Browsing by Author "Pathak, R"
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Publication Clinical Spectrum of Spontaneous Bacterial Peritonitis in Tertiary Care Centre(Institute of Medicine, 2013) Pathak, R; Harsh, S; Adhikari, A; Khadga, PKAbstract Introduction: Cirrhosis is a common diagnosis in the inpatient population seeking care at the gastroenterology department of the Institute Of Medicine. Spontaneous Bacterial Peritonitis (SBP) is commonly associated with decompensated liver cirrhosis and has been associated with frequent adverse outcome. This small study was designed to spectrum of disease and profile of patient having Spontaneous Bacterial Peritonitis. Methods: The retrospective study was conducted in patient admitted in department of gastroenterology. A total of 51 patients suffering from cirrhosis with ascites was studied. All subject underwent different investigations, like abdominal paracentesis, abdominal Ultrasonography and biochemical analysis, these tests were analyzed. MELD score was calculated for all the patient. Results: Total of 51 patients with Spontaneous Bacterial Peritonitis were enrolled. Majority Of patient had alcohol as the cause of cirrhosis, Jaundice, abdominal pain and fever along with hepatic encephalopathy were chief presenting complaints. A mortality rate of 22% was seen in this small sample of patients. Conclusions: SBP is a major concern in case of hepatic cirrhosis as it can cause considerable risk of adverse outcome and prolong the hospital stay. Early diagnosis and aggressive treatment should be practiced in order to eliminate the risk. Keywords: Spontaneous Bacterial Peritoniti, Cirrhosis, Ascites, MELDPublication Differentiation of Crohn’s disease from intestinal Tuberculosis and Ulcerative Colitis: a single tertiary centre experience in Nepal(Institute of Medicine, 2018) Hamal, R; Pathak, R; Kafle, B; Khadga, PK; Sharma, SAbstract Introduction: Differentiating intestinal luminal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. Likewise differentiating ulcerative colitis from Crohn’s disease with colonic or ileocolonic involvement is difficult. The aim of this study was to investigate the clinical, endoscopic, radiologic and histological features that will help to differentiate Crohn’s disease from intestinal luminal tuberculosis as well as from ulcerative colitis. Methods: A total of 40 patients diagnosed with Crohn’s disease, Intestinal luminal TB and Ulcerative colitis who were admitted under the Gastroenterology Department TUTH from July 2017 to February 2018 were included in this retrospective study. Clinical, endoscopic, radiologic, histopathologic and microbiologic features as well as response to treatment of these patients were studied in detail. Results: Among 40 patients, Intestinal TB was diagnosed in 52.5% patients, ulcerative colitis in 32.5% patients and Crohn’s disease in 15% patients. There was a higher incidence of fever, night sweats, lung involvement and ascites in Intestinal TB whereas diarrhea, perianal disease, hematochezia and extraintestinal were predictive for Crohn’s disease. Similarly on colonoscopy involvement of IC valve, patulous IC valve and transverse ulcers favored a diagnosis of intestinal TB in contrast to Crohn’s disease where longitudinal ulcers, aphthous ulcers, cobblestone appearance and rectal involvement were seen.Similarly the diagnosis of Ulcerative colitis was favored by rectal involvement and contiguous involvement whereas patients with Crohn’s disease had significantly more deep ulcers, cobblestoning, skip areas and ileal involvement. Conclusions: Crohn’s disease must be differentiated from Intestinal luminal TB and Ulcerative colitis before treatment. According to our study, a combination of clinical, endoscopic, serologic, radiologic, histopathologic and microbiologic features can be utilized in order to reliably predict and distinguish Crohn’s disease from Intestinal luminal TB and from Ulcerative colitis. In complicated cases deep enteroscopy and surgery may be needed before a confident diagnosis is reached.Publication Frequency and Severity of Portal Hypertensive Gastropathy in Cirrhosis(Institute of Medicine, 2017) Poudyal, S; Sharma, S; Khadga, PK; Pathak, R; Jha, A; Shrestha, RAbstract Introduction: Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients with Cirrhosis. The pathophysiology of PHG was not clearly understood. It was thought that Portal Hypertension was an important triggering factor for the development of PHG but the other factor must be considered for its progression. It is one of the clinically important gastric mucosal lesions because it may cause acute and chronic gastrointestinal blood loss leading to anemia. The aim of our study is to determine the frequency and severity of PHG in patient with Cirrhosis. Methods: This was a Cross-sectional observational study involving 61 consecutive Cirrhotic Patients, who attended Upper GI endoscopy were enrolled in this study as per inclusion and exclusion criteria in the Department of Gastroenterology Tribhuvan University Institute of Medicine. Child-Pugh’s score and MELD score was determined at the entry to determine the severity of liver disease. Data regarding clinical and laboratory investigations were collected. Variceal size was measured endoscopically and the severity of PHG was graded according to Mac Cormack Classification. Results: Out of total 61 patients, the frequency of PHG was found to be 47.5% among them where 44.2% patients had mild PHG and 3.3% patients having severe PHG. There were 29.5% patients in child pugh A, 39.3% in child pugh B and 31.2% in child pugh C. During analysis insignificant relation was found between the PHG with Child pugh