Case Report: A 31-year-old Post Cesarean Section Women with Intrahepatic Cholestasis of Pregnancy and Post Partum Bell’s Palsy

Intrahepatic cholestasis of pregnancy (ICP) is cholestasis condition characterized by pruritus, elevated serum aminotransferase and bile acid levels with onset in the second or third trimester of pregnancy. Estimated of ICP prevalence only 0.001% to 0.3%. Bell's Palsy is a neurological disorder that causes facial muscles on one side of the face to suddenly weaken or become paralyzed. Bell's Palsy is more common in young adults, older people, diabetics and pregnant women. A 31-year-old women with major complaint is yellow eyes. She got itching  in all over the body. Patient was in second pregnancy with gestational age was 39-40 weeks. She suffered from unable to close her eyelid or blink. Patient was diagnosed with cholestasis intrahepatal in pregnancy and Bell’s palsy post partum. Diagnosis was established concluded from anamnesis, physical examination and hepar biopsy. The result of a liver biopsy showed intrahepatic cholestasis. From Fibroscan examination was visible with F2 category or Moderate Fibrosis. The main management of this patient is cesarean section with UDCA and corticosteroid therapy. Patient was administrated with antiviral therapy for her Bell’s Palsy condition. After 1 week hospitalization, patient was discharged with improvement of her major complaint

An 18-Year-Old Man with Idiopathic Non-cirrhotic Portal Hypertension

Non-Cirrhotic Portal Hypertension (NCPH) is a rare cause of hematemesis and melena. Like in cirrhotic patient, hematemesis in NCPH patient was caused by rupture of esophageal varices. But unlike in cirrhotic patient, in NCPH there are no sign of liver failure, because liver physiology is still normal. We reported case of male patient with NCPH that had hematemesis because of rupture of esophageal varices

The Association of COVID-19 Degree on Transamination and Bilirubin Levels of COVID-19 Patients in RSUD Dr. Saiful Anwar Malang

Background : Corona virus 2019 (COVID-19) is an infectious viral disease caused by SARS-CoV-2 that has infected the world. COVID-19 can cause abnormalities which are characterized by increased levels of the enzyme transaminase and bilirubin. Research on the association between transaminase enzymes and bilirubin is still limited, further research is needed on the association between the degree of COVID-19 and levels of the transaminases and bilirubin enzymes. Aim: To determine the association between liver function on the degree of severity and outcome of COVID-19 patients. Method: This was the cross-sectional study. Sampling method was using consecutive sampling at RSUD Dr. Saiful Anwar Malangwho was treated from June 1st 2021 until November 31st 2021 by the Department of Internal Medicine. Statistical analysis used the Kruskal Walllis and Mann Whitney test with a significance level of p<0.5% and correlation analysis using Spearman. Result: Among 90 patients included in this study there was a strong positive correlation between the degree of COVID-19 and levels of SGOT (r=0.954, p <0.001) and SGPT (r=0.727, p <0.001) and according to regression test, SGOT has the positive correlation towards degree of COVID-19 severity (p=0.026 CI95%: 0.002-0.028). There was a correlation between the degree of COVID-19 and the total bilirubin level (r=0.586, p=0.011). There was no correlation between levels of transaminase enzymes, total bilirubin, direct and indirect bilirubin on the patient's outcome (p>0.050). Conclusion: There is a positive correlation between the degree of COVID-19 with levels of the enzyme transaminases, indirect and total bilirubin

The Prevalence, Profile, and Risk Factor of Patients with Ulcerative Colitis at Dr. Saiful Anwar Malang General Hospital

Background: The prevalence ulcerative colitis (UC) in RSCM Jakarta in 1991-1995 is 2.5%. The disease affects men and women at similar rates or slightly more common in women than in men. Age of onset follows a bimodal pattern, with a peak at 15-25 years and a smaller one at 55-65 years, although the disease can occur in people of any age. The precise etiology of UC is not well understood. UC is precipitated by a complex interaction of environmental (cigarretes, diet, non-steroidal anti-inflammatory drug/NSAID, etc), genetic, and immunoregulatory factors. This study aimed to identify the prevalence, profile and risk factor of ulcerative colitis in Dr. Saiful Anwar General Hospital Malang.Method: This is a retrospective survey analysis from medical record which was taken from 2170 patients who underwent colonoscopy in Dr. Saiful Anwar General Hospital Malang from January 2010 to December 2014. Demographic setting (sex, age), clinical features, lifestyle, diagnosis based on colonoscopy were analyzed as the variables.Results: Total patients with UC was 176 patients. The prevalence of UC during 2010-2014 was 8.2% at Dr. Saiful Anwar General Hospital. There was a similar prevalence of sex between male and female patients, in which 95 (53.4%) were male and 81 (46.6%) were female. The average age of patients with UC was 41,6 years. Most patients were presented with abdominal pain (32.90%) and weight loss (42.1%). The diagnosis based on colonoscopy were pancolitis (36%), proctosigmoiditis/proctitis (31.81%), and left-sided colitis (21.9%). The risk factors of UC identified in this study were current smoker, use of NSAIDs/traditional herbs/potion and fiber diet. Majority of ulcerative colitis study samples were non-smoker (75%), not consuming herbal treatment/NSAID (60.22%), and rarely consuming fiber (36.93%). There is a significan correlation between frequency of fiber diet and UC (r = -0.106,  p = 0.000).Conclusion: The prevalence of UC was 8.2%  in our hospital with men and women were equally affected, and average age was 41.6 years. Patients presented with various clinical symptoms, most are abdominal pain and weight loss. The most frequent diagnosis were pancolitis, proctosigmoiditis/proctitis, and leftside colitis. There is a significant correlation between frequency of fiber diet and UC (r = -0.106,  p = 0.000).Keywords : ulcerative colitis, prevalence, profile, risk factor

