Page 213 - Abstract Book KONIKA 18

Gastroenterohepatology

P-GEH-007
Comprehensive Management of Elevated Intraabdominal Hypertension in
Pediatric Acute Decompensated Heart Failure: A Case Report

2
1
Gryselda Hanafi , Angela Kimberly Tjahjadi , Antonius Hocky Pudjiadi , Fatima Safira Alatas 2
1
1
Faculty of Medicine, Universitas Indonesia and Department of Child Health, Faculty of Medicine,
Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital , Jakarta, Indonesia
2
Abstract
Background Intraabdominal hypertension (IAH) occurs when intraabdominal pressure (IAP) increases
above the normal range. Early diagnosis of IAH is of utmost importance to prevent complications. However,
unlike in adult, IAH in children was an unfamiliar topic to tackle. Objective To further expand our knowledge
on the multiple approach for pediatric IAH treatment. Case A 14-year-old male came to the ER with chief
complaint of worsening dyspnea for 3 hours before hospital admission. He had intermittent chest pain and
complained of enlarged abdomen for the last 2 weeks. Upon physical examination, the patient had tachypnea
(35x/min), tachycardia (130x/min), and increased JVP. Both lungs had decreased breathing sound and rales.
Abdominal examination showed abdominal distension, tense, and enlarged liver. Both of the legs and genitalia
were edematous. Measured IAP was 16 mmHg. Radiological findings confirmed right pleural effusion,
cardiomegaly, pneumonia, and ascites. Laboratory examinations revealed hypoalbuminemia. The liver and
kidney function test were within normal limits. ECG showed right ventricular hypertrophy. Concurrently, the
patient was diagnosed with heart failure Ross III, right pleural effusion, and intraabdominal hypertension.
The patient was given broad-spectrum antibiotic, furosemide, spironolactone, prednisone, albumin, and
digoxin. He also underwent pleural puncture (1000 mL) and percutaneous drainage (950 mL). The IAP 12h
post procedure was 14 mmHg. The respiratory and heart rate was improved after treatment. Conclusion
Comprehensive treatment for IAH are important for rapid reduction of IAP. Hemodynamic improvement
would benefit the overall status of the patient and reduce morbidity. Routine IAP measurement is recommended
for patient with high risk of developing IAH. The goal is to reduce the IAP to normal limit.
Keywords: abdominal distension; intraabdominal hypertension; acute decompensated heart failure

P-GEH-008
The Source of Bleeding and Optimal Timing of Esophagogastroduodenoscopy in
Pediatric Upper Gastrointestinal Bleeding Patients
at Mohammad Hoesin Hospital Palembang

Stefani Gunawan, Hasri Salwan, Achirul Bakri, Sri Kesuma Astuti
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia
Abstract
Background Gastrointestinal (GI) bleeding may occur in any area of the GI tract. Esophagogastroduodenoscopy
(EGD) procedure is available to investigate upper GI bleeding sources. Some bleeding stops spontaneously,
which the physician cannot localize the source and may impact the precision of diagnosis. Objectives To
review the proportion of bleeding source findings in pediatric patients with upper GI bleeding and its relation
with the timing of EGD procedure. Methods Data of pediatric patients with upper GI bleeding who underwent
EGD procedure from 2018 to 2020 were collected from the medical record. The timing of EGD procedure
was calculated from bleeding onset to time of procedure. Results A total of 34 patients were enrolled; 18
were male. The bleeding manifestations in 15/34 patients were hematemesis, 10/34 melena, and 9/34 both.
The sources of bleeding were found in 28/34. The etiologies were gastritis (13/34), esophageal varices
(6/34), duodenal ulcer (5/34), gastric mucosal petechiae (3/34), and esophagitis (1/34). The average timing
of EGD procedure was 8,5 days (range 1-31 days). The bleeding sources were found in 6/6 if the timing of
EGD was less than 48 hours, 5/6 if 48-72 hours, 4/5 if 3-7 days and 13/17 if more than 7 days. Conclusions
The sources of bleeding were found in most children with upper GI bleeding underwent EGD procedure.
The most common etiology was gastritis. Timing of procedure is an important consideration to explore the
source of GI tract bleeding.
Keywords: esophagogastroduodenoscopy; upper gastrointestinal bleeding; sources of bleeding;
timing of procedure; hematemesis

KONIKA XVIII Abstract Book 165