Bagian 1 Kirim Deni Noviana Abdomen Radiografi Hand Out Materi ADHPHKI Surabaya 16 Juli 2011

download Bagian 1 Kirim Deni Noviana Abdomen Radiografi Hand Out Materi ADHPHKI Surabaya 16 Juli 2011

of 18

Transcript of Bagian 1 Kirim Deni Noviana Abdomen Radiografi Hand Out Materi ADHPHKI Surabaya 16 Juli 2011

  • 7/14/2011

    1

    Drh.Deni Noviana,Ph.DStaf Bagian Bedah dan Radiologi

    Fakultas Kedokteran Hewan IPB

    Email:[email protected]

    http://deni.staff.ipb.ac.id/

    istheuseofXraystoviewunseenorhardtoimageobjectsandisusedforbothmedicalandindustrialapplicationspp

    isanXrayimageoftheinternalstructureofanobject.

    isahealthcareprofessionalwhocreatesmedicalimagesofthebodytohelphealthcareprovidersdiagnoseandtreatillnessandinjury

    a unit of measurement for ionizing radiationaunitofmeasurementforionizingradiationanalternativename

    forXrays

    Radiographmerupakan gambaran karya seni 2dimensi hasil dari suatu organ/struktur yangtadinya 3 dimensitadinya 3dimensi,

    Gambaran 3dimensi dapat diimajinasikan darigambaran 2dimensi yangdiambil dengan sudutpandang yangtepat.

    Imajinasi3dimensididapatkandenganmenggunakan hasil pengambilan 2 gambarmenggunakanhasilpengambilan2gambarstandarradiografi

    Digantung pada iluminator dengan prosedur standardan pola tetap yangtelah ditentukan sebelumnya

    Hasil pengambilan radiograf lateral,bagian kranialp g g , gdiletakkan di sisi kiri

    Hasil pengambilan radiograf VD/DV,bagian kranialpasien di letakkan di atas,sedangkan bagian kiri pasiendiletakkan di kanan

    Kondisi lingkungan yangtenang,pencahayaaniluminator yang cukup kurangi cahaya ruangan yangiluminator yangcukup,kurangi cahaya ruangan yangtidak perlu,fokuskan lesio organpada titik tertentu

  • 7/14/2011

    2

    Setiap bayangan yangmuncul harus dievaluasidan dijelaskan,apakah:yBentukan normal anatomiyBentukan normalanatomiyPecahan/serpihan struktur dari struktur yangbertumpuk/superimposyArtefak dari kesalahan posisiyLesio pathologiyLesio pathologi

    Contoh langkah interpretasi yangbaik dan benar

    Contoh langkah interpretasi yangsalah

    Berdasarkan arah datangnyasinar X,standarpandangyang

    Gambar standar pandang padapengambilan foto sinarx , p g y g

    umum dipakai untuk regioabdomen: Laterolateral (LL) Lateral Ventrodorsal (VD) Dorsoventral (DV) Decubitus lateral Decubitus lateral

  • 7/14/2011

    3

    Evaluasi radiografik abdomenRasasakit pada regio abdominalGangguan gastrointestinalseperti anorexia,vomit,nauseaatau diarrhea.Gangguan traktus urinaria seperti hematuria,dysuria,strauria,perubahan frekuensi urineatau calculiVUatau ureter.Gangguan traktus genitaliaseperti dischargedarivulvaEvaluasi pada kebengkakan/masa abdomenEvaluasi distensi abdomen,tenesmus

    RadiografiRadiografilaterallateralpadapadaregioabdomenregioabdomen::

    Rightrecumbency lebih seringdigunakan, dapat memperlihatkanujung limpa

    SStandartandarppandangandang1.1. LateralLateral

    j g p Leftrecumbency memiliki

    keunggulantersendiri yaitumembuatgasdalamlambungdapatberpindahkepylorusdanduodenum

    Kakidepandiposisikansecranialmungkin,dankakibelakangsecaudal

    2.2. VDVD

    mungkin. Standar pandang lateraldengan

    posisi hewan berdiri dan arah sinar Xhorizontal untuk deteksi cairandalam peritoneum.

