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

Rinaldi A Lesmana

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Author-ID : 5436750

Medicine & Pharmacology

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Articles

Pharmacological and Non-Pharmacological Treatment in Non-Alcoholic Fatty Liver Disease Perdana Aditya; Rinaldi A Lesmana
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease, from steatosis to liver cirrhosis in individual who does not consume alcohol in significant amount. The prevalence of NAFLD in Indonesia was estimated around 30%, this condition related to the increased incidence of metabolic disorders. Current understanding of NAFLD pathogenesis is the third-hit theory, in which insulin resistance resulting in free fatty acid accumulation that triggers inflammation causing fibrosis and hepatocyte death, and these conditions are not followed by adequate hepatocyte proliferation.Treatment of NAFLD requires both non-pharmacologic and pharmacologic interventions. Life style intervention includes restricting calories, low saturated fat and low sugar diet, and also physical activity. Bariatricsurgery remains controversial since in several study participants had experienced deterioration of disease. There are no definitive treatment for NAFLD currently. Treatment is aimed to improved insulin sensitivity, decreased oxidative stress and inflammation. Several agents use for treatment of NAFLD are insulin sensitizer (metformin and glitazones), statin, omega-3, vitamin E, ursodeoxycholic acid, orlistat, pentoxyphylline, and losartan.Keywords: NAFLD, treatment, pharmacologic, non-pharmacologic

Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management Nikko Darnindro; Rinaldi A Lesmana
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Hepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.Keywords: hepatitis A, prolonged cholestasis, steroid therapy

Co-Authors Nikko Darnindro Perdana Aditya

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