Download - px. Abdomen radiologi
-
7/27/2019 px. Abdomen radiologi
1/46
ABDOMEN
Mellissa
PPDS I Radiologi FK UNDIP / RSUP Dr. Kariadi
Semarang2010
-
7/27/2019 px. Abdomen radiologi
2/46
Plain Abdominal Radiographs
Paling sering : AP, supine
Batas atas : diafragma. Kedua basis paru
harus tampak
Batas bawah : simfisis pubis
Diambil saat ekspirasi, 1-2 detik setelah
ekspirasi
Ideal : empty bladder
-
7/27/2019 px. Abdomen radiologi
3/46
Sinar X arah horizontal
Foto abdomen supine,
pasien telentang,sinar tegak
lurus/vertikal.
LLD
-
7/27/2019 px. Abdomen radiologi
4/46
Foto abdomen tegak, pasien berdiri, sinar horizontal.
-
7/27/2019 px. Abdomen radiologi
5/46
Gas in
stomach
Gas in a few
loops of
small bowel
Gas in
rectum or
sigmoid
Normal Gas Pattern
-
7/27/2019 px. Abdomen radiologi
6/46
Plain film radiography
Normally there is a
small amount of gas in
the stomach and
nondistended small-bowel loops. The
colon normally
contains gas and feces.
-
7/27/2019 px. Abdomen radiologi
7/46
Plain Abdominal Radiographs
Gas normal di gaster & colon Sedikit di usus halus Fluid level NORMAL : di colon, 3-5,
panjang < 2.5 cm
Fluid level di small bowel, > 3, kaliber > 3cm ABNORMAL
Udara pada usus berguna utk : Menilai diameter usus. Menilai posisi usus. Banyaknya cairan didalamnya
-
7/27/2019 px. Abdomen radiologi
8/46
Plain Abdominal Radiographs
Diameter usus bervariasi
Small bowel : < 3 cm
Colon transversum : < 6 cm
Caecum : < 9 cm
Caecum paling distensible
-
7/27/2019 px. Abdomen radiologi
9/46
Plain Abdominal Radiographs
Gas sampai di colon 30 menit
severe pain is present anywhere in the
body, or when respiration is laboured as
in pneumonia or asthma amount of air
swallowed >> producing a dramatic
PAF (such gas-filled, slightly dilated loops
of bowel contain relatively little fluid) meteorism
-
7/27/2019 px. Abdomen radiologi
10/46
Organ yang dapat diidentifikasi dari lemak
yang melingkupinya :
Batas ginjal.otot psoas.
VU.
Peritoneum.
Batas posterior hepar dan lien.
Fat line dapat tergeser o/k :
Pembesaran organ.Adanya inflamasi.
Adanya cairan.
-
7/27/2019 px. Abdomen radiologi
11/46
Soft t issue/v isceral
out l ines The outlines of soft tissue is
made possible by radiolucentfat which surrounds intra-abdominal organs.
Liver - posterior margin visiblewhere outlined byretroperitoneal fat.
Spleen - often visible
Kidneys - outlines may not be
seen in entirety because ofoverlying gas and stool
Psoas muscles - marginsusually visible but may not beseen in entirety
-
7/27/2019 px. Abdomen radiologi
12/46
a number of normal people these fat
lines may be blurred or not identified at
all. In around half of normal children, the
psoas outlines are indistinct. These facts
must be considered carefully when
assessing the significance of fat line
changes.
-
7/27/2019 px. Abdomen radiologi
13/46
ACUTE ABDOMEN
Tehn ik radiog raf i
1.Posis i s up ine :
Pre peritoneal Fat line Kanan & kiri.
Garis Psoas kanan & kiri
Batu radioopak, kalsifikasi, benda asing radioopa
Kontur ginjal kanan & kiri.
Gambaran udara usus
Kesuraman yang dapat disebabkan oleh cairan
diluar usus atau massa tumor.
-
7/27/2019 px. Abdomen radiologi
14/46
2.Posisi erect/ semi erect. Gambaran udara cairan dalam usus / diluar
usus. Gambaran udara bebas dibawah
diafragma. Gambaran cairan di rongga pelvis /
abdomen bawah.3.Posisi LLD.
Gambaran udara bebas antara hati dengandinding abdomen atau pelvis dengandinding abdomen.
-
7/27/2019 px. Abdomen radiologi
15/46
Juga dibutuhkan foto thorax
Krn beberapa penyakit spt :Pneumonia.Infark paru.Dissecting aneurysma.
Infark miokard.mirip dengan akut abdomen
Foto dada PA utk :
Melihat gambaran free air di bawah diafragma.Pada komplikasi di dada.Abses subfrenik yg merp komplikasi.
