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GAMBARAN PERLEMAKAN HATI NON-ALKOHOLIK DI RSUP SANGLAH DENPASAR PERIODE TAHUN 2017-2018 Timothy Subroto, Derryl Ravertio; Mariadi, I Ketut
E-Jurnal Medika Udayana Vol 8 No 2 (2019): Vol 8 No 2 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Perlemakan hati (fatty liver, disingkat FL) merupakan penyakit yang paling sering terjadi di negara-negara barat. Diabetes Melitus (DM) adalah penyakit metabolik kronis yang terjadi akibat gangguan fungsi pankreas dalam menghasilkan insulin atau tubuh tidak dapat menggunakan insulin (resistensi insulin). Resistensi insulin yang disebabkan oleh T2DM juga dapat menjadi penyebab dari NAFLD ini. Selain itu, pasien T2DM juga berpotensi mengidap fibrosis dan sirosis, akibat perkembangan penyakit NAFLD. Studi ini adalah studi deskriptif potong lintang (cross-sectional). Sampel yang digunakan adalah seluruh populasi terjangkau yang diambil dari rekam medis. Data kemudian diolah menggunakan analisis deskriptif. Hasil penelitian diperoleh 13 sampel dengan reratausia 49,62 tahun (SD ± 9,57) dan penderita terbanyak pada kelompok umur 50-59 tahun. Didapatkan 8 penderita dengan indeks massa tubuh (IMT) berlebih (IMT ?23) (61,5%), dan 5 orang dengan IMT tidak berlebih (<23) (38,5%). Selain itu, hanya 2 penderita (15,4%) yang menderita diabetes melitus dan NAFLD, dan 11 orang sisanya (84,6%) tidak menderita diabetes melitus. Berdasarkan hasil penelitian yang sudah dilakukan disimpulkan bahwa jumlah penderita NAFLD pada RSUP Sanglah periode 2017-2018 sebanyak 13 kasus, dengan rerata usia 49,62 tahun ( ± SB 9,57), 61,5% dengan IMT berlebih (?23), dan 15,4% menderita diabetes melitus. Kata Kunci : Gambaran, Berat Badan Lebih, NAFLD, DM Tipe 2, RSUP Sanglah.
HUBUNGAN ANTARA KLASIFIKASI CHILD-TURCOTTE-PUGH DENGAN DERAJAT VARISES ESOFAGUS PADA PASIEN SIROSIS HATI DI RUMAH SAKIT UMUM PUSAT SANGLAH Surya Ardiana, I Wayan; Mariadi, I Ketut
E-Jurnal Medika Udayana Vol 8 No 11 (2019): Vol 8 No 11 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

