The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Clinical Manifestation and Diagnosis of Cryptosporidiosis in Adult Infected with HIV
No full textCryptosporidiosis is a rare infection caused by a coccidian parasite, Cryptosporidium, which could cause diarrhea in humans, especially those who are immunocompromised Cryptosporidiosis could cause self- limited diarrhea infection in immunocompetent hosts, but in immunocompromised hosts, especially those with AIDS, the diarrhea can be chronic and severe. To date, no known effective therapeutic agents have been identified. The following is one case report of cryptosporidiosis of a 27 year-old male admitted with chronic diarrhea since 2 months. Endoscopy of the ileum and colon showed hyperemia, erosion and edema, and biopsy was performed. Histopathological examination of ileum showed an atrophic villous and atypical degeneration. There was a number of circular cryptosporidium lining up along the surface of epithelium. There was inflammatory cell infiltration, consisting of lymphocytes, eosinophils and a few neutrophils in the lamina propria. Serological examination revealed an HIV-positive result. Keywords: Cryptosporidiosis, HIV, diarrhe
Impact of Low Fiber Diet on Gastrointestinal Disorders
No full textFiber is not digested or absorbed in the small intestine. The main site of action of fiber is in the colon. In the colon, fiber will increase stool output and frequency, increase stool water, dilute the colonic content, reduce the toxins, bile acid, increase colonic fermentation and also stimulate probiotic growth. Some meta-analysis of observational epidemiologic and case control studies have found a protective effect of dietary fiber against colon cancer that increase with intake. Therefore, the high fiber diet is healthy recommendation to prevent various gastrointestinal disorders. Keywords: dietary fiber - colon cancer - constipatio
Clinical Approach to Chronic Pancreratitis
No full textChronic pancreatitis is still considered an uncertain process with an undetermined pathogenesis and ill defined treatment. Chronic pancreatitis is distinguished from acute pancreatitis based on structural and functional differences. In acute pancreatitis, the gland is normal prior to the attack, and returns to normal after an acute attack, while in chronic pancreatitis, the gland is already in an abnormal state prior to or following an attack or prior to and following an acute attack. The most common local complication of chronic pancreatitis is the formation of pseudocysts. Psedocysts are usually formed due to passage obstruction of the pancreatic tract (retention cyst) or due to recurrent acute exacerbation Several pancreatic abnormalities, such as stones, ductal stricture, fluid collection, and functional sphincter abnormality, could be treated using endoscopy. Adjuvant treatment for biliary duct abnormality such as biliary stricture due to pancreatitis, and stent insertion in cases of duodenal obstruction, could also be performed via endoscopy Keywords: Chronic pancreratitis, tropical pancreatitis, treatmen
Management of Duodenal Ulcer with Gastroesophageal Reflux Disease (GERD) with Intravenous Pantoprazole
No full textProton pump inhibitors (PPIs) are the most effective anti secretory drugs available for controlling gastric acid acidity and volume. They are the drug of choice in the treatment for gastro esophageal reflux disease (GERD), Helicobacter pylori eradication, peptic ulcer and non steroidal anti-inflammatory drug (NSAID) gastropathy: For acute cases, an intravenous PPI is needed, especially for hospitalized patient. Recently, intravenous pantoprazole represents an alternative to intravenous histamine-2 receptor antagonists. We observed 2 patients who were treated with pantoprazole for duodenal ulcer, where one case had a complication of bleeding with a history of long term use of NSAID. After two weeks of treatment with pantoprazole, significant lesion healing from endoscopy findings was achieved in both cases. Keywords: peptic ulcer, upper gastrointestinal bleeding, proton pump inhibitors, pantoprazol
Diagnostic Findings and ERCP Treatment in Patients with Obstructive Jaundice during two years at H. Adam Malik Hospital, Medan
No full textBackground: The methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bile duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP during a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of 10 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCP, the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (2.8%), bile duct stone 46 cases (43.4%), carcinoma of ampula vater 20 cases (18.9%), CBD tumor 7 cases (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (3.8%), duodenal tumor 1 case (0.9%), carcinoma of ampula vater and bile duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure 16 cases (15.1%). The patients receivied the following treatment: sphyncterotomy 36 cases (51.4%), stent application 11 cases ( 15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases (7.1%). Keywords: ERCP, obstructive jaundic
