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Liver Disorders in Type 2 Diabetes Mellitus Suzanna Ndraha; Marshell Tendean; Fendra Wician; Henny Tanadi Tan; Helena Yap
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Patients with type 2 diabetes mellitus (T2DM) are frequently diagnosed with some abnormal liver features. These liver abnormalities are suggested to be correlated with insulin resistance. The aim of thisstudy was to evaluate liver abnormalities and fasting insulin levels in patients with T2DM.Method: This study was conducted in Koja Hospital from February to July 2013. Study design was analytical study. Data for sex, age, complication, body mass index (BMI), liver function, liver enzyme, and fasting insulinlevel were collected. Univariate and bivariate statistical analyses were done using SPSS 20.Results: Twenty eight patients were included in this study, 71.43% of them were female. The age group of 40-60 years was the highest among the patients (64.28%). Highest complication was neuropathy, BMI of mostpatients were obese. Liver abnormalities were documented in 35.8% patients, liver enzyme increased in 21.4% patients. Non alcoholic fatty liver disease (NAFLD) were noted in 46.6% patients, and one patient was positive for hepatitis B. Mean fasting insulin in T2DM with NAFLD were higher than in T2DM without NAFLD. However, it was not statistically significant (40.08 ± 36.8 μU/mL vs. 54.3 ± 37.1 μU/mL; p = 0.27).Conclusion: Liver abnormalities found in T2DM patients were elevated liver enzyme, decreased albumin and increased of bilirubin. Through ultrasound, NAFLD and liver cirrhosis were found. Fasting insulin levelwas higher in T2DM with NAFLD but it was not statistically significant.Keywords: type 2 diabetes mellitus, non alcoholic steato-hepatitis, fasting insulin

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

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

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

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

Survei Pasien Penyakit Jantung Koroner yang Memenuhi Target Pencegahan Sekunder di De La Salle University Medical Center Fendra Wician
Jurnal Ners Vol. 9 No. 3 (2025): JULI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v9i3.44644

Penyakit jantung koroner (PJK) masih merupakan penyebab utama morbiditas dan mortalitas di dunia. Pada pasien PJK, pencegahan sekunder bertujuan mencegah infark miokardial dan kematian, serta mengurangi gejala dan meningkatkan kualitas hidup. Studi ini dilakukan untuk mengetahui proporsi pasien PJK yang memenuhi sasaran rekomendasi pencegahan sekunder PJK berdasarkan The 2012 Joint European Societies’ guidelines. Ini adalah penelitian survei potong lintang yang dilakukan di rumah sakit De Lasalle University Medical Centre di Filipina. Pasien berusia 18 tahun atau lebih dengan riwayat PJK lebih dari 6 bulan yang berkonsultasi di poliklinik kardiologi dan rawat inap sejumlah 209 orang diikutsertakan secara konsekutif dalam penelitian. Rata-rata usia 62.34 (SD±12.77) tahun dengan distribusi jenis kelamin hampir sama. Komorbiditas tersering adalah dislipidemia (88.5%). Empat dari 10 pasien memiliki riwayat merokok. Sepertiga dari pasien memiliki riwayat keluarga dengan penyakit kardiovaskular prematur. Faktor risiko PJK tersering adalah kolesterol HDL yang rendah (77.5%). Proporsi pasien PJK yang memenuhi sasaran pencegahan sekunder PJK adalah sebagai berikut: berhenti merokok (79,5%), tekanan darah <140/90mmHg (71,8%), total kolesterol <4.5 mmol/L (56%), IMT 18,5 – 24,9 (56%), Hba1c <7% pada pasien DM (41,6%), sasaran aktivitas fisik (31,1%), sasaran lingkar pinggang (28,2%), dan kolesterol LDL <1.8mmol/L (14,8%).

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