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"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"

"PURPOSE: A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP. METHODS: One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density. RESULTS: Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037). CONCLUSION: Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use."

"Latar belakang dan tujuan : Hemosiderosis jantung dan pankreas merupakan komplikasi transfusi pada pasien thalassemia mayor. Evaluasi hemosiderosis pankreas dan jantung dilakukan dengan pemeriksaan MRI sekuens T2*. Kedua organ tersebut mempunyai kesamaan dalam penyimpanan besi dan tehnik pemeriksaan T2* pankreas lebih mudah dan cepat dibandingkan tehnik pemeriksaan jantung, sehingga diharapkan evaluasi hemosiderosis jantung dipermudah dengan menghitung nilai T2* pankreas.Metode : Uji korelatif dengan pendekatan potong lintang pada nilai T2* pankreas dan nilai T2* jantung dihitung menggunakan perangkat lunak CMRtools™ pada 30 subjek thalassemia mayor.Hasil : Tidak terdapat korelasi antara nilai T2* pankreas dengan nilai T2* jantung (R = 0,05, p = 0,798).Kesimpulan : Tidak terdapat korelasi antara nilai T2* pankreas dengan nilai T2* jantung pada pasien thalassemia mayor.

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Background and objective : Cardiac and pancreatic hemosiderosis are transfusion complication in major thalassemia patients. Evaluation of cardiac and pancreatic hemosiderosis assessed by MRI T2* examination. Both organs have same iron deposition, pancreatic T2* examination easier and faster than cardiac. Pancreatic T2* score can be used to evaluate cardiac hemosiderosis.

Method : A cross sectional correlation study between pancreatic and cadiac T2*score calculated with CMRtools™ software conducted in 30 major thalassemia patients.

Result : There is no correlation between pancreatic and cardiac T2* score (R = 0,05, p = 0, 79)

Conclusion : There is no correlation between pancreatic and cardiac T2* score in major thalassemia patients."

"Pelaksanaan praktek klinik selama masa residensi Keperawatan Medikal Bedah peminatan Digestif bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti secara khusus pada keahlian Digestif. Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien dengan kanker pankreas dan 30 kasus pasien dengan masalah digestif lainnya. Salah satu karaktristik perawat spesialis adalah memberikan intervensi keperawatan berbasis bukti Evidence-based Nursing practice , yang dilakukan melalui penggunaan Animal Naming Test ANT untuk mengidentifikasi gangguan fungsi kognitif pada pasien sirosis hepatis yang sedang dirawat. Animal Naming Test ANT yang diterapkan pada 16 pasien sirosis telah berhasil mengidentifikasi lebih banyak pasien yang mengalami gangguan kognitif dibandingkan dengan asesmen klinis yang sudah ada di ruang perawatan. Inovasi dalam pelayanan keperawatan yang dilakukan melalui program inovasi kelompok berupa penerapan kegiatan ERAS yakni memberikan minuman karnohidrat Maltodextrin, mobilisasi dini dan mengunyah permen, terbukti berhasil meningkatkan pemulihan perawatan pasien pembedahan sistem pencernaan.

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The purpose of Clinical learning practice during Medical Surgical Nursing Residency Program, with specialisation in digestive, is to facilitate the student in developing capability to perform the roles of nurse specialist as advanced nursing care provider, educator, advocator, counselor, collaborator, innovator and researcher. Advance nursing care provider role is implemented by using Roy Adaptation Model on pancreatic carcinoma patiet and 30 other digestive cases. Evidence Based Nursing Practice as other character of nurse specialist practice was performed by applying animal naming test ANT to identify cognitive problem in hospitalized cirrhotic patients. It is based on the importance for nurse to recognize early cognitive dysfunction to provide better nursing care especially in latent asymptomatic hepatic encephalopathy that common happens in cirrhosis patient. ANT was tested on 16 hospitalized cirrhotic patients and succeeded in identifying more cirrhosis patient with cognitive dysfunction compared to available assessments in ward. The innovation program which was implementing ERAS activities carbohydrate loading, early mobilization and chewing gum have proven to be effective perioperative management in digestive surgery. "

