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HEPATIC ISCHEMIA REPERFUSION INJURY IN SEPSIS: BASIS PATHOGENIC MECHANISMS Suryadarma, I Gusti Agung
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Hepatic ischemia reperfusion injury is a complex patho-physiology with a number contributing factors. Ischemia insultcan lead to sublethal cell injury, which is aggravated by the formation of reactive oxygen from various intracellular sources duringreperfusion. In addition, formation of proinflammatory mediators and the recruitment and activation of macrophages, neutrophiland lymphocyte can further enhance the injury. Microcirculatory disturbances lead to underperfused areas in the liver and maycause ischemic injury. Hepatic IR injury involves interaction between different cell types and a variety of cellular and molecularmechanisms including kupffer cells activation, formation of ROS, release of cytokines and chemokines, neutrophil recruitment,mitochondrial permeability transition and pH paradox. There are two distinct phase of liver injury after warm ischemic reperfusion,such as early phases and followed by late phases. Clinical presentation of hepatic ischemic reperfusion injury in sepsis, includingsepsis-associated cholestasis, hepatitis ischemic, cholangitis lenta and progressive sclerosing cholangitis

HUBUNGAN C-REACTIVE PROTEIN DENGAN PEMANJANGAN PROTHROMBIN TIME PADA PASIEN SIROSIS HATI YANG MENGALAMI PERDARAHAN SALURAN MAKANAN BAGIAN ATAS Mariadi, IK; Wibawa, IDN; Purwadi, N; Suryadarma, IGA
journal of internal medicine Vol. 12, No. 1 Januari 2011
Publisher : journal of internal medicine

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Bacterial infections are common complications in cirrhosis, and cause the systemic in! ammation process. The natureof the relationship between gastrointestinal bleeding and infection in cirrhosis has not been clari" ed. Infection is associatedwith failure to control variceal bleeding and early variceal rebleeding in these patients. Bacterial infections, and particularlyendotoxemia, have been shown to activate the coagulation system and generally to interfere with hemostasis. We performedcross-sectional analytic study in cirrhosis patients with upper gastrointestinal bleeding to assess whether there are any associationbetween in! ammation process (CRP) with defect in haemostatic system (prolongation in prothrombin time). Forty-nine patientswere evaluated, 37 (75.5%) out of these were male and the rest were female. Ninteen out of this with in! ammation process and30 without in! ammation process. Fourteen out of 19 patients (73.7%) in in! ammation group have prolongation on prothrombintime and 12 out of 30 patients (40%) in non in! ammation group have prolongation on prothrombin time. The difference of thisproportion statistically signi" cant (Chi-square test X2: 5.29; p = 0.021). The CRP also have positive correlation with prolongationin prothrombin time (Spearman correlation R = 0.390; p = 0.006). In conclusion there is signi" cant association between CRP andprothrombin time in cirrhosis patients with upper gastrointestinal bleeding.

ADIPONECTIN ACTIVITY IN ACUTE VIRAL HEPATTOBI Suryadarma, I Gusti Agung
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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The mechanisms of hepatocellular necrosis in acute viral hepatitis, primarily through cytopathic immune mechanisms,however the processes of hepatic parenchyma necrosis also might be secondarily involved the roles of cytopathic non-immunemechanisms. Once of the defend mechanisms to the hepatic viral infection is through the releases of adiponectin. Adiponectin is ahormone secreted by adipocytes. The protective effect of adiponectin against liver injury likely involve multiple mechanisms,especially to the ability effects of adiponectin as a anti-inflammatory cytokines. Thus, decreased of the adiponectin concentration<10 mg/dl in the acute viral hepatitis, especially Hepatitis B and C perhaps as the early biomarkers of possibility progression tothe chronic hepatitis.

CASE REPORT: LIVER CIRRHOSIS Pande Made Aditya Saskara; IGA Suryadarma
E-Jurnal Medika Udayana vol 2 no4 (2013):e-jurnal medika udayana
Publisher : Universitas Udayana

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Liver cirrhosis is a state of the accumulation of extracellular matrix or scar tissue in response to acute or chronic liver injury. The causes are varied, but the majority of patients with chronic liver disease caused by a virus or drinking alcohol. Liver cirrhosis often occur without symptoms and found during routine examination, but in advanced complications such as liver failure and portal hypertension can arise. Therapy in patients with liver cirrhosis aims to reduce the progression of diseases such as prevent further liver damage, prevention, and complications management.

