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All Journal Indonesian Journal of Medicine The Indonesian Journal of Infectious Diseases PREPOTIF : Jurnal Kesehatan Masyarakat JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Berita Kedokteran Masyarakat The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Gema Lingkungan Kesehatan Jurnal Penyakit Dalam Indonesia Jurnal Pengabdian Masyarakat dan Riset Pendidikan Indonesian Journal of Medical and Pharmaceutical Science
Triyanta Yuli Pramana
Universitas Sebelas Maret
Humanities Biochemistry, Genetics & Molecular Biology Chemistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Mathematics Medicine & Pharmacology Nursing Public Health Other

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Bilateral Hepatic Subcapsular Biloma: A Rare Case Report Pramana, Triyanta Yuli; Widiastuti, Widiastuti
Indonesian Journal of Medicine Vol 5, No 1 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Biloma is loculated collection of bile that may develop due to iatrogenic causes, trauma­tically or spontaneously with biliary tree disruption. Hepatic bilateral subcapsular bi­loma is a rare complication of laparoscopic cho­lecys­­tec­tomy and an even more scarce when it occurs spontaneously.Case Presentation: A 65 years old man came to our hospital with abdominal pain and en-larged abdomen. Six weeks earlier he under­went laparoscopic cholecys­tectomy in a private hospi­tal, because of stone in the gall bladder and cho­lecys­titis. The physical examina­tion obtained no icteric and distended abdomen with pain on palpation. Laboratory findings were within nor­mal limit with negative viral infection markers. Abdominal ultrasonography revealed chronic liver disease with giant liver cyst and ascites. Contrast abdominal multi-slice computed mono­graphy (MSCT) demonstrated bila­teral hepatic sub­capsular biloma. Laparatomy and drainage were then performed and he was discharged from the hospital several days later in good condition.Discussion: Biloma was first introduced by Gould and Patel in 1979. The incidence of past laparoscopic cholecystectomy biloma is very low, between 0.6% and 1.5%. Early accurate diagnosis is very important to determine the proper mana­gement. In our case, the biloma was found by using USG and MSCT.  Usually it presents with right upper quadrant or epi­gastric pain, abdo­minal distention, fever and leukocytosis, but our patient did not have either fever or leukocytosis. Actua­lly the first treatment choice is percuta­neous catheter drai­nage but in our case laparo­tomy drainage was performed because of sub­capsular, biloma in both right and left hepatic lobes.Conclusion: Bilateral hepatic subcapsular bilo­ma is a rare case. One of its diagnostic tools is MSCT. Biloma drainage is the first choice of treatment.Keywords: Biloma, post laparoscopic cho­lecys­­­tec­tomy, drainageCorrespondence: Triyanta Yuli Pramana. Department of Gastro­enterology and Hepatology Division, Dr. Moe­wardi Hospital/ Faculty of Medi­cine, Univer­si­tas Sebelas Maret. Email: typra­ma­na@­gma­il­.comIndonesian Journal of Medicine (2020), 05(01): 52-56https://doi.org/10.26911/theijmed.2020.05.01.08
Histopathology of Helicobacter pylori in Chronic Dyspepsia Patients Wildan Nur; Paulus Kusnanto; Triyanta Yuli Pramana; Michael Tantoro Harnomo; Oyong Oyong; Ambar Mudigdo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (341.801 KB) | DOI: 10.24871/1332012161-165

Abstract

ABSTRACTBackground: Helicobacter pylori (H. pylori) are the most common infection found in dyspepsia cases. This infection is almost always found in digestive tract inflammation and commonly develops into chronic gastritis. Meanwhile, chronic gastritis is a condition assumed as the early event in pathological abnormalities of the stomach which finally may develop into carcinoma of the gaster. In Indonesia, data describing the incidence of H. pylori infection based on the histopathological appearance, location of specimen collection, inflammatory degree, and age of chronic dyspepsia patients is not yet available. The aim of this study is to determine the incidence of H. pylori based on histopathology appearance in chronic dyspepsia patients in Moewardi Hospital Surakarta.Method: This study is a cross sectional descriptive study by performing endoscopy-biopsy and histopathology examination to chronic dyspepsia patients who came to Gastroenterohepatology Clinic, Department of Internal Medicine, Moewardi Hospital, Surakarta on 1 January 2009 - 31 December 2010.Results: More than 90% subjects were 40 year old with the distribution of majority patients were 46-55 year old (32.43%). The most commonly found endoscopic appearance in subjects with positive H. pylori was superficial chronic gastritis (81.08%) with mild inflammatory degree (64.86%) and majority located in the antrum 97.3%.Conclusion: The proporsion of H. pylori infection in male and female was almost equal and was mostly found in the age group of 46-55 year old. This infection frequently happens in chronic dyspepsia who has histopathologic appearance of superficial chronic gastritis with mild inflammatory degree in the antrum area. Keywords: Helicobacter pylori, superficial chronic gastritis, age
The Correlation Between MIR-146A and Platelet to Lymphocyte Ratio to Liver Fibrotic on Hepatitis B S.R, Brillian Van Fito; Budi S, R. Satriyo; Pramana, Triyanta Yuli
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 2
Publisher : UI Scholars Hub

