Gas in stomachGas in a few loops of small bowelGas in rectum or sigmoidNormal Gas Pattern

Hirschsprung's Disease(from Grainger)

Hirschsprung's adalah obstruksi fungsional kolon yang terjadi karena kegagalan migrasi neuroblast bagian kaudal saat perkembangan GIT.

Usus bagian bawah dari tempat berhentinya neuronal sampai anus tidak terdapat ganglion / aganglionik.

Ultrashort jarang terjadi dan hanya mengenai anus pada level internal sphincter.Short segment pada daerah rektosigmoid( 75%).Long segment apabila mengenai kolon dengan berbagai variasi, dari kolon proksimal sampai sigmoid, Total aganglionosis coli seluruh colon dan sebagian terminal ileum. 'Skip lesions' sangat jarang terjadi.

Alimentary CanalMouthPharynxEsophagusStomachSmall / Large Intestine

Accessory glandsLiverGallbladderSalivary glandsPancreas

Originates around C-6In thorax, it is anterior to spine, posterior to trachea and heartPasses through diaphragm through esophageal hiatus

Inferior to diaphragm curves sharply leftIncreases in diameterJoins stomach at esophagogastric junctionAt level of xyphoid tip4 layers of the esophagusOutermost - fibrousMuscularSubmucosalInnermost - Mucosal

Dilated saclike portion of digestive tractComposed of same 4 layers as esophagusOutermost - fibrousMuscularSubmucosalInnermost - Mucosal

Divided into 4 partsCardiaFundusBodyPyloric portionEntrance to stomach is cardiac orificeControlled by cardiac sphincterExit is the pyloric orificeControlled by pyloric sphincter

Contains same four layers as stomach and esophagusMucosa contains projections called villi to facilitate digestion and absorptionDivided into 3 parts:DuodenumJejunumIleum

8 - 10 inches in length

Widest portion of small intestine

Follows a C-shaped course

Contains 4 regionsSuperior, descending, horizontal, ascending1st region is known as the duodenal bulb4th portion joins jejunum and is supported by ligament of TrietzHead of pancreas is contained in duodenal loop - second portion

JejunumUpper remaining 2/5 of small bowelIleumTerminates at ileocecal valveBoth are gathered into freely movable loops (gyri)Attached to posterior abdominal wall by mesentaryGenerally found in central and lower part of abd. cavity within arch of large intestine

DEFENISI : Pemeriksaan radiologis dengan menggunakan kontras media untuk memvisualisasikan saluran pencernaan bagian atas secara dinamik dengan fluoroskopi dan radiografi.

Menggunakan kontras media positif ( kontras ) dan negatif (udara) untuk menilai abnormalitas pergerakan, lumen dan mukosa .Kontras : Barium Sulfat dan menggunakan evervescent untuk menghasilkan udara.Penilaian : esofagus gaster- duodenum.

Kelainan mobilitias Kelainan mukosa (ulkus, divertikel, inflamasi)KeganasanDegeneratifKelainan kongenital Kelainana obstruktif

Perforasi Alergi kontras Obstruksi total upper GI

Anamnese pasien adanya obstruksi Puasa selama 6 jam sebelum pemeriksaanPersiapan kontras barium , esofagus 1: 1 dan saluran cerna yang lain 1: 3Bila curiga perforasi atau fistel menggunakan kontras water soluble

Kontras diminumkan mll oral ( 1; 1) , untuk mengisi esofagus sambil dilakukan fluoroskopi Lalu kontras Barium sulfat (1 : 3 ) diminumkan mll oral , namun untuk mengisi udara di lambung, pasien menggunakan evervescent . Posisi pasien supine

Pasien diminta untuk berputar, terlentang , miring , telungkup , miring kontralateral dilakukan 2 kali. Lakukan fluoroskopi untukmelihat kelainan. Setelah full filling , dapat dinilai mulai gaster, duodenum saat bulbus terbuka dan terisi pars descendens dan ascendens duodenum

Varises esofagusAchalasia esofagus Striktur esofagus Atresia esofagus Esofagitis Tumor esofagusFistula esofagus Divertikulum dan spasme esofagus

Congnital : hernia diafragmatika, sliding hernia, etcGastritisGastric Ulcer plg sering terjadi pada : minor curvature , anthrum pyloricum, corpus, fundus, cardiaTumor , mis : adeno ca, leiomiosarkoma

Congenital : atresia duodeni, spasme duodeniDuodenitisTumor : polip, divertikulum benign maligna : filling defek irreguler , umbrella signTumor Caput Pancreas : enlarge C loop

Cricopharyngeus Muscle At level of C5-C6,Part of upper esophageal sphincter (UES) EsophagusBarium Swallow, Single Contrast

Barium Swallow, Single ContrastMain Indication:Dyshagia

Identation of A.ASingle ContrastIndentation of L.main bronchusDouble Contrast

Barium Swallow, Single ContrastDouble ContrastHeartL.V.L.A.

