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All Journal Acta Interna : The Journal of Internal Medicine MEDICINUS The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia

Fahmi Indrarti

Division Of Gastroentero-hepatology, Department Of Internal Medicine Faculty Of Medicine, University Of Gadjah Mada/Dr. Sardjito General Hospital, Jogjakarta

Author-ID : 286942

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

Published : 8 Documents Claim Missing Document

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Articles

Evaluating Indications and Diagnostic Yield of Colonoscopy in Sardjito General Hospital Suharjo Broto Cahyono; Putut Bayupurnama; Neneng Ratnasari; Catharina Triwikatmani; Fahmi Indrarti; Sutanto Maduseno; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Inappropriate colonoscopy indications increase rate of complications.Aim: The main aims of our study were to evaluate indications, fi ndings and diagnostic yield at colonoscopy.Methods: A retrospective study of all colonoscopy was conducted from January 2012 through August 2013, at Dr. Sardjito General Hospital, Yogyakarta and there were 688 colonoscopy reports. Seven colonoscopy indications were documented and presented: rectal bleeding or hematochezia, chronic diarrhea, abdominal pain, constipation, screening and surveillance for colonic neoplasia, change in bowel habit and anemia. Diagnostic yield was defi ned as the ratio between signifi cant fi ndings detected on colonoscopy and the total number of procedures performed for the indication. In our study, diagnostic yield was established by colonoscopy, not confirmed by biopsy.Results: Overall diagnostic yield was 72.53%. The leading indication for colonoscopies was rectal bleeding or hematochezia (36.19%), followed by chronic diarrhea (23.11%), abdominal pain (14.09%), constipation (13.37%), screening and surveillance (5.66%), change in bowel habit (5.52%) and anemia (2.02%). Diagnostic yields according colonoscopies examination were normal (37.14%), colorectal cancer (19.33%), proctitis (14.24%), infl ammatory bowel disease (12.50%), polyps (11.19%),hemorrhoid (10.03%), and diverticel(3.78%). Colorectal cancers were found in patients with hematochezia (74 patients, 29.71%), chronic diarrhea (34 patients, 21.38%), constipation (13 patients, 14.13%). Of 249 patients presenting with hematochezia were found colorectal cancer (74 patients), hemorrhoid (50 patients), proctitis (30 patients), normal (30 patients). Our study showed that diagnostic yield was far lower in patients below 50 years (38.48%) compared > 50 years (61.52%), especially for colorectal cancer (p < 0.001), polyps (p = 0.004) and diverticular (p < 0.001).Conclusions: Hematochezia was the leading indication for colonoscopy and the diagnostic yield was 72.53%. The leading of colonoscopy fi ndings were normal colonoscopies, followed by colorectal cancer, proctitis,infl ammatory bowel disease, polyps and diverticel. Colonoscopy indications should be based on the available guidelines to minimize as much as possible the number inappropriate procedures and complications.Keywords: Colonoscopy, diagnostic yield, colonic indications, appropriateness of colonoscopy

Correlation between the Severity of Liver Cirrhosis (Chil-Pugh Score) and QTc Interval Prolongation Rachmad Aji Saksana; Putut Bayupurnama; Fahmi Indrarti; Neneng Ratnasari; Sutanto Maduseno; Catharina Triwikatmani; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

ABSTRACT Background:Liver cirrhosis causes changes in cardiovascular system. Electrographic (ECG) abnormality commonly found in cirrhosis patients is QT interval prolongation. It is part of cirrhotic cardiomyopathy. QTc interval prolongation is correlated to the incidence of life-threatening arrhythmias. The objective of this study was to recognize the correlation between the severity of liver cirrhosis and QTc interval prolongation in patients with liver cirrhosis at Sardjito General Hospital, Jogjakarta.Method: The design of this study was cross-sectional. The subjects were hospitalized patients with liver cirrhosis at the Department of Internal Medicine, Sardjito Hospital, Jogjakarta between January 2011 and March 2012. ECG was performed in all patients and QTc interval was measured. The severity of liver cirrhosis was determined by Child-Pugh score. Spearman correlation analysis was used to determine the correlation between variables of QTc interval prolongation and Child-Pugh score.Results: A total of 73 patients were enrolled, including 51 (69.9%) male and 22 (31.1%) female patients with mean age of 54.05 ± 12.55 years (range 20-80). Liver cirrhosis was caused by hepatitis B virus in 36 (49.3%) patients, hepatitis C virus in 20 (27.4%) patients and other causes in 19 (26%) patients. The Child-Pugh score for liver cirrhosis was found as follows: child A in 10 (13.6%) patients, child B in 27 (36.9%) patients and child C in 36 (49.3%) patients. The correlation between the severity of liver cirrhosis and QTc interval prolongation was weak (r = 0.255; p = 0.029).Conclusion:Severity of liver cirrhosis has a weak positive correlation with QTc interval prolongation. Keywords: liver cirrhosis, QTc interval, Child-Pugh score

Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient Catharina Triwikatmani; Putut Bayupurnama; Sutanto Maduseno; Neneng Ratnasari; Fahmi Indrarti; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/10120092-6

Background: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p 0.05. Results: During the period of May 1st - September 30th 2007, there were 36 eligible patients. The mean value of zinc serum levels was 63.70 ± 24.85 µg/dL. There were 24 (66.67%) patients with hypozincemia. The mean value of 24-hour-urinary zinc excretion was 787.52 ± 570.20 µg. There were 19 (52.8%) patients with urinary zinc excretion 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume. Keywords: liver cirrhosis, serum zinc level, urinary zinc excretion

Factors that Influence Cecal Intubation Rate in Unsedated Patients during Colonoscopy Suharjo B Cahyono; Putut Bayupurnama; Neneng Ratnasari; Catharina Triwikatmani; Fahmi Indrarti; Sutanto Maduseno; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Successful cecal intubation is a primary quality indicator in colonoscopies and the mostimportant factor in detecting abnormal lesion in the colon. There are many factors that influence cecal intubationrate during colonoscopy procedure. The aim of this study is to evaluate the factors that influence cecal intubationrate in unsedated patients during colonoscopy. Method: A retrospective study of colonoscopy performed at Sardjito General Hospital, Jogjakarta, from January 2012 to August 2013. Age, sex, bowel preparation, indication for colonoscopy, colonoscopist, andreasons of incomplete colonoscopy from 564 colonoscopy reports were recorded and analysed. Results: Overall successful cecal intubation rate was 408 (72.34%). Causes of incomplete colonoscopywere patients discomfort or pain 41.66%, looping/redundant 28.85%, poor bowel preparation 18.59%, fixation/adhesion 6.41%, and bleeding risk 4.49%. Female was more unsuccessful in cecal intubation than male (31.50%vs. 24.05%; p = 0.048). The successful cecal intubation rates for gastroenterologists compared to gastroenterology(GI) fellows were 77.92% vs. 49.55%; p 0.001, and poor bowel preparation was more difficult to reach cecalthan good preparation (57.58% vs. 23.69%; p 0.001). Multivariate logistic regression analysis demonstratedthat female and poor bowel preparation were independently associated with lower cecal intubation rate, andgastroenterologists were independently associated less unsuccessful to reach cecal. Conclusion: The overall successful cecal intubation rate was still below the set standard. Several identifiedfactors that may predict lower of cecal intubation rate: the skill and experience of colonoscopists (GI fellows),poor bowel preparation and female.Keywords: cecal intubation rate, colonoscopy, unsedated colonoscopy

Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment Catharina Triwikatmani; Putut Bayupurnama; Sutanto Maduseno; Neneng Ratnasari; Fahmi Indrarti; Siti Nurdjanah
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: 10.24871/1132010121-124

Background: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p 0.001). Re-bleeding and recurrence rates were 38.64% and 84.21% for endoscopic sclerotherapy, and 25.93% and 70% for endoscopic band ligation (p 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices. Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxis

Anti-DFS70 as Nonsystemic Autoimmune (Primary Billiar Cholangitis) Concomitant Disease Marker in Systemic Lupus Erythematosus Putra, Yasjudan Rastrama; Mulya, Deshinta Putri; Indrarti, Fahmi
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Anti-dense fine speckled 70 (DFS70) is known as a non-systemic autoimmune marker. It is only found in 1% of systemic autoimmune patients and 2–22% in healthy population. To the best of our knowledge, no anti-DFS70 positive has been reported in systemic lupus erythematosus (SLE) patients with primary billiary cholangitis (PBC) comorbidities. We reported a 40-year-old woman that was diagnosed with SLE 1-month before, came to the hospital due to seven days of fatigue, loss of appetite, icteric, arthralgia, hair loss, and unexplained fever. Total bilirubin was 9.46 mg/dl, direct bilirubin 7.73 mg/dl, gamma-glutamyl transferase (GGT) 503 U/L, alkaline phosphatase (ALP) 520 U/L, ANA-IF 1:1000, ANA-profile measurement borderline on the anti-centromere B, and three positives on the DFS70. Magnetic resonance cholangiopancreatography (MRCP) shown the PBC feature. After ursodeoxycholic acid (UDCA) therapy 250 mg twice daily, ALP and GGT backed to normal limits within two months. This case reminds the doctor that anti-DFS70 finding in SLE needs further evaluation, whether other nonsystemic autoimmune exist or not. Concomitant PBC with SLE well responded with UDCA standard therapy.

