ABDOMEN dan TRAKTUS

DIGESTIVUS

Anggraheny S
FK UNIVERSITAS WIJAYA
KUSUMA SURABAYA
Modalitas
 X Ray : BOF
 Kontras : Esofagogram, UGI (Barium Follow

Trough), Colon In Loop (Barium Enema),

Appendicogram, Cholangiography
 USG
 CT Scan
 MRI
 PET Scan
BOF
 Plain Foto Abdomen / BOF (Buich Over Sich) atau BNO
(Bladder Nier Over Sich), yaitu pemeriksaan abdomen tanpa
bahan kontras.
 Merupakan pemeriksaan pendahuluan / screening sblm di
lakukan pmx yg lain.
 Daerah yg hrs masuk dlm pmx
bagian atas : diafragma,
bagian bawah : pubis.
 Organ yg diperiksa : hepar, lien, ginjal, pancreas,intestine ,
tulang vertebrae & soft tissue/flank area.
 Foto yg baik : KV rendah → kontras baik, beda jaringan yg
difoto jelas.
 Tujuan : u/ mengetahui kelainan dlm abdomen.
Posisi :

 AP (Antero Posterior), utk melihat scr

maximal detail organ-organ secara anatomi.
 Berdiri, utk melihat : air fluid level,

membedakan masing2 usus & gambaran

ketebalan dinding usus, mobilitas udara dlm
abdomen termasuk udara bebas dibawah
diafragma.
 Decubitus film, utk evaluasi adanya udara

bebas (minimal posisi miring 15’ kemudian di

foto)
Persiapan

 Makin baik persiapannya, makin baik hasilnya.

 Pmx pd wanita usia 12-50 th hrs memperhatikan
10 days rule, yi 10 hr stlh menstruasi, hati2 !
 Kecuali pd wanita : tdk kawin/tdk b’hub sex, saat
mens, dg kontrasepsi pil/IUD slm 3 bln efektif &
telah dilakukan sterilisasi.
 Kurangi bentukan fecal dg makan tanpa sayur,
lavement / urus-urus (30 gr garam inggris / 30 cc
castor oil), tidak merokok agar tdk banyak gas
dlm abdomen, BAK sblm foto dikerjakan,
perhatikan ten days rule utk mencegah terjadinya
radiasi pada kehamilan.
BOF sbg screening
 u/ menentukan ukuran exposure faktor, sentrasi,
kolimasi & posisi px  px yg akan melakukan
pmx IVP, Colon in loop, CT Scan dll.
 u/ mengetahui adanya sisa bahan kontras dr pmx
sblmnya yg akan mengganggu hasil foto.
 u/ menunjukkan letak opasitas yg ada yg
mungkin mjd kabur krn tertutup kontras.
 u/ mengetahui tanda2 fisik spt scoliosis, anomali
dll.
 Foto hrs ada label : nama, umur, no registrasi, tgl,
marker (tanda kanan-kiri).
Gambaran normal pada BOF

 Usus halus : central, fluid level pendek (max :

3), max diameter 2,5mm, sedikit gas, valvula
conniventes hanya terlihat di jejunum.
 Usus besar : perifer, fluid level panjang t.u.

caecum (max 5), max diameter variable,

haustra, feses.
 Kalsifikasi normal : arterial (t.u. splenic arteri

pd ortu), phleboliths (dlm pelvis), mesenteric

nodes, costal cartilage.
Gambaran abnormal pada BOF
 Fluid levels
 Dilatasi loops (gas / cairan)
 Displacement bowel o.k. massa
 Abnormal gas shadow : free gas,

retroperitoneal gas, gas in biliary tree, portal

vein, bowel wall,abscess, hernia, gas in
abdominal wall.
 Abnormal kalsifikasi, fecoliths (appendix,

usus besar, diverticulum meckel), fat

lines(displacement, blurring,effacement), free
fluid, chest (elevasi diafragma, effusi pleura,
atelektasis), tulang (metastase, abnormal
kongenital)
BOF
BOF
 Flank area / Soft tissue
 Gas Usus
 Psoas shadow
 Tulang
 Liver
 Ginjal
 Spleen
Ultrasound
Ultrasound
 Probe convex 3,5 Hz
 Puasa 8 jam
 USG tdk dapat evaluasi organ berongga,

kecuali : ada mass

 Target sign, kidney like appearance
 Intususepsi, volvulus
 Appendix edema, dg infiltrate
 GB : sludge / batu, mass, itis
Biliary Tract
Imaging : Plain film, oral cholecystography,
USG, Percutaneous Transhepatic
Cholangiography, CT Scan, Radioisotop
imaging, T tube cholangiography,
Intravenous cholangiography, MRI.
Kelainan kongenital
 GB (agenesis, hypoplasia, floating, double,

septate, diverticula,cystic fibrosis)

