radioimaging of digestive system
TRANSCRIPT
7/28/2019 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