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"Choledocoltthiasis may cause acute cholangitis which is life-threatening condition. It has non specific clinical signs from mild to severe condition such as septicemia. Diagnostic and treatment modalities had developed a great deal recently. Therapeutic options include endoscopic retrograde cholangio pancreatography (ERCP), common bile duct exploration (CEDE), laparoscopic CBDE and stone retrieval. The important thing is to choose the appropriate method for each patient. We reported a case of choledocolithiasis in 40 years old, male patients who was clinically diagnosed as acute cholangitis. Diagnostic approach to find the etiology was done. Abdominal USG and CT were performed and showed multiple stones in gallbladder and intrahepatic biliary duct, suspected mass at capul of the pancreas and hepatomegaly. The ERCP showed dilatation of intra and extra hepatic biliary ducts with multiple stone in common bile duct (CBD), hepatic duct and gallbladder. The slent was placed for biliary drainage. The patient underwent cholecystectomy per laparoscopy, but further evaluation of the cholangiography still showed the presence of stones in intrahepatic biliary duct. Laparotomy exploration of CBD was done and it revealed multiple stones and dilatation of distal CBD. Surgical treatment selected for this case was chole docojej unostomy."

"ABSTRACTThyroid nodule is a health problem which commonly found in daily practice, therefore clinical guidance is needed. This guideline was compiled by a multidisciplinary team and expected to be a guideline in diagnosing thyroid nodules on daily clinical practice."

"Inflammatory bowel disease (IBD) has begun to emerge in Indonesia. The disease is further classified into two types, ulcerative colitic (UC) and crohn's disease (CD). Diagnosis of IBD is initiated from symptom findings such as diarrhea, abdominal pain, bleeding diarrhea, and weight loss, and supported by physical examination and additional tests. The options for additional examinations of IBD are mainly endoscopy (esophagogastroduodenoscopy, colonoscopy, and also intestinal endoscopy), imaging the techniques and laboratory examinations either from blood or feces. The application of these modalities should be prompted by sufficient clinical suspicion to promote their efficiency as well as prevent underdiagnosis or overdiagnosis. In primary health care settings, patients with IBD are expected to be recognized for therapy or to use appropriate referral system to warrant a proper treatment."