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"Pendahuluan: Sirosis hati merupakan penyebab mortalitas dan morbiditas global, terutama melalui komplikasi hipertensi porta yang menyebabkan perdarahan varises esofagus (VE). Pasien yang pernah mengalami perdarahan pertama memiliki tingkat kejadian perdarahan berulang yang tinggi dengan angka survival yang rendah. Meskipun endoskopi dapat memprediksi perdarahan berulang, pendekatan ini mahal dan bersifat invasif. Oleh karena itu, pemeriksaan non invasif lain dengan tingkat akurasi yang tinggi perlu dipelajari.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi prediktor non-invasif perdarahan berulang VE (kekakuan hati, kekakuan limpa, skor Child Pugh, dan jumlah trombosit) pada pasien sirosis hati.Metode: Sebanyak 102 sampel pasien sirosis hati yang mengalami riwayat perdarahan VE. Variabel prediktor dalam memprediksi kejadian perdarahan berulang varises esofagus pada penelitian ini meliputi kekakuan hati, kekakuan limpa, skor Child Pugh, serta jumlah trombosit. Analisa multivariat dan uji skor dengan validasi internal untuk mendapatkan model performa terbaik sebagai prediktor perdarahan VE berulang.Hasil: Hasil menunjukkan bahwa kekakuan hati, kekakuan limpa, skor Child Pugh, dan trombositopenia signifikan sebagai prediktor perdarahan berulang VE. Dengan menggabungkan variabel ini, model prediksi dihasilkan dengan AUC 0,870. Diperoleh uji skor dengan validasi bahwa keempat variabel tersebut signifikan sebagai faktor yang berhubungan dengan perdarahan berulang varises esofagus. Kesimpulan: kombinasi kekakuan hati, kekakuan limpa, skor Child Pugh, dan jumlah trombosit memiliki performa baik dalam memprediksi risiko perdarahan varises esofagus berulang pada pasien sirosis hati.

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Background: Liver cirrhosis is a global cause of mortality and morbidity, especially through complications of portal hypertension which causes esophageal variceal (VE) bleeding. Patients who have experienced a first bleed have a high rate of recurrent bleeding with a low survival rate. Although endoscopy can predict recurrent bleeding, this approach is expensive and invasive. Therefore, other non- invasive examinations with a high accuracy need to be researched.

Objective: This study aims to identify non-invasive predictors of recurrent VE bleeding (liver stiffness, spleen stiffness, Child Pugh score, and platelet count) in liver cirrhosis patients.

Methods: A total of 102 samples of liver cirrhosis patients who had a history of VE bleeding were included in this study. Predictor variables in predicting the incidence of recurrent esophageal variceal bleeding in this study include liver stiffness, spleen stiffness, Child Pugh score, and platelet count. Multivariate analysis and internal validity test were used to obtain the best performance model as a predictor of recurrent VE bleeding.

Results: The results showed that liver stiffness, spleen stiffness, Child Pugh score, and thrombocytopenia were significant as predictors of recurrent VE bleeding. By combining these variables, a prediction model was generated with an AUC of 0.870. Validity test of these four variables were significant as factors associated with recurrent esophageal variceal bleeding.

Conclusion: The combination of liver stiffness, spleen stiffness, Child Pugh score, and platelet count has good performance in predicting the risk of recurrent esophageal variceal bleeding in patients with liver cirrhosis."

"Latar Belakang: Pecahnya varises esofagus (EV) tetap menjadi salah satu komplikasi sirosis yang paling parah. Sebagai gold standard untuk memprediksi kecelakaan ini, Esophagogastroduodenoscopy (EGD) sendiri juga memiliki kelemahan. Tidak semua pasien nyaman dan mau menerima modalitas ini dalam praktik klinis terlepas dari risiko dan beban biaya. Oleh karena itu, pencarian modalitas noninvasif lain yang nyaman tetapi dengan akurasi tinggi masih perlu dipelajari. Diantaranya, Pengukuran Kekakuan Limpa (SSM), Pengukuran Kekakuan Hati (LSM), dan skor Aspartate Amino Transferase to Platelet Ratio Index (APRI) menjadi populer dan dipelajari secara intensif di banyak pusat dengan akurasi yang baik, tetapi hasilnya tetap bertentangan di beberapa penelitian.

Tujuan : Mengetahui kinerja skor SSM, LSM, APRI, dan kombinasinya untuk memprediksi EV pada pasien sirosis hati.