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Abstract

Introduction. Liver fibrosis is a pathological condition as a recovery tissue respond, characterized by excessive extracellular matrix deposit. MicroRNA (miRNA or miR) has a pivotal role on progression of hepatic cirrhosis. Platelet to lymphocyte ratio (PLR) could be as a good predictor of liver fibrosis. This study aimed to find the correlation between miR-146a and PLR with liver fibrosis in Hepatitis B.Method. The cross sectional study conducted in Gastroenterohepatology Clinic of Internal Medicine Department RSUD Dr. Moewardi Surakarta in Januari – Juli 2020, involving 26 Hepatitis B naïve patients. Complete blood count, serum creatinine, liver enzyme, HBsAg, miR-146a, elastography measurement using FibroScan were performed.Results. The average age of patients was 49 (SD 11) years, mainly men (n : 17, 66%). The results from bivariate analysis demonstrated that miR-146a was significantly associated with liver fibrosis (r = 0,639 dan p < 0,001). PLR was also significantly associated with liver fibrosis (r = -0,455 dan p = 0,020). Conclusion. There was a significant correlation between miR-146a and PLR with liver fibrosis on Hepatitis B.
Sarkopenia sebagai Faktor Risiko Varises Esofagus Risiko Tinggi berdasarkan Stratifikasi Child-Pugh Pasien Sirosis Hati Sepmeitutu, Iwandheny; Kurniawan, Juferdy; Maulahela, Hasan; Rinaldi, Ikhwan; Shatri, Hamzah; Pramana, Triyanta Yuli; Makmun, Dadang; Lesmana, Cosmas Rinaldi A; Hidayat, Rudy; Laksmi, Purwita Wijaya; Sunardi, Diana
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Background The high prevalence of sarcopenia in chronic liver disease negatively impacts the quality of life and increases the risk of various complications of cirrhosis, one of which is the development of esophageal varices. The aim of this study was to determine the prevalence of sarcopenia in cirrhosis patients based on the severity of liver cirrhosis and to explore the association of sarcopenia with high-risk esophageal varices stratified by Child-Pugh. Methods This observational cross-sectional study involved patients with liver cirrhosis at Cipto Mangunkusumo Hospital between January and September 2023. Sarcopenia was defined as a reduction in muscle mass accompanied by decreased grip strength or walking speed, according to the AWGS 2019 criteria (Asian Working Group for Sarcopenia). Multivariate logistic regression analysis was conducted to evaluate the association between sarcopenia and high-risk esophageal varices. Results A total of 155 patients with liver cirrhosis were included in this study. The majority of liver cirrhosis patients were males, with hepatitis B being the most commonly found etiology. The prevalence of sarcopenia was found in 40.0% of Child-Pugh A patients, 53.8% of Child-Pugh B patients, and 50.0% of Child-Pugh C patients with a p-value of 0.411. The high-risk of esophageal varices was found more frequently in Child-Pugh B (53.8%) and Child-Pugh C (50.0%) compared to Child-Pugh A (25.6%) with a p-value of 0.013. Bivariate analysis showed that the presence of sarcopenia in liver cirrhosis patients has a statistically significant association with an increased risk of high-risk esophageal varices, especially in the Child-Pugh B and C subgroups of liver cirrhosis patients (OR = 7.50 (95% CI: 1.48 – 37.91, p<0.030)). However, no association was found between sarcopenia and high-risk esophageal varices in the Child-Pugh A subgroup (OR = 1.46 (95% CI: 0.65 – 3.29, p<0.477)). Conclusion Sarcopenia significantly increases the risk of high-risk esophageal varices in liver cirrhosis, especially in those with Child-Pugh B and C classification.
PERAN URSODEOXYCHOLIC ACID (UDCA) DALAM PENGELOLAAN PENYAKIT BATU EMPEDU Hidayah, Rochima Ridha; Pramana, Triyanta Yuli
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 1 (2025): APRIL 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i1.43148

