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"BackgroundHepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non-ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion.Study aimTo determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet).MethodThis is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group was given a tempe diet, while the second (control) group was given liver diet Will (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT).ResultsIn the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories.ConclusionA 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test. Key words: liver cirrhosis, hepatic encephalopathy, tempe diet, numeric connection test, Child-Pugh criteria"

"Since the limulus test, a method for the evaluation of endotoxin levels using extract from horsehoc crabs (limulus, spp), was developed in the year 1969 by Levin and Bang, there have been reports on endotoxin from portal blood without negative gram bacterial infection, a condition known as endogenous endotoxemia."

"Small intestinal bacterial overgrowth is a condition where the proximal small intestine harbours more than 10 organisms/ml intestinal fluid for a long period. Bacterial overgrowth could be found in patients with certain clinical conditions, such as intestinal anatomical disorders, intestinal motility disorders, and several diseases including liver cirrhosis. It was reported that the prevalence of bacterial overgrowth in patients with liver cirrhosis was around 30%-75%. Small intestinal bacterial overgrowth could induce various clinical conditions from mild to severe cases, therefore it is important to recognise its signs and symptoms, diagnosis, and management. This article will also review the clinical management of small intestinal bacterial overgrowth in liver cirrhosis."

"Spontaneous bacterial peritonitis (SBP) is one of serious complication of liver cirrhosis. Most of the patient with SBP have severe reduced liver function that clasified as Child Plugh class C. There are other risk factors for SBP such as poor nutritional status, GI bleeding, intravascular catheter insertion, ascites fluid protein concentration of less than I g/L, large volume paracentesis, urinary tract infection and respiratory tract infection. The management of SBP is mainly the administration of proper antibiotics. The antibiotic of choice for the emperial treatment is cefotaxim."

"Liver cirrhosis is a chronic and irreversible disease. The patients quality of life (QOL) may be impaired because of long-standing burden of the disease. This research was a cross-sectional study conducted at Dr. Sardjito Hospital, Yogyakarta to determined the QOL of patients with liver cirrhosis who hospitalized in this institution. The parameter for the QOL was measured according to Spitzer index. Sixty-five patients with liver cirrhosis of various etiology were abled to be studied. The number of male and female patients were almost equal (30 and 35 respectively). There was a reduction in QOL in both male (21/30) and female (28/ 35) but no significant different between this variable. There was a significant positive correlation between Child criteria, and nutritional status with QOL (r=0.68, p<0.05 and r=0.37, p<0.05). It was concluded that Child criteria and nutritional status were positively correlated with QOL."

"protein-energy malnutrition is common in patients with liver cirrhosis , especially in advanced and severe stage. Liver cirrchosis patients with malnutrition have increasing risk to get post-operative complication and mortality...."

"Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding."

