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Kadar Amonia Darah pada Pasien Sirosis Hati dengan Ensefalopati di RSUD Koja Ndraha, Suzanna; Wician, Fendra; Santoso, Mardi
Jurnal Kedokteran Meditek Vol. 18 No. 46 Januari - April 2012
Publisher : Jurnal Kedokteran Meditek

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Abstrak Latar belakang. Peningkatan pembentukan amonia banyak diyakini sebagai faktor utama dalam patogenesis ensefalopati Â hepatikum (EH). Namun di RSCM dan RSUD Koja belum pernah diteliti apakah pada pasien sirosis hati dengan ensefalopati memang ditemukan peningkatan Kadar amonia darah. Tujuan penelitian ini adalah mengetahui Kadar amonia darah pada pasien sirosis hati dengan ensefalopati dan menilai presisi alat Ammoniachecker kit II.Metoda. Semua pasien sirosis hati yang berkunjung ke RSCM dan RSUD koja dalam periode Juni-Agustus 2009dievaluasi. Kriteria inklusi adalah sirosis hati dengan ensefalopati, yang diukur dengan tes critical flicker frequency(CFF). Nilai CFF <39 Hz dinyatakan sebagai ensefalopati. Kadar amonia darah diukur dengan ammonia checker kitII. Nilai normal adalah < 54 tmol/L. Presisi alat Ammonia checker II dinilai dengan memeriksa 10 pasien sirosis hatisebanyak masing-masing 2 kali pemeriksaanHasil. Didapatkan 28 orang penderita sirosis hati, 26 (92,9%) laki-laki dan 2 (7,1%) perempuan yang memenuhiKriteria ensefalopati dan bersedia diperiksa kadar amonia darahnya. SebagianÂ besar (67.9%) berusia 40-60 tahun,dan hampir semua (92,9%) child B. Hasil amonia darah semua diatas normal, bervariasi antara 87- 205 tmol/Ldengan rata-rata 133,7Â±32,2 tmol/L. Hasil uji presisi terhadap 10 pasien sirosis adalah kedua hasil berkolerasisignifikan (p=0,037,r=0.439).Kesimpulan: Didapatkan peningkatan amonia darah pada semua pasien dengan ensefalopati (tes CFF <39 Hz).Presisi ammonia checker II terhadap 10 pasien sirosis hati adalah baik (p<0.05)Â Keywords: Sirosis hati, ensefalopati, tes crtical flicker frequency, kadar amonia, Ammonia checker kit IIÂ Â Â Â

Tes Critical Flicker Frequency pada Sirosis Hati di RSUD Koja Ndraha, Suzanna; Tendean, Marshell; Wician, Fendra; Sujana, Surjadi; Santoso, Mardi
Jurnal Kedokteran Meditek Vol. 16 No. 42A Januari - April 2010
Publisher : Jurnal Kedokteran Meditek

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AbstrakLatar belakang. Ensefalopati Â hepatikum minimal (EHM) adalah keadaan dimana secara klinis tidak terdapat tanda gangguan mental namun pada tes psikometrik sudah ditemukan kelainan . EHM sulitDidiagnosis karena tes psikometrik tida mudah di lakukan, hasilnya di pengaruhi usia dan tingkatPendidikan, serta memakan banyak waktu. Belakangan ini tes critical flicker frenquency Â (CFF) telahDikembangkan untuk diagnosis EHM. Tujuan penelitianÂ ini adalah mengevaluasi hasil tes critical flickerFrequency pada pasien sirosis hati di RSUD koja.Metoda. Semua pasien sirosis hati yang datang ke RSUD koja selama juni âagustus Â 2009 di evaluasiÂ tesCFF dilakukan dengan mengunakan alat HEP Atonorm TM analyzer. Pasien sirosis dengan ferkuensi kritis<39 Hz di golongkan kedalam ensefalopati .Hasil. Didapatkan 38 penderita sirosis hati yang datang berkunjung. Tigapuluh empat subjek (89,5%)Tergolong ensefalopati berdasarkan tes CFF.Kesimpulan :dari pemeriksaan CFF, didapatkan 89,5%dari penderita sirosishati tergolong EHMÂ Kata kunci:sirosis hati , ensefalopati hepatikum minimal (EHM), critical flicker frequency (CFF)

A Deterioration of Anemia in Hemoglobin E Disease caused by Cholestatic Hepatitis A Fabiani, Helena; Ndraha, Suzanna; Tan, Henny Tanadi; Wician, Fendra; Santoso, Mardi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

ABSTRACTPatients with hemoglobin E disease usually have mild hemolytic anemia and mild splenomegaly. Acute infection including acute inflammatory disease of the liver caused by hepatitis A viral, which attacks patients with previous hemolytic anemia, may result in deterioration of anemia.A 17-year-old female patient was admitted with chief complaint of having jaundiced body and non-specific prodromal symptoms within one week prior to admission. Physical examination revealed jaundiced skin and sclera as well as tenderness in right upper quadrant of the abdomen. Laboratory tests revealed microcytic hypochromic anemia with hemoglobin (Hb) level of 6.3 g/dL, increased reticulocyte count and abnormal morphology of erythrocyteson blood smear. Hemoglobin electrophoresis indicated hemoglobin E disease and serologic tests suggested a positive anti-HAV immunoglobulin M (IgM) with increased level of liver enzymes and functions. Abdominal ultrasound showed hepatosplenomegaly without extra-hepatic cholestasis. The working diagnosis was hepatitis A with intrahepatic cholestasis and hemoglobin E disease. The patient was treated with hepatoprotector and ursodeoxycholic acid. Anemia was not treated specifically. It was assumed that hemolytic anemia was worsened by acute infection of hepatitis A viral. The assumption had been proven to be right since there was improvement of anemia after the acute infection had recovered. Patients with hemoglobin E disease usually have mild anemia; however, in this case, the hemoglobin level decreased significantly due to the acute co-infection. Keywords: hemoglobin E disease, anemia, acute infection, acute hepatitis A infection