Metode : Sebanyak 141 pasien sirosis hati yang menjalani endoskopi, SSM, LSM, dan perhitungan skor APRI antara Januari 2023 dan Maret 2023. Analisa diagnostik dinilai menggunakan area di bawah kurva penerima-operator (AUC) untuk mengukur dan membandingkan kinerja setiap pengukuran dan kombinasi untuk memprediksi EV dan untuk mendapatkan nilai prediksi optimal yang sesuai. Pengukuran elastografi transien (TE) dilakukan menggunakan fibroscan khusus limpa dengan probe 100 hz.

 

Hasil : Dari 141 pasien, etiologi terbanyak adalah hepatitis B sebanyak 71 pasien (50,4%). Varises esofagus ditemukan pada 116 pasien (86,3%). Dengan menggunakan area under receiver, SSM pada titik potong 40,1 kPa memiliki kinerja terbaik untuk memprediksi EV pada sirosis dengan AUC 0,892 (sensitivitas 88,79%, spesifisitas 80%), diikuti oleh LSM pada titik potong  10,2 kPa dengan AUC 0,832 (sensitivitas 90,52%, spesifisitas 60%), dan skor APRI pada titik potong 0,72 memiliki AUC terendah antara lain 0,780 (sensitivitas 77,59%, spesifisitas 80%). Kombinasi ketiga pemerikssan tidak menunjukkan performa yang lebih baik dibandingkan SSM secara tunggal dengan AUC 0,892.

 

Kesimpulan : SSM memberikan kinerja yang lebih baik daripada skor LSM dan APRI untuk memprediksi EV.

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Background: Esophageal varices (EV) rupture remains one of the most severe complications of cirrhosis. As a gold standard to predict this accident, Esophagogastroduodenoscopy (EGD) itself also has a weakness. Not all patients are convenient and willing to accept this modality in clinical practice apart from the risk and cost burden. Hence, the search for other noninvasive modalities that are convenient but with high accuracy is still noteworthy to be studied. Among them, Spleen Stiffness Measurement (SSM), Liver Stiffness Measurement (LSM), and the Aspartate Amino Transferase to Platelet Ratio Index (APRI) score become popular and intensively studied in many centers with good accuracy, but the results remain conflicting in some studies.

 

Objective: To investigate the performance of SSM, LSM, APRI score, and their combination for predicting EV in liver cirrhosis patients.

 

Methods: A total of 141 patients with liver cirrhosis who had undergone endoscopy, SSM, LSM, and APRI score calculation between January 2023 and March 2023 were enrolled. Diagnostic applicability was assessed by the area under the receiver-operator curve (AUC) to measure and compare the performance of each measurement and combination for predicting EV and to obtain the corresponding optimal prediction value. Transient elastography (TE) measurement was done using spleen-dedicated fibroscan with a 100 Hz probe.

 

Results: Of the 141 patients, the most common etiology was hepatitis B 71 patients (50,4%). Esophageal varices were found in 116 patients (86,3%). Using area under receiver, SSM at cut-off 40,1 kPa had the best performance for predicting EV in cirrhosis with AUC 0,892 (sensitivity 88,79%, specificity 80%), followed by LSM at cut-off 10,2 kPa with AUC 0,832 (sensitivity 90,52%, specificity 60%), and APRI score at cut-off 0,72 had the lowest AUC among others 0,780 (sensitivity 77,59%, specificity 80%). The combination of all measurement tools did not show better performance than SSM alone with AUC 0,892.

 

Conclusion: SSM provides better performance than LSM and APRI score for predicting EV"

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 ? 0,026 x hitung trombosit ? 2,243 x kadar albumin - 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 ? 0.026 x platelet count ? 2.243 x albumin level - 0.184 x PT."

"Varises esofagus (VE) merupakan salah satu komplikasi hipertensi vena porta yang serius. Pemanfaatan teknologi informasi dalam pelayanan keperawatan dapat membantu memonitor kondisi klien sirosis hepatis setelah perawatan di Rumah Sakit. Meskipun sebagian edukasi diterima dengan baik, seringkali edukasi yang diberikan kurang optimal, khususnya pada pasien berobat jalan di poliklinik. Penelitian ini bertujuan untuk menganalisis efektivitas edukasi melalui WebApps pencegahan perdarahan berulang varises esofagus terhadap pengetahuan pasien sirosis hepatis di RSUP Nasional Dr. Cipto Mangunkusumo. Metode penelitian ini menggunakan Kuasi Eksperimen dengan Nonequivalent Kontrol Group Design. Sample dipilih secara purposive sebanyak 132 responden dengan 66 pada kelompok kontrol dan 66 pada kelompok intervensi. Hasil penelitian menunjukkan tidak ada hubungan signifikan antara kelompok usia, jenis kelamin, pekerjaan, dengan pengetahuan (p>0,05). Lama rawat (0,05). Pendidikan (rendah, menengah, tinggi) tidak menunjukkan perbedaan signifikan dalam nilai pengetahuan pre-test dan post-test pada kelompok intervensi. Meskipun terdapat variasi, nilai pre-test dan post-test pada semua tingkat pendidikan tidak berbeda secara signifikan. Kesimpulan penelitian ini bahwa karakteristik responden seperti usia, jenis kelamin, pekerjaan tidak berhubungan signifikan dengan pengetahuan, meskipun pendidikan sedikit memiliki variasi nilai, namun tidak signifikan. Sedangkan lama rawat hanya signifikan pada pengetahuan pretest.

