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Delayed Admission in Neonatal Cholestasis Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Winahyu, Anindya Kusuma; Arief, Sjamsul
Journal of Community Medicine and Public Health Research Vol. 5 No. 2 (2024): Journal Community Medicine and Public Health Research
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jcmphr.v5i2.47315

Abstract

Delayed diagnosis of cholestasis in neonates remains a problem. Cholestatic jaundice is a pathological condition that requires immediate treatment, such as biliary atresia. This study aims to analyze the characteristics of infants with cholestasis who seek treatment at a tertiary hospital. This study was a cross-sectional study to determine the characteristics of infants with cholestasis treated at the tertiary hospital at Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. Subjects were collected using medical records using the consecutive method from 2019 to 2021. The inclusion criteria in this study were infants aged >2 weeks who suffered from cholestasis. The age of the 111 infants with cholestasis involved was 4.8 ± 2.9 months old. A total of 27 (24.3%) infants visited the hospital at the age of <2 months, 36 (32.4%) at the age of 2-4 months, but most of them, consisting of 48 (43.2%) infants, came to the hospital at the age of >4 months. Jaundice was present at birth in 23 infants (20.7%), and most infants had jaundice at 1 month of age in 75 infants (67.6%). Most of the infants (75 infants) had jaundice at the age of 1 month but visited the hospital at the age of >4 months. This showed that the late diagnosis of cholestasis in infants was still quite high. This study supports education for early detection of cholestasis in primary healthcare medical personnel, community health workers, and parents.
Socialization of stool color card for early detection of biliary atresia among healthcare professionals in Primary Healthcare facilities in Probolinggo Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Utomo, Martono Tri; Akbas, Ahmad Maulana Ifan; Octariyandra, Syania Mega; Arief, Sjamsul
Caring: Jurnal Pengabdian Masyarakat Vol 4, No 3 (2024): CARING Jurnal Pengabdian Masyarakat (Desember 2024)
Publisher : Caring: Jurnal Pengabdian Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.caringjpm.2024.004.03.4

Abstract

AbstractBackground: Biliary Atresia (BA) is an idiopathic progressive fibro obliterative disease affecting the extrahepatic biliary duct with clinical manifestations of biliary obstruction in the neonatal period. Infants with BA are characterized with acholic stools which are frequently unidentified due to daily variations in stool color. Early detection is essential to reduce morbidity and mortality rates in infants with BA. Objective: This project aimed to improve the knowledge of health workers in primary health facilities in Probolinggo about BA through socialization of stool color cards as an early detection tool. Methods: Socialization was conducted to midwives in primary health facilities in Probolinggo with pre-test and post-test methods. Results: A total of 35 midwives participated in this activity. The evaluation showed a significant increase in health workers' understanding of biliary atresia. The average pre-test score was 83.82 and increased to 92.18 in the post-test with a p-value=0.00, indicating the effectiveness of counseling in improving health workers' knowledge. In addition, the implementation of the stool color card as an early detection tool received a positive response from the participants, who stated that the tool is easy to use and helps in identifying infants at risk of biliary atresia more accurately. Conclusion: The level of knowledge of health workers in primary health facilities regarding BA is still varied. Socialization of stool color cards may improve the understanding of health workers to accelerate early detection of cholestasis and improve the prognosis of infants with BA.
Perbedaan Profil Abses Hati Pyogenic dengan Amoebic pada Pasien Abses Hati Rawat Inap di RSUD Dr Soetomo Tahun 2016-2019 Paramitha, Annisya Dinda; Kholili, Ulfa; Setyoboedi, Bagus
Jurnal Kesehatan Andalas Vol. 9 No. 3 (2020): Online September 2020
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v9i3.1391