"Latar Belakang: Kondisi dekompensata tanpa infeksi bakteri pada pasien sirosis hati dapat meningkatkan kadar prokalsitonin (PCT). Belum ada penelitian yang secara khusus membandingkan kadar PCT berdasarkan kompensasi hati dan ada tidaknya infeksi bakteri. Tujuan: Mengetahui peran PCT dalam membantu menegakkan diagnosis infeksi bakteri pada pasien sirosis hati. Metode: Studi potong lintang dilakukan terhadap pasien sirosis hati yang berobat jalan dan dirawat inap di RSUPNCM Jakarta dari April sampai Mei 2016. Pada pasien dilakukan pemeriksaan PCT dan penentuan ada tidaknya infeksi bakteri berdasarkan pemeriksaan standar sesuai jenis infeksi yang dicurigai. Dilakukan analisis untuk mengetahui perbedaan rerata kadar PCT pada pasien sirosis hati yang tidak terinfeksi bakteri dan yang terinfeksi bakteri, serta pencarian nilai titik potong PCT untuk mendiagnosis infeksi bakteri pada sirosis hati dekompensata dengan menggunakan receiver operating curve (ROC). Hasil: Didapatkan 55 pasien sirosis hati, pria sebanyak 65,5%, dengan rerata usia 55,34±1,308 tahun. Sebanyak 38 (69,1%) pasien sirosis hati dekompensata yang 22 (57,9%) diantaranya tidak terinfeksi bakteri dan 16 (42,1%) terinfeksi bakteri. Pada pasien yang tidak terinfeksi bakteri terdapat perbedaan rerata kadar PCT yang bermakna antara pasien dekompensata (0,738ng/mL±1,185) dibandingkan dengan 17 pasien kompensata (0,065ng/mL±0,022). Rerata kadar PCT pasien dekompensata yang terinfeksi bakteri (3,607ng/mL±0,643) lebih tinggi bermakna dibandingkan dengan yang tidak terinfeksi bakteri(0,738ng/mL±1,185). Dari kurva ROC, kadar PCT pada pasien sirosis hati dekompensata didapatkan area under curve (AUC) 0,933 (IK 0,853-1,014) untuk diagnosis infeksi bakteri. Nilai titik potong kadar PCT untuk mendiagnosis infeksi bakteri pada pasien sirosis hati dekompensata adalah 2,79ng/mL dengan sensitivitas 87,5% dan spesifisitas 86,4%. Kesimpulan: Pada pasien sirosis hati yang tidak terinfeksi bakteri, kadar PCT pasien dekompensata lebih tinggi dibandingkan dengan yang kompensata. Kadar PCT pasien sirosis hati dekompensata yang terinfeksi bakteri lebih tinggi dibandingkan dengan yang tidak terinfeksi bakteri. Sementara nilai titik potong kadar PCT untuk mendiagnosis infeksi bakteri pada pasien sirosis hati dekompensata adalah 2,79ng/mL.

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Background: Liver decompensated without bacterial infection may increase procalcitonin (PCT) level in liver cirrhosis patients. Previous studies did not provide conclusive results about the differences of PCT level due to specific liver compensation and bacterial infection.

Objective: To examine the role of PCT in assisting the diagnosis of bacterial infection in liver cirrhosis patients.

Methods: A cross sectional study was conducted in liver cirrhosis patients who were outpatients and admitted to Cipto Mangunkusumo Hospital, Jakarta between April and May 2016. Procalcitonin were examined and bacterial infection were identified using standard criteria for each type of infection being suspected. Analysis were performed to determine differences in the level of PCT among liver cirrhosis patients without bacterial infection and with bacterial infection, also to get cut off point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients using receiver operating curve (ROC).

Results: There were 55 patients with liver cirrhosis, 65,5% male, with mean of age 55,34±1,308 years. A total of 38 (69,1%) patients had decompensated liver cirrhosis, while 22 (57,9%) of them without bacterial infection and 16 (42,1%) with bacterial infection. In the absence of bacterial infection, there was significant difference between PCT level in decompensated patients (0,738ng/mL±1,185) and 17 compensated patients(0,065ng/mL±0,022). Decompensated patients with bacterial infection (3,607ng/mL±0,643) had significantly higher PCT levels than those without bacterial infection(0,738ng/mL±1,185). From ROC, level of PCT for bacterial infection in decompensated liver cirrhosis was area under curve (AUC) 0,933 (IK 0,853-1,014). Cut off point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2,79ng/mL with a sensitivity of 87.5% and specificity of 86,4%.

Conclusion: In the absence of bacterial infection, PCT levels of decompensated patients was higher than compensated ones. Procalcitonin levels of decompensated liver cirrhosis patients with bacterial infection was higher than those without bacterial infection.Cut off point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2,79ng/mL."

"Patients with liver cirrhosis frequently have infection which can deteriorate further the already impaired liver function. The most common form of infection in this particular patients are spontaneous bacterial peritonitis, urinary tract infection, and respiratory infection. Causative organism mostly Gram negative micro organism and originate from the gastrointestinal tract. The weaken of immune defense mechanism and also the altered gastrointestinal tract motility can explained most of these infection. This paper will review the bacterial infection in liver cirrhosis with some guidance in the management."