Diabetes Mellitus Due to Liver Cirrhosis in 33-Year-Old Female Tan, Henny Tanadi; Ndraha, Suzanna; Fabiani, Helena; Wician, Fendra; Santoso, Mardi; Tendean, Marshell
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

Impaired glucose metabolism can occur in patient with chronic liver disease, either it is impaired glucose tolerance or diabetes mellitus (DM). DM due to liver cirrhosis is known as hepatogenous diabetes (HD). HDis different from type 2 DM in clinical signs and management.A 33-year-old female came with chief complaint of fatigue since three days before admission. Patient also complained of nausea, vomiting, and increased abdominal circumference since one year ago. Patient wasdiagnosed with DM two months ago. From physical examination, anemic and ascites without signs of cirrhosis were obtained. Laboratory test showed mild anemia with hemoglobin levels 6.5 g/dL, elevated serum bilirubinand liver enzymes, decreased serum albumin, prolonged prothrombin time and elevated random blood glucose. Serologic test showed chronic hepatitis B with HBV DNA 1.61 x 104 copy/mL. The abdominal ultrasound resultshowed liver cirrhosis with ascites.The patient was diagnosed with hepatogenous diabetes in liver cirrhosis due to chronic hepatitis B infection and anemia of chronic disease. The management of this patient was quite complex especially in administrationof oral antidiabetic agent which could affect the liver function.Keywords: hepatogenous diabetes, liver cirrhosis, diabetes mellitus, chronic hepatitis B infection

Impaired Glucose Metabolism in Liver Cirrhosis Ndraha, Suzanna; Wician, Fendra; Tendean, Marshel; Sunardi, Ivan DP; Santoso, Mardi
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: Approximately 30% of patients who suffer cirrhosis maybe diabetic, called hepatogenous diabetes (HD). Insulin resistance seems to be the pathophysiologic basis for HD. Aims of this study were to evaluate the glucose metabolism disorders in liver cirrhosis patients and to observe the insulin resistance in HD.Method: This study was conducted from February-July 2013 in Koja Hospital Jakarta. In the first phase, with observational design, inclusion criteria were liver cirrhosis and exclusion was an acute complication. We recorded their oral glucose tolerance test (OGTT). Patients who met the HD criteria were continued to the second phase, using analytic design, and were compared with type 2 diabetes mellitus (T2DM) patients as control. Mean differences of 2-hours postprandial plasma glucose/fasting plasma glucose (2hPPG/FPG) ratio, as well as fasting insulin levels between both groups were assessed.Results: Twenty four patients were included in our study. Normal glucose tolerance test were noted in 7 (29%) patients, impaired glucose tolerance (IGT) in 6 (25%) patients and HD in other 11 (46%) patients. In the second phase, we obtained the ratio of 2hPPG/FPG in HD was 2 ± 0.5 and T2DM was 1.5 ± 0.4 (p = 0.01). Mean fasting insulin levels in HD was 10.8 ± 4.2 μIU/mL, while T2DM was 9.3 ± 5.3 μIU/mL (p = 0.5). The ratio of 2hPPG/FPG was higher in HD compared to T2DM, assuming the role of insulin resistance in HD.Conclusion: There were impaired glucose metabolism in liver cirrhosis patients, as well as hepatogenous diabetes. Insulin resistance and hyperinsulinemia appeared to play role in HD.Keywords: hepatogenous diabetes, type 2 diabetes mellitus, 2hPP/FPG ratio, fasting insulin level

Liver Disorders in Type 2 Diabetes Mellitus Ndraha, Suzanna; Tendean, Marshell; Wician, Fendra; Tan, Henny Tanadi; Yap, Helena
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Patients with type 2 diabetes mellitus (T2DM) are frequently diagnosed with some abnormal liver features. These liver abnormalities are suggested to be correlated with insulin resistance. The aim of thisstudy was to evaluate liver abnormalities and fasting insulin levels in patients with T2DM.Method: This study was conducted in Koja Hospital from February to July 2013. Study design was analytical study. Data for sex, age, complication, body mass index (BMI), liver function, liver enzyme, and fasting insulinlevel were collected. Univariate and bivariate statistical analyses were done using SPSS 20.Results: Twenty eight patients were included in this study, 71.43% of them were female. The age group of 40-60 years was the highest among the patients (64.28%). Highest complication was neuropathy, BMI of mostpatients were obese. Liver abnormalities were documented in 35.8% patients, liver enzyme increased in 21.4% patients. Non alcoholic fatty liver disease (NAFLD) were noted in 46.6% patients, and one patient was positive for hepatitis B. Mean fasting insulin in T2DM with NAFLD were higher than in T2DM without NAFLD. However, it was not statistically significant (40.08 ± 36.8 μU/mL vs. 54.3 ± 37.1 μU/mL; p = 0.27).Conclusion: Liver abnormalities found in T2DM patients were elevated liver enzyme, decreased albumin and increased of bilirubin. Through ultrasound, NAFLD and liver cirrhosis were found. Fasting insulin levelwas higher in T2DM with NAFLD but it was not statistically significant.Keywords: type 2 diabetes mellitus, non alcoholic steato-hepatitis, fasting insulin

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