Abstract

Penyakit batu empedu adalah salah satu gangguan saluran cerna yang paling umum dan berisiko tinggi. Batu empedu kolesterol menyumbang 80%-90% dari semua batu empedu di negara-negara Eropa dan Amerika, sedangkan batu empedu pigmen lebih banyak dilaporkan di negara-negara Asia. Pengobatan hanya diperlukan untuk pasien yang bergejala atau pasien berisiko tinggi dengan komplikasi lain yang berhubungan dengan batu empedu. Penanganan konservatif dapat digunakan pada kasus-kasus di mana pasien tidak dapat mentoleransi pembedahan atau memilih untuk tidak menjalani pembedahan, termasuk pemberian UDCA atau drainase batu melalui kolesistostomi perkutan. UDCA memainkan peran penting dalam penanganan penyakit batu empedu, terutama untuk batu empedu berbasis kolesterol. UDCA diberikan secara oral dengan dosis 8-10 mg/kg berat badan per hari dalam dua atau tiga dosis terbagi. Pengobatan biasanya bersifat jangka panjang dan memerlukan evaluasi rutin menggunakan ultrasound setiap enam bulan untuk memantau respons pengobatan. Pemantauan jangka panjang juga diperlukan untuk mengamati potensi efek samping, seperti gangguan pencernaan atau reaksi alergi, serta untuk memastikan kepatuhan pasien terhadap terapi jangka panjang. Jika terapi UDCA terbukti tidak efektif, alternatif lain seperti kolesistektomi atau litotripsi harus dipertimbangkan. Penelitian lebih lanjut diperlukan untuk mengeksplorasi mekanisme molekuler dan genetik yang memengaruhi respons terhadap UDCA, terutama dalam memahami variabilitas individu dan bagaimana faktor genetik dapat memprediksi keberhasilan pengobatan.  
Peran Vitamin D pada Sirosis Hepatis : Penelitian Dharma, IGN Surya; Pramana, Triyanta Yuli
Jurnal Pengabdian Masyarakat dan Riset Pendidikan Vol. 3 No. 4 (2025): Jurnal Pengabdian Masyarakat dan Riset Pendidikan Volume 3 Nomor 4 (April 2025
Publisher : Lembaga Penelitian dan Pengabdian Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jerkin.v3i4.1297

Abstract

Vitamin D adalah hormon sekosteroid yang dikenal karena perannya dalam kesehatan tulang dan metabolisme kalsium. Kekurangan vitamin D dikaitkan dengan peningkatan risiko dan perkembangan beberapa penyakit kronis, termasuk sirosis hati. Mekanisme yang menyebabkan sirosis hati dapat terjadi karena kekurangan vitamin D termasuk gangguan sintesis dan metabolisme hati, malabsorpsi karena gangguan sintesis asam empedu, dan penurunan paparan sinar matahari. Kekurangan vitamin D dapat memperburuk sirosis hati melalui disregulasi respon imun, peningkatan resistensi insulin dan disfungsi metabolik yang terkait dengan perkembangan steatosis hati, fibrosis dan gangguan regenerasi hati. Delapan puluh delapan persen dari 25(OH)D terikat pada DBP, protein yang disintesis oleh hati dan anggota keluarga gen albumin, homolog dengan albumin dan α-fetoprotein. 25(OH)D diangkut ke ginjal di mana ia dihidroksilasi ulang secara enzimatik untuk membentuk 1,25(OH)D3 atau kalsitriol, bentuk aktif vitamin D3. Mekanisme kerjanya dimulai dengan 1,25(OH)2D, yang kemudian mengaktifkan VDR. VDR kemudian membentuk heterodimer dengan reseptor retinoid X sebagai faktor transkripsi dan mengikat elemen respons vitamin D di daerah promotor gen target. VDR mengatur ekspresi lebih dari 200 gen dan, mempengaruhi proliferasi sel, diferensiasi, apoptosis, imunomodulasi, dan angiogenesis. Komplikasi Kekurangan Vitamin D pada Sirosis dapat menyebabkan osteomalasia, osteoporosis, PBS, dan ensefalopati hati.
Real-Life Situation Of Bile Duct Injury Management: Challenges And Lessons From A Tertiary Care Center Pramana, Triyanta Yuli; Adhyaksari, Apriliana; Lee, See Young; Ratanachu-ek, Thawee; Ranty, Stefanus Satrio; Prasetyo, Ari; Darmayani, Aritantri; Prasetyo, Didik; Notonugroho, Anung
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025143-153