Abstract

Abses hati dibagi menjadi dua berdasarkan penyebab, yaitu bakteri pyogenik dan amoebik. Abses hati yang terjadi pada Dr. Soetomo masih belum diketahui, tetapi protozoa atau bakteri yang menyebabkan abses hati ditemukan banyak di Indonesia. Tujuan: Menentukan perbedaan profil klinis pasien dengan abses hati amoebik dan pyogenik di RSUD Dr. Soetomo pada periode 2016 sampai 2019.  Metode: Studi ini adalah analitik observasional menggunakan pendekatan cross-sectional pada rekam medis, dengan kriteria inklusi tes seroamoeba dan USG. Data dianalisis menggunakan uji Chi-square untuk skala nominal, t-test dan Man-Whitney untuk skala interval. Hasil: Ada 58 pasien dengan abses hati, masing-masing terdiri dari 29 pasien pada kedua jenis abses hati. Abses hati terjadi lebih dari 85% pada pria dengan usia rata- rata 42 hingga 45 tahun. Manifestasi klinis yang paling umum adalah nyeri RUQ (Kuadran Kanan Atas) (93,1%), hepatomegali (70%), dan demam (69%). Hasil pemeriksaan USG adalah abses tunggal di lobus kanan. Tinjauan terapi menggunakan drainase perkutan lebih dari operasi. Komplikasi yang paling umum adalah efusi pleura (37,9%) dan sepsis (34,5%). Kematian hanya terjadi pada abses hati pyogenik sebesar 13,8%, sedangkan pada amoebik 0%. Dan rata-rata lama durasi abses hati (LOS) adalah 15 (sekitar 7 hari). Simpulan: Terdapat perbedaan karakteristik, gambaran klinis, dan angka kematian antara pasien abses hati amoebik dan pyogenik, dan terbukti secara statistika pada mortalitas.Kata kunci: abses hati amoebic, abses hati pyogenic, rawat inap
Challenges in Managing Portal Hypertension and Fibrosis in a Case of Biliary Atresia Post-Kasai Procedure—Implications for Early Detection and Long-Term Care Jasin, Yayu Dwinita; Prihaningtyas, Rendi Aji; Octariyandra, Syania Mega; Setyoboedi, Bagus; Arief, Sjamsul
Current Internal Medicine Research and Practice Surabaya Journal Vol. 6 No. 1 (2025): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v6i1.54321

Abstract

Biliary atresia frequently causes portal hypertension, resulting in significant morbidity and mortality. Elevated portal pressure can be detected as early as during a Kasai procedure. Pediatric portal hypertension is the primary cause of various complications, including variceal hemorrhage, ascites, and extra-hepatic processes. This paper aims to draw attention to the complications and limitations of the Kasai procedure by presenting a case of portal hypertension and fibrosis in an 8-month-old male infant with biliary atresia who underwent the procedure at 3 months. The patient was never completely free of jaundice post-surgery. The jaundice worsened, and the pale-colored stool reappeared two months later. The abdomen was distended, accompanied by ascites, hepatomegaly, splenomegaly, and dilated veins. Edema was present on the lower extremities and the scrotum. The patient was diagnosed with biliary atresia and portal hypertension. Supportive therapy was recommended as a preparatory measure before a liver transplant. However, the parents declined the procedure due to financial constraints. This case suggests that the Kasai procedure may not always be effective. Despite the timely execution of the procedure, liver fibrosis may persist and be associated with portal hypertension. Most patients develop significant fibrosis that progresses to cirrhosis, requiring a liver transplant. To date, biliary atresia remains the primary indication for liver transplant in children, with no alternative medical treatment recognized. This case report highlights the progression of portal hypertension and liver fibrosis following the Kasai procedure for biliary atresia, emphasizing the challenges in early detection, complications management, and the exploration of alternative therapeutic strategies.   Highlights: 1. This study critically reviews the limitations and complications of the Kasai procedure in treating biliary atresia, with particular focus on portal hypertension issues, for which case reports are limited. 2. This study highlights the important need for accessible and effective long-term treatment alternatives by presenting a pediatric case where financial constraints prevented a liver transplant. 3. The data from this study are anticipated to contribute to the advancement of healthcare equity and pediatric liver disease management.
The Correlation between Cardiac and Liver Function in Children with Heart Failure Utamayasa, I Ketut Alit; Wicaksono, Henry; Karyani, Enny; Nastiti, Prima Hari; Setyoboedi, Bagus; Rahman, Mahrus A.
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2478

