflux disease, esophagus pH-metry, symptoms-reflux correlatio
A 17-Years Old Man of Colitis Tuberculosis with Fistula Perianal
No full textTuberculosis (TB) remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tracts. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to its nonspecific signs and symptoms. Perianal granulomas or perianal fistula presents some degree of diagnostic difficulty. A spectrum of diseases can produce granulomas in perianal region and perineum. Most are infectious or inflammatory diseases. Standard histological diagnosis often less significant to clarify the etiology and treatment will vary from one to another disease entity. In this report, we present a case 17-years old man with colitis TB and fistula perianal, in which the initial diagnostic workup suggested Crohn’s disease. Mantoux test, Acid Fast Bacilli test on fecal examination and polymerase chain reaction analysis revealed negative result. The chest X-ray was normal; while the fistulography X-ray: revealed 2 orifices in rectosigmoid area. The colonoscopy revealed mucosa edema with ulceration in rectosigmoid and pedincular polyp in the caecum. Initial colonoscopy diagnosis was Crohn’s disease with differential diagnosis colitis ulcerative, colitis TB, colitis infection. results of direct or post homogenizes examination (Ziel–Nielsen staining) revealed that no acid-fast bacilli was found. Multiple biopsies were done, which indicated mucosa edema with ulceration in rectosigmoid area, pedincular polyp in the caecum, and surrounded by fistula perianal; while histopathological examination showed inflammatory-caseating-epithelioid-granulomas and giant cells (Langhans datia cell) caused by tuberculosis. It highlights the need for awareness of intestinal TB along with the differential diagnosis of chronic intestinal disease. Standard regimen of antituberculosis treatment was given and the patient showed good clinical response. Keywords: Crohn’s disease, caseating epithelioid granuloma, giant cell, colitis TB, perianal fistul