OLEH : Endro Susilo Putro, S.ked PEMBIMBING: dr. SUHARYANTO, Sp.

Rad

Cholecystitis

Pancreatitis Ulcer

Appendicitis

Diverticulitis

Pemeriksaan Radiologi GIT

Foto Polos Abdomen (FPA)

Colon in loop

PX Radiologi GIT

USG Abdomen

CT Scan Abdomen

Foto Polos Abdomen

lien Usus kecil

Hepar

usus besar

Gaster

adalah suatu pemeriksaan perut dengan menggunakan sinar X yang menggambarkan struktur dan organ dalam perut,

diafragma

FOTO POLOS ABDOMEN

TANPA KONTRAS DENGAN KONTRAS

KONTRAS POSITIF (BaSO4) KONTRAS NEGATIF(udara)

INDIKASI OBSTRUKSI USUS

PERFORASI SALURAN CERNA PANKREATITIS BATU SALURAN KEMIH IMPAKSASI FAECES

Kontra Indikasi Tidak ada kontraindikasi mutlak, pada wanita sampai akhir periode reproduksi dan wanita hamil dihindari untuk mencegah paparan radiasi

What to Examine
Gas pattern

Extraluminal air
Soft tissue masses Calcifications

Skeletal 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 Pattern

Stomach Always Small Bowel Two or three loops of non-distended bowel Normal diameter = 2.5 cm Large Bowel In rectum or sigmoid almost always

Gas in stomach

Gas in a few loops of small bowel

Gas in rectum or sigmoid

Normal Gas Pattern

Normal Fluid Levels

Stomach Always (except supine film) Small Bowel Two or three levels possible Large Bowel None normally

Always air/fluid level in stomach

A few air/fluid levels in small bowel

Erect Abdomen

Large vs. Small Bowel

Large Bowel Peripheral Haustral markings don't extend from wall to wall Small Bowel Central Valvulae extend across lumen

Haustra films

Faecal mottling

Abdomen Position
Supine

Erect or left decubitus

Chest - erect or supine Prone or lateral rectum

Complete Abdomen
Supine

Looking for Scout film for gas pattern Calcifications Soft tissue masses Substitute none

Complete Abdomen
Erect

Looking for Free air Air-fluid levels Substitute left lateral

decubitus

Complete Abdomen
Erect Chest

Looking for Free air Pneumonia at bases Pleural effusions Substitute supine chest

Complete Abdomen
Prone

Looking for Gas in rectum/sigmoid Gas in ascending and descending colon Substitute lateral rectum

Abnormal Gas Patterns

1. Functional Ileus Localized (Sentinel Loops) Generalized adynamic ileus 2. Mechanical Obstruction SBO LBO

Localized Ileus Key Features

One or two persistently dilated loops of large or

small bowel Supine Gas in rectum or sigmoid

Sentinel Loops

Prone

Localized Ileus
Pitfalls

May resemble early

mechanical SBO
Clinical course Get follow-up

Generalized Ileus
Key Features Gas in dilated small bowel and large bowel to rectum
Long air-fluid levels Only post-op patients have generalized ileus Other causes: Peritonitis

Hypokalemia
Metabolic disorder as hypothyroidism Vascular occlusion

Supine

Erect

Generalized Adynamic Ileus

Mechanical SBO
Key Features

Dilated small bowel Fighting loops Little gas in colon, especially

rectum Key: disproportionate dilatation of SB

SBO

LBO

Supine

Prone

LBO

Mechanical LBO
Causes

Tumor Volvulus Hernia Diverticulitis Intussusception

Mechanical LBO
Pitfalls

Incompetent ileocecal valve Large bowel decompresses into small bowel May look like SBO Get BE or follow-up

Supine

Prone

Carcinoma of Sigmoid LBO Decompressed into SB

Air in biliary tree

Gallstone

Gallstone Ileus

Post-op C-section Adynamic Ileus

Mesenteric Occlusion

Air in Rectum or sigmoid Localized Ileus Generalized Ileus SBO LBO

Yes

Air in Small Bowel

2-3 distended loops Multiple distended loops Multiple dilated loops None-unless ileocecal valve incompetent

Air in Large Bowel

Air in rectum or sigmoid YesDistended No YesDilated

Yes

No

No

RLQ Abscess

RLQ Abscess

Signs of Free Air

Crescent sign

Air beneath diaphragm Both sides of bowel wall

Falciform ligament sign

In the biliary system

Free Intraperitoneal Air

Free Air
Causes

Rupture of a hollow viscus Perforated ulcer Perforated diverticulitis Perforated carcinoma Trauma or instrumentation Post-op 57 days NOT perforated appendix

Extraperitoneal Air

CT Scan Abdomen
Kontras oral, melapisi mukosa usus-usus hingga usus-

usus mudah diidentifikasi. IV Gambaran 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 fat 2. Peripancreatic fluid collections can often be seen 3. 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 colon .and pericolonic stranding typical of inflammation

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

Diverticulitis

USG Abdomen
USG: pencitraan bagian / organ dalam manusia dengan menggunakan gelombang suara ultra dengan frekuensi tinggi (MHz) yang menghasilkan gambaran organ yang dipindai tersebut

Hepar

pankrea s

Gall Blader

Yang dinilai
Kidney Lien

Prostat

Colon In Loop
Memasukan 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.

neoplasia trauma polip

kongenital

invaginasi

infeksi

Membantu diagnosis

volvulus

Kolitis Berat

perforasi

Kontra indikasi
Ileus paralitik

KU yang jelek