Abstract

Background: Bile duct injury (BDI) is a serious complication of cholecystectomy, particularly with the widespread adoption of laparoscopic cholecystectomy (LC). Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. This study evaluates reallife clinical experiences in managing post-cholecystectomy BDIs in Central Java, Indonesia. We aim to discuss the prevention of BDI further and find out the most effective management and timing of interventions for BDI based on these analyses.Methods: Twenty-seven cases with iatrogenic BDI following cholecystectomy were classified according to BDI Strasberg classification, repair procedures, mortality and success rate procedures, onset of BDI, and timing of repair procedures. The correlation analyses were performed using the Contingency Coefficient Correlation Test.Results: Of the 27 patients, BDIs were detected in 33.3% of patients within two weeks of surgery. Major BDIs (Strasberg E) often required biliodigestive surgery, with variable outcomes. The overall mortality rate was 29.6%, mainly due to biliary sepsis. ERCP success was significantly associated with less severe BDI (p=0.018). This study stated that the type of previous cholecystectomy, timing of BDI diagnosis, and duration of BDI to repair procedures did not statistically influence mortality (p=0.822, p=0.551, p=0.958, respectively).Conclusion: Prevention of BDI is paramount, emphasizing surgical training, careful patient selection, and the critical view of safety technique. Early detection, multidisciplinary management tailored to the injury’s severity improve outcomes. While minimally invasive approaches are preferred for minor BDIs, major injuries necessitate surgical intervention by experienced hepatobiliary surgeons.
A 57-year-old woman with chronic hepatitis B and left hepatic nodularity unmasking intrahepatic hilar adenocarcinoma: A diagnostic case report Pramana, Triyanta Yuli; Gunawan, Timotheus A.; Prasetyo, Didik; Darmayani, Aritantri; Jati, Agus; Wasita, Brian
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 16, No 2, (2025)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol16.Iss2.art16

Abstract

Metastatic breast cancer involving the biliary tract is a rare case with an incidence rate of 1.49 per 100.000 persons. Chronic hepatitis B virus (HBV) infection is associated with tumor development and migration and promotes metastasis. While hepatocellular carcinoma is the most common primary liver cancer, cholangiocarcinoma is a rarer malignancy originating from epithelial cells in various parts of the bile ducts. Intraluminal adenocarcinoma of the common hepatic duct (CHD) is an exceptionally uncommon hepatic tumor. We reported that a 57-year-old female has been complaining of abdominal pain on the upper right side for 1 year, accompanied by nausea and icterus. The patient had a history of breast cancer in 1995 and chronic hepatitis B for 20 years on Tenovofir 1x300 mg. No abnormalities were found on physical examination. However, Magnetic Resonance Cholangiopancreatography (MRCP) revealed bilateral dilatation of the intrahepatic bile duct (IHBD), common hepatic duct (CHD), ductus cysticus, and common bile duct (CBD) distal to proximal, suggesting an intraluminal mass likely due to a tumor. A plastic stent was then placed, which reduced the lesion size. Immunohistochemistry (IHC) test confirmed adenocarcinoma, in which CK-7 and mammaglobin were positive, indicating metastatic breast cancer.. A thoracic MSCT revealed multiple lytic lesions in the T1, T7, T9–T12, and L2–L3 vertebral bodies. The patient was diagnosed with intraluminal adenocarcinoma of the CHD, representing metastatic Stage I triple-negative breast cancer with biliary, pulmonary, and osseous involvement, along with chronic hepatitis B. The chemotherapy regimen included carboplatin 370 mg and paclitaxel 260 mg, continued with Taceral 500 mg 2x3 in two weeks and Zometa every 6 weeks. Post-chemotherapy MRCP evaluation showed a solid intraluminal liver lobe lesion with partial obstruction. Metastatic adenocarcinoma of the CHD caused by breast cancer is a highly unusual clinical problem. In such cases, IHC plays a vital role in identifying the primary tumor site.
The Role of PPAR in Liver Cirrhosis: An Update Review Sholihah, Mentari Maratus; Pramana, Triyanta Yuli; Hanif, Muhammad Ifham
Gema Lingkungan Kesehatan Vol. 23 No. 3 (2025): Gema Lingkungan Kesehatan
Publisher : Poltekkes Kemenkes Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36568/gelinkes.v23i3.346