"ABSTRAK Latar Belakang : Pada studi invivo, seperti indometasin dan diklofenak,, ketoprofen menghambat aktifitas enzim fosfolipase A2 yang memainkan peran penting dalam patogenesis pankreatitis. Tujuan : Mengetahui efektifitas ketoprofen suppositoria terhadap pencegahan pankreatitis pasca ERCP Metode : Uji klinis acak tersamar ganda ini dilakukan di Pusat Endoskopi Saluran Cerna dan ruang rawat inap Rumah Sakit Pusat Nasional Dr Cipto Mangunkusumo pada bulan oktober 2016 sampai dengan Januari 2017 terhadap 74 pasien ikterus obstruktif dewasa atau dengan indikasi ERCP lainnya. Pasien yang memenuhi kriteria penerimaan diberikan ketoprofen suppositoria atau plasebo dosis tunggal sesaat sebelum tindakan ERCP dan dievaluasi tanda dan gejala pankreatitis akut serta evaluasi ulang amilase lipase 24 jam pasca tindakan untuk menentukan adanya pankreatitis pasca ERCP. Derajat pankreatitis akut dinilai berdasarkan kriteria imrie modified glasgow pada 48 jam pasca ERCP Hasil : 74 subjek yang memenuh kriteria penelitian dirandomisasi menjadi dua kelompok, masing-masing terdiri dari 37 pasien, terdapat 1 pasien dari setiap kelompok yang tidak dapat dikanulasi. Dilakukan analisis dengan prinsip intention to treat analysis, kedua kelompok sebanding dalam karakteristik demografis dan klinis termasuk faktor risiko terkait pasien dan prosedur. Insidens PPE pada kelompok ketoprofen sebanyak 13,5 5 sedangkan pada kelompok plasebo sebanyak 21,6 8 , Absolute Risk Reduction ARR = 0,081, Relative Risk RR = 0,625, Relative risk reduction RRR = 0,375, Number Needed to Treat NTT =12 95 IK=-9-25 . Terdapat laporan adverse event berupa perforasi usus pada 1 subjek. Kesimpulan: ketoprofen suppositoria menurunkan insidens pankreatitis pasca ERCP Kata Kunci : ketoprofen, insidens, pankreatitis pasca ERCP

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ABSTRACT Background An invitro study showed ketoprofen as well as indomethacin and diclofenac inhibits the activity of phospholipase A2 that is supposed to play a major role in the pathogenesis of pancreatitis. Objectives To determine the effect of rectal suppository ketoprofen to prevent post ERCP pancreatitis Methods This randomized double blind controlled trial performed at Gastrointestinal Endoscopy Center and inpatient unit in Cipto Mangunkusumo National General Hospital during October 2016 to January 2017 among patients with obstructive jaundice and patients with other indications of ERCP. All subjects with inclusion criteria were treated with rectal ketoprofen or rectal placebo suppository single dose immediately before ERCP. Sign and symptoms of acute pancreatitis and serum amylase and lipase level observed in 24 hours after ERCP to determine post ERCP pancreatitis. Acute pancreatitis was graded according to the Imrie rsquo s modified Glasgow severity criteria in 48 hours after ERCP. Result In total, 74 subjects were randomized into two groups containing 37 subjects in each group. One patient in each group was failed for cannulation. We used intention to treat analysis, both groups were comparable regarding demographic and clinical factors. The incidence of PEP was 13,5 5 in ketoprofen group and 21,6 8 in placebo group, Absolute Risk Reduction ARR 0,081, Relative Risk RR 0,625, Relative risk reduction RRR 0,375, and Number Needed to Treat NTT 12 95 CI 9 ndash 25 . Reported adverse event was bowl perforation in 1 subject. Conclusion Rectal ketoprofen reduced the incidence of post ERCP pancreatitis Key Words Ketoprofen, Incidence, Post ERCP pancreatitis"