Anda di halaman 1dari 91

KKD Radiologi FK Trisakti

Traktus Digestivus
22 April 2014
Foto Polos Abdomen / BNO

Udara nyata pada colon dan gaster dan jumlahnya


minimal pada duodenum

Udara digunakan untuk menilai :


Diameter usus
Posisi usus
Banyaknya cairan didalamnya
Foto polos abdomen
( supine AP projection )

Sinar X melewati / melalui


tubuh pasien dari anterior
ke posterior dengan posisi
supine.
Penilaian

1. Udara usus
Differentiate small vs large bowel gas
Rule of 3/6/9
Distribusi normal pada gaster, colon dan rectum
Pada small bowel normal jika 2-3 loop non distended
bowel dengan normal diameter = 2.5 cm.
2. Batu / kalsifikasi
Batu bisa berasal dari GI tract maupun traktus urinarius
GI tract : Kandung empedu ( cholelithiasis )
Traktur urinarius : ginjal, ureter, vesika urinaria,
urethra

Batu opak vs batu lusen


Kalsifikasi

Normal vs abnormal

Normal kalsifikasi :
- Vascular veins calcification
- costal cartilage
- lymph node
Abnormal kalsifikasi :

- Stone : renal, urinary tract, appendicolith


- Vascular calcification, aneurysm
- Pankreas
- Leiomyoma
- Kalsifikasi tumor
3. Psoas line
4. Peritoneal fat line
5. Kontur ginjal
Ginjal setinggi corpus vert. Th 12 L1
Ginjal kiri lebih tinggi 1 corpus dari ginjal kanan
Axis : sejajar dengan psoas line / 20 thd sumbu tubuh
6. Tulang
FPA 3 posisi

Posisi :
1. FPA AP supine
gas pattern, kalsifikasi, massa tumor
2. LLD
free air, air fluid level
3. FPA erect / duduk
free air, air fluid level
Oesophagus Maag Duodenum /
Barium Meal

Modalitas radiologi yang digunakan untuk menilai


esofagus, lambung dan duodenum dengan menggunakan
zat kontras ( barium / water soluble ) dibawah kontrol
fluoroskopi.
Normal Biphasic Upper GI
series
Colon in Loop / Barium enema

Modalitas radiologi yang digunakan untuk menilai rektum,


sigmoid, colon sampai ke caecum dengan menggunakan
kontras barium / water soluble di bawah kontrol fluoroskopi
Ultrasonografi

Modalitas radiologi dengan sumber gelombang suara


untuk menilai bagian bagian tubuh

Dapat menilai organ organ solid intra-abdomen, dapat


mengetahui struktur interna suatu lesi ( padat / kistik ),
baik mendeteksi batu ( opak maupun lusen )

Limitasi untuk pemeriksaan gaster dan usus.


Meteorismus

Merupakan peningkatan jumlah udara usus yang mengisi


keseluruhan lumen usus tanpa menyebabkan distensi
maupun dilatasi usus.
Ileus

1. Fungsional
lokal ( sentinel loop )
adynamic ileus ( ileus paralitik )

2. Mekanik
Ileus obstruktif letak tinggi
Ileus obstruktif letak rendah
- ileocecal valve kompeten
- ileocecal valve inkompeten.
Sentinel loop

1-2 persistent dilated loops small / large bowel

Gas in rectum / sigmoid


Ileus paralitik
Udara di small bowel dan large bowel sampai rectum
Long air-fluid level
Pada pasien post op
Ileus obstruktif letak tinggi

Dilatasi small bowel dengan gambaran coiled spring dan


Herring bone.
Air fluid level pendek pendek / step ladder pattern
Sedikit udara di rektum
Level obstruksi sampai setinggi ileocecal valve.
Ileus Obstruktif letak rendah

Dilatasi colon
Tidak adanya udara pada rektum
Tidak ada udara di small bowel jika ileocecal valve
kompeten.
Penyebab

1. Tumor
extraluminer / intraluminer
extraluminer hanya menyebabkan pendesakan terhadap
dinding bowel tanpa merubah struktur anatomi ( indentasi )
intraluminer merubah struktur anatomi berupa filling
defek ( apple core )
2. Invaginasi
3. Volvulus sigmoid
Volvulus caecal
Extraluminal air

TYPES
Pneumoperitoneum/free air/intraperitoneal air

Retroperintoneal air

Air in the bowel wall (pneumatosis intestinalis)

Air in the biliary system (pneumobilia)


Sign

Large collection of gas Small amount of gas


Abdominal distension, gatric
Doges Cap sign
air fluid level
Falciform ligament sign
Crescent sign
Lig teres notch
Football sign
Lig teres sign
Rigler sign
Cupola/saddle bag/
Falciform ligament sign
mustache sign
Triangle sign
Parahepatic air sign
Inverted V sign
Single large area of
Urachus sign hyperlucency over the liver
Continous diaphragm sign
Upright film best

The patient should be positioned sitting


upright for 10-20 minutes prior to acquiring
the erect chest X-ray image.

This allows any free intra-abdominal gas to


rise up, forming a crescent beneath the
diaphragm. It is said that as little as 1ml of gas
can be detected in this way.
Free Air
Causes
Rupture of a hollow viscus
Perforated peptic ulcer
Trauma
Perforated diverticulitis (usually seals off)
Perforated carcinoma

Post-op 5-7 days normal, should get less with successive


studies *NOT ruptured appendix (seals off)
Crescent Sign
Free air under the diaphragm

Best demonstrated on
upright chest x rays or
left lat decub

Easier to see under


right diaphragm
Riglers Sign
Bowel wall visualised on both sides due to intra and extraluminal air
Usually large amounts of free air
May be confused with overlapping loops of bowel, confirm with upright view
Football Sign
Large pneumoperitoneum outlining entire abdominal cavity
Falciform ligament sign

Long vertical line to


the right of the
midline extending
from ligamentum
teres notch to
umbilicus
Other patterns of air around liver

Doges Cap Sign


Doges cap sign

Triangular collection of gas


in Morrisons pouch ( posterior
hepatorenal space )
Inverted V sign

On the supine radiograph, an inverted "V"


may be seen over the pelvis in a patient with
pneumoperitoneum.

While in infants this is produced by the


umbilical arteries, in adults it appears to be
created by the inferior epigastric vessels
Inverted V

Urachus sign

Outline of both lateral umbilical ligament ( containing inferior epi


gastric vessel
Continous Diaphragm Sign

Sufficient free
air, left and
right hemi-
diaphragms
appear
continous
Triangle Sign

Triangular air pocket


between 3 loops of bowel
Cupola Sign

Gas trapped below central tendon of diaphragm


Urachus Sign

Outline of middle umbilical ligament


Ligamentum teres sign ( arrow ) : air out
lining fissure entering teres hepatis seen
vertically oriented sharply defined slitlike/
oval area of hyperlucency between 10
12th rib within 2.5 4 cm right of vert. Bor
der 2-7 mm wide 6-20 mm long

Ligamentum teres notch ( curve arrow ) :


inverted V-Shaped area of hyperlucency
along undersurface live r
Contrast examination in GI tract