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Abstract

Varises esofagus (VE) merupakan komplikasi utama dari pasien sirosis hati. Sirosis hati diklasifikasikan menggunakan klasifikasi Child-Turcotte-Pugh (CTP) untuk menentukan prognosis dan mortalitasnya. Penelitian sebelumnya menemukan peningkatan prevalensi VE pada pasien dengan kelas CTP A, B, C secara berturut-turut. Namun, hubungan antara antara CTP dengan VE masih belum jelas. Tujuan penelitian ini untuk menentukan hubungan antara kelas CTP dengan kejadian VE dan derajat VE pada pasien sirosis hati. Penelitian ini merupakan studi cross-sectional yang diikuti oleh 90 pasien terdiagnosis sirosis hati di Rumah Sakit Sanglah dari April 2016 - Agustus 2017. Analisis statistik dikerjakan dengan uji chi-square, dan uji Kruskal-Wallis H non-parametric dengan nilai-p < 0,005 dianggap secara statistik signifikan. Hasil penelitian menunjukan dari 90 pasien, 71 (78,9%) laki-laki dan 19 (21,1%) perempuan. Rerata umur sampel 54±13 tahun, dengan rentangan 28-91 tahun. Kelas CTP teridentifikasi 20 (22,2%) kelas A, 45 (50%) kelas B, dan 25 (27,8%) kelas C. VE teridentifikasi 65 kasus(72,2%). prevalensi VE pada setiap kelas CTP ditemukan 10 (50%) pada kelas A, 34 (75,6%) pada kelas B, dan 21 (84%) pada kelas C. Uji Chi-square antara kelas CTP and kejadian VE ditemukan hasil signifikan (p=0,032) dengan OR=3,667 dan IK95% =1,288-10,437. Namun, uji Kruskal-Wallis H nonparametric tidak ditemukan hubungan yg signifikan antara kelas CTP dan derajat VE (p=0,168). Disimpulkan bahwa kelas CTP yang lebih tinggi pada pasien sirosis hati berhubungan dengan kejadian VE, namun tidak berhubungan dengan derajat VE Kata kunci: child-turcotte-pugh, varises esofagus, sirosis hati
Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Budiyasa, Dewa Gde Agung; Ariawan, Yuna; Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Purwadi, Nyoman; Suryadarma, I Gusti Agung
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p < 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis.   Keywords: albumin, degree of EV, liver cirrhosis
Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia Koncoro, Hendra; Mariadi, I Ketut; Somayana, Gde; Suryadarma, IGA; Purwadi, Nyoman; Wibawa, IDN
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Upper gastrointestinal (UGI) malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI malignancy. This study was aimed to determine the prevalence of UGI malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age > 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age >45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI malignancy.Keywords: dyspepsia, alarm symptoms, upper GI malignancy, clinical prediction model
HUBUNGAN ANTARA INTERLEUKIN- 6 DAN C-REACTIVE PROTEIN PADA SIROSIS HATI DENGAN PERDARAHAN SALURAN MAKANAN BAGIAN ATAS Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Variceal bleeding is a frequent complication of liver cirrhosis. Upper gastrointestinal (GI) bleeding is a risk factor forinfection. The severity of liver cirrhosis was correlated with infection and GI bleeding. Bacterial infection and endotoxin promotecytokine proinflammation (IL-6) release from monocyte. IL-6 stimulates the liver to produce CRP. Does liver cirrhosisaffect the CRP production? Recently, there are no data about the correlation of IL-6 and CRP in liver cirrhosis with uppergastrointestinal bleeding. A cross-sectional analytic study was performed to describe the correlation between IL-6 and CRP inliver cirrhosis patient with upper gastrointestinal bleeding.We performed a cross-sectional analytic study in 52 liver cirrhosis patients. The liver cirrhosis patients with uppergastrointestinal bleeding in last 14 days, absence of steroid and statin treatment, without hepatoma, and GFR 15 ml/mnt/1.73m2, were collected consecutively. The correlation of IL-6 and CRP was analyzed with Pearson correlation test, mean differenceof CRP between Child Turcotte Pugh (CTP) group was analyzed by Ancova test continued with post hoc Tamhane test, the effectof CTP on CRP production was analyzed with Ancova test.Seventy-five percent out of 52 samples were male and the rest were female. Two of them (3.8%) with CTP score A, 20(38.5%) CTP score B and 30 (57.7%) CTP score C. Mean of IL-6 was 28.29 ± 34.60. Mean of CRP was 17.17 ± 28.80 mg/L. Wefound strong positive correlation between IL-6 and CRP (r = 0.610; p<0.001). CTP score didnt have significant independenteffect on correlation of IL-6 and CRP level (F=2.33; p=0.108). Significant mean difference of CRP was found between CTP scoregroup (F=4.27; p=0.02).In conclusion, Interleukin-6 has a strong correlation with CRP in liver cirrhosis with upper GI bleeding. CRP level issignificantly higher in severe liver cirrhosis. And the degree of liver damage doesnt have significant independent effect oncorrelation of IL-6 and CRP level. These results show us that hepatocyte in liver cirrhosis still adequately produce CRP.
PERKEMBANGAN TERKINI DALAM DIAGNOSIS DAN PENATALAKSANAAN IRRITABEL BOWEL SYNDROME Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) motility and sensory disorder that ischaracterized by abdominal pain/discomfort, bloating and altered bowel habit. The disease accounts for hugecosts for both patients and health-care systems and worsens significantly patients’ quality of life. Diagnosis isbased on the identification of symptoms according to Manning, Rome I and Rome II criteria and the most recentRome III criteria and exclusion of alarm indicators. The treatment of IBS is centred on an excellent doctor–patient relationship along with drugs targeting the predominant symptom, especially during exacerbations. Thisreview aim to explain new ctriteria to diagnose IBS and to conduct a systematic evidence-based review ofpharmacological therapies currently used, or in clinical development, for the treatment of IBS
Association Between Red Cell Distribution Width (RDW)/Platelet Ratio and Degree of Fibrosis in Patient with Chronic Hepatitis B Mirdania, Yaditta; Mariadi, I Ketut; Wibawa, IDN
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (312.851 KB) | DOI: 10.24871/191201820-24

