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I Ketut Mariadi
Departemen/KSM Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana/RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Laporan Kasus Hepatopulmonary Syndrome (HPS) pada Pasien Sirosis Hepatis dengan Penyulit Melena Akut dan Orthodeoxia Yogi Haditya; I Ketut Mariadi
MEDICINUS Vol. 39 No. 6 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/jpeytk40

Abstract

Hepatopulmonary syndrome (HPS) is a complication that frequently occurs in patients with end-stage liver disease. It is characterized by a triad of abnormal arterial oxygenation, intrapulmonary vascular dilatations (IPVD), and chronic liverdisease. A 48-year-old man presented with complaints of shortness of breath for about 3 months, which improved when lying down but worsened when sitting or standing. The patient also reported blackish stool since one day prior to admission and had a history of liver cirrhosis since 2020. Vital signs were normal except for peripheral oxygen saturation, which was 86% when lying down and 79% when sitting. Physical examination revealed anemic palpebra, clubbing finger on hands and foots. Laboratory results revealed anemia, with an increased alveolar-arterial (A-a) gradient of 64.7 mmHg on blood gas analysis. A transthoracic contrast echocardiography (TTCE) or “buble study” was performed and the result show more than 20 microbubles in the left chambers of the heart after 5 cardiac cycles, indicating an intrapulmonary shunt caused by IPVD. These findings confirmed the diagnosis of HPS. Management of HPS is supportive, as there is no specific medical therapy available other than liver transplantation.
"Steakhouse Syndrome" pada Pasien Dewasa di RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar Ni Made Ayu Dwipayanti; I Ketut Mariadi
MEDICINUS Vol. 39 No. 3 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/tvmwhd73

Abstract

Esophageal obstruction by foreign body is a common emergency condition, third rank after upper and lower gastrointestinal bleeding. This condition may be life-threatening, depending on the type of ingested object, the location of the obstruction, the patient’s condition, and the time interval from the incident until the treatment is given. The annual incidence has been reported to be 13 per 100,000 of the general population. We report the case of a 30-year-old female patient who presented with difficulty swallowing for two days prior to hospital admission after eating beef steak. This complaint was accompanied by chest pain and a burning sensation. Examination revealed a patent airway, with no complications such as hematemesisor abnormal breath sounds. Upper gastrointestinal endoscopy showed a food blockage (a mass of insufficiently chewed steak) in the esophagus, located 20 cm from the teeth, with erosion of the surrounding mucosa. This location is consistentwith previous studies showing that, in adults, about 68% of obstructions occur in the distal esophagus, between the aortic arch and the lower esophageal sphincter (LES). In this case, no medications were administered to relax the smooth muscles of the LES. The steak was pushed from the esophagus into the stomach using endoscopy. The obstruction was successfully removed, and the patient’s symptoms resolved. In conclusion, the patient’s symptoms were caused by an acute steak mass, known as “steakhouse syndrome”.
Co-Authors Ni Made Ayu Dwipayanti Yogi Haditya