radioimaging of digestive system

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RADIOIMAGING OF

DIGESTIVE SYSTEM

Dr. H. Muhammad Salim, SpRadDepartemen Radiologi RSMH Palembang

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MODALITAS YANG DIPAKAI PADA PEMERIKSAANIMAGING OF DIGESTIVE SYSTEM:

1. Panoramic (memakai sinar X)

2. Foto x-ray baik tanpa kontras atau dengan

menggunakan kontras :

- cair (ultravist, iopamiro)

- bubur barium sulfat

3. Ultrasonografi (USG)

memakai gelombang suara frekuensi tinggi

4. CT Scan

menggunakan x-ray dengan sistem komputerisasi

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Traktus digestif 

Cavum oris

Oesophagus

Gaster

Duodenum

Jejunum

IleumColon

Rectum

anus

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Traktus digestif 

1. Cavum orisPemeriksaan radiologi Cavum oris:Muara dari berbagai kelenjar:

- Kelenjar sub mandibularis kanan/kiri USG

- Kelenjar sub parotis kanan/kiri sialografi

- Kelenjar sub lingualis kanan/kiri

Pemeriksaan radiologi duktus:

Digunakan pemeriksaan fluoroskopi dengan kontras cair(ultravist)

Pemeriksaan radiologi gigi dan TMJ (temporomandibula joint): Digunakan foto panoramic

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Traktus digestif 

2. Oropharynx : digunakan CT scan

3. Oesophagus : digunakan pemeriksaan fluoroskopidengan kontras barium (pada dewasa) atau kontrascair (pada anak)

4. Gaster , duodenum, jejunum, ileum, colon dananorectal : digunakan foto x-ray tanpa kontras

atau foto x-ray dengan kontras barium

5. Organ pada traktus digestif, bila diperlukandapat dilakukan pemeriksaan CT scan terumapada kasus tumor untuk menentukan stagingdan perluasan tumor.

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Cavum oris

Foto panoramic

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Pada pemeriksaan USG kelenjar sub mental

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Esofagus

Modalitas yang paling sering digunakan untuk melihatkelainan pada esofagus adalah barium swallow(esofagogram) dan barium meal.

Pemeriksaan barium meal untuk melihat:

Esofagus Lambung duodenum

Kontras yang dipakai barium Sulfat dengan atau tanpaudara/double kontras. Pemeriksaan diikuti denganfluoroskopi

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Esofagus 

Pada pemeriksaan barium meal pada esofagus, yang harusdiperhatikan adalah, bahwa pada esofagus terdapat

daerah penyempitan yang normal

Penyempitan yang normal

Sekitar Arcus Aorta Sekitar Carina Sekitar Cardia

Gambaran normal dari mukosa :o Biasanya lurus

o Lengkungan sejajar collumna vertebralis

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Esofagus

Gambaran mukosa normalesofagus.Tampak tipis, paralel, lipatan

mukosa sama

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Esofagus

Akalasia esofagus

Pada pemeriksaanfluoroskopi tampak bagianesofagus yang menyempitdengan bagian atasnyadilatasi. Penyempitan inimenyebabkan terjadinyaobstruksi

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Esofagus

Carcinoma esofagusPada pemeriksaan fluoroskopi

tampak ada nya filling defectpada lumen esofagus.

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Esofagus

Striktur esofagus

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Esofagus

Atresia esofagusAda 6 tipe  

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Esofagus

Atresia esofagus.Pada pemeriksaanfluoroskopi tampakkontras mengisi esofagusdan sedikit trakea padaesofagus kontras berhentipada 1/3 atas esofagus.

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Gaster - DuodenumGambaran mukosa gaster

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Gaster – DuodenumGAMBARAN BARIUM MEAL

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Gaster – Duodenum Kelainan Yang Tampak Pada Mukosa

Filling defect :

▫ Bisa dari luar – sudut tumpul, atau dari dalamlumen – tajam

▫ Bisa massa benigna – tepi halus/ rata,

▫ atau maligna – tepi irreguler

 Additional defect/ Shadow :Bayangan tambahan di luar lumen.

Bentuk menentukan jinak/ ganas

Ulcus atau diverticle

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Gaster – Duodenum

Gambaran Kelainan Mukosa Gaster

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Gaster-duodenum

Gambaran normalpemeriksaan dengan barium meal.

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Gaster – Duodenum 

Ulkus peptikum.

Pada pemeriksaan barium meal Tampak 

gambaran barium collection disertaigambaran radiating di sekitarnya

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Gaster

 Atresia gastricaTampak gambaran

single bubble

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Duodenum

Atresia duodenumTampak gambaran double

bubble sign.

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PEMERIKSAAN FOTO POLOS ABDOMEN 

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PEMERIKSAAN FOTO POLOS ABDOMEN 

Pemeriksaan bisa dengan :

Foto Polos BNO foto( tanpa persiapan ) ( dengan persiapan )

Cara Persiapan pemeriksaan Foto BNO (Foto polos abdomen dengan persiapan) :

1. 1 – 2 hari sebelum foto BNO, pasien diberi makan bubur kecap.