Management of Paralytic Ileus
No full textIleus is a pathophysiologic state of inhibited motility in the gastrointestinal tract due to a physical/ anatomic obstruction in the lumen (obstructive ileus) or due to cessation of smooth muscle motor activity in the small intestine and colon. In Internal Medicine, paralytic ileus is most commonly caused by peritonitis, which is most often caused by acute pancreatitis. To establish a diagnosis, several diagnosis evaluation procedures may need to be performed such as laboratory evaluation, radiologic examination, ultrasonography and CT examination. Management of paralytic ileus is aimed at the underlying disease and supportive therapy. With this management paralytic ileus will spontaneously remit. Keywords: paralytic ileus, pathogenesis, diagnosis, managemen
A Randomized Trial Comparing The Effect of Soy Protein Diet Supplement Versus Hospital Standard Supplement on Clinical and Laboratory Parameters in Malnutrition Patients
No full textBackground: Studies have shown that soy protein diet may improve clinical nutrition status of malnutrition patients. Soybeans itself are unique foods because of their rich nutrient content. The complete nutrient in soybean is important and also offers many health benefits especially in malnutrition patient during hospitalization. Objective: The objective of this study was to assess the effect of soy protein supplement and hospital standard supplement (animal protein) on anthropometries and laboratory findings in malnutrition patients during hospitalization. Method: Forty-eight patients with malnutrition (confirmed by Body Mass Index < 20 kg/m2) aged 14- 70 years old were recruited from Internal Medicine wards in Cipto Mangunkusumo hospital, Jakarta, Indonesia. The study design was randomized controlled trial. The subjects were randomly divided into 2 groups were fed supplement diet contained soy protein supplement diet (40 g/d) or hospital standard supplement (40 g/d) for 2 weeks. Body weight was measured in the first day (base line data), 7-dayand 14-day after intervention. Blood and urine was collected at baseline, 7-day and 14-day for measuring transferin, prealbumin and nitrogen balance. The intake of supplement, gastrointestinal symptoms and others adverse event were noted every day. Result: From 48 subjects, there were only 32 patients that completed the study during 2 weeks. In the base line data there were no significant different for intake diet calculation, anthropometrics and laboratory parameters in study group and control group. A total of patients 32 consist of 20 (62,5 %) female and 12 (37,5%) male with a mean age 31,8 + 12,9 years old. Anthropometrics evaluation after 1 week and 2 weeks intervention in soy protein supplement showed significantly increased every week in 2 weeks. In control group, significantly increased showed only after two weeks intervention. But there was no significantly increased of BMI of two groups. Serum transferin concentration increased from 1,489 ± 0,502 at base line to be 1,600 ± 0,502 at week 1 and to bel, 695 ± 0,402 in study group. But this increasing was no significantly between two groups. No significant differences were found between two groups for prealbumin level after 1 week and 2 weeks intervention. Nitrogen balance improved significantly (p<0,05) more with soy protein supplement than hospital standard supplement (animal protein). In this study, there was no side effect in soy protein supplement diet and 1 case with diarrhea and nausea in hospital standard supplement (animal protein) Conclusion: Soy protein supplement diet improved both of nutrition parameter: anthropometrics and laboratory parameter. There were no significantly different in anthrometrics and laboratory parameter berween soy protein supplements tahan hospital standar supplement (animal protein). But nitrogen balance improved significantly in study group than control group. Substitution of soy protein for animal protein has the potential role for the patient with malnutrition Keywords: Soy protein diet, Malnutritio
Spontaneous Bacterial Peritonitis
No full textInfected ascites is one of the complication happened in liver cirrhotic patient in ascites. There are 5 infected ascites classifications i.e. Spontaneous Ascites Infection Consist of Spontaneous Bacterial Peritonitis, Monomicrobial Non Neurocytic Bacteriascites, Culture Negative Neurocytic Ascites, Secondary Bacterial Peritonitis and Iantrogenic Polimicrobial Bacterascites. Spontaneous Bacterial Peritonitis (SBP) is the infection in ascites without unrecognized intra abdominal infection source.The normal floras in the gastrointestinal, respiratory or urinal tract are the important infection source in SBP. As we know that normal ascites has ability to kill micro organism through phagocitosis function, opsonization, but when infected occurs ; phagocitosis function, opsonization, and MPS could be worst so that the possibility of being SBP increased. The common frequently sign