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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Eric Daniel Tenda
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Medicine & Pharmacology

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Papilla Vaterƒs Tumor in Elderly: an Interdisciplinary Issue Eric Daniel Tenda; Murdani Abdullah; Kuntjoro Harimurti; Edy Rizal Wahyudi; Czeresna Heriawan Soejono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010155-159

Abstract

Tumors of the papilla Vater are very rare. Papilla Vater’s tumors are benign or malignant tumors in the ampulla of Vater and periampullary region. Blockage of ampulla leads to the development of obstructive jaundice; intermittent cholangitis, epigastric discomfort and weight loss. Treatment possibilities include endoscopic ampulectomy, surgical transduodenal excision of tumors of the ampulla and pancreatoduodenectomy (PDE). Prognosis depends on histological typing of the tumor and their clinical stage. We report a case of papilla Vater’s tumor in elderly with comorbidities based on literature review. A 68-year-old female patient was referred for evaluation of intra and extra hepatic bile duct dilatation noted on abdominal ultrasonography. She complained of intermittent epigastric and right upper abdominal pain, with yellowish skin for two months. The laboratory findings showed leukocytosis, hyperbilirubinemia, abnormal liver function test, and high Ca 19-9. An endoscopic retrograde cholangiopancreatography (ERCP) revealed a distal obstruction caused by papilla Vater’s tumor. Abdominal computed tomography (CT) with contrast, revealed a dilated common bile duct and pancreatic duct. The histologic evaluation was highly suggestive for dysplasia. She is now on a schedule for a Whipple procedure. To make a true diagnosis and optimal treatment of papilla Vater’s tumor is multimodal. By doing a comprehensive geriatric assessment, with a careful modality selection, a Whipple procedure can be performed in elderly (65 years) safely. The post operative morbidity and mortality depends on their multi morbidity. Surgical, endoscopic, or radiologic biliary decompression; relief of gastric outlet obstruction; and adequate pain control may improve the quality of life but do not affect overall survival rate. By building a great interdisciplinary teamwork, the quality of life increased as follows.Keywords: papilla Vater tumor, elderly, Whipple procedure
The Effect of Branched Chain Amino Acids and L-Ornithine L-Aspartate Combination as The Late Evening Snacks on Nutritional Status and Minimal Hepatic Encephalopathy in Liver Cirrhosis Eric Daniel Tenda; Irsan Hasan; Andri Sanityoso; Siti Setiati
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (325.89 KB) | DOI: 10.24871/1332012151-156

Abstract

ABSTRACTBackground:Minimal hepatic encephalopathy (MHE) in liver cirrhotic patients is critical manifestation of low grade hepatic encephalopaty (HE), is caused quality of life decrease and risk of deteriorating into distinct HE. The study was conducted to asses the effect of combination of branched-chain amino acids (BCAA) and L-ornithine L-aspartate (LOLA), which was given late evening, on nutritional status and degree of HE.Method: This single-blind randomized study was conducted on liver cirrhotic outpatients in hepatology clinic of Cipto Mangunkusumo Hospital period June 2011-June 2012. The study subjects were divided into two groups, group of late evening snack (LS) and day snack (DS). Each group was supplemented with combination of milk of BCAAs and LOLA (3.7 g/serving). Evaluation based on history, physical examination, laboratory tests and critical flicker frequency (CFF) was performed one month after the intervention. Data were statistically analyzed with SPSS 15.Results: Thirty-two patients whose the inclusion criteria were divided into 16 subjects for each group, LS and DS. After one month of the intervention, the average level of prealbumin for DS group was increased statistically significant (p 0.001), but not significant for LS group (p = 0.259). The increase of average body weight,mid-arm muscle circumference (MAMC) and CFF test result in both groups. There was no improvement on subject global assessment (SGA) score after one month intervention in both groups.Conclusion: This study proved that giving combination of BCAAs and LOLA may improve the condition of MHE, however for nutritional status can not be assessed. Keywords: minimal hepatic encephalopathy, BCAAs, LOLA, prealbumin, SGA score, nutritional status
Co-Authors Andri Sanityoso Andri Sanityoso Czeresna Heriawan Soejono Edy Rizal Wahyudi Irsan Hasan Irsan Hasan Irsan Hasan Kuntjoro Harimurti Murdani Abdullah Murdani Abdullah Siti Setiati