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The liver has a complex dual blood supply, which makes it more resistant to hepatocyte necrosis due to hemodynamic disturbances. Prior hemodynamic data has indicated that an elevation in right atrial pressure in patients with heart failure may result in aberrant cholestatic markers of liver function. This cross-sectional study examined the correlation between ejection fraction and liver function in 85 children (1–18 years) with congenital or acquired heart disease. Echocardiography assessed TAPSE, Tricuspid Regurgitation (TR), E/A ratio, and Left Ventricular Ejection Fraction (LVEF), while liver function was evaluated using total bilirubin and SGPT. Results showed a strong negative correlation between TAPSE and total bilirubin (p=0.001, r= -0.725) and a moderate positive correlation between tricuspid regurgitation and total bilirubin (p=0.001, r=0.548). The E/A ratio, LVEF, and total bilirubin showed weak correlations, while TAPSE and SGPT had a weak negative correlation (p=0.025, r= -0.243). No correlation was found between TR, E/A ratio, LVEF, and SGPT. A strong correlation existed between heart failure severity and total bilirubin (p=0.001, r=0.603), but not with SGPT. These results highlight the correlation between the severity of heart failure and liver impairment by indicating that decreasing right ventricular function correlates to elevated total bilirubin.
Hepatitis B and Hepatocellular Carcinoma: A Case Report and Literature Review Rendi Aji Prihaningtyas; Muhammad Irawan; Qurrota Ayuni Novia Putri; Bagus Setyoboedi; Sjamsul Arief
MEDICINUS Vol. 38 No. 6 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/e6bqh839

Abstract

Introduction: Current data estimates that over 90% of primary liver tumors are hepatocellular carcinomas (HCC), a type of malignant hepatocyte tumor. Viral hepatitis B is particularly associated with HCC. Early detection of chronic hepatitis B is crucial to prevent complications. Case Presentation: A 17-year-old girl presented with a one-month history of abdominal enlargement, jaundice, dark urine, and pale-colored stool. She experienced weight loss and a lack of appetite. Anthropometric assessment indicated severe malnutrition. The abdomen appeared distended with ascites. There was a palpable liver, with a firm consistency and a lumpy surface up to the epigastrium, with a size of 8 x 7 x 6 cm, and accompanied by splenomegaly. Laboratory examination indicated anemia (hemoglobin 9.5 g/dl), white blood cells 12.38 x 10³/μl, platelets 859 x 10³/μl, AST 1,095 U/l, ALT 104 U/l, cholestasis (total bilirubin 66.5 mg/dl and direct bilirubin 4.14 mg/dl), hypoalbuminemia (albumin 2.81 g/dl), LDH 3146 U/l, reactive HBsAg >1,000, AFP >1,000 ng/ml. An abdominal ultrasound revealed hepatomegaly with multiple nodules distributed across nearly all liver segments, and some of which formed a mass measuring 7.9 x 6.4 x 5.8 cm in the right lobe. Additionally, splenomegaly and ascites were observed. CT scan of the abdomen showed masses distributed throughout the hepatic lobe with contrast enhancement in the arterial phase and feeding from hepatic artery, in the venous phase, contrast washout with ascites. These findings support the diagnosis of hepatocellular carcinoma. Conclusion: Children with HBV may have had prior medical visits without being accurately diagnosed, representing missed opportunities for timely HBV detection. There is a critical need for increased awareness and early screening for hepatitis B virus (HBV) infection in children, especially in regions where HBV prevalence is high.
LIVER CANCER ASSOCIATED WITH HEPATITIS B VIRUS INFECTION IN A CHILD: A CASE REPORT Karina Pharamita Dewi; Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief
Journal of Vocational Health Studies Vol. 9 No. 1 (2025): July 2025 | JOURNAL OF VOCATIONAL HEALTH STUDIES
Publisher : Faculty of Vocational Studies, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jvhs.V9.I1.2025.64-69

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Background: Two-thirds of primary liver tumors in children are malignant. Hepatoblastoma (HBL) accounts for 40-60 percent of pediatric liver tumors and is the most common malignant liver tumor. Hepatocellular Carcinoma (HCC) is the second most common malignancy in children, accounting for approximately 20% of cases. Both malignant liver tumors have similar clinical and imaging features, but different prognosis and treatment. Purpose: This report aims a case of liver cancer related to hepatitis B virus infection in a child. Case analysis: A 15-year-old girl presented with a two-month history of right upper quadrant pain along with abdominal distension, weight loss, back pain, anorexia, nausea, weakness and fatigue for 5 months prior to admission. Physical examination revealed a hard, firm mass with a bumpy surface in the right upper quadrant of the abdomen and splenomegaly. Laboratory test showed an increase in Lactate Dehydrogenase (LDH), Gamma-Glutamyl Transpeptidase (GGT), Alpha Feto Protein (AFP), quantitative Hepatitis B Virus (HBV) DNA, and HBsAg reactive. Abdominal Multi-Slice Computed Tomography (MSCT) revealed malignant solid mass with necrotic component inside, indistinct borders, irregular margins and kissing spleen. Result: The diagnosis of liver cancer in this patient suggested HCC associated with chronic hepatitis B infection. Conclusion: Routine follow-up of all children with chronic hepatitis B infection is crucial because of the risk of developing liver cancer in adolescence and adulthood.
Steroid Therapy on Cholestasis: A Case Report Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief; Prihaningtyas, Rendi Aji
MEDICINUS Vol. 38 No. 11 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/mp7wkf03