and symptom of SBP are fever, abdominal pain, consciousness assault, tenderness, diarrhea, paralytic ileus, hypotension and hypothermia. Some of the invasive actions like endoscopy, variceal sclerotherapy and ligation may cause intestine flora translocation to mesenteric gland, bacterimia and infected ascites also made transmural passage intestine micro organism to ascites may cause infected ascites. Cefotaxime is the antibiotic that more frequently studied to SBP patient. The dose of cefotaxime to SBP patient show that 2 gram/6 hours and 2 gram/12 hours injected produce SBP resolution and the same survival, besides that 2 gram/8 hours injected for 5 and 10 days also show the same effectively. The antibiotic prophylaxis such as quinolon group show the effective result in liver cirrhotic with the gastroentestinal tract bleeding and low total protein (<1 gram/dl ) or has the SBP experience patients
Irritable Bowel Syndrome: Diagnosis and Treatment
No full textIrritable bowel syndrome (IBS) is the most common functional disorder of the gastrointestinal tract. As a result of the lack of specific diagnostic testing and absence of circumscribed biology markers of the disease, its diagnosis is based on a myriad of symptoms. The term irritable bowel syndrome was probably first coined in 1944 by Peters and Bargen. In 1849, Cumming described the clinical manifestations of Irritable Bowel Syndrome. Irritable bowel syndrome is defined on the basis of the recently modified Rome criteria as the presence of at least 12 weeks (not necessarily consecutive) of abdominal discomfort or pain in the preceding 12 months that cannot be explained by structural or biochemical abnormalities, and that has at least two of the following three features: pain relieved with defecation, an onset associated with a change in the frequency of bowel movements (diarrhea or constipation), or an onset associated with a change in form of stool (loose, watery, or pellet-like). The syndrome can be divided into three subcategories according to the Modified Rome criteria II; those with a predominant symptom of diarrhea, constipation, or constipation alternating with diarrhea. There are several criteria for irritable bowel syndrome, one of which is the Manning criteria, applied in many epidemiological and clinical studies to identify irritable bowel syndrome. However, many investigators disagree with this criteria due to a seemingly poor validity in men. In an attempt to bring order to the specialty, consensus-based approach is adopted by a group of international experts, which led to the development of the Rome criteria for irritable bowel syndrome (Table 1). Extra-intestinal symptoms, including headache, backache, urinary and gynecologic symptoms, and fatigue, are more common in the constipation-predominant subgroup
The Role of Ascitic Paracentesis in Liver Cirrhosis in Improving the Function and Structure of the Heart
No full textBackground: Heart abnormalities in cirrhotic patients have been known for five decades, with atria and ventricular dilatation. Pozzi et al reported that in cirrhotic patients with or without ascites, the diastolic function was lower than control. Ascitic paracentesis improved diastolic function. The diameter of both atria was larger in cirrhotic patients with or without ascites. The diastolic diameter of left ventricle did not differ significantly in cirrhotic patients with or without ascites compared to control, but there was an increase after paracentesis. Ejection fraction was lower in cirrhotic and increased after ascitic parancentesis although the increase was not significant. The aim of the Study: To compare the function and structure of the heart before and after ascitic paracentesis in cirrhotic patients. Methods: This study took place from February 2000 to April 2001 in dr. Pringadi Hospital/H.Adam Malik Hospital. There were 18 samples (12 men and 6 women), 15 of which were cirrhotic patients with tense ascites and 3 cirrhotic patients with refractory ascites. The mean age was 51,8 + 8,28 years, the youngest being 29 years and the oldest 65 years. The mean ascitic fluid removed by paracentesis was 7,20 liters with a range of 5 to 9 liters. Immediately following paracentesis, Dextran 40 % was administered at a dose of 8g/ 1L ascitic fluid aspirated. Results: The diameter of the four heart chambers decreased after paracentesis, but the decrease was not statistically significant. There was increase in E/A ratio after ascitic paracentesis, from 0,93 + 0,370 to 1,06 + 0,383 (significant, p<0,05), meaning that there was an improvement in diastolic function after ascitic paracentesis. There was also an increase in ejection fraction from 68,99 + 13,26 % to 72,10 + 11,10 %, but this was not significant (p>0,05). Conclusion: After paracentesis, there was a significant improvement in diastolic function while the diameter of the four heart chambers decreased and the ejection fraction increased insignificantly. Keywords: Ascitic paracentesis - liver cirrhosis - heart function and structure