Barium Swallow, Double ContrastIndentation of L.main bronchusSingle ContrastDouble Contrast

Barium Swallow, Single ContrastAmpulla Normal VarientFundusBody

Barium Swallow, Single ContrastAortic Arch

Barium Swallow, Double ContrastNarrowing:Could be peristalsisSo other shot is advised

Angular NotchIncisura AngularisBarium Meal, Double Contrast(Supine Position)BodyAntrumSupine Position:Note Barium Distribution in the Fundus due to gravity

Barium Meal + Follow-Through(Erect Position)Barium MealBarium Follow-ThroughDuodenal CapPyloric Canal2nd Part of Duodenum3rd Part of DuodenumBodyAntrumDJJ:Normal Position= Left sideAngular NotchIncisura AngularisJejunum:Plica Circularis on the outer borderIleum

Barium Follow-Through to Cecum(Erect Position)2nd Part of Duodenum3rd Part of DuodenumDJJ:Normal Position= Left side

Small Bowel EnemaA Modified Follow-Through which is called Small Bowel Enema note that the bowel is more distended hereThis procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject barium, methylcellulose and water into the small bowel. This allows for better visualization of the small bowel than can be seen during a small bowel follow-through

EsophagusBarium Swallow, Single ContrastProximalDilatationsNarrowing (Stricture)Bird Peak SignDDx: Achalasia

Barium Swallow, Single ContrastProximalDilatationsDistal NarrowingBenign Stricture:The transitional Zone looks smooth and free of filling defects

Barium Swallow, Single ContrastMalignant Stricture:The transitional Zone looks Irregular & ill defined Presence of many filling defectsDDx:Adeno CASq. Cell CAFilling DefectIt shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagusFilling DefectMalignant StrictureLong Irregular NarrowingBarium Swallow, Single Contrast(Oblique)

Barium Swallow, Single Contrast(Oblique)Barium swallow in this patient with achalasia reveals a smooth distal tapering caused by the hypertensive lower esophageal sphincter that straddles the diaphragm, and multiple non-Peristaltic contractions throughout the body of the esophagus. This radiographic appearance sometimes has been called "vigorous achalasia". This term has little value, however, because recent studies suggest that patients with so-called vigorous achalasia cannot be distinguished clinically from non-vigorous achalasia. Irregular Wall & Dilatation:Tertiary Contraction (Pathological non-propulsive Contraction)Funnel Shape(Achalasia)

Barium Swallow, Single Contrast(Oblique)Well Defined Contrast Filled left cervical level sacPharyngeal Pouch(Zenker's Diverticulum):occurs in an area of anatomic weakness known as Killian's dehiscence

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-contoured filling defects are present in the inferior two thirds of the esophagus. The contour of the esophagus is irregular and spiculated. Barium Swallow, Single ContrastIrregular Multiple Filling DefectsDifferential Diagnosis Multiple Esophageal Filling Defects:Fungal InfxPolypsEsophageal Varices (irregular)Food Particles

Barium Swallow, Single ContrastIrregular Multiple Filling Defects(Esophageal Varices)

Barium Meal, Double ContrastContrast Filled Speculated Lesion(Gastric Ulcer)

Barium Meal, Double ContrastRugaeContrast Filled Outpouching at the Greater Curviture(Malignant Gastric Ulcer)

Barium Meal + Follow-ThroughContrast Filled Speculated Lesion(Duodenal Ulcer)4th Part of duodenum1st Part of duodenum2nd Part of duodenum3rd Part of duodenum

StomachBarium Meal, Double ContrastUlcerSpeculated MassPylorus

Barium Meal, Double Contrast(Erect Position)Shoulders SignMushrooms Sign(or apple core Sign)Strings SignDDx:Pyloric StenosisFor further information refer to Pediatric Abdomen Radiology Slides (37-46)

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*It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus*Barium swallow in this patient with achalasia reveals a smooth distal tapering caused by the hypertensive lower esophageal sphincter that straddles the diaphragm, and multiple non-Peristaltic contractions throughout the body of the esophagus. This radiographic appearance sometimes has been called "vigorous achalasia". This term has little value, however, because recent studies suggest that patients with so-called vigorous achalasia cannot be distinguished clinically from non-vigorous achalasia. *Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-contoured filling defects are present in the inferior two thirds of the esophagus. The contour of the esophagus is irregular and spiculated.