score (ρ=0.4) and MELD score (ρ=0.7).When PHG frequency was related to alcohol intake the relations were statistically not significant. There was no association found between portal hypertensive gastropathy with esophageal varices and gender of the patient. Conclusion: Our data showed that the frequency and the severity of PHG are not influenced by the Gender of the patient, etiology and severity of cirrhosis or by presence of esophageal varices. Keywords: Cirrhosis, Portal hypertensive gastropathy, esophageal varicesPublication Glue therapy for bleeding gastric varices: a single tertiary center experience in Nepal(Institute of Medicine, 2017) Jha, A; Sharma, S; Khadga, PK; Pathak, R; Poudyal, S; Hamal, RAbstract Introduction: Bleeding is a common presentation in the Department of Gastroenterology, Institute of Medicine, Tribhuvan University Teaching Hospital. Of the varied causes of upper gastrointestinal bleed, bleeding gastric varices pose a major challenge to the endoscopist and the treating physician. Endoscopic injection of N-butyl-2-cyanoacrylate is the standard of care for treating gastric varices at present. Methods: We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients presenting with gastric variceal bleed. Between May 2016 to April 2017, 25 patients (14-M, 11-F) who presented to Institute of Medicine, Tribhuvan University Teaching Hospital with gastric variceal bleeding underwent endoscopic treatment with N-butyl-2-cyanoacrylate. Results: Eleven patients had cirrhosis secondary to alcohol, 9 had non-cirrhotic portal hypertension, cirrhosis due to hepatitis B-1, hepatitis C-1, NASH-1, and cryptogenic- 2. Child-Pugh score at presentation for patients was Child A-52%, Child B-36% and Child C-12. Successful hemostasis. rebleeding rate and complications were reviewed. Immediate hemostasis was observed in 100 of the cases and carly rebleeding rate of 8% was seen in 2 patients. Complications included post procedure pain 16%, fever 16% and pulmonary embolism 4%. Conclusion: N-butyl-2-cyanoacrylate is an effective, lifesaving modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Keywords: N-butyl-2-cyanoacrylate, endoscopic injection, gastric variceal bleedPublication Nail Changes Following Valproate Therapy(Kathmandu University, 2024) Shrestha, S; Pandey, A; Pathak, RABSTRACT Valproic acid is a widely prescribed medication for seizure disorders, mood disorders, and migraines. The adverse effects involving nails following the use of sodium valproate are rare. The nail changes reported so far include onycholysis, onychomadesis, the roughness of the nail, brownish-yellow discoloration, and a transverse yellow band. These changes are independent of the age of the patients, dose, and duration of medication. The nail changes are reversible following the discontinuation of the medication. KEY WORDS Onycholysis, Onychomadesis, Nail discoloration, Valproic acidPublication Risk factors of reflux esophagitis observed in tertiary care centre of Nepal(Institute of Medicine, 2017) Poudyal, S; Pathak, R; Hamal, R; Kafle, B; Sharma, S; Khadga, PKAbstract Introduction: Gastroesophageal reflux disease (GERD) is considered to be common disease in western countries. The prevalence of GERD is believed to be less in Asia than in Western countries. Upper GI Endoscopy is the valuable tools in the evaluation of reflux esophagitis which is a common complication of GERD. The present study aimed to determine the risk factor of Reflux Esophagitis in Nepalese with Gastroesophageal Reflux disease symptoms. Methods: It was a cross sectional observational study conducted in the department of Gastroenterology at Tribhuvan University, Institute of Medicine. Patients were recruited as per inclusion and exclusion criteria. The study involved data on 166 patients with Gastroesophageal reflux disease symptoms. After fulfilling the criteria of validated GERD questionnaire, patient were divided into two groups those having reflux esophagitis and Non erosive reflux disease according to the upper Gastrointestinal Endoscopy. Association of reflux esophagitis with different variables including patient characteristics, clinical features of GERD and endoscopic findings were tested using Chi-square test for discrete variables and continuous variables are measured as Mean SD. Multivariate analysis was performed for the association of risk factors with reflux esophagitis using logistic regression analysis. p value <0.05 was considered statistically significant. Results: Among the total of 166 patients with GERD, 63.3% were female and 36.7% were male. Mean BMI of the patient was 23.47±4.59. Of the total 7.8% had history of smoking and 12% patients were alcohol consumer. 27.7% patients were found to have reflux esophagitis. There was statistically significant difference between gender of the patients between the two group (p value=0.05). There was significant association found between current smoking and reflux esophagitis (p=0.03), also, between alcohol consumer and reflux esophagitis (p=0.021) While comparing the endoscopic findings Hiatus hernia was found significantly associated with Reflux esophagitis (p=0.004), Mean BMI and presence of peptic ulcer disease was not significantly associated with Reflux esophagitis (p=0.9) and (p=0.36). Conclusion: The frequency of Reflux esophagitis is 27.7% in our Nepalese patient. Reflux esophagitis is more common in male, predominantly in current smoker and alcoholics and those who are having hiatus hernia. Abstinence of smoking and alcohol drinking along with lifestyle modification might be important steps for prevention of Reflux esophagitis. Keywords: Gastroesophageal reflux disease, Upper GI endoscopy, Reflux esophagitis