Abstract

Background : Histological examination of the liver remains the  gold standard of assessing liver cirrhosis. However, this examination is an invasive method with many complications.Objectives : This study aims to determine the relationship between degree of liver fibrosis with RDW (Red cell Distribution Width) / platelet ratio which can then be used as non invasive  diagnostic method of liver fibrosis. Methods : This was a retrospective study, the data of hematological profiles including hemoglobin, RDW, and platelet was taken from medical records of all chronic hepatitis B patients undergoing Fibroscan at Sanglah Hospital in January 2016 to February 2017. Results : Of 58 patients, 9 patients was excluded due to chronic kidney disease, malignancy and coincide with hepatitis C and HIV. The analysis using Kruskal-Wallis test, found a significant relationship between RDW / platelet ratio with degree of fibrosis in chronic hepatitis B (p<0.05). Of the 49 patients, 23 patients with mild-moderate fibrosis (metavir F0-2) and 26 patients with severe fibrosis (metavir F3-4) were found. In ROC analysis, the AUC was 0.701, using cut off 0,065 RDW/platelet ratio predict severe fibrosis about 73.1% sensitivity, spesificity 73.9%, positive prediction value 73.1%, and negative prediction value 70.8%. Conclusion : the RDW / platelet ratio can be used as a noninvasive diagnostic test of liver fibrosis in chronic hepatitis B patients.
Red Cell Distribution Width to Platelet Ratio is not Inferior than Aspartate Aminotransferase to Platelet Ratio Index Score in Predicting Liver Fibrosis in Chronic Hepatitis B Patients at Sanglah General Hospital Denpasar Tubung, Jemi; Mariadi, I Ketut; Wibawa, IDN
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 3 (2018): VOLUME 19, NUMBER 3, December 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (421.753 KB) | DOI: 10.24871/1932018137-140

Abstract

Background: Red cell distribution width to platelet ratio (RPR) is known to be associated with a degree of liver fibrosis in patients with hepatitis B. This study aims to compare the under curve area, sensitivity, specificity, positive predictive value, and negative predictive value between RPR and aspartate aminotransferase to platelet ratio index (APRI) score with degree of fibrosis.Method: This study is a retrospective study, data taken from medical records of all chronic hepatitis B patients examined by Fibroscan at Sanglah General Hospital Denpasar, Bali from January 2016 to February 2018.Results: Ninety eight patients with chronic hepatitis B, 81 patients were recovered after exclusion of patients with chronic kidney disease, malignancy, and dengue haemorrhagic fever (DHF). In receiver operating characteristic (ROC) analysis, obtained area under the ROC curve (AUC) at RPR of 0.816, and at APRI score 0.797. In RPR with cut off 0.066 the sensitivity was 76.9%, specificity 78.6%, PPV 79.5%, NPV 73.8%. While APRI score with cut off 0.85 got 69.2% sensitivity, specificity 76.2%, PPV 73.0%, and NPV 72.7%. According to Kappa test, we found kappa coefficient 0.653 (p < 0.05).Conclusion: In predicting severe liver fibrosis in chronic hepatitis B patients, RPR is not inferior than APRI score, and may be used as a diagnostic marker, with 65.3% conformity.
Detection of Helicobacter pylori CagA gene and Its Association with Endoscopic Appearance in Balinese Dyspepsia Patients Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Wibawa, Ida Bagus Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (396.866 KB) | DOI: 10.24871/172201699-105

Abstract

Background: Helicobacter pylori (H. pylori) infection causes various abnormalities in the stomach. Only particular strain can cause severe problems in the stomach. CagA is a microbial virulent factor which is associated with more severe stomach problems, such as: peptic ulcer and stomach cancer. We would like to know the prevalence of CagA in Balinese population, and the association of H. Pylori CagA status with the severity of endoscopic appearance in dyspepsia patients.Method: Study design being used was analytic cross sectional study, involving 71 dyspepsia patients who underwent upper gastrointestinal endoscopic examination in Surya Husada Hospital and Balimed Hospital in June-December 2013. Sample was chosen in consecutive manner. Later, polymerase chain reaction (PCR) examinations of the stomach mucous biopsy tissue to determine H. pylori infection status and CagA status were performed. Further, Chi square test was used to identify the difference in proportion of H. pylori and CagA between mild and severe endoscopic appearance.Results: In this study, we found that the prevalence of H. pylori infection was 22.5% using PCR examination. Prevalence of CagA positive in H. pylori positive was 62.5%. There was significant association between status of H. Pylori infection and severity of endoscopic appearance (p = 0.038; OR= 2.67; 95% CI = 1.18-6.05). Status of CagA in H. pylori infected patients was not associated with the severity of endoscopic appearance. Additionally, there was significant association between patients’ age and severity of endoscopic appearance.Conclusion: The prevalence of CagA in H. pylori positive was 62.5%. H. pylori infection was associated with severity of endoscopic appearance and CagA status in H. pylori infected patients was not associated with severity of endoscopic appearance.
Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Budiyasa, Dewa Gde Agung; Ariawan, Yuna; Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Purwadi, Nyoman; Suryadarma, I Gusti Agung
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/121201123-27

Abstract

Background: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p < 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis.   Keywords: albumin, degree of EV, liver cirrhosis