The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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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
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
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
Expression of Cyclooxygenase Enhances Tumor Invasion and Metastasis in Human Gastric Carcinoma
No full textBackground: Expression of COX-2 in vitro has been shown to have a number of cellular effects including increasing proliferation, reducing apoptosis promoting angiogenesis, decreasing E-cadherin expression and increasing invasive/metastatic potential. Aims: To determine the role of COX-2 in the development and metastasis potential of gastric carcinoma in human subjects. Methods: Tissue samples were obtained from surgically removed specimens of 48 patients with primary gastric adenocarcinoma who underwent gastrectomy from January 1998 to December 1999. The specimens were stained for HE while COX-2 expressions in cancer fold and antrum site were evaluated immunohistochemically. Expression of COX-2 was defined as positive when either one of cancer lesion or antrum site showed immunoreactivity. Results: Preliminary result from 12 out of 48 cases, COX-2 immunoreactivity was detected in 50% (6 of 12 specimens). Expression of COX-2 were more frequent in tumor with serosal invasion (5 of 6 specimens), lymph node metastases (3 of 3 specimens), tumor size more than 4 cm and were significant, statistically (p<0.05). The expression of COX-2 in well differential carcinoma type was similar with in poorly differentiated carcinoma type. Conclusion: COX-2 expression in gastric carcinoma tissue is correlated closely with tumor size, serosal invasion and lymph node metastases, indicating that COX-2 is involved in the growth and metastases of gastric carcinoma. Keywords: Gastric carcinoma, cyclooxygenase-2, invasion, immunochemistr
The Role of Specific Cellular Immune System in Chronic Hepatitis C
No full textHepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune respons
Chronic Viral Hepatitis: Etiology, Pathogenesis of Liver Damage and Mechanisms of Persistence
No full textChronic hepatotropic viruses commonly evade the antiviral defence systems of the body and cause a long - lasting persistent infection. The prolonged nature of the infection ensures that every infected person has ample opportunity to transmit the virus to others, allowing many millions of people world- wide to become infected. Three viruses commonly cause chronic hepatitis B virus, hepatitis C virus and hepatitis Delta virus. Virus specific CD8 T cells of the host, represent the main effector cells against viral infection. Where as the antiviral cytokines have a major role in the control of viral replication (non-cytolytic inhibition). To cause persistent infection, a virus must avoid the host defences and that hepatotropic viruses have developed elaborate strategies to achieve this. In the case of hepatitis B virus, two proteins are involved in the inhibition of the host defences; those are the core protein that has been shown to inhibit the production of interferon and the polymerase protein has been shown to inhibit its effect. Where as in the case of hepatitis C virus, the NS5A and E2 protein reduce the effect of interferon by inhibiting the antiviral kinase. In order to survive and persistent in the liver, the hepatotropic viruses must be able to avoid both arms of the immune system, either by mutation of viral proteins or by preventing activation of the immune system. Keywords: Hepatotropic viruses, core proteins, interfero
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
Diseases in Chronic Non-infective Diarrhea
No full textBackground: Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea. Methods: We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray. Result: Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn’s disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc. Conclusion: The most frequent abnormality found in chronic non-infective diarrhea was maldigestion. Keywords: Chronic diarrhea, non-infectiv
A Comparison of the Endoscopic and Histopathological Findings of Upper Gastrointestinal Mucosa with Helicobacter pylori infection
No full textHelicobacter pylori infects the gastric mucosa or the duodenal wall undergoing gastric meteplasia, and is found in nearly 100% of chronic gastritis and duodenal ulcers. Helicobacter pylori produces urease that converts urea into ammonia, which will protect the organism from the acidic environment and will cause further damage to the gastrointestinal mucosa. Helicobacter pylori can be detected through histopathological evaluation, macroscopic endoscopy, serologic test, urea breath test, biopsy urease test, culture and stool analysis. Histiopathologically, Helicobacter pylori infection demonstrates neutrophil infiltration into the gastric mucosa, classified as focal infiltration. We conducted a prospective study of 50 chronic dyspeptic patients. We took their history, performed physical examinations, gastroscopy with judgement for macroscopic endoscopic appearance, histopathology from biopsy specimens, and the CLO test. There were 50 chronic dyspeptic patients in the study, with an age ranging from 23-81 years, and a mean age 49±12 year. Most of them were male (33 cases). There were 17 female cases. From the CLO test, there were 30 cases with CLO (+) and 20 cases CLO (-). From the 30 cases with CLO (+), 22 were male and 8 female. Gastroscopy revealed 25 cases of gastric ulcer, 7 duodenal ulcer, 2 gastric cancer, 15 gastritis, and 30 gastropathy. A gastroscopic appearance of chronic dyspepsia with positive Helicobacter pylori were found mostly in gastric ulcer (18 cases), followed by duodenal ulcer (6 cases), gastritis (5 cases) and one case of gastric cancer. A gastroscopic appearance of chronic dyspepsia with negative Helicobacter pylori were found mostly in gastritis 10 cases, while the remaining in gastric ulcer (7 cases), gastric cancer (2 cases), and a case of duodenal ulcer. Gastroscopy revealed 15 cases of gastritis. From the 5 gastritis cases with CLO (+), 3 cases had lesions located at the antrum and 2 cases at the corpus, while from the remaining 10 cases of gastritis with CLO (-), 8 cases had lesions located at the antrum, and 2 at the corpus. The time to colonization was shortest in duodenal ulcer (grade IV), followed by gastric ulcer (grade II) and gastritis (grade I) in CLO (-) examination. From cases of gastritis with CLO (+), 4 were moderate cases and one case severe, while from cases of gastritis with CLO (-) there were 7 mild cases, and 3 moderate cases with no severe case found. Keywords: Endoscopic findings, histopathology, Helicobacter pylori
Fever of Unknown Origin due to Liver Tuberculosis
No full textInfection, especially extra pulmonary tuberculosis, remain the leading cause of fever of unknown origin (FUO). FUO is defined as temperature higher than 38.3 ºC with duration of fever of more than 3 weeks. We reported a case of liver tuberculosis, whose had fever more than 38.3 ºC in 2 months. A liver biopsy and histology evaluation have performed revealing liver tuberculosis. The patient received oral anti-tuberculosis agents. But after three days of anti-tuberculosis treatment, the patient experience jaundice. The patient was diagnosed as a drug induced hepatitis. After adjusted regimen of oral anti- tuberculosis, the patient’s condition improved. The patient was back home with good conditions. Keywords: fever of unknown origin - liver tuberculosis