Lung Abnormalities in Liver Cirrhosis

Regardless of preexisting lung illness, patients suffering from liver cirrhosis, especially decompensated liver cirrhosis can develop distinct pulmonary complications. Liver cirrhosis patients should be assessed for hepatopulmonary syndrome (HPS), portopulmonary hypertension (PoPH), hepatic hydrothorax (HH) and spontaneous bacterial empyema (SBEM)  which are the most clinically significant pulmonary consequences, in particular when dyspnea develops in conjunction with hepatic cirrhosis. These entities differ in terms of pathophysiology, clinical characteristics, diagnosis and suitable treatment options. This emphasize the need of specific diagnostic algorithm in liver cirrhosis patients presenting with dyspnea or other pulmonary symptoms. These pulmonary complications might be rare in patients with liver cirrhosis and portal hypertension but these complications might carry significant morbidity and mortality risks and, therefore, strong clinical suspicion is required to make an early accurate diagnosis. There are several medical therapies available for each condition in the multiple studies but most of the treatments and proceures doesn’t have significant benefit or have short lived benefit. The only treatment that changes the clinical prognosis of decompensated cirrhosis effectively in long term is liver transplantation. However liver transplantation also needs careful considerations as on some cases it might increase the risk of morbidity and mortality.   Keywords:  Cirrhosis Hepatis, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic Hydrothorax, Spontaneous Bacterial Empyem

Comparison of HBV DNA Quantitative Log in Patients Hepatitis B with Telbivudine Therapy Compared with Tenofovir Therapy in Saiful Anwar General Hospital Malang: January 2016 - December 2017

Background: Hepatitis B is a health problem with high endemic in Indonesia. Hepatitis B virus infection is transmitted parenterally, has a risk of liver cirrhosis and hepatocellular carcinoma. Detection and quantification of HBV DNA are markers of active HBV replication and determine treatment options for hepatitis B. Methods: compare log reduction of HBV DNA in patients treated with Telbivudine and Tenofovir. Results: There was no significant difference in HBV DNA levels between before and after Tenofovir treatment, namely 6 months follow-up (OR 95% CI = 5.41 [0.83 - 35.16], p = 0.0770) and 12 months (OR 95% CI = 5.39 [0.83 - 34.99], p = 0.0780). Telbivudine administration showed a significant difference in HBV DNA levels between before and after treatment at 6 months follow-up (OR 95% CI = 13.69 [4.53 - 41.40], p = 0.0001) and 12 months (OR 95% CI = 13.69 [ 4.53 - 41.41], p = 0.0001). Comparison of Tenofovir and Telbivudine therapy showed no significant difference at 6 months follow-up (OR 95% CI = 0.44 [0.10 - 1.88], p = 0.2690) but significant at 12 months follow-up (OR 95% CI = 6.23). [1.39 - 27.97], p = 0.0170). Conclusion:  There was a significant difference between the administration of Telbivudine as a treatment for hepatitis B with lower serum HBV DNA levels compared with the administration of Tenofovir at 12-month follow-up therapy

Barrett’s Esophagus

Gastroesophageal reflux disease (GERD) is a condition commonly managed in the primary care setting. Patients with GERD may develop reflux esophagitis as the esophagus repeatedly is exposed to acidic gastric contents. Over time, untreated reflux esophagitis may lead to chronic complications such as esophageal stricture or the development of Barrett’s esophagus (BE). BE may progress to oesophageal adenocarcinoma. There is currently a rising incidence of BE. The pathogenesis of BE is not well-understood although genetic and environmental factors play significant roles. BE is characterized by the replacement of distal esophageal stratified squamous epithelium by columnar epithelium. It is rare in children and the risk factors may include mental retardation, cerebral palsy, esophageal atresia, etc. As patients with BE can be entirely asymptomatic, it is difficult to screen this population group. BE is present in 10%–20% of patients with GERD and has also been detected in patients who deny classic GERD symptoms and are undergoing endoscopy for other indications

Reactivation of Hepatitis B Infection During the Cause of Non Hodgkin\u27s Lymphoma Chemotherapy

Hepatitis due to hepatitis B virus (HBV) reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. Frequently used combination regimens in Non-Hodgkin\u27s lymphoma are cyclophosphamide, hydroxydaunomycin (adriamycin), vincristine (oncovin), and prednison (CHOP). The use of rituximab, a monoclonal antibody targeting CD20 antigen present in benign and Malignant B-cells, in combination with systemic chemotherapy has resulted in an improved duration of remission and survival for this patients. Rituximab is a HBV reactivation risk factor even greater than corticosteroids in a series of patients with lymphoma treated with combined-modality treatment (CMT).A 43 years old female patient who already diagnosed with Non-Hodgkin\u27s lymphoma, came with chief complain nausea and vomiting for three weeks. The patient recently got hospitalized with icteric and known have positive HBsAg. She received chemotherapy rituximab CHOP (R-CHOP) for four times and got rituximab in the last chemotherapy. Previously she had icteric and increased liver function test. After exclude other possibility causes this symptom and sign, it was concluded this is HBV reactivation. The chemotherapy was postponed until this reactivation of hepatitis B resolved and start giving lamivudine two weeks before reintroduce chemotherapy