Digestive system:

Digestive tracts:
- Oral cavity
- Pharyng.
- Oesophagus.
- Gaster.
- Small bowel.
- Large bowel (Colon).
- Rectum.
Accessories organs:
- Parotis.
- Liver.
- Billiary.
- Pancreas.
Plain Photo

Barium Enema

MRI
USG
CT Scan
 PLAIN
ABDOMINAL
RADIOGRAPH
Technique :
AP - erect
AP - Supine

LLD

Semi recumbent
PA - CXR
AP-supine; vertical ray

AP-supine; horizontal ray

 What to Examine
Plain abdominal photo

1. Supine position :
abdominal wall
(preperitoneal fat
line)
psoas line
opaque stone /
calcification / foreign
body
renal contour
bowel gas
ascites
soft tissue mass
plain abdomen x-ray

2. Erect / semirecumbent
position.

air-fluid level
plain abdomen x-ray

2. Erect / semirecumbent.

Subdiaphragmatic free air

(perforation)
plain abdomen x-ray

3. LLD (left lateral decubitus, horizontal ray)

Free air (between liver and abdominal wall)

plain abdomen x-ray

radioopaque stone soft tissue mass

Mechanical small bowel
obstruction

-small bowel dilatation

-colon gas (-)
Mechanical small bowel obstruction

String of beads sign :

Trap air in valvulae conniventes
 Mechanical large bowel
obstruction

Colon dilatation

obstruction.

Barium enema
volvulus of descending colon
 Intussusception
Invagination type :

Crescent sign
 ileocecal intussusception

Coiled spring sign

plain abdomen photo Barium enema

 Acute appendicitis

Small bowel
dilatation
appendicolith

appendicolith
Plain abdomen photo: urolithiasis

Left kidney stone Kidneys and bladder stones

Plain photo IVP

Hydronephrosis caused by proximal ureteral stone

Ascites
NEC

gas in portal
vein

pneumatosis intestinalis
 Knee-chest position
AP

Atresia duodenum :
Double bubble sign.
Post operation complication :
Metallic clamp is found intrabdominal
Eosophagography
OESOPHAGUS
Location of esophageal
physiologic narrowing:
1.Caudal margin to
cricoid cartilage (VC-
6)
2.Aortic arch which cross
esophagus (VT- 4)
3.Left bronchus which
cross esophagus (VT-
6)
4.Crossing the
diaphragm (VT 10)
 Radiologic cases

Achalasia
Esophageal stricture
Barrets esophagus
Esophageal carcinoma
Barium Meal
GASTER
 Ca gaster

Tumor gaster sugestif ganas tipe schirrous di daerah

korpus hingga antrum
Small intestine
Barium Follow Through
Patient Fasting
Minum Barium 1 gelas (200 cc)
Diikuti dengan flouroskopi atau foto
konvensional.
Dengan mengambil foto serial, misalnya 5
menit, 10 menit, 20 menit dst.
Sampai masuk ke sekum.
 Ascaris in small bowel.
Infection : Crohns dss.
Barium enema

Single Contrast
Double Contrast
 THE DIFFRENCE BETWEEN SINGLE AND
DOUBLE CONTRAST

SINGLE CONTRAST DOUBLE CONTRAST

Baik untuk menilai Motorik (+/-).

kelainan motorik. Superior untuk menilai
Menilai kontur, bukan mukosa dan sekaligus
mukosa menilai kontur.
Tehnik sederhana dan Teknik lebih sulit.
mudah dilakukan.
PREPARING BEFORE EXAMINATION

Persiapan pasien

Mengubah pola makan

Minum air sebanyak-banyaknya
Pemberian pencahar (bila perlu)
Persiapan alat enema

Irigator plastik yang td :

enema tip
enema tube
enema reservoir bag
retention balloon dengan
inflatornya.
Anatomy Radiology
Barium enema :

Kolon normal Kolitis ulseratif

 - tubular bowel
Kolitis ulseratif
- haustrae menghilang.
Barium enema :

polypoid carcinoma in
ulcerative colitis.
Divertikel
Divertikulitis kolon dan fistula ke buli-buli

fistula
Buli-buli
Buli-buli

Posisi AP Posisi oblik

 Polip

Bubble
Sessile polip
Polip Pedunculated
Tumor diluar usus
yang menekan
kolon
Annular carcinoma of
the rectum (lateral
position).
Cecal Tumor
Ny. TB, 81 Th
Ca Colon di fleksura lienalis dengan
metastasis pada hepar
Anular type
Ulseratif colitis
Kolitis TB
Penyakit Crohn :

terlihat lesi yang

meloncat dengan
kolon normal
diantaranya.

Lesi pada kolon

Kolon normal
Histopathology : amoeboma
 Ileocecal
intussusception

Coiled springs sign

Komplikasi

Gas pain : residu udara menyebabkan nyeri

setelah tindakan barium enema.
Perforasi atau ruptur kolon
Intoksikasi air
Colonic intramural barium
Laserasi rektum
Kontaminasi bakteri
Reaksi alergi (hipersensitif) terhadap barium
atau glukagon/buscopan
TERIMA KASIH