gastrointestinal tract presentation.ppt
DESCRIPTION
:)TRANSCRIPT
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Dr. Pherena Amalia Rohani. Sp.Rad
Gastrointestinal tract
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Akut abdomenTujuan pemeriksaana.Memperlihatkan adanya perforasi ususb.Mencari adanya tanda sumbatan gastrointestinal (obruksi ileus) atau paralitik.
c.Menilai adanya distensi usus besar dan usus kecil
d.Mencari adanya udara bebas, asites, kalsifikasi intra dan ekstra peritoneal dan dinding abdomen
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Teknik pemeriksaanPemeriksaan abdomen dilakukan dengan 3 posisi :
a. Terlentang
b. Setengah duduk
c. Lateral dekubitusPada penderita yang payah pemeriksaan dilakukan sbg
berikut :
a. Posisi AP terlentang
b. Posisi terlentang, sinar horizontal
c. Lateral dekubitus kalau mungkin, atau posisi semi erect dengan fluoroskopi
Lain lain :Untuk melihat udara di rektum, gunakan posisi telungkup
dengan sinar horizontal. Pada kasus bayi dan anak, gunakn posisi terlentang AP dan posisi lateral. Gunakan sinar horizontal bila perut sangat kembung. Bila perut tidak terlalu kembung, gunakan posisi telungkup, dengan sinar horizontal.
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Duodenal Hematoma
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Shock Bowel with hemoperitonium
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Pneumoperitoneum with Rigler`s sign (Radiography, )
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Pneumoperitoneum with Rigler`s sign - CT
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Pneumoperitoneum (Radiography, CT, )
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Free intraabdominal air (after iatrogenic perforation) (Radiography, )
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Pneumoperitoneum mimicker: Colonic interposition (Radiography, CT, )
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Pneumoperitoneum mimicker: Diaphragmatic eventration (Radiography, )
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Pneumatosis (Radiography, CT, )
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Pneumatosis � portal venous gas (CT)
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Small bowel obstruction (Radiography, CT, )
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Obstructing abdominal wall hernia (Radiography, )
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Large bowel obstruction (CT, )
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Cecal volvulus mimicking sigmoid volvulus (CT, Radiography, )
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Diverticulitis (CT, )
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Normal appendix (CT, )
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Appendicitis (CT, )
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Appendicitis caused by an appendicolith (CT, )
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Ruptured appendicitis with abscess formation (CT, )
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Crohn’s disease causing small bowel obstruction (CT, )
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Colitis (CT, )
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Manfaat USG Beberapa manfaat dari USG diantaranya :
• Menemukan dan menentukan letak massa dalam rongga perut atau pelvis.• Membedakan kista dengan massa yang solid• Mempelajari pergerakan organ (jantung, aorta, vena kava), maupun pergerakan janin dan jantungnya.• Pengukuran dan penentuan volum. Pengukuran aneurisma arterial, fetal-sefalometri, menentukan kedalaman dan letak suatu massa untuk biopsi. Menentukan volum massa ataupun organ tubuh tertentu (misalnya buli-buli, ginjal, kandung empedu, ovarium, uterus, dan lain-lain).• Biopsi jarum terpimpin. Arah dan gerakan jarum menuju sasaran dapat dimonitor pada layar USG.• Menentukan perencanaan dalam suatu radioterapi. Berdasarkan besar tumor dan posisinya, dosis radioterapi dapat dihitung dengan cepat. Selain itu setelah radioterapi, besar dan posisi tumor dapat pula diikuti.• Ultrasound Doppler Tiga dimensi (3-D) membantu mengidentifikasi tumor ganas pada payudara. Ultarosund Doppler mengukur pembluh darah tumor, atau aliran darah Jaringan kanker memperlihatkan ketinggian rata-rata aliran darah dibandingkan jaringan yang bukan kanker
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Keuntungan USG• Bersifat non-invasif• Dapat digunakan untuk melihat pergerakan organ, sama eperti fluoroskopi• Sifat jaringan-jaringan yang dicitrakan dapat dibedakan• Alatnya kecil dan dapat dibawa ke mana-mana (misal ke bangsal, unit darurat dll)• Pemeriksaan tidak memerlukan waktu yang lama• Tenaga listrik yang diperlukan hanya sedikit• Tidak memerlukan kamar gelap• Ruangan yang diperlukan relatif kecil dan dinding tidak perlu diberi proteksi tambahan• Memungkinkan tindakan biopsi jaringan yang tepat• Peralatan relatif lebih murah kalau dibandingkan dengan alat roentgen diagnostik khusus, kedokteran nuklir, tomografi komputer, dan alat magnetic resonance.
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Kelemahan USG
• USG tidak mampu menembus bagian tertentu badan.• 70 % gelombang suara yang mengenai tulang akan dipantulkan, sedang pada perbatasan rongga-rongga yang mengandung gas 99 % dipantulkan
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SONOGRAPHY KELAINAN HEPAR
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Anatomi dan Fungsi : AnatomiHepar :
Organ terbesarDua lobus1 lobus assesoriusRo: 8 segmenVascularisasiSaluran billier
Fungsi.
