Perbandingan Penyekat Pompa Proton Rute Intravena Intermiten dan Intravena Drip Kontinu Pada Tatalaksana Perdarahan Saluran Cerna Atas Nonvariseal

Perdarahan Saluran Cerna Atas (PSCBA) non variseal merupakan keadaan darurat yang membutuhkan penanganan cepat serta diberikan terapi yang tepat. Salah satu terapi yang direkomendasikan adalah Penyekat Pompa Proton (Proton Pump Inhibitor/PPI). Studi ini akan membandingkan kedua rute pemberian PPI yaitu esomeprazole baik dengan rute intravena intermiten maupun intravena drip kontinu dengan parameter kejadian perdarahan dan lama rawat inap pasien. Penelitian ini menggunakan metode kohort retrospektif dengan pengambilan data melalui data rekam medis dari tahun 2019-2022. Hasil yang didapatkan terdapat 48 kasus pemberian esomeprazole, 31 kasus dengan intravena intermiten dan 17 kasus dengan intravena drip kontinu. Laki-laki memiliki persentase yang lebih tinggi dibandingkan perempuan pada kedua kelompok pemberian. Rentang usia 18-69 tahun memiliki persentase yang lebih tinggi pada kedua kelompok. Kejadian perdarahan intravena intermiten lebih rendah dibandingkan intravena drip (29% vs 58,8%, p=0,04). Namun, berbeda halnya dengan lama rawat inap dimana intravena drip kontinu memiliki rerata lama rawat inap yang lebih rendah dibandingkan intermiten (2,5 hari vs 4,7 hari, p=0,05). Perbandingan antara keduanya perlu dilakukan penelitian lebih lanjut dengan jumlah sampel yang lebih besar

Correlation Between the Severity of Liver Cirrhosis (Chil-Pugh Score) and QTc Interval Prolongation

Background:Liver cirrhosis causes changes in cardiovascular system. Electrographic (ECG) abnormality commonly found in cirrhosis patients is QT interval prolongation. It is part of cirrhotic cardiomyopathy. QTc interval prolongation is correlated to the incidence of life-threatening arrhythmias. The objective of this study was to recognize the correlation between the severity of liver cirrhosis and QTc interval prolongation in patients with liver cirrhosis at Sardjito General Hospital, Jogjakarta.Method: The design of this study was cross-sectional. The subjects were hospitalized patients with liver cirrhosis at the Department of Internal Medicine, Sardjito Hospital, Jogjakarta between January 2011 and March 2012. ECG was performed in all patients and QTc interval was measured. The severity of liver cirrhosis was determined by Child-Pugh score. Spearman correlation analysis was used to determine the correlation between variables of QTc interval prolongation and Child-Pugh score.Results: A total of 73 patients were enrolled, including 51 (69.9%) male and 22 (31.1%) female patients with mean age of 54.05 ± 12.55 years (range 20-80). Liver cirrhosis was caused by hepatitis B virus in 36 (49.3%) patients, hepatitis C virus in 20 (27.4%) patients and other causes in 19 (26%) patients. The Child-Pugh score for liver cirrhosis was found as follows: child A in 10 (13.6%) patients, child B in 27 (36.9%) patients and child C in 36 (49.3%) patients. The correlation between the severity of liver cirrhosis and QTc interval prolongation was weak (r = 0.255; p = 0.029).Conclusion:Severity of liver cirrhosis has a weak positive correlation with QTc interval prolongation

THE DIFFERENCE OF TRANSAMINASE LEVEL IN GALLSTONES LOCATION OF GALLSTONE PATIENTS IN RSUP DR SARDJITO

ABSTRACT Background: Gallstone can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. To identify a biliary etiology, several biochemical investigations have been proposed including bilirubin, ALT, AST, GGT, and alkaline phosphatase. Objectives: To know the difference between the location of gallstones and the level of transaminase. Method: The data of cholelithiasis patient is collected by analysing the medical records obtained from RSUP Dr. Sardjito in 2010 to 2013. The medical record chosen is cholelithiasis patients who were diagnosed by the internist and undergo surgery to remove the stones and classified into cholelithiasis, choledocholithiasis and both cholelithiasis and choledocholithiasis. The data is analysed by using computer. Result: Shapiro-Wilk Test is used for normality test. The difference of transaminase level based on gallstones location was analysed using Kruskal-Wallis H Test. In SGOT, there is statistically significant difference between the gallstone location, (H=18.84,p=0.000), with a mean rank of 52.69 for cholelithiasis, 88.88 for choledocholithiasis, 87.21 for cholelithiasis and choledocholithiasis. In SGPT, there is a statistically significant difference between the three groups of gallstone location, (H=13.52,p=0.001), with a mean rank of 55.61 for cholelithiasis, 81.17 for choledocholithiasis, 86.29 for cholelithiasis and choledocholithiasis. Conclusion: Based on the study, there is difference in the value of SGOT and SGPT according to the gallstones location

THE DIFFERENCE OF ALKALINE PHOSPHATASE, BILIRUBIN,AND GAMMA GLUTAMYL TRANSFERASE LEVEL IN DIFFERENT GALLSTONE LOCATION OF GALLSTONE PATIENT IN RSUP DR SARDJITO.