Abstract

Introduction: Cholestasis is a pathological condition associated with immune-mediated processes that interfere with bile flow, thus requiring early diagnosis and prompt treatment to ensure optimal outcomes. The use of steroid therapy in the treatment of cholestasis has not been previously reported. Case: A 2-month and 9-day-old male infant presented with jaundice beginning at one week of age, followed by pale stools and tea-colored urine. Physical examination revealed jaundice, hepatomegaly, and splenomegaly. Laboratory investigations showed elevated liver enzymes: aspartate aminotransferase (AST) 292 U/l, alanine transaminase (ALT) 187 U/l, gamma-glutamyl transferase (GGT) 312.7 U/l, and alkaline phosphatase (ALP) 882 U/l), along with elevated bilirubin level (total bilirubin 7.9 mg/dl and direct bilirubin 6 mg/dl). Cytomegalovirus (CMV) IgG was reactive. A two-phase abdominal ultrasound examination revealed a preprandial gallbladder size of 0.65 x 0.33 x 1.91 cm, a postprandial size of 0.37 x 0.29 x 0.73 cm. Liver biopsy revealed chronic hepatitis and mild fibrosis (F1). The patient was treated with methylprednisolone, which was gradually tapered off. Following steroid therapy, liver enzyme and bilirubin levels normalized, gallbladder size increased, and stool color darkened. Posttreatment gallbladder size showed an increase (preprandial 3.05 x 0.96 x 0.72 cm, postprandial 2.45 x 0.72 x 0.82 cm). Conclusions: Steroids may improve bile flow and prevent further liver damage. Targeting immune mechanisms could represent a promising approach for future cholestasis treatments.
Successful Steroid Treatment of Extrahepatic Cholestasis: A Case Report Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Irawan, Muhammad; Octariyandra, Syania Mega; Arief, Sjamsul
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.963

Abstract

Background: Biliary atresia is the most common cause of cholestasis. However, not all healthcare facilities are capable of performing Kasai surgery and liver transplantation. The involvement of inflammatory processes in the bile ducts triggered by viral infections has been suggested in several theories of pathogenesis. This case report describes the successful steroid treatment of an infant with extrahepatic cholestasis. Case presentation: A girl aged 2 months and 20 days presented with complaints of jaundice since the age of 2 weeks, with no improvement and worsening of the jaundice, with the color of the stools becoming paler than before. The nutritional status is normal. The physical examination revealed icteric sclera, hepatomegaly, and splenomegaly. There was cholestasis (total bilirubin 7.30 mg/dL and direct bilirubin 5.75 mg/dL), as well as elevated levels of AST (249 U/L), ALT (251 U/L), GGT (995.7 U/L) and increased to 1529.6 U/L, CMV reactive IgG 28.9, and Rubella reactive IgG 6.90. A two-phase ultrasound of the abdomen showed a thickening of the gallbladder wall. A liver biopsy showed mild portal fibrosis (F1). Steroids at a dose of 2 mg/kg/day in combination with ursodeoxycholic acid were administered. At follow-up one month later, the jaundice had improved. Stools were yellow-brown, and liver function tests and bilirubin were normal. Conclusion: Adjunctive steroid therapy to suppress the inflammatory process in biliary obstruction may be beneficial in the early phase of the disease, especially in limited surgical and transplant settings.
Steroid therapy in extrahepatic cholestasis suggestive of biliary atresia: A case report Syahbani, Primadita; Prihaningtyas, Rendi Aji; Setyoboedi, Bagus; Arief, Sjamsul
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 9 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i9.1042

Abstract

Background: Biliary atresia is a fibroinflammatory disease obstructing the extrahepatic biliary system. Biliary atresia is the leading cause of cholestasis in infants and the cause of end-stage liver disease in the first two years of life. Surgical treatment with Kasai portoenterostomy has been performed but has not eliminated the need for liver transplantation. The consideration of adjuvant steroid therapy for suppressing the fibro-inflammatory process in the bile ducts may improve the outcome of extrahepatic cholestasis. Case Presentation: A case of a 2-month 7-day-old boy with a chief complaint of jaundice with suspicion of biliary atresia. Jaundice started 1 week after birth, followed by acholic stools, yellow-brown urine, distended abdomen, hepatomegaly, and visible abdominal veins. Laboratory examination revealed an elevated level of direct bilirubin (cholestasis) in combination with elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and Gamma-glutamyl transferase (GGT), hypoalbuminemia, and reactive of IgG and IgM CMV. A percutaneous liver biopsy was performed and showed extrahepatic cholestasis with mild fibrosis consistent with biliary atresia. The patient was treated with oral methylprednisolone and ursodeoxycholic acid (UDCA). After 12 weeks of therapy, the patient was free of jaundice and darkening of stool color, followed by a normal bilirubin level. Conclusion: In young infants with extrahepatic cholestasis suggestive of biliary atresia, steroid administration resulted in clinical and laboratory improvement. The involvement of the immune response in the pathogenesis of biliary atresia may suggest new therapeutic targets for biliary atresia, such as steroids for improving the outcome of biliary atresia in young infants.
Co-Authors Agrasenfani Hadi Akbas, Ahmad Maulana Ifan Amilia krisdiantini Anggi Sepfana Zizilia Anindya Kusuma Winahyu Anisa Yuniar Fadilla Annisya Dinda Paramitha Arvelina Novia Damayanti Budiono Budiono Budiono Budiono Cindy Wahyu Agustina Eighty Mardiyan K, Eighty Enny Karyani, Enny Evi Rokhayati Farahdina Farahdina Farida Triani Fathurrachman, Muhammad Rais Firyal Nadiah Rahmah Gina Noor Djalilah Gondo Mastutik Henry Wicaksono, Henry IDG Ugrasena Ilya Krisnana, Ilya Irawan, Muhammad Irwanto Irwanto Irwanto, Irwanto Jasin, Yayu Dwinita Karina Pharamita Dewi Kuntoro Kuntoro Lasmauli Situmorang Linda Dewanti Mahrus A Rahman, Mahrus A Manika Putri Kunigara Maretha Sukmawardani, Maretha Martono Tri Utomo Masturina, Melinda Maytasya Dwinaqifah Melantika Nur Fitria Syahri Melinda Masturina Muhammad Faizi Muhammad Irawan Muhammad Nur Alpi Apriansyah Muhammad Rais Fathurrachman Muji Retnaning Rini Mukarromah, Nur Nabilah Khansa Nastiti, Prima Hari Nesa, Ni Nyoman Metriani Ni Nyoman Metriani Nesa Ningrum, Astika Gita Nisak Luvi Mega Irawati Nur Mukarromah Octariyandra, Syania Mega Paramitha, Annisya Dinda Pratiwi, Fauziah Prihaningtyas, Rendi Aji Puspa Wardhani Qurrota Ayuni Novia Putri Rachmat Hargono Rahma Fadila, Zakiya Nur Rani Sidaryanti Rendi Aji Prihaningtyas Rendi Aji Prihaningtyas Reny Widayanti Samisatun Maulina, Siti Samsriyaningsih Handayani Savitri, Yovani Situmorang, Lasmauli Sjamsul Arief Sjamsul Arief Sjamsul Arief Sjamsul Arief Sjamsul Arief Sjamsul Arief, Sjamsul Sri Umijati Sulistiawati Sulistiawati Sulistiawati Sulistiawati Syahbani, Primadita Teddy Ontoseno Tiyas Kusumaningrum Tri Utomo, Martono Ulfa Kholili Utamayasa, I Ketut Alit Viky Nafi&#039;ah Rahma Maulidia Viky Nafi'ah Rahma Maulidia Widati Fatmaningrum Winahyu, Anindya Kusuma Woro Setia Ningtyas Yovani Savitri Zizilia, Anggi Sepfana Zubaity Ardhanariswari