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Indikasi1. Rasa nyeri perut kanan atas2. Hepatomegali3. Teraba massa di kanan atas4. Jaundice (intra, ekstra)5. Kondisi fisik yang menurun
drastis6. Proses metastase7. Konfirmasi hasil skintigrafi8. Kelainan pada diafragma kanan
Kontra indikasi : tidak ada
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Persiapan USGPada keadaan akut seperti trauma, persiapan puasa ( - )
Pada keadaan elektif, puasa ( + ) 5-6 jam
Neonatus, puasa 2-3 jam20 -30 menit harus minum, melihat buli-buli
Melihat pankreas : Minum 500 cc agar lambung terisi air sehingga pankreas bagian kauda terlihat
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Cara pemeriksaan1. Persiapan : tanpa persiapan2. Posisi : supine, oblique kiri3. Teknik pengambilan :
• Membujur // sb. Tubuh lob. Ki, Ao.• Subcostal lob. Ka, v. hepatica, GB.• Intercostal (setinggi proc. Xyphoidius) :
lob. Kanan vena porta, GB.• Melintang kel. Para aorta, pancreas, v.
lienalis, struktur lain (vena porta, VCI, AO, Stomach).
Pada keadaan tertentu pasien menahan nafas pada akhir menarik nafas panjang
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Gambaran USG hati normal1. Ukuran normal : lob. Ki < 8 cm
lob. Ka < dari 10 cm2. Permukaan licin, homogen, tepi rata, sudut
tajam.3. Intensitas echo normal ren. dextra4. V. porta/ hepatica normal
Vena porta < dari 1,2 cmV. hepatica < dari 1 cm
5. IHBD/ CBD tidak dilatasi IHBD Ø (1-4) mmCBD Ø 8 mmCHD Ø < 5mm
6. Tidak ada mass/ cyste/ abscess/ ascites.
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Kelainan HatiA. Focal :
1. Benign focal liver lesion Cyste Abscess Hemangioma
2. Malignant liver disease HCC Metastatic
B. Diffuse liver disease1. Fatty infiltration2. Hepatitis
Acute Chronic
3. Cirrhosis hepatis
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Kista hepar Massa bulat, dinding halus,
well defined Echo free intensity
meskipun gain di tinggikan.
Posterior echo enhancement.
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Poly cystic liver diseaseCyste multiple Ada under lying diseaseKelainan kongenital Hepar membesar dengan distorsi arsitektur
Acoustic posterior enhancement terjadi pada tiap cyste.
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Daugther CystsCart WheelHoney comb appearanceMultiple Cyst
terinfeksi•Sama dengan Complicated
hydatid cyst
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Abscess HeparMassa bulat, oval, lobulated, dinding tebal, irreguler
Tidak echo free seperti cyste, melainkan echo sand
Abscess amoeba : sub capsular, gas +Abscess pyogenic : echopoor, gas >>keduannya sulit dibedakan
Serial abscess yang diobati tanpa aspirasi :
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Hemangioma Cavernosa7% Massa bulat, well defined, intensitas echo tinggi, bisa homogen ( < 2 cm ), heterogen (> 2,5 cm)
Posterior acoustic enhancement, dan lobulated pada yang > 2,5 cm.
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HCCCarcinoma : HCC >>>
Cholangio Ca < cirrhosis : 80% di Barat dan Timur Jauh
40% di Afrika SelatanType : - infiltratif
- ekspansif- mixed- diffuse
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Gambaran USG :Bentuk :Noduler : Single / multipel, well defined Batas dengan parenchym hati normal jelas .
Massive Ø > 5 cm Batas tumor dengan parenchim hati sulit ditentukan.
DiffuseMassa besar , batas dengan parenchym hati tidak dapat ditentukan.
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2 cm, highly reflective
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6 bln; 3,4 cm; isoechoic
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9 bln; 4,9 cm; poorly reflective
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ISO, TUMOUR IN TUMOUR
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•Reflektivitas :bervariasi“Tumour in Tumour phenomena”Invasi ke vena porta / v . Hepatika /
VCI.
Patokan :Nodul kecil (1-3) cm , hiperreflektif ,
pasien sehat Dx. HemangiomaTarget lesion , dengan echo poor ring Dx.Curiga maligna
Area an echoic didalam lesi reflektif Dx.Lesi meta dengan central nekrotik .
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TUMOR METASTASE1. Poor reflektive Lymphoma 2. Highly reflektive
Gastrointestinal , traktus urogenital .
3. Cystic Ca Ovarii4. Calcified Colorectal5. Confluent Tumor ekstensif 6. Diffuse Lymphoma dan
Leukemia
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ECHO POOR , Ca BRONCHUS
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GI T
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BULL’S EYE
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