2. Malam hari diberi laksansia, dan minum 3 – 4 gelas air putih

3. Subuh pasien akan BAB4. Tidak boleh makan, minum, bicara, tertawa atau merokok 

5. Pasien kemudian di foto

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PEMERIKSAAN FOTO POLOS ABDOMEN 

Pada akut abdomen, pemeriksaan foto yg dilakukan:Foto tiga posisi

1. Foto BNO2. LLD = Left Lateral Decubitus

3. Foto polos setengah duduk AP

Posisi diatas untuk melihat udara bebas dlm

cavum abdomen

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DARI HASIL FOTO YANG HARUS DIPERHATIKAN 

1. Bagaimana distribusi gas dalam usus (normal gas

dalam gaster, duodenum, colon sampai rectum)

2. Bagaimana gambaran hepar dan lien.

3. Bagaimana gambaran/ bayangan kedua ginjal

(apakah ada bayangan (batu) radiopaqe disepanjang UG tract)

4. Gambaran psoas line/ psoas shadow.

5. Bagaimana keadaan tulang-tulang.

6. Bagaimana keadaan flank area.

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Pemeriksaan colon dengan kontras

1. Metode pemeriksaan: Barium enema / colon in loopdengan Single contrast atau Double contrast

2. Tujuan pemeriksaan :

-Diagnostik 

-Terapi3. Indikasi pemeriksaan:

-Kelainan congenital

-Infeksi

-Tumor abdomen-Obstruksi

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Pemeriksaan colon dengan kontras 

Kontra indikasi pemeriksaan colon inloop :Tanda-2 ileus paralitik 

Tanda-2 perforasi

Kontra indikasi Ileus obstrukstif > 6 – 8 jam

Tanda-2 peritonitis

Infeksi akut GI tract

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 ANATOMI COLON

1. Caecum 3 5 5. Flexura4 Lienalis

2. Colon ascendens 6. Colon

descendens

3. Flexura hepatis 2 6 7. Colon

Sigmoid

4. Colon transversum 7 8.Rectum

1

8

Panjang +/- 150–

160 cmDiameter : 5 – 7,5 cm

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Foto polos abdomen

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FOTO ABDOMEN TIGA POSISI

Posisi supineTampak gambaran freeair subdiaphraghmkanan

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Ileum

Ileus obstruksiPada foto polos abdomen

tampak gambaran dilatasi

dari usus halus membentuk

gambaran herring bone.

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Ileum

Ileus obstruksi disertaiperitonitis e.c perforasi

ileumPada foto polos abdomen tampakgambaran dilatasi dari usus halusmembentuk gambaran herringbone.Tampak gambaran free air subdiafragma kana

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Ileum

Pemeriksaan bariumfolow trough.Tampak gambaran divertikel

pada dinding luar usus halus

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Ileum

Ileus obstruksiPada CT scan potongan

transversal dijumpai

adanya dilatasi dari usus

halus

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Colon

Volvulus

Pada foto abdomentampak dilatasimaksimal usus yangterpuntir membentukgambaran coffee beansign

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Colon

Ca colonPada pemeriksaan colon in

loop tampak gambaran filling

defect pada lumen colon  

carcinoma colon funguating

type.

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Colon

Ca colonPada pemeriksaan colon in

loop tampak gambaran apple

appearance pada colon  

carcinoma colon annular

type.

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Colon

Mikro colonPada pemeriksaaan colon in

loop.

Tampak gambaran kolon

lebih kecil dari ukuran

normal.

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Rectosigmoid

Megacolon congenitalHirschprung diseasepada foto polos abdomen,Tampak distensi usus besardisertai fecal material yangdominan.

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Rectosigmoid

Megacolon congenital

Hirschprung diseasePada pemeriksaan tekhnikhirschprung.

Tampak bagian colon distalyang aganglionik.

Gambaran colon proksimaldilatasi dengan bagian distalmenyempit (gambaran

terompet).

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Rektosigmoid

Megacolon congenital

Hirschprung diseasePada pemeriksaan dengan

tekhnik hirschprung.

Tampak segmen aganglionik di

daerah rektum menyempit.

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Anus

Atresia ani

Pada pemeriksaan denganknee chest position.

Tampak gambaran udara usus

tidak melewati koksigeal – 

pubis line atresia ani letak

tinggi.

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Umbilikus

Ductus omfalo-mesenterikapersistentPada pemeriksaan fistulografidengan menggunakan kontrascair.

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Appendix

AppendisitisPada USG appendiks

dijumpai adanya

gambaran target sign

yg khas pada

appendisitis

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Abdomen

Gambaran CT scan abdomen potongan transversal

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SISTEM BILIER

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Gall bladder

Pada USG gall bladder Tampak gambaranhiperekhoik disertaiaccustic shaddow batukandung empedu /kolelithiasis

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Gall bladder dan pankreas

Pada CT scan abdomen . Tampak penebalan pada dinding

gall bladder disertai peradangan pada pankreas  

kolesistitis + pankreatitis

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Hepar

Ca hepar. Pada gambaran CT scan abdomen potongan transversaldengan dan tanpa kontras IV. Tampak gambaran nodul isodens yangmenyangat pada pemberian kontras.

H

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Hepar

On USG a livermass was seen and free fluid surrounding the liver. This is a

typical presentation of an adenoma. On portal phase CT, the lesion is

hypointense with haemorrhage adjacent to the lesion, extendingsubcapsularly.

CD

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Traktus biliaris

Pemeriksaan ERCPTampak gambaran

normal kolangiogrampada gambar C,D,E.

Tampak gambaran non

obstructing gall stone di

CBD (common bile duct).

D

E F

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Traktus biliaris

Pemeriksaan ERCP.Tampak gambaran

normal pancreatic

ductogram.

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TERIMA 

KASIH