CASE STUDY

TREATMENT PATIENT EVALUATION OBSTRUCTIVE JAUNDICE

IN PGI CIKINI HOSPITAL
Arif Setiawan, S.Farm
1343700026
Email : arif.setiawan_23@yahoo.co.id
Program Profesi Apoteker, Fakultas Farmasi
Universitas 17 Agustus 1945 Jakarta

ABSTRACT
Obstructive Jaundice is a condition where the blockage of the flow of bile from the liver.
Jaundice (jaundice) is defined as the yellowing of skin and sclera color due to the accumulation
of the pigment bilirubin in the blood and tissues. Bilirubin levels will reach 35-40 mmol / L
before jaundice cause clinical manifestations. When the blood bilirubin level exceeds 2mg%
increase then jaundice will be visible. It can happen to an increase in indirect bilirubin
(unconjugated) or direct (conjugated). Jaundice obstructive jaundice that is caused by obstruction
of bilirubin secretion in normal circumstances should be channeled to the gastrointestinal tract.
Male patient aged 30 years old, admitted to hospital with complaints of itching all over
the body, eyes yellow. Had a history of hepatitis A in 2011. Based on the results of laboratory
tests were known there was an increase in total bilirubin level that is equal to 13.7 mg / dL.
Ultrasound examination of patient has fatty liver known. Patient on therapy with ceftriaxone
injection 1g, 1g inj cefoperazon, hepabalance, inpepsa syr, CTM, urdahex tab, estazor tab. In this
case found a DRP (Drug Related Problem) in the form of drug interaction (ceftriaxone and
cefoperazon, inpepsa and urdahex, hepabalance and urdahex, CTM and hepabalance).

Keywords: obstructive jaundice, indirect or direct bilirubin, PGI Cikini Hospital

INTRODUCTION
Obstructive Jaundiceis a condition where there is a block age of bile flow from the liver .
Jaundice (jaundice) is de fine das they ellowing of skin and sclera colordue to the accumulation
of the pigment bilirubin in the blood and tissues. Bilirubin levels should reach 35-40 mmol/L
before jaundice cause clinical manifestations. When the blood bilirubin level exceeds 2mg%
increase it will be visible jaundice bilirubin increase in indirect (unconjugated) or direct
(conjugated) (Rusepno Hasan, et al, 2007). Jaundiceis a condition where tissue eyello wish due
to deposition of bilirubin that occurs when blood bilirubin level sreached 2mg/dL. Obstructive
jaundice it self is jaundice caused by obstruction of bilirubin secretion in normal circum stances
should bechanneled to the gastrointestinaltract. As a result of these obstac les occure gurgitation
of bilirubin into the blood stream so that there was jaundice (Sudoyo A, etal. 2006).
In the absence of obstructive jaundice occurring components of bile in the small in testine
and reserves that caused the spillin the systemic circulation. Feces usually become spaledue toa
lack of bilirubin reaching the small intestine, the absence of biles alt scan cause mal absorption,
resulting in vitamin deficiency. (Prodjosudjadi, Wiguno. 2006).
ETIOLOGY
Bile block age can occurdue to abnormalities in the wall of the channel such as the
presence of tumor so rnarrowing due to trauma. The conditions that can cause this block age also
include most of tenis the state of biliary atresia is the failure of formation of bilirubin bile ducts
so jetting out to disturbed bowel. The failure of the current formation in fetalgrow this also an
influence of various factors among pregnant women is excessive anxiety and the use of certain
drugs during pregnancy. Other conditions that can cause obstructive jaundice is koledokalcysts
(Choledochal Cyst) and spontan eous perforation of the extrahepaticbile duct. (Sudoyo A, etal.
2006)
MANAGEMENT
Management of obstructive jaundice is by surgically removing the cause of the
obstruction. Performed exploratory surgery to diagnose whether the obstruction caused by gall
bladder stones or tumors. If caused by carcinoma (usually at the head of the pancreas), the
surgeon may make a bypass from the gallbladder to the jejunum (Sudoyo A, et al. 2006)

The general objective of the management of jaundice is to prevent indirect bilirubin levels in the
blood reached levels that allow for neurotoksikositas.
CASE

PRESENTATION
30-years old male patient has complained of itching of the skin around the 1 week

before entering the hospital PGI Cikini, yellow eyes since 3 weeks before entering the hospital.
History of right upper abdominal pain 1 month before admission. Patient was diagnosed by a
physician

with

obstructive

jaundice.