-
7/27/2019 px. Abdomen radiologi
16/46
Pneumoperitoneum
resulting from perforation
of a duodenal ulcer. Erect
chest radiograph. Typical free
gas between the liver and theright hemidiaphragm. Note
also the small triangular
collection between the loops
of the splenic flexure of the
colon, beneath the left
hemidiaphragm.
-
7/27/2019 px. Abdomen radiologi
17/46
Abnormal Gas Patterns
l Functional Ileus
n Localized (Sentinel Loops)
n Generalized adynamic ileus
l Mechanical Obstruction
n SBOn LBO
-
7/27/2019 px. Abdomen radiologi
18/46
Udara / gas memberi gambaran bentuk usus
Jejunum
Upper Ileum
Lower Ileum
Colon
-
7/27/2019 px. Abdomen radiologi
19/46
Perbedaan dilatasi Usus Halus & Besar
Usus Halus Kolon
Haustra _ +
Valvula
conniventes
+ _
Jumlah loop >>>>
-
7/27/2019 px. Abdomen radiologi
20/46
Adynamic Ileus
-
7/27/2019 px. Abdomen radiologi
21/46
Ileus Paralitik
-
7/27/2019 px. Abdomen radiologi
22/46
Adynamic Ileus
-
7/27/2019 px. Abdomen radiologi
23/46
Small Bowel Obstruction
-
7/27/2019 px. Abdomen radiologi
24/46
Ileus Obstruktif
-
7/27/2019 px. Abdomen radiologi
25/46
Ileus Obstruktif
-
7/27/2019 px. Abdomen radiologi
26/46
string of beads sign, due to a line of gas
bubbles trapped between the valvulae
conniventes, is seen only when very
dilated small bowel is almost completely
filled with fluid, and is virtually diagnostic
of SBO
-
7/27/2019 px. Abdomen radiologi
27/46
STRING OF BEADS /
STRING OF PEARLS
-
7/27/2019 px. Abdomen radiologi
28/46
-
7/27/2019 px. Abdomen radiologi
29/46
Localized Ileus
-
7/27/2019 px. Abdomen radiologi
30/46
BEDA ILEUS OBSTRUKTIF & PARALITIK
OBSTRUKTIF1. Dilatasi pada proksimal lesi
dengan udara yg meningkat.
2. Didistal sumbatan udara
menurun s/d (-).3. Step ladder app (+), ciri :
pendek & banyak.
4. Hearing bone (+)
5. Penimbunan cairan
ekstraluminal.
PARALITIK1. Dilatasi usus hebat s/d
rectum
2. Gas (+) s/d rectum &
sigmoid.3. Step ladder app (+), ciri :
panjang & sedikit.
4. Flank strip.
5. Sering disertai Rx.Pleura.
6. Gerakan diafragma menurun.
-
7/27/2019 px. Abdomen radiologi
31/46
-
7/27/2019 px. Abdomen radiologi
32/46
Free Air (Pneumoperitoneum)
-
7/27/2019 px. Abdomen radiologi
33/46
Free Air (pneumoperitoneum)
R
R
-
7/27/2019 px. Abdomen radiologi
34/46
Free air
(pneumoperitoneum)
-
7/27/2019 px. Abdomen radiologi
35/46
Pneumoperitoneum
-
7/27/2019 px. Abdomen radiologi
36/46
Riggler sign
-
7/27/2019 px. Abdomen radiologi
37/46
-
7/27/2019 px. Abdomen radiologi
38/46
ASCITES
-
7/27/2019 px. Abdomen radiologi
39/46
Appendicolith
-
7/27/2019 px. Abdomen radiologi
40/46
Atresia Ani
-
7/27/2019 px. Abdomen radiologi
41/46
Ureterolitiasis
sinistra
-
7/27/2019 px. Abdomen radiologi
42/46
Duodenal atresia
-
7/27/2019 px. Abdomen radiologi
43/46
Bayi sungsang
-
7/27/2019 px. Abdomen radiologi
44/46
Vesikolitiasis
A MK / 8 th Il b t ktif
-
7/27/2019 px. Abdomen radiologi
45/46
An MK / 8 thn. Ileus obstruktif
-
7/27/2019 px. Abdomen radiologi
46/46
Free air. There is a large
quantity of free air in this
patient's abdomen. The image is
obtained with the patient supine,
yet there are crescents of air
seen beneath each
hemidiaphragm (white arrows),
and both sides of the bowel wall
are visible (blue arrow). There is
a lucency overlying the liverwhich is caused by the large
volume of free air.