PEMERIKSAAN RADIOLOGI GASTROINTESTINAL TRACT

PEMERIKSAAN RADIOLOGI GASTROINTESTINAL TRACTOLEH : Endro Susilo Putro, S.kedPEMBIMBING: dr. SUHARYANTO, Sp. Rad

PancreatitisUlcerDiverticulitisCholecystitisAppendicitisPemeriksaan Radiologi GITFoto Polos AbdomenFOTO POLOS ABDOMENINDIKASIOBSTRUKSI USUSPERFORASI SALURAN CERNAPANKREATITISBATU SALURAN KEMIHIMPAKSASI FAECESKontra IndikasiTidak ada kontraindikasi mutlak, pada wanita sampai akhir periode reproduksi dan wanita hamil dihindari untuk mencegah paparanradiasiWhat to ExamineGas patternExtraluminal airSoft tissue massesCalcificationsSkeletal pathology

Key to densities in AXRs Blackgas Whitecalcified structures Graysoft tissues Darker grayfat Intense whitemetallic objects

The clarity of outlines of structures depends, on the differences between these densities.Normal Gas PatternStomachAlwaysSmall BowelTwo or three loops of non-distended bowelNormal diameter = 2.5 cmLarge BowelIn rectum or sigmoid almost always

Gas in stomachGas in a few loops of small bowelGas in rectum or sigmoidNormal Gas PatternNormal Fluid LevelsStomachAlways (except supine film)Small BowelTwo or three levels possibleLarge BowelNone normally

Erect AbdomenAlways air/fluid level in stomachA few air/fluid levels in small bowelLarge vs. Small BowelLarge BowelPeripheralHaustral markings don't extend from wall to wall

Small BowelCentralValvulae extend across lumen

Haustra filmsFaecal mottlingAbdomen PositionSupineErect or left decubitus Chest - erect or supine Prone or lateral rectum

Complete AbdomenSupineLooking forScout film for gas patternCalcificationsSoft tissue massesSubstitute none

Complete AbdomenErectLooking forFree airAir-fluid levelsSubstitute left lateral decubitus

Complete AbdomenErect ChestLooking forFree airPneumonia at basesPleural effusionsSubstitute supine chest

Complete AbdomenProneLooking forGas in rectum/sigmoidGas in ascending and descending colonSubstitute lateral rectum

Abnormal Gas PatternsFunctional IleusLocalized (Sentinel Loops)Generalized adynamic ileusMechanical ObstructionSBOLBOSentinel Loops

Supine

Prone

Localized Ileus Key FeaturesOne or two persistently dilated loops of large or small bowelGas in rectum or sigmoidLocalized IleusPitfallsMay resemble early mechanical SBOClinical courseGet follow-up

Generalized IleusKey FeaturesGas in dilated small bowel and large bowel to rectumLong air-fluid levelsOnly post-op patients have generalized ileusOther causes:-PeritonitisHypokalemiaMetabolic disorder as hypothyroidismVascular occlusion

Generalized Adynamic IleusSupineErect

Mechanical SBOKey FeaturesDilated small bowelFighting loopsLittle gas in colon, especially rectumKey: disproportionate dilatation of SB

SBO

LBOLBO

SupineProneMechanical LBOCausesTumorVolvulusHerniaDiverticulitisIntussusception

Mechanical LBOPitfallsIncompetent ileocecal valveLarge bowel decompresses into small bowelMay look like SBOGet BE or follow-upCarcinoma of Sigmoid LBO Decompressed into SB

Prone

Supine

Air in biliary treeGallstoneGallstone Ileus

Post-op C-section Adynamic Ileus

Mesenteric Occlusion

RLQ Abscess

RLQ AbscessSigns of Free AirAir beneath diaphragmBoth sides of bowel wallFalciform ligament sign In the biliary system

Crescent signFree Intraperitoneal AirFree AirCausesRupture of a hollow viscusPerforated ulcerPerforated diverticulitisPerforated carcinomaTrauma or instrumentationPost-op 57 daysNOT perforated appendix

Extraperitoneal AirCT Scan AbdomenKontras oral, melapisi mukosa usus-usus hingga usus-usus mudah diidentifikasi.IVGambaran pada CT Scan dilihat dengan potongan aksial, koronal dan sagital.

- Diagnosa batu ginjal, apendisitis,pankreatitis,divertikulitis,aneurisma aorta abdomen, obstruksi usus Pancreatitis Acute pancreatitis is most often secondary to alcohol abuse or gallstone impaction in the distal common bile duct.

Other causes include trauma, cryptogenic, tumor, infection, hyperlipidemia, and ERCP.

CT Findings typical of pancreatitis include:

1. An enlarged pancreas with infiltration of the surrounding fat2. Peripancreatic fluid collections can often be seen3. Pseudocysts, (encapsulated fluid collections containing pancreatic secretions, are later complications of pancreatitis)

Notice the peripancreatic stranding (bars) as well as the fluid thickening of the interfascial space

Pancreatic necrosis

Pancreatic pseudocyst

Appendicitis Right lower quadrant pain, fever and leukocytosis are the classical clinical findings.

CT and US are being used more often to confirm clinical suspicions and reduce the number of unnecessary laporotomies.

General CT findings for acute appendicitis include:1. Dilated appendix greater than 6 mm or visualization of an appendicolith with an appendix of any size 2. Peri-appendicial fat stranding

Inflammation- Colitis Colitis, or inflammation of the colon, is a frequent cause of abdominal pain. Specific entities which produce inflammatory thickening of the colon include:-

Diverticulitis, inflammatory bowel disease, pseudomembranous colitis, and other bacterial infections (i.e. typhlitis).

This example of colitis shows thickening of the colonand pericolonic stranding typical of inflammation.

A case of diverticulitis showing a thickened sigmoid colon and a diverticulum

Diverticulitis USG AbdomenUSG: pencitraan bagian / organ dalam manusia dengan menggunakan gelombang suara ultra dengan frekuensi tinggi (MHz) yang menghasilkan gambaran organ yang dipindai tersebutColon In LoopMemasukan media kontras positif yaitu Barium Sulphat (BaSO4) yang dimasukkan lewat anus. Media kontras positif adalah suatu zat yang dapat memberikan gambaran radio opak atau putih pada radiograf. Dan unsur dasar terbuat dari unsur yang bernomor atom tinggi. TERIMA KASIH

Air in Rectum or sigmoidAir in Small BowelAir in Large Bowel

LocalizedIleusYes2-3 distended loopsAir in rectum or sigmoid

GeneralizedIleusYesMultiple distended loopsYes-

Distended

SBONoMultiple dilated loopsNo

LBONoNone-unless ileocecal valve incompetentYes-

Dilated