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A Nurman, A
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Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Journal : Universa Medicina

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Perlemakan hati non alkoholik Nurman, A
Universa Medicina Vol 26, No 4 (2007)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2007.v26.205-215

Abstract

Spektrum patologi klinik dari perlemakan hati non alkoholik (PHNA) terentang dari simple steatosis sampai non alkoholic steatohepatitis (NASH). Simple steatosis memiliki perjalanan klinik yang relatif jinak, namun NASH dapat berkembang ke sirosis dan karsinoma hepatoseluler. PHNA umumnya asimtomatik dan harus dicurigai pada pasien-pasien dengan obesitas abdominal dan diabetes melitus tipe 2. Peningkatan alanine aminotransferase (ALT) serum dan/atau gambaran perlemakan hati pada USG sering kali merupakan temuan pertama yang mengarahkan diagnosis ke PHNA. Diagnosis PHNA ditegakkan setelah menyingkirkan penyakit hati kronis yang lain; diagnosis definitif hanya dibuat dengan biopsi. Peningkatan ALT umumnya tidak melebihi 5 kali batas atas nilai normal. Adanya ikterus, bilirubinuria dan demam juga menyingkirkan diagnosis PHNA. Sebagian besar steatosis hepatik tidak berkembang menjadi fibrosis atau steato hepatitis, 30-40% akan menjadi fibrosis dalam periode 4 tahun dan +15% akan berkembang menjadi sirosis. Penatalaksanaan PHNA tidak ditargetkan pada hepar saja, melainkan harus holistik, berpusat pada perbaikan resistensi insulin dan gangguan metabolisme terkait, yang dimulai dengan modifikasi gaya hidup. Berat badan harus diturunkan secara bertahap.Vitamin E dan asam ursodeoksikolat diberikan karena dapat menurunkan ALT. Metformin dan/atau rosiglitazone dapat diberikan pada pasien tanpa diabetes yang nyata, karena obat-obat ini tidak menyebabkan hipoglikemia, dan dapat meningkatkan sensitivitas insulin. Perburukan fungsi hati juga harus dicegah dengan menghindari zat-zat hepatotoksik.
Magnetic resonance cholangiopancreatography: practical experience in 30 subjects Nurman, A
Universa Medicina Vol 27, No 4 (2008)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2008.v27.150-156

Abstract

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method of imaging the biliary and pancreatic ducts. No special patient preparation is    required but the usual contraindications to MR scanning apply. The diagnostic performance of MRCP in most biliary tract diseases is similar to that of more invasive techniques of direct cholangiography such as endoscopic retrograde cholangiopancreatography (ERCP). The objectives of this study were to           investigate the diagnostic efficacy of MRCP in patients with abdominal pain with lesser likelihood of having choledochal stone and to determine whether use of MRCP could eliminate the need for purely diagnostic endoscopic retrograde cholangio-pancreatography (ERCP). A total of 30 patients with suspected biliopancreatic pathology from several hospital was studied retrospectiely between January 2007 and December 2008 in Jakarta. The sensitivity and specificity of MRCP was 92.59% (95% Confidence Interval, 74.25 - 98.71%) and 66.67% (95% Confidence Interval, 12.53 – 98.23%), respectively. The positive predictive value of MRCP for all biliary pathology was 96.15% (95% Confidence Interval, 78.42 – 99.79%) The negative predictive value of MRCP was 50.00% (95% Confidence Interval, 9.19 – 90.81%). MRCP seems to be effective in diagnosing patients with abdominal pain with lesser likelihood of having choledochal stone.
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