Abstract

Liver cirrhosis is the final stage of various chronic liver diseases characterized by fibrosis and nodule formation in the liver. The pathophysiology of liver cirrhosis involves a complex process, in which the role of peroxisome proliferator-activated receptors (PPAR) is very important. PPARα, which is mainly expressed in the liver, plays an important role in the regulation of hepatic lipid metabolism. In cirrhosis, PPARα expression is decreased, resulting in impaired fatty acid oxidation and increased lipogenesis. This contributes to the accumulation of fat in the liver, which is one of the characteristics of NAFLD that can progress to cirrhosis. PPARγ, although better known for its role in adipose tissue, also has important functions in the liver. In cirrhosis, PPARγ plays a role in inhibiting the activation and proliferation of HSCs, and modulating macrophage polarization. PPARγ activation can reduce liver inflammation and fibrosis, and increase insulin sensitivity. Recent studies have shown that PPARγ agonists can improve steatosis, reduce inflammation, and significantly improve the response to hepatitis viruses. PPARδ, which is widely expressed in various tissues including the liver, plays a role in lipid metabolism and liver inflammation. Moreover PPARs role in viral hepatitis induced liver chirrosis is still remain controversial. Although research on PPARδ in the context of liver cirrhosis is still limited, several studies have shown its potential anti-fibrotic effects. Thus, a deeper understanding of the role of PPARs in the pathophysiology of liver cirrhosis opens up new opportunities for the development of more effective therapies to treat this chronic liver disease.
Google Trends data analysis of hepatitis B and their correlation with hepatitis B early detection program for pregnant women in Indonesia Nugraha, Dwi Adhi; Pramana, Triyanta Yuli
BKM Public Health and Community Medicine Vol 38 No 04 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v38i04.4413

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Purpose: Hepatitis B is still a problem in Indonesia. National surveillance project [Basic health survey (Riskesdas)] data in 2013 showed the prevalence of hepatitis B surface antigen (HBsAg) was 7.1%. One effort has been made to reduce the transmission of hepatitis B: the hepatitis B early detection program (DDHB) for pregnant women. Early changes in population health may be reflected in shifts in information and communication patterns on the internet. Changes in information and communication patterns on the internet can be an early "symptom" of changes in population health. This study aimed to know the correlation of hepatitis B relative search volume with HBsAg reactive percentage and coverage of the DDHB program for pregnant women in Indonesia. Methods: The value of relative search volume for hepatitis B in various regions in Indonesia in 2020 based on Google trends correlated with reactive HBsAg percentage and coverage of the DDHB program for pregnant women in 2020. Researchers compared the value of relative search volume for hepatitis B with hepatitis, hepatitis A, and hepatitis C. Spearman correlation analysis test was used to find the relationship between variables. Results: East Nusa Tenggara had the highest hepatitis B relative search volume and reactive HBsAg percentage in the DDHB program for pregnant women in 2020. Hepatitis B relative search volume was correlated with reactive HBsAg percentage (r=0.618; p<0.001) but did not correlate with DDHB coverage (r=-0.65; p=0.374). The popularity of hepatitis B (19.81±6.68) was higher than hepatitis A (8.65±5.79) and hepatitis C (3.90±1.75) but lower than hepatitis alone (54.08±19.02). Conclusion: East Nusa Tenggara had the highest hepatitis B relative search volume and reactive HBsAg percentage. Hepatitis B’s relative search volume in Google Trends data analysis significantly correlated with reactive HBsAg percentage in the DDHB program for pregnant women in Indonesia.
Co-Authors Abd. Rasyid Syamsuri Adhyaksari, Apriliana Ambar Mudigdo Ambar Mudigdo Ari Prasetyo Brian Wasita Budi S, R. Satriyo C Rinaldi A Lesmana Dadang Makmun Darmayani, Aritantri Darmayani, Aritantri Dharma, IGN Surya Diana Sunardi Didik Prasetyo Dwi Adhi Nugraha E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Gunawan, Timotheus A. Hanif, Muhammad Ifham Hasan Maulahela, Hasan Ikhwan Rinaldi Jati, Agus Juferdy Kurniawan Lee, See Young Michael Tantoro Harnomo Muhammad Zuhdan Fannani Notonugroho, Anung Oyong Oyong Paulus Kusnanto Purwita Wijaya Laksmi Ranty, Stefanus Satrio Ratanachu-ek, Thawee Retno Widyastuti, Retno Robert Satriyo Budhi Susilo ROCHIMA RIDHA HIDAYAH Rudy Hidayat S.R, Brillian Van Fito Sepmeitutu, Iwandheny Sholihah, Mentari Maratus Susanto, Agung Wildan Nur