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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Femmy Nurul Akbar
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Medicine & Pharmacology

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Vasoactive Intestinal Peptide-Secreting Tumor Femmy Nurul Akbar; Dadang Makmun
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009120-124

Abstract

Vasoactive intestinal peptide-secreting tumor (VIPoma) is one of the tumors which cause “ watery diarrhea, hypokalemia, hypochlorhydria and acidosis syndrome” (WDHHA syndrome). These tumor caused by to non-insulin-secreting pancreatic islet tumor that associated with elevated vasoactive intestinal polypeptide (VIP) plasma level. VIP is a potent stimulator of gut cyclic adenosine monophosphate (cAMP) production, which leads to massive secretion of water and electrolytes mainly potassium. Over expression of VIP causes diarrhea and cancerous growth. The other clinical features of VIPomas such as hypercalcemia, abdominal discomfort, tetany, facial flushing are associated with the actions of VIP, which stimulate intestinal secretion, inhibit gastric acid secretion. VIP also regulates the synthesis, secretion, and action of neuroendocrine hormones such as secretin, glucagon, prostaglandin E, somatostatin and pentagastrin as well as cytokines and chemokines. Diagnosis is based on clinical, laboratory test show elevation VIP level, electrolyte and acid base imbalance also imaging such as CT scan or magnetic resonance imaging (MRI) which shows primary tumor in the pancreas and metastasis especially in the liver. Somatostatin receptor scintigraphy may be useful in identifying extrapancreatic VIPomas, i.e. the sympathetic chain, colon, bronchus and occult or distant metastases. Initial treatment is to correct volume, electrolyte, and acid-base abnormalities with intravenous normal saline, potassium chloride, and, sodium bicarbonate. Somatostatin or long acting ocreotide is effective in reducing serum VIP levels and promptly controlling diarrhea. Interferon alpha and glucocorticoid may be useful for reducing symptoms. Surgical resection depends on staging of pancreatic tumor.   Keywords: VIPoma, WDHHA syndrome, VIP, non insulin secreting pancreatic islet tumor
Benign Recurrent Intrahepatic Cholestases Femmy Nurul Akbar; Sjaifoellah Noer; L A Lesmana; Unggul Budihusodo; Wirasmi Marwoto
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 1, April 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/21200141-44

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Benign recurrent intrahepatic cholestasis (BRIC) or idiopathic recurrent intrahepatic cholestasis is a rare case. It is a familial and autosomal recessive. The etiology of BRIC is still unknown. We report the case of a patient with BRIC who suffered from recurrent jaundice 7 times in 7 years that occurred for 1-3 months with spontaneous resolutieon. This patient received ursodeoxycholic acid, cholestiramine and prednisone. And within 2 months, the jaundice resolved together with other complaints.    Keywords: cholestasis, autosomal, familial
Correlation between the Degree of Esophageal Varices and Liver Stiffness in Liver Cirrhosis Patients Femmy Nurul Akbar; Tjahjadi Robert Tedjasaputra; Dadang Makmun; Nurul Akbar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 2, August 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/102200963-65

Abstract

Background: Bleeding due to rupture of esophageal varices is one of main cause of death in liver cirrhosis, that endoscopy screening is recommended. However endoscopy is invasive and frequently cannot be performed due to contraindication, high-cost or uncomfortable effect to the patients, particularly on patients have not had any bleeding before. Consequently, it is necessary to find other assessment which can predict the presence of esophageal varices. Recent studies found liver stiffness measurement by the liver transient-elastography is one of non invasive measurement to evaluate liver fibrosis.This study was designed to know the correlation between degree of the esophageal varices and the degree of liver stiffness. Method: This was cross sectional study. Liver cirrhosis patients were consecutively enrolled in this study. They underwent endoscopy to determine esophageal varices and subsequently the liver transient- elastography by Fibroscan technique to determine liver stiffness. Degree of the esophageal varices based on OMED criteria. Liver stiffness are expressed in kilopascal (kPa). Correlation analysis was done to assess this study. Result: There were 13 subjects. Most subjectswere male, age 50 years and Child-Pugh A or B. The mean value of liver stiffness was 35.55 ± 23.60 kPa and mean OMED was 5.61 ± 2.14. The coefficient correlation between degree esophageal varices and degree liver stiffnes was 0.492, p = 0.087. Conclusion: There is moderate correlation but not statistically significant between the degree of liver stiffness and the degree of esophageal varices. Larger sample size is necessary to find the correlation between the degree of liver stiffness and esophageal varices.   Keywords: liver cirrhosis, degree of esophageal varices, liver stiffness
Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin Femmy Nurul Akbar; Zuljasri Albar; Abdul Muthalib; Laurentius Lesmana; Nurul Akbar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/7120066-10

Abstract

Background: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration 14 g/dl was found to be the risk factor of anemia. Conclusion: Prevalence of anemia was 52.5%. Pretreatment hemoglobin concentration 14 g/dl was only found to be the risk factors of anemia. Although age 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy.   Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemia
Co-Authors Abdul Muthalib Dadang Makmun L A Lesmana Laurentius Lesmana Nurul Akbar Sjaifoellah Noer Tjahjadi Robert Tedjasaputra Unggul Budihusodo Wirasmi Marwoto Zuljasri Albar