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"Leptospirosis is a wide-spread zoonosis in the world, especially in the tropical countries. Ninety percent of cases are characterized by abrupt fever and have good prognosis, but in 10% of cases, exacerbation will occur and the mortality rate is about 10%. Leptospirosis may strike the entire organ, including gastrointestinal tract. Pancreatitis in leptospira is characterized by increased serum amylase levels, with mean values of five times normal. Early diagnosis and prompt treatment will engender good prognosis. Treatment of acute pancreatitis caused by leptospira is similar with other acute pancreatitis treatment caused by other agents. The pathophysiology of leptospira infection includes endotoxin, hemolysis and lipase."

"Menentukan penyebab kolestasis merupakan tantangan tersendiri, namun hal itu perlu mendapatkan perhatian khusus karena akan menentukan langkah selanjutnya. Leptospirosis, yang dapat bermanifestasi sebagai kolestasis, mempunyai gambaran klinis yang sangat bervariasi sehingga penegakkan diagnosis seringkali sulit. Pada makalah ini dilaporkan kasus laki-laki, usia 50 tahun dengan nyeri perut kanan atas dan kolestasis disertai gangguan fungsi ginjal, pneumonia dan gambaran EKG abnormal. Pemeriksaan serologi leptospira menunjukkan hasil IgM positif. Perlu dipertimbangkan pemeriksaan screening leptospirosis pada pasien dengan kolestasis terutama pasien dengan risiko tinggi terinfeksi leptospira.

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Discovering the etiology of cholestasis is challenging, but it requires particular rconsideration, because it will determine our next steps. While leptospirosis may cause cholestasis, leptospirosis has diverse clinical spectrum so that it is often difficult to establish the diagnosis. We reported a fifty-year-old man with right upper quadrant abdominal pain and cholestasis. In addition, we also found distorted renal function, pneumonia, and ECG abnormalities. The patient underwent serologic test for leptospiral infection and the IgM was positive. These findings showed the necessity for considering leptospirosis screening in patients with cholestasis especially those in higher risk group."

"Leptospirosis is a zoonotic disease cause by a microorganism? leptospira, with animals especially rats acting as the reservoir host. Humans are infected by direct contact with urine or tissues of the infected animals and indirectly by contaminated water, soil, and vegetation leptospira. Infection can result in acute renal failure, or liver damage and pancreas.In this case patient with the problem is leptospirosis, acute pancreatitis and acute renal failure. Serologic test resulted in positive leptospira with titer 400 for serovar Hardjo and titer 100 for serovar Bataviae."

"Recurrent acute pancreatitis is often caused by excessive alcohol intake and bile stones. Patients suffering from more than one episode of acute pancreatitis are diagnosed with recurrent acute pancreatitis. The etiology of recurrent acute pancreatitis is known in 70 to 90% of patients after evaluation incorporating history taking, physical examination, routine laboratory assessment, and transabdominal ultrasonography or CT scan. However, the etiology of 10 to 30% of patients with recurrent acute pancreatitis remains undetermined. Further more sensitive evaluation is often performed, such as ERCP, ultrasound endoscopy, or MRCP, in order to determine the cause for recurrent acute pancreatitis. These tests are usually able to diagnose microlithiasis, sphincter oddi dysfunction, or pancreatic division,3-4'5-6>7.Medina- Perez M, Garcia Ferris G, Caballow Gomes J, Hospital de la Merced, and Ossuna Sevilla reported a rare case on a 33-year old woman with recurrent acute pancreatitis related with an anatomical abnormality in the form of a duplicate duodenal ampulla with multiple stones2 Even though several researches were able to detect microlithiasis in less than 10% of all patients with recurrent acute pancreatitis, most of them found microlithiasis in approximately two thirds of the patients.3"

"Tuberculosis is a common infectious disease in our community. The management of this disease become more difficult and also the prognosis when there were an advanced complication and a high prevalence of multidrugs resistance. We report a -10-year-old female patient with pyopneaenatorax with history of discontinuing tuberculosis drugs before"

"ABSTRACTDiabetic gastroenteropathy is a common complication in prolonged diabetic patients, particularly patients with poor glycemic control or other complications, including all form of diabetic complication on the gastrointestinal tract, which prompts various symptoms of heartburn, abdominal pain, nausea, vomiting, even constipation, diarrhea, and fecal incontinence. The underlying pathophysiology of this complication manifestations are different on each organ or symptom, but may include autonomic nervous system neuropathy, loss of Interstitial Cell of Cajal as gastric muscle pacemaker leading to dysmotility, impair of liquid transportation and motoric function, as well as hyperglycemia causing oxidative stress, and other factors like Insulin-Growth Factor I inducing smooth muscle atrophy. Diabetic gastroenteropathy is one of major morbidity on diabetes mellitus patients. Patients with this complication need to be well diagnosed and ruled out other diagnosis possibilities. Management of the complication includes resolving main symptoms and maintaining good glycemic control. With growing number of diabetes mellitus patients and the prevalence of diabetic gastroenteropathy complication not being well recorded, caused by lack of attention and knowledge of healthcare provider in identifying the complication; it is important to be able to identify and to give early treatment to diabetic gastroenteropathy patients, to increase quality of life and maintain glycemic control of the patient."