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Esophageal varices (VE) is one of the serious complications of portal vein hypertension. Utilization of information technology in nursing services can help monitor the condition of hepatic cirrhosis clients after hospitalization. Although some education is well received, often the education provided is not optimal, especially for outpatients at the polyclinic. This study aims to analyze the effectiveness of education through WebApps to prevent recurrent bleeding of esophageal varices on the knowledge of patients with hepatic cirrhosis at Dr. Cipto Mangunkusumo National Hospital. This research method uses Quasi Experiment with Nonequivalent Kontrol Group Design. The sample was purposively selected as many as 132 respondents with 66 in the kontrol group and 66 in the intervention group. The results showed no significant relationship between age group, gender, occupation, and knowledge (p>0.05). Length of stay (0.05). Education (low, middle, high) showed no significant difference in pre-test and post-test knowledge scores in the intervention group. Despite the variation, the pre-test and post-test scores at all education levels were not significantly different. The conclusion of this study is that the characteristics of respondents such as age, gender, occupation are not significantly related to knowledge, although education has a slight variation in value, but not significant. While the length of hospitalization is only significant in pre-test knowledge."

"ABSTRAKLatar belakang dan Tujuan : Varises esofagus merupakan komplikasi sirosis hati dengan mortalitas tertinggi. Pemeriksaan USG Doppler yang bersifat non invasif, tersedia luas dan relatif murah, dipertimbangkan sebagai metode skrining, namun belum ditemukan parameter Doppler splenoportal yang dapat digunakan sebagai indikator varises dengan akurat. Indeks volume aliran vena lienalis terhadap kecepatan aliran vena porta dipikirkan dapat menjadi parameter baru yang akurat.Metode : Studi observasional potong lintang dilakukan pada 28 pasien sirosis hati di Divisi Hepatologi Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dalam kurun waktu November 2015 hingga Februari 2016. Indeks dan parameter Doppler lainnya merupakan data primer. Subjek dibagi menjadi tiga kelompok, yakni kelompok non varises, varises kecil dan besar. Uji komparatif dilakukan untuk membandingkan indeks dan parameter Doppler lainnya diantara ketiga kelompok tersebut. Analisis kurva receiver operating characteristic (ROC) dilakukan pada parameter yang secara statistik bermakna untuk mendapatkan nilai sensitifitas dan spesifisitasnya.Hasil : Nilai tengah indeks pada kelompok non varises 9,60 (4,67 – 15,07), varises kecil 21,18 (8,92 – 25,24) dan varises besar 64,43 (46,67 – 145,88) dengan nilai p<0,001. Pada analisis kurva ROC didapatkan titik potong indeks 15,78 dengan sensitifitas 80% dan spesifisitas 100% untuk membedakan kelompok varises kecil dan non varises, serta titik potong 36,0 dengan sensitifitas dan spesifisitas 100% untuk membedakan kelompok varises besar dan kecil.Kesimpulan : Terdapat hubungan yang bermakna antara indeks volume aliran vena lienalis terhadap kecepatan aliran vena porta secara ultrasonografi dengan derajat varises esofagus secara endoskopi pada pasien sirosis hati dan indeks tersebut dapat digunakan sebagai indikator varises esofagus dengan akurasi tinggi.