INTERLEUKIN 8 BERHUBUNGAN DENGAN DERAJAT GASTRITIS PADA PASIEN TERINFEKSI HELICOBACTER PYLORI Mariadi, IK; Kurniari, PK; Wibawa, IDN; Purwadi, N; Suryadarma, IGA
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Helicobacter pylori infection induces a local pro-inflammatory cytokine response. The secretion of IL-8 by epithelialcells is probably a key factor in host defenses at mucosal sites, permitting a rapid polymorph response against infectious agents.Interleukin-8 is an important chemotactic and activating factor for neutrophils. If defense mechanisms fail and chronic infectionresults, continued up regulation of IL-8 and neutrophil activation could lead to mucosal damage and increased free radicalformation. Mucosal IL-8 production in Helicobacter pylori infection may be an important factor in the immunopathogenesisof gastritis and peptic ulcer disease. This study aim to investigate correlation between IL-8 and severity of gastritis in ourpopulation. We performed a cross-sectional analytic study in Helicobacter pylori infected patients. Severity of gastritis wasdetermined base on The Updated Sydney System. IL-8 level was analyzed from gastric mucosa biopsy using ELISA method.We included 65 samples. 31 (47.7%) men and the rest was women. Base on Kruskalwallis test we found significant associationbetween IL-8 gastric mucosa and severity of gastritis (x2 = 12.8; p = 0.002). We also found significant association between IL-8gastric mucosa and density of H pylori infection (x2 = 10.6; p = 0.01), severity of atrophy (x2 = 9.4; p = 0.02) and neutrophilscount (x2 = 11.0; p = 0.01). But notmethaplasia (x2 = 3.3; p = 0.18). Base on this study we concluded that IL-8 was associatedwith severity of gastritis in Helicobacter pylori infected patients.

Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Mariadi, I Ketut; Suryadarma, I Gusti Agung; Purwadi, Nyoman; Wibawa, I Dewa Nyoman; Ariawan, Yuna; Budiyasa, Dewa Gde 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

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

Kadar Resistin Serum Berhubungan Dengan Skor Child-Turcotte Pugh Pada Penderita Sirosis Hati Koncoro, Hendra; Primadharsini, Putu Prathiwi; Mariadi, I Ketut; Somayana, Gde; Suryadarma, I Gusti Agung; Purwadi, Nyoman; Wibawa, I Dewa Nyoman
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Latar Belakang: Sirosis hati (SH) sering disertai tingginya resistensi insulin dan kondisi proinflamasi. Resistin yang merupakan suatu adipokin, diketahui memiliki hubungan dengan resistensi insulin dan inflamasi. Studi-studi resistin pada SH memperlihatkan hasil yang bervariasi. Tujuan penelitian ini adalah untuk mencari hubungan kadar resistin serum dengan skor Child-Turcotte Pugh (CTP) pada penderita SH. Metode: Penelitian observasional, studi potong lintang ini dilaksanakan di RSUP Sanglah dari September 2014 sampai dengan Juni 2015 dengan menggunakan 75 pasien sirosis hati sebagai sampel. Kriteria inklusi mencakup pasien sirosis hati tanpa memandang etiologinya dan berusia 12 tahun atau lebih. Variabel yang diperiksa pada penelitian ini yaitu skor CTP (kadar albumin serum, kadar bilirubin total serum, nilai waktu protrombin, kadar international normalized ratio (INR), tanda ascites, tanda ensefalopati hepatikum), kadar C-reactive protein (CRP), dan kadar resistin serum. Hasil: Enam puluh lima persen dari 75 sampel adalah laki-laki dan sisanya perempuan. Sebelas diantaranya (14,7%) adalah kelas CTP A, 31 (41,3%) kelas CTP B, dan 33 (44%) kelas CTP C. Rerata kadar CRP adalah 15,05 Â± 15,86 mg/L. Rerata kadar resistin adalah 23,39 Â± 17,79 ng/mL. Hasil uji korelasi didapatkan korelasi positif yang sedang antara kadar resistin dan skor CTP (r = 0,438; p < 0,001). Korelasi positif sedang juga didapatkan antara CRP dan resistin (r = 0,478; p < 0,001). Simpulan: Kadar resistin memiliki korelasi sedang dengan skor CTP pada pasien SH. Kadar resistin didapatkan lebih tinggi kadarnya pada SH yang berat. Hal ini menunjukkan adanya kondisi inflamasi dan resistensi insulin seiring dengan peningkatan derajat beratnya SH.

Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia Koncoro, Hendra; Wibawa, IDN; Suryadarma, IGA; Purwadi, Nyoman; Somayana, Gde; Mariadi, I Ketut
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

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

Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia Hendra Koncoro; I Ketut Mariadi; Gde Somayana; IGA Suryadarma; Nyoman Purwadi; IDN Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

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

Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Dewa Gde Agung Budiyasa; Yuna Ariawan; I Ketut Mariadi; I Dewa Nyoman Wibawa; Nyoman Purwadi; I Gusti Agung Suryadarma
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201123-27

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

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