Correlation Between the Presences of Ascites with MELD-Na Scoring in Liver Cirrhosis Patients Marcellus, Marcellus; Ratnasari, Neneng; Indrarti, Fahmi
Acta Interna The Journal of Internal Medicine Vol 12, No 2 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98482

Background. Global prevalence of liver cirrhosis (LC) ranges from 4.5% to 9.5% of the general population amounting to more than fifty million people in the world. The Model for End Stage Liver Disease (MELD-Na) is commonly used to determine the prognosis and survival of liver cirrhosis patient. MELD-Na scoring consists of creatinine, bilirubin, international normalized ratio (INR), and serum sodium. Ascites is one of the clinical signs of decompensated liver cirrhosis, as well as present in Child Turcotte Pugh (CTP). The purpose of this study was to investigate the association between the presence of ascites and MELD-Na scores of LC patients.Methods. This cross-sectional study was performed in LC patients who met the inclusion without exclusion criteria. The study was conducted at RSUP Dr. Sardjito, Yogyakarta, Indonesia during 2017-2018 periods. The MELD-Na value was calculated using the following equation:MELD-Na = 9.57 ln (creatinine mg/dL) + 11.2 ln (INR) + 3.78 ln (bilirubin mg/dL) + 1.59 (135-Na [mEq/L]) + 6.43. Differences of mean MELD-Na scores based on presenting of ascites were tested by independent T-tests. The cut-off value of MELD-Na was determined through the Receiver Operating Characteristic (ROC) curve. The relationship between the presence of ascites and the MELD-Na value was determined by the Fisher exact test; the correlation strength was determined by Phi and Crammer's V test. Prevalence ratio (PR) was calculated for determining the predictor factors. The results were considered statistically significant when the probability value p <0.05 was obtained.Results. There were 59 subjects (41 male and 18 female). The mean age of subjects was 52.05 years old. The 39 patients were found ascites and 20 patients were not. Based on independent T test results there was a significant difference in mean values of MELD-Na (p=0.006). Based on the ROC curve result, a cut-off point of 20.7 (95% specificity, 35% sensitivity) with Area under the Curve (AUC) was 0.662 (p=0.042). Based on the cut-off, Fisher test with 2x2 tables, Phi and Cramer's V test were done with p value 0.022; 0.015; 0.015 respectively. The PR value was 1.607 (95% CI: 1.203-2.145).Conclusion. There was a significant correlation between the presences of ascites with MELD-Na scoring using cut-off point of 20.7 and value of Prevalence Ratio of 1.6.

Persistent Jaundice in a Tuberculosis Patient After Treatment: A Rare Case of Primary Sclerosing Cholangitis Endro Tanoyo; Fahmi Indrarti; Deshinta Putri Mulya; Nur Rahmi Ananda; Naomi Yoshuantari; Bestari Ariningrum Setyawati
MEDICINUS Vol. 38 No. 8 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/9gdf2175

Primary sclerosing cholangitis (PSC) presents diagnostic challenges due to its overlapping features with other conditions. This case report describes a 28-year-old woman with a history of pulmonary tuberculosis who developed jaundice weeks after completing antituberculosis treatment, initially resembling drug-induced liver injury (DILI). In 2021, patient was diagnosed with tuberculous sclerosing cholangitis and showed improvement with antituberculosis therapy. However, in 2022, patient experienced recurrent jaundice, fever, dark urine, and weight loss, without gastrointestinal symptoms. Laboratory tests revealed elevated bilirubin (total 13.8 mg/dl, direct 12.9 mg/dl), increased liver enzymes (SGOT 177 U/l, SGPT 91 U/l), and a positive antinuclear antibody indirect immunofluorescence (ANA IF) test with a centromere pattern. Magnetic resonance cholangiopancreatography (MRCP) and liver biopsy findings supported a diagnosis of PSC, overlapping with tuberculous sclerosing cholangitis. Treatment with ursodeoxycholic acid, methylprednisolone, and mycophenolic acid led to significant improvement in bilirubin and liver enzyme levels, although they remained above the normal range. This case highlights the diagnostic complexity of PSC in tuberculosis patients, particularly in the absence of typical gastrointestinal symptoms. The relationship between tuberculosis and PSC remains unclear, necessitating further investigation. Despite treatment, serum bilirubin and transaminase levels were fluctuated but persisted above the normalrange, highlighting the challenges in managing PSC with concurrent tuberculosis. This report emphasizes the importance of comprehensive diagnostic approaches, including imaging and histopathology, in identifying atypical presentations of PSC.

Co-Authors Bestari Ariningrum Setyawati Catharina Triwikatmani Deshinta Putri Mulya Deshinta Putri Mulya Endro tanoyo Marcellus, Marcellus Naomi Yoshuantari Neneng Ratnasari Nur Rahmi Ananda Putra, Yasjudan Rastrama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Rachmad Aji Saksana SATRIYAS ILYAS Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Suharjo B Cahyono Suharjo B Cahyono Suharjo Broto Cahyono Sutanto Maduseno Sutanto Maduseno Sutanto Maduseno Yasjudan Rastrama Putra

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