Background : In daily practice, it is difficult to differentiate between cholelithiasis and choledocholithiasis patients by clinical symptoms. Even though obstructive jaundice usually happen in choledocholithiasis, but it can also being absence. This problem can lead to underdiagnosis and cause the stone to be remain in the bile duct even after operation. The biochemical testing such as bilirubin, alkaline phosphatase and gamma glutamyl transferase can indicate biliary obstruction. Aim : The aim is to evaluate the difference in biochemical marker which are bilirubin, alkaline phosphatase and gamma glutamyl transferase at different gallstone locations in cholelithiasis and choledocholithiasis patients. Method : 88 patients from surgery department are selected for this research. The subjects are divided into two groups which are patients with choledocholithiasis (n=11) and cholelithiasis (n=77). For total bilirubin, 75 cholelithiasis and 11 choledocholithiasis are selected. While 28 cholelithiasis and 7 choledocholithiasis patients for difference in alkaline phosphatase and 18 cholelithiasis and 7 choledocholithiasis patients for difference in Gamma Glutamyl Transferase. The liver marker level were taken maximum one week before the operation. Results : Significant different was found in Bilirubin and ALP P < 0.05 . Overall, the median shows that the level of Bilirubin and ALP is higher in choledocholithiasis if compared with cholelithiasis patients. While no significant different in Gamma Glutamyl Transferase was found P > 0.05. Eventhough overall median results shows that the level of GGT in choledocholithiasis is higher than in cholelithiasis but some low ranks and some high ranks will occur in each group, that is the ranks will be distributed across the two group which are cholelithiasis and choledocholithiasis more or less evenly. Conclusion : In a conclusion, only bilirubin and alkaline phosphatase level have a significant difference in different gallstone location

LEUKOCYTOSIS AND NEUTROPHILIA AS PREDICTIVE FACTORS OF ACUTE ON CHRONIC CHOLECYSTITIS A Graduating Paper

Background: Acute cholecystitis could progress into chronic cholecystitis, and acute exacerbations of chronic cholecystitis could occur (acute on chronic cholecystitis). Neutrophilia is one of the systemic features of acute inflammation. Typically, leukocytosis in the range of 10,000-15,000 cells per microliter with a left shift on differential count is found. Leukocytosis and neutrophilia were chosen to be studied if they can be predictive factors of acute on chronic cholecystitis. Objectives: The objective of this research is to search whether leukocytosis or neutrophilia can become the predictive factors of acute on chronic cholecystitis. Method: The study design of this research is a retrospective cross-sectional study. The study was conducted among acute cholecystitis and acute on chronic cholecystitis patients with cholelithiasis from year 2010-2013. It was conducted using medical records and laboratory reports of the patients in Sardjito Hospital, Yogyakarta. The data was analysed using computerized analysis. Results: Leukocytosis is a predictive factor of acute on chronic cholecystitis, however, it is not statistically significant (PR=2.364, p=0.129). Neutrophilia is a predictive factor of acute on chronic cholecystitis but is not statistically significant (PR=2.250, p=0.174). Conclusion: Leukocytosis and neutrophilia are not the predictive factors of acute on chronic cholecystitis

Tuberculosis Peritonitis Patient with Septic Shock caused by Extended–Spectrum Beta Lactamases Producing Pseudomonas Aeruginosa

According to World Health Organization (WHO), tuberculosis (TB) is a worldwide pandemic. Up to 5% of patients with TB may have abdominal disease and 25-60% may have peritoneal involvement. Diagnosis of TB peritonitis is still challenging, and symptoms are usually insidious. The sensitivity of acid fast bacilli (AFB) is very low, ranging from 0-6%. Conventional mycobacterial culture takes up to 8 weeks to achieve results. Laparoscopic or laparotomy biopsy is uncomfortable for patient. The consequence of these problems is missing and delays in diagnosing TB peritonitis. In the end, it can results in significant morbidity and mortality. This case described a 20 year old female patient with TB peritonitis that suffered from septic shock caused by extended-spectrum beta lactamases (ESBL) producing Pseudomonas aeruginosa.  In this case, TB peritonitis was diagnosed based on clinical features, high levels of adenosine deaminase (ADA) and a positive rapid DNA test with Xpert MTB/RIF.  Keywords: tuberculosis peritonitis, extended-spectrum beta lactamases producing bacilli, adenosine deaminase, XpertMTB/RIF assa

Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment

Background: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices.   Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxi