The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Colorectal Cancer in Young Patient: A Distinguished Disease Entity?
No full textBackground: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients (< 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher’s exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients < 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p < 0.05 was considered as significant. Results: Sixteen young aged (< 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p < 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habits Keywords: Young aged colorectal cancer patients, cross sectional analysis, clinical and histological differenc
The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period
No full textBackgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), < 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age > 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study. Keywords: upper gastrointestinal bleeding, endoscop
Non Cirrhotic Portal Fibrosis
No full textDiagnosis of non cirrhotic portal fibrosis was considered when the following criteria were fulfilled evidence of portal hypertension (oesophageal varices, hypersplenism, ascites, or increased hepatic venous pressure gradient), Doppler ultrasound showing patent portal and hepatic veins, and liver biopsy showing sign of cirrhosis. Non cirrhotic portal fibrosis clinically characterized by splenomegaly, anemia, portal hypertension, and histopathological examination portal tract showing fibrosis and sclerosis. Portal hypertension are most caused by a cirrhotic liver (85%), there are only a few reports on non cirrhotic portal hypertension, mostly in Japan and India. We reported a case of non cirrhotic portal fibrosis in young male. The clinical complications of portal hypertension are variceal bleeding and pancytopenia due to hypersplenism. Variceal band ligation and splenectomy were performed. The patient showed good clinical response. Keywords: portal hypertension, non cirrhotic portal fibrosis, young mal
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
Difficulties in Making Diagnosis of Inflammatory Bowel Disease: Several Cases Analysis
No full textInflammatory bowel disease (IBD) is rarely found in clinical practice. However, the incidence of IBD seems to have increased recently. Generally, the patients will come to hospital with chief complaint of chronic diarrhea with or without hematochezia. We reported two cases of IBD in which they had been misdiagnosed as colitis tuberculosis based on colonoscopy examination. Treatment of anti tuberculosis drugs had made no clinical improvement. Further evaluation suggested the diagnosis of IBD. They responded very well clinically after treated as IBD. This case report reminds us to consider the diagnosis of IBD in patient with chronic diarrhea and ulceration in colonic mucosa at colonoscopy. Keywords: Chronic diarrhea, inflammatory bowel disease, hematochezi
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
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
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
Prolonged QTc-Interval in Liver Cirrhotic Patient: Prevalence and Its Relationship with Severity of Liver Dysfunction
No full textBackground: The aim of the study was to determine the prevalence of prolonged QTc -interval and it’s relationship with the severity of liver dysfunction in liver cirrhotic patient in the outpatient clinic of Hepatology, Dr. Cipto Mangunkusumo General National Hospital Methods: cross sectional study. Eighty one subjects was recruited and being followed as a consecutive non random sampling. The patient was divided according to the modified Child-Pugh classification and undergo to the ECG examination (with minimal 2 leads have measured QT-interval; one of these is II, aVL, V2 or V3 lead). Result: The prolonged QTc-interval prevalence in liver cirrhotic patient was found in 55 subjects (67,9%) with the mean 448.6 msec (SD = 28,9; 95% CI = 442.2 - 454.8). Using the Forward Stepwise Method in multivariate analysis to the independent variables (p < 0.05) was found only the modified Child-Pugh classification had strongly correlation with the prolonged QTc-interval (OR = 11.2; 95% CI = 3.57-35.47; p = 0.000) Conclusion: The prolonged QTc-interval prevalence in liver cirrhotic patient is 67.9%. The prolonged QTc-interval were strongly associated with the severity of liver dysfunction. Keywords: The prolonged QTc-interval, liver dysfunction, liver cirrhosi
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