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Journal : The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

A Deterioration of Anemia in Hemoglobin E Disease caused by Cholestatic Hepatitis A Helena Fabiani; Suzanna Ndraha; Henny Tanadi Tan; Fendra Wician; Mardi Santoso
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 (314.026 KB) | DOI: 10.24871/1332012185-188

Abstract

ABSTRACTPatients with hemoglobin E disease usually have mild hemolytic anemia and mild splenomegaly. Acute infection including acute inflammatory disease of the liver caused by hepatitis A viral, which attacks patients with previous hemolytic anemia, may result in deterioration of anemia.A 17-year-old female patient was admitted with chief complaint of having jaundiced body and non-specific prodromal symptoms within one week prior to admission. Physical examination revealed jaundiced skin and sclera as well as tenderness in right upper quadrant of the abdomen. Laboratory tests revealed microcytic hypochromic anemia with hemoglobin (Hb) level of 6.3 g/dL, increased reticulocyte count and abnormal morphology of erythrocyteson blood smear. Hemoglobin electrophoresis indicated hemoglobin E disease and serologic tests suggested a positive anti-HAV immunoglobulin M (IgM) with increased level of liver enzymes and functions. Abdominal ultrasound showed hepatosplenomegaly without extra-hepatic cholestasis. The working diagnosis was hepatitis A with intrahepatic cholestasis and hemoglobin E disease. The patient was treated with hepatoprotector and ursodeoxycholic acid. Anemia was not treated specifically. It was assumed that hemolytic anemia was worsened by acute infection of hepatitis A viral. The assumption had been proven to be right since there was improvement of anemia after the acute infection had recovered. Patients with hemoglobin E disease usually have mild anemia; however, in this case, the hemoglobin level decreased significantly due to the acute co-infection. Keywords: hemoglobin E disease, anemia, acute infection, acute hepatitis A infection
Impaired Glucose Metabolism in Liver Cirrhosis Suzanna Ndraha; Fendra Wician; Marshel Tendean; Ivan DP Sunardi; Mardi Santoso
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (379.303 KB) | DOI: 10.24871/142201385-89

Abstract

Background: Approximately 30% of patients who suffer cirrhosis maybe diabetic, called hepatogenous diabetes (HD). Insulin resistance seems to be the pathophysiologic basis for HD. Aims of this study were to evaluate the glucose metabolism disorders in liver cirrhosis patients and to observe the insulin resistance in HD.Method: This study was conducted from February-July 2013 in Koja Hospital Jakarta. In the first phase, with observational design, inclusion criteria were liver cirrhosis and exclusion was an acute complication. We recorded their oral glucose tolerance test (OGTT). Patients who met the HD criteria were continued to the second phase, using analytic design, and were compared with type 2 diabetes mellitus (T2DM) patients as control. Mean differences of 2-hours postprandial plasma glucose/fasting plasma glucose (2hPPG/FPG) ratio, as well as fasting insulin levels between both groups were assessed.Results: Twenty four patients were included in our study. Normal glucose tolerance test were noted in 7 (29%) patients, impaired glucose tolerance (IGT) in 6 (25%) patients and HD in other 11 (46%) patients. In the second phase, we obtained the ratio of 2hPPG/FPG in HD was 2 ± 0.5 and T2DM was 1.5 ± 0.4 (p = 0.01). Mean fasting insulin levels in HD was 10.8 ± 4.2 μIU/mL, while T2DM was 9.3 ± 5.3 μIU/mL (p = 0.5). The ratio of 2hPPG/FPG was higher in HD compared to T2DM, assuming the role of insulin resistance in HD.Conclusion: There were impaired glucose metabolism in liver cirrhosis patients, as well as hepatogenous diabetes. Insulin resistance and hyperinsulinemia appeared to play role in HD.Keywords: hepatogenous diabetes, type 2 diabetes mellitus, 2hPP/FPG ratio, fasting insulin level
Diabetes Mellitus Due to Liver Cirrhosis in 33-Year-Old Female Henny Tanadi Tan; Suzanna Ndraha; Helena Fabiani; Fendra Wician; Mardi Santoso; Marshell Tendean
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (294.011 KB) | DOI: 10.24871/1422013117-119