 Bile duct (atresia, choledocal cyst, Choledocal

divertikel,choledochocele,caroli’s disease)
Kelainan GB
 Gallstones (10%)
 Cholecystitis akut ( gallstones 90%,

acalculous 10%)
 Penebalan dinding GB (cholecystitis akut/

kronik, ascites, hypoalbumin, ca GB,

Hipertensi portal, alkoholic, hepatitis,
pankreatitis akut, gagal jantung kongestive,
non fasting GB)
 Udara di biliary tree: iatrogenic (fistula post

op, endoscopy), infeksi o.k. Bakteri

pembentuk gas, inkompeten sphincter pd
ortu.
 GB tumor ( benign / malignan)
Bile duct tumor
 Benign : adenoma, mesenchymal, papilom.
 Malignant : cholangiocarcinoma

( adenocarcinoma, squamous cell), sarcoma,

metastase)
Bile duct stricture
 Malignant : cholangiocarcinoma, ca pancreas,

ca ampulla, portal lymphadenopathy,

malignancy gaster, duodenum, liver, GB.
 Benign : surgery (80%), inflamatory, batu,

tumor, TB, sclerosing cholangitis, trauma.

Akut Abdomen
 Imaging : BOF, USG,CT Scan.
 Obstruksi Usus : Obstruksi usus halus, Obstruksi

Usus besar.
 Merupakan penyebab tersering dr akut abdomen,

tdk sama dg meteorismus (e.c kolik renal /

respiratory problem)
Penyebab obstruksi usus :
 Congenital (atresia, stenosis,webs,

bands,duplikasi, internal/eksternal hernia,

malrotasi, meconium ileus, Hirschsprung’s disease)
 Infeksi (TB, parasit, actinomycosis,

lymphogranuloma venereum)
 Tumor (intrinsik / ekstrinsik)
 Intususepsi
 volvulus,
 Diverticulitis
 Chron’s disease
 Intraluminal (gallstone ileus, food bezoar)
 Fecal impaction
 Drug related stricture
 Trauma
Obstruksi usus halus
 E.c adhesi, strangulated hernia, gallstone

ileus,intususepsi.
 Ro : dilatasi usus, fluid level(+), coiled spring

pd jejunum o.k. Valvula conniventes.

 Fluid filled loop : sausage shape soft tissue

mass.
 Jika dg sedikit gas : string of beads pattern

o.k terjebak diantara valv.conniventes.

 Jk hanya terisi gas : coffee bean shape.
Obstruksi usus besar
 E.c : keganasan, diverticulitis, volvulus

(gaster, caecum, sigmoid,ileosigmoid knot),

mass ekstrinsik.
 Pseudoobstruksi : idiopatik, penyakit acute

( renal failure, pneumonia, infarct myocard,

gagal jantung, infeksi abdomen), Obat,
neurologis(DM,spinal cord lesion,parkinson),
penyakit collagen, endokrin
(hiperparatiroidsm).
Pneumoperitoneum
 Udara bebas di intraperitoneal (dibawah

diafragma) o.k. perforasi dr ulkus peptic,

tampak jelas pd foto erect, supine, left lateral
decubitus (LLD), CT Scan.
 Ro : Double wall sign (Rigler’s sign), udara di

morrison pouch, lucent liver sign, udara di

subhepatic space, udara di lesser sac,
triangular gas shadow antara bowel loops,
outlined falciform, umbilical ligament.
Penyebab pneumoperitoneum
 Perforasi (ulkus, tumor, sikemia, infeksi,

divertikulitis, toxic megacolon)

 Necrotizing enterocolitis (NEC)
 Pneomatosis coli, jejunal diverticolosis
 Post op, peritoneal dialisis, endoscopy
 Pneumomediastinum, pneumothorax
 Trauma
 Gas pd tuba fallopii
Penyebab paralitik ileus
 Post op

 Inflamatory (peritonitis, appendicitis, abses,

pankreatitis akut, cholecystitis, salpingitis

septicemia, chest infection)
 Metabolik (renal failure, hypokalemia, Coma

diabetic)
 Drugs (morfin, atropin)

 Trauma (spinal, aneurysma, retroperitoneal

bleeding)
 Vascular (gagal jantung, oklusi, sickle cell

disease)
 Renal colic
Tanda Appendicitis akut
 Dilatasi dg fluid level
 Appendicolith
 Cairan di kuadrant kanan bawah
 Psoas line kabur / tdk ada
 USG : appendix non compressible, thick wall

diameter > 6mm, target sign pd cross

section, appendicolith, cairan di paracolic
gutter jk tjd peritonitis, mass (abses,
mesentery inflamasi, omentum)
Infeksi
 Appendisitis akut, colitis akut
 Abses intraabdominal
 Abses subphrenic
 Peritonitis

Lesi Vaskular
 Aneurisma aorta
 Oklusi A.Mesentery inferior
 Bleeding diathesis (intramural hematoma pd

duodenum o.k. Purpura Henoch Schonlein pd

anak-anak)
Obstruksi Neonatal
 Pyloric stenosis
 Obstruksi duodenum
 Atresia usus halus
 Duplikasi cyst
 Malrotasi
 Meconium ileus
 Hirschsprung’s disease
 NEC
 Anorectal abnormalities
Hirschprung Disease
Hirschprung Disease
Hirschprung Disease
Hirschprung Disease
Hernia Diafragmatika
Atresia Ani
Ca Colon
Mass Gaster - UGI
Mass Gaster - UGI
Terimakasih