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ABSTRACTBackground and Objective : Esophageal varices is a complication of liver cirrhosis with high mortality. Doppler ultrasound examination is non-invasive, widely available and relatively low cost to be considered as a screening method of varices. Unfortunately, there is still no splenoportal Doppler parameter that can be used as an indicator of varices with high accuracy. Index of splenic vein flow volume to portal vein flow velocity is thought to be a new, more accurate parameter.Methods : A cross-sectional observational study conducted in 28 patients with liver cirrhosis in the Division of Hepatology Department of Internal Medicine Cipto Mangunkusumo Hospital during November 2015 to February 2016. Index and other splenoportal Doppler parameters are the primary data. Subjects were divided into three groups : a group of non varices, small and large varices. The comparative test conducted to compare the mean index and other splenoportal Doppler parameters among the three groups. Analysis of receiver operating characteristic (ROC) curve was performed on parameters that are statistically significant to get the sensitivity and specificity value.Results : Median index in the group of non varices is 9,60 (4,67 – 15,07), 21,18 (8,92 – 25,24) in small varices and 64,43 (46,67 – 145,88) in large varices group with p<0.001. ROC curve analysis generated optimal cutting point index 15,78 which gives 80% sensitivity and 100% specificity to differentiate small and non varices group and the cutoff point of 36.0 which provides 100% sensitivity and specificity to differentiate among the large and small varices.Conclusions : There is a significant association between the index of splenic vein flow volume to portal vein flow velocity by ultrasound with the degree of esophageal varices by endoscopy in patients with liver cirrhosis and this index can be used as indicator of esophageal varices with high accuracy."

"Pasien sirosis hati perlu dievaluasi secara berkala untuk menentukan adanya varises esofagus (VE) dan ukurannya (besar atau kecil), karena VE besar membutuhkan penatalaksanaan yang lebih agresif. Evaluasi ini dilakukan dengan endoskopi yang tidak selalu ada, invasif, dan berbiaya tinggi. Penelitian ini bertujuan untuk mendapatkan pemeriksaan yang non invasif, lebih murah, dan lebih mudah diakses untuk menentukan besarnya VE. Parameter yang diteliti adalah hitung trombosit, prothrombin time (PT), kadar albumin, dan bilirubin. Desain penelitian adalah potong lintang dengan 64 subjek, terdiri atas 24 pasien sirosis hati dengan VE besar dan 40 tanpa VE besar. Pada penelitian ini didapatkan perbedaan bermakna pada hitung trombosit, PT, dan kadar albumin antara kedua kelompok, sedangkan kadar bilirubin tidak memberikan perbedaan yang bermakna. Untuk parameter hitung trombosit didapatkan besar area under the curve untuk memprediksi VE besar sebesar 80,9%, dengan cutoff 89,5 x 103/μL didapatkan sensitivitas 79,2% dan spesifisitas 75,0%; PT 68,4%, dengan cutoff 14,05 detik didapatkan sensitivitas 70,8% dan spesifisitas 67,5%; kadar albumin 76,6%, dengan cutoff 3,275 g/dL didapatkan sensitivitas 70,8% dan spesifisitas 75,0%. Model prediksi sirosis hati dengan VE besar adalah P = 1/(1 + Exp-Logit (y)) dengan Logit (y) = 11,989 – 0,026 x hitung trombosit – 2,243 x kadar albumin – 0,184 x PT.

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Patients with liver cirrhosis require periodic evaluation to determine the presence and size of esophageal varices (EV), because the large ones demand more aggressive management. Evaluation is done using endoscopy, which is not always available, invasive, and costly. This study aims to acquire tests that are noninvasive, cheaper, and more accessible to determine the size of EV. Studied parameters were platelet count, prothrombin time (PT), albumin, and bilirubin level. The study design was cross sectional with 64 subjects, consisted of 24 liver cirrhotic patients with large VE and 40 without.

This study found significant difference in platelet count, PT, and albumin level between both groups, while bilirubin level was not. The size of area under the curve for platelet count to predict large VE was 80.9%, cutoff 89.5 x 103/μL (sensitivity 79.2%, specificity 75.0%), PT 68.4%, cutoff 14.05 seconds (sensitivity 70.8%, specificity 67.5%), and albumin level 76.6%, cutoff 3.275 g/dL (sensitivity 70.8%, specificity 75.0%). Prediction model for liver cirrhosis with large VE was P = 1/(1 + Exp-Logit (y)) with Logit (y) = 11.989 – 0.026 x platelet count – 2.243 x albumin level – 0.184 x PT."

