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All Journal Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Tan, Christine
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Health Professions Medicine & Pharmacology Public Health

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Trombosis pada Pasien COVID-19 Tan, Christine
Cermin Dunia Kedokteran Vol 48, No 12 (2021): General Medicine
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (174.105 KB) | DOI: 10.55175/cdk.v48i12.1571

Abstract

Penyakit Coronavirus 2019 (COVID-19) memiliki spektrum klinis yang luas. Salah satu gejala berat penyakit ini dan menunjukkan prognosis buruk adalah trombosis. Risiko tinggi trombosis pada COVID-19 ditunjukkan dari peningkatan D-dimer yang merupakan perubahan paling signifikan parameter koagulasi, yang menandakan produksi trombin dan aktivasi fibrinolisis. Namun, D-dimer adalah reaktan fase akut non spesifik dan dapat meningkat karena penyebab dan inflamasi lain. Identifikasi risiko dini dan tanda trombosis pada pasien COVID-19 dapat mencegah kejadian trombotik dan gagal organ lainnya, memandu tenaga kesehatan pada strategi intervensi awal, dan fokus pada kelompok pasien yang berisiko prognosis buruk.Coronavirus disease 2019 (COVID-19) has a broad clinical spectrum. Thrombosis may herald severe symptom and indicates a poor prognosis. Risk of thrombosis in COVID-19 is indicated by increased D-dimer, which is the most significant change in coagulation parameters, indicating thrombin production and fibrinolysis activation. However, D-dimers are nonspecific acute-phase reactants and may increase due to other causes and inflammation. Identifying early risks and signs of thrombosis in COVID-19 patients to prevent thrombotic events and other organ failure, may guide health professionals on early intervention strategies, and to focus on groups of patients at risk of poor prognosis.
Peptic Duodenal Stricture Causing Gastric Outlet Obstruction: A Case Report Kurniawan, Andree; Tan, Christine
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 2 (2023): VOLUME 24, NUMBER 2, August, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2422023176-181

Abstract

Gastric outlet obstruction (GOO) is an uncommon but serious problem caused by benign causes. The incidence of GOO caused by peptic ulcer disease (PUD) is decreasing due to successful Helicobacter pylori treatment. Hence, these aggressive cases are rare. We present a case of a man who experienced intermittent abdominal pain and constipation for a week but acutely worsened in the last five days. He complained of intractable nausea and vomiting, leading to intolerable oral intake. Physical examination revealed abdominal distention, tenderness in epigastrium and right hypochondrium, and hypoactive bowel sounds. Laboratory results revealed leukocytosis with neutrophilia. Gastroscopy showed erosive esophagitis, pangastritis, and large duodenal ulcer causing stricture of duodenum pars I. An open distal gastrectomy, Roux-en-Y reconstruction, and fundoplication was then performed. The patient’s general condition improved after ninth day of care and was discharge on the eleventh day of care. PUD is a major cause of GOO, but incidence has decreased to 5% with the use of proton pump inhibitors. If the distal stomach or duodenum is significantly obstructed, GOO should be considered. The gold standard for diagnosis is endoscopy. Initially, conservative and supportive therapy should be done followed by endoscopic treatment in appropriate cases. If there is no improvement, surgical interventions should be done. This case demonstrated the need for definitive invasive procedures in the intervention of GOO caused by PUD. When conservative measures fail, this case also adds support to the direct anatomic treatment of duodenal strictures.
A Case Report of Untreatable Complication of Umbilical Hernia in Cirrhosis: A Flood Syndrome Tan, Christine; Audi Yanto, Theo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, August, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025188-194

Abstract

Flood syndrome is a rare, life-threatening complication of end-stage liver disease, characterized by the spontaneous rupture of an umbilical hernia. It frequently presents with sepsis, peritonitis, and bowel incarceration, carrying a high mortality rate. The lack of standardized treatment guidelines and the complexities of advanced liver disease make management particularly challenging. We report a case of a 53-year-old woman with decompensated hepatitis B-related cirrhosis (Child-Pugh Class C, MELD score of 26) and refractory ascites, who developed Flood syndrome. She presented with a ruptured umbilical hernia leaking ascitic fluid, accompanied by sepsis, diabetic ketoacidosis, acute kidney injury, and hypoalbuminemia. Surgical intervention was deemed high-risk, and conservative management was undertaken, focusing on infection control, wound care, and medical stabilization of her comorbidities. Despite a multidisciplinary approach, the patient succumbed to the cumulative effects of her advanced disease and associated complications. This case highlights the complexities of managing Flood syndrome, particularly in patients with advanced liver disease. The absence of standardized treatment protocols necessitates a multidisciplinary, individualized approach. Key considerations include managing ascites, preventing infection, optimizing glycaemic control, and carefully evaluating the risks of surgical intervention. This case report illustrates the clinical course, management challenges, and outcomes of Flood syndrome in a patient with advanced cirrhosis, in order to highlight key considerations for clinicians and underscore the urgent need for further research to establish evidence-based guidelines for managing this rare but life-threatening condition.
Co-Authors Agatha, Cindy Monika Andree Kurniawan Audi Yanto, Theo Halim, Devina Adella Jovita Jovita Maria, Eva Soputri, Christin Wijovi, Felix Winata, Sharleen