CLINICAL

EVALUATION

In the case of patient treated for 10 days from the date of 5-14 March 2014 using 1g inj
ceftriaxone, cefoperazone injection 1g, hepabalance, inpepsa syr, CTM, urdahex tab, and estazor
tab.
LABORATORY

EXAMINATION

RESULTS

On hematological examination results increased erythrocyte sedimentation rate is 19 mm

/ h (0-10 mm / h), ie a decrease in erythrocyte 3L 3.93 10 ^ (10 ^ 3L 4.5-5.5), high reticulocyte
values are 17/mil (5-15 mile), low neutrophil rod that is 0% (2-6%), low platelet 3L ie 120 10 ^
(10

3L

150-450).

Clinical chemistry examination, showed abnormal low albumin 3.0 g / dl (3.4 to 4.8 g /
dl), high value globulin 3.9 g / dl (1.3 to 3.7 g / dl ), high ALP 298 U / L (30-120 U / L), a high
value of GGT is 59 U / L (0-30 U / L), high SGOT is 46 U / L (0-35 U / L), alanine
aminotransferase values as high as 76 U / L (0-35 U / L). High blood calcium 8.5 mEq / L (8.8 to
10.3 mEq / L), the value of direct bilirubin 11.8 mg / dL (0.1-0.2 mg / dL), indirect bilirubin
value of 2, 1 mg / dL (0.8-1.0 mg / dL) and total bilirubin 13.7 mg / dL (0.1-1.0 mg / dL).
The results of the examination were known elevated levels of SGPT (Serum Glutamic
Pyruvic transaminase) and SGPT (Serum Glutamic Oxaloacetic transaminase) which is a
parameter to determine the health of the liver due to viral or bacterial infection. The presence of
AST levels at 46 U / L and SGPT are high at 76 U / L of the patient indicates that the patient was
suffering from obstructive jaundice. Check laboratory results also showed bilirubin levels
reached 13.7 mg / dL. Whereas the normal maximum level of 1.0 mg / dL. Increased bilirubin

cause reddish urine like strong tea and yellowish eyes and skin obstructive jaundice causes of the
disease. During the treated patient were given drugs for injection 1g ceftriaxone for treatment of
infection of the lower respiratory tract, and cefoperazone injection 1g for the treatment of
respiratory tract infections because the top and bottom, hepabalance to help maintain healthy
liver function, inpepsa syr duodenal ulcer as a treatment of chronic gastritis and gastric , CTM
for the treatment of urticaria, urdahex tab used for cholestatic hepatitis, and estazor tabs are used
as hepatic cirrhosis.
DRUG

RELATED

1.

PROBLEM

Dose

subterapetik

On day 2 of 5-7 patient were given antibiotics that ceftriaxone and cefoperazone. Both of these
drugs is aclass that has abroad spectrum cephalosporin effective against microorganisms and
gram-positive and gram-negative. Treated patient given the drug for injection 1g ceftriaxone for
treatment of infection of the lower respiratory tract, and cefoperazone injection 1g for the
treatment because of respiratory trac tinfections the top and bottom.
2.

Drug

interactions

a)

Ceftriaxone

and

cefoperazone

Interactions occur when administered concurrently because it can cause nephrotoxic, should be
given

one

b)
Inpepsa

of

the

drug

Inpepsa
can

inhibit

c)

the

and

absorption

of

Hepabalance

Hepabalance

can

improve

alone.
urdahex

urdahex

in

and
the

the

stomach.

urdahex

work

of

urdahex.

d) CTM and hepabalance

CTM can reduce the effects of hepabalance work.
ADVICE
1. Disease In patient with obstructive jaundice should beno dose adjustment. Dosage adjustments
may include dose reduction, extending the time of drug administration or a combination of both.
2.

Monitor

bilirubin

levels

during

treatment.

3. Non-pharmacological therapy: low-fat diet, quitting smoking and doing regular physical
activity.
CONCLUSION
Based on the results of the examination of patient was found a DRP that is the
subtherapeutic dose and drug interactions.
REFERENCES
Anonymous. , 2005. Stocley's Drug Interactions. The pharmaceutical Press
Bertram G.Katzung, 2012. Basis and Clinical Pharmacology, 10th edition. EGC Medical Book
Prodjosudjadi, Wiguno. 2006. Ilmu Medicine Volume 2 Issue 4. Jakarta: Department of Medicine
Faculty of Medicine, University of Indonesia.
Rusepno Hassan, et al. , 2007. Books Lecture Pediatrics Faculty of medicine Volume 2.
Infomedika, Jakarta.
Saragi, Sahat, 2012, for the Use of Drugs Concept Equipped with Pharmaceutical Care, Drug
Counseling Theory, Theory Drinking Drug Compliance, Publishers Rosemata Publisher, Jakarta.
Sudoyo A, et al. , 2006. Dalam.Jakarta Textbook of Medicine: Faculty of medicine.