"ABSTRAK Latar Belakang : Malnutrisi merupakan faktor independen yang berhubungan dengan morbiditas, mortalitas dan tingginya biaya pengobatan sirosis hati. Kekuatan Genggam Tangan (KGT) merupakan suatu metode yang sering digunakan untuk mendeteksi malnutrisi dan menilai prognosis pasien. Hubungan KGT dengan Skor Child Pugh (CP) dan massa otot masih dalam kontroversi. Indonesia sampai saat ini belum memiliki data tersebutMetode : Studi potong lintang pada pasien sirosis hati di poliklinik hepatobilier RSCM dari Februari-Juni 2015. Status nutrisi dinilai berdasarkan KGT. Massa otot diukur menggunakan bioimpedans. Analisis statistik menggunakan uji korelasi spearmanHasil : Terdapat 115 pasien yang kontrol di poliklinik hepatobilier RSCM, 112 pasien memenuhi kriteria penelitian, terdiri dari 79 laki-laki dan 33 perempuan. Usia pasien rata-rata 54,15±10,55 tahun, median skor CP 6(5-13) dengan median KGT 26(11-50) kgF, rata-rata massa otot 44,43±8,12 kg. Median asupan energi 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalensi malnutrisi berdasarkan KGT ditemukan sebanyak 33%. Kekuatan genggam tangan tidak berkorelasi dengan skor CP (p 0,046, r=-0,19) namun berkorelasi dengan massa otot (p <0,001, r= 0,70) Simpulan Terdapat 33% kasus malnutrisi berdasarkan KGT pada pasien sirosis rawat jalan. KGT tidak berkorelasi dengan skor Child Pugh namun berkorelasi dengan massa otot pasien sirosis hati.ABSTRACT Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis.;Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis.;Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis."

"Latar Belakang: Penderita sirosis hati sering mengalami gangguan sistem hemostasis yang kompleks dan komplikasi perdarahan akut varises gastroesofageal. Peran gangguan sistem hemostasis dalam perdarahan akut varises gastroesofageal penderita sirosis hati masih belum jelas.Tujuan: Mengetahui perbedaan jumlah trombosit, nilai PT, nilai APTT dan kadar protein C penderita sirosis hati yang mengalami dan yang tidak mengalami perdarahan akut varises gastroesofageal. Metode: Penelitian ini merupakan studi potong lintang pada penderita sirosis hati. Subjek penelitian diperoleh dari penderita yang berobat di RS Cipto Mangunkusumo, Jakarta. Seluruh penderita dilakukan pemeriksaan jumlah trombosit, nilai PT, nilai APTT dan kadar protein C. Penderita dengan gejala perdarahan akut saluran cerna bagian atas dilakukan pemeriksaan Esofago-Gastro-Duodenoskopi EGD. Diagnosis perdarahan akut varises gastroesofageal ditentukan dari hasil pemeriksaan EGD. Untuk mengetahui perbedaan jumlah trombosit, nilai PT, nilai APTT dan kadar protein C penderita sirosis hati yang mengalami dan yang tidak mengalami perdarahan akut varises gastroesofageal dipakai uji T indepedent dan uji Mann-Whitney. Hasil: Terdapat total 63 penderita sirosis hati yang ikut serta dalam penelitian, 21 penderita mengalami perdarahan akut varises gastroesofageal dan 42 penderita tidak mengalami perdarahan akut varises gastroesofageal. Perbedaan jumlah trombosit penderita sirosis hati yang mengalami perdarahan dan yang tidak mengalami perdarahan akut varises gastroesofageal mempunyai nilai p>0,05. Jumlah trombosit.

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Background Patients with liver cirrhosis have complex hemostatic system disturbances and acute gastroesophageal varices bleeding frequently. The role of hemostatic system disturbances in acute gastroesophageal varices bleeding has not been yet clear in liver cirrhosis.Objective To know the difference of thrombocyte count, PT, APTT and protein C level in liver cirrhosis patients with and without acute gastroesophageal varices bleeding.

Methods: This was a cross sectional study. Patients with liver cirrhosis were enrolled from Cipto Mangunkusumo Hospital, Jakarta. All patients underwent examination for thrombocyte count, PT, APTT and protein C level. Patients with acute upper gastrointestinal bleeding underwent examination for esophago gastro duodenoscopy EGD. Diagnosis of acute gastroesophageal varices bleeding based on the result of EGD examination. To know the difference of thrombocyte count, PT, APTT and protein C level in liver cirrhosis patients with and without acute gastroesophageal varices bleeding, T independent test and Mann Whitney test were used for statistical analysis.

Results There are 63 patients with liver cirrhosis in this study, 21 patients with acute gastroesophageal varices bleeding and 42 patients without acute gastroesophageal varices bleeding. The difference of thrombocyte count in liver cirrhosis patients with and without acute gastroesophageal bleeding has p value 0,05. Thrombocyte count. "

"Based on its relation to the liver sinusoid, increased pressure of portal vein can occur at three levels: presinusoid, sinusoid ,and postsinusoid. Obstruction of the presinusoid veins can be caused by extra-hepatic condition such as venous thrombosis.

We reported a case of portal hypertension with esophageal varices bleeding was a result of obstruction due to thrombosis of the splenic vein and portal vein under hypercoagulant conditions due to thrombocyto-sis. The management of esophageal varices was sclerotherapy while for overcome the thrombosis the patient was given hydroxy urea."