Abstract

Impaired glucose metabolism can occur in patient with chronic liver disease, either it is impaired glucose tolerance or diabetes mellitus (DM). DM due to liver cirrhosis is known as hepatogenous diabetes (HD). HDis different from type 2 DM in clinical signs and management.A 33-year-old female came with chief complaint of fatigue since three days before admission. Patient also complained of nausea, vomiting, and increased abdominal circumference since one year ago. Patient wasdiagnosed with DM two months ago. From physical examination, anemic and ascites without signs of cirrhosis were obtained. Laboratory test showed mild anemia with hemoglobin levels 6.5 g/dL, elevated serum bilirubinand liver enzymes, decreased serum albumin, prolonged prothrombin time and elevated random blood glucose. Serologic test showed chronic hepatitis B with HBV DNA 1.61 x 104 copy/mL. The abdominal ultrasound resultshowed liver cirrhosis with ascites.The patient was diagnosed with hepatogenous diabetes in liver cirrhosis due to chronic hepatitis B infection and anemia of chronic disease. The management of this patient was quite complex especially in administrationof oral antidiabetic agent which could affect the liver function.Keywords: hepatogenous diabetes, liver cirrhosis, diabetes mellitus, chronic hepatitis B infection
Co-Authors Aang Wahidin Abd. Gafur Adianto Adianto Adityo Pratomo Putro Afifah, Rizqi Nur Agustina Merdekawati Ahmad Rizqi Alima Fabri Alfanda, Benedcita Dian Aminatus Sa’diyah Ananda Krisna Aldianita Andifa, Vinda Aprilia Nurul Angelia Angelia Ani Iryani Anisa Rahma Maharani Ardi Lukman Hakim Arif Fadlan Ariwiyono, Nopem Ashari, Moch. Luqman Aunurohim Aunurohim Awik P.D. Nurhayati Azhaar, Nadia Bambang Antoko Benedicta Dian Alfanda C. I. Sutrisno Cahyaningati, Desi Cahyono, Luqman Cicilia Puspa Rini Dahlena Ariyani David StC Black Dewi Kurniasih Dheva Noveilya Didik Prasetyoko Didik Sukoco Djoko Hartanto Edi Haryono Eko Julianto Eky Novianarenti Eky Novianarenti Endro, R. Dimas Eva Melinda Evan Evan Fadlan, Arif Fahimah Martak Fatimatul Munawaroh Fatimatul Munawaroh Fendra Wician Fendra Wician Fiqey Indriati Eka Sari Ghaissani, Shabrina Syifa Gusma Hamdana Putra Hadi Nur Hadi Nur Haidhar Wahyu S Hakam, M Hanafi Hanafi Haniarta Gemilang Sari Hartati Hartati Hartono Gunarso Hasliza Bahruji Healthy Kainama Helena Fabiani Hendro Agus Widodo, Hendro Agus Henny Tanadi Tan Herdayanto Sulistyo Putro Herijono, Boedi Heriyansyah, Rafi Akbar I Made Putra Ananta W Ikang Martin Trasnowo Imelda Imelda Imelda Priskila Simanjuntak Imroatul Qoniah Ingeswari, Aulya Vidiana Ivan DP Sunardi Jesika Setiawan Jovita Jovita Kamilia Mustikasari KAMILIA MUSTIKASARI Kavin, Layli Adha Nadira kholifatu rosyidah Kholifatu Rosyidah Khozin, Muhamad Nur Kristian Ariya Sedayu Kusdiantomo Kusdiantomo Kusminah, Imah Luluk Kusuma, George Endri Laila Khamsatul Muharrami, Laila Khamsatul Leaw Wai Loon Lingga Kamadatu Lukman Atmaja M Anis Mustaghfirin M Daffa Aditya M Hakam M. Rizal Fahmi Maharani, Aditya Maria Dewi Astuti Marshel Tendean Marshell Tendean Marshell Tendean Maya Damayanti Mochammad Choirul Rizal Mochammad Purwanto Mohammad Abu Jami'in Monica Puspa Sari muhammad fatoni, muhammad Muhammad Nur Kholis Muhammad Nur Kholis Mustaghfirin, M Anis Nabilah Dita Anaqah Nadia Sasanti Naufal Salehtra Ghalib Ni Kadek Githa Kartika Gunadyani Nindyapuspa, Ayu Ni’matut Tamimah Noer Komari Nor Farida Novpi Susanto Nugraeni, Christine Dyta Nugraheni, Zjahra Vianita Nur Hayati Nur Hayati Nurjanah, Ana Pieter Kakisina Ponti Almas Karamina Pramesti, Lely Pranowo Sidi Purwanto, Mochammad Puspitasari Puspitasari Rafi Akbar Heriyansyah Rahma Rahayu Dinarlita Rahmat Rosid Ratna Ediati Regie Santoso Reynaldi Aurel Fadiilah Rini Indarti RR. Ella Evrita Hestiandari Ruzain Rafie Sukma Putra Salsabila, Yofinta I Sarmoko Sarmoko Sa’diyah, Aminatus Sembiring, Rinawati Sri Fatmawati Sugeng Triwahyono Sumardiono . Susan Susan Susana Chandra Susanna Ndraha Susi Agustina Wilujeng Susy Budi Astuti SUYATNO Suzanna Ndraha Syafiuddin Syafiuddin Tamimah, Nimatut Taslim Ersam Taslim Ersam Umbara, Albert Wida Utomo, Agung Prasetyo Vanuella Tresnaning Budi Wati, First Ambar Wong Hendra Widjaja Yani Cahyo Susilo Yaqdhan Nufal Rafi Yatim Lailun Ni’mah Yuli Kusumawati Yuli Kusumawati Zainul Mujib Zulqurnain, Muhammad