    3.3. DVDV

    RadiografiRadiografiVD/DVVD/DVpadapadaregioabdomenregioabdomen::

    VDlebih baik daripada DV DVcenderung menekan viscerayang

    menyebabkan perpindahan organ

    SStandartandarppandangandang1.1. LateralLateral

    y p p g Posisi VDakan membantu

    penyebaran luas normalorganorgandalam rongga abdomen

    VDsulit dilakukan pada hewantraumapada pelvisatau kakibelakang ,karena tidak dapat

    2.2. VDVD

    dilakukan penarikan Kakidepandiposisikansecranial

    mungkin,dankakibelakangsecaudalmungkin.

    3.3. DVDV

    Anjing:Pusatpenyinaran kirakira padat l t t khi d t h ttulang costaeterakhir dan pertengahanantaraumbilicusdantulangbelakanglumbalis.

    Kucing:Pusatpenyinaran kirakira 2jari dibelakang tulang costaeterakhir danpertengahanantaraumbilicusdantulangp g gbelakanglumbalis.

  • 7/14/2011

    4

    Protocol :

    1. Appropriate cassette should be selected

    2. Cranial boundaries entire diaphragm3. Caudal boundaries throchanter mayor femur4. Dorsal and ventral boundaries (lateral view)

    soft tissue margins of the abdomensoft tissue margins of the abdomen.

    5. Medial and lateral boundaries (DV or VD view)soft tissue margins of the abdomen

    Posisi Radiografi LateralAbdomen

    Posisi Radiografi VDAbdomen

    Perbedaan kerapatan atau densityantara satuorgandengan organlainnya

    Banyaknya lemak dalam abdomen Pergerakan pasien atau hewan selama

    pemotretan

    Ketebalan hewan

  • 7/14/2011

    5

    Thegrossanatomyoftheabdomenarenotexactlythesamewithradiographicanatomy(ex:uterus)

    Thinkabouttherelationshipsoforgans TheabdomendividedintofivezonesonlateralviewandfourzonesonVDview.

    L3

    Zone1

    Zone3

    Zone4

    Zone5

    Zone2

    L 1

    Zone1 Zone2

    L1

    Zone3

    Zone4

    L3Zone1 Liver(Right&caudate) Stomach(Fundus,body)

    Zone1 Rightkidney Pancreas* Mesentericlymphnode* Spleen&rightadrenal*Zone2

    Zone2

    Liver Stomach(Body,pylorus) Pancreas* Gallbladder* Mesentericlymphnode*

  • 7/14/2011

    6

    Zone1 Liver(Right) Stomach

    P i l d dZone1 Zone2

    Proximalduodenum Rightkidney Rightadrenalgland* Pancreas* Mesentericlymphnode* Gallbladder*Zone2 Liver(Left)

    L1

    Liver(Left) Stomach Spleen(Head) Leftadrenalgland*

    L3 Spleen(Body,tail).

    Small intestineZone1

    Zone4

    Zone5

    Smallintestine Largeintestine Leftkidney Pancreas* Left ovary*

    Zone2 Leftovary Uterus*

    L1

    Zone1 Zone2

    Stomach* Smallintestine

    Zone3

    Largeintestine Leftkidney Pancreas* Rightandleftovaries*Ut ( i l

    Zone4

    Uterus(cranialhorns)*

    Zone4

    L3Zone4 Colon&Rectum Medialiliaclymph

    Z 5

    y pnodes*

    UretersZone5 Urinarybladder Ureter

    Zone3 Zone5 Uterus Prostategland

  • 7/14/2011

    7

    Colon/rectum Ureter

    Zone 3 Uterus Urinarybladder Medialiliaclymphnodes*

    Prostate gland (M)*

    L5

    Zone3

    Zone4

    Prostategland(M) Rectallymphnode

    Zone4

    L3Zone5 Urinarybladder Ureter

    Z 5

    Ureter Uterus Prostategland(M)

    Zone3 Zone5

    Pemeriksaan radiografi lambung denganmenggunakan bahan kontras untuk

    mengetahui struktur lambung

    Bahan kontras dibagi 3macam :

    1.1.BahanBahan KontrasKontras PositifPositif :BariumSulfat dan Iodium

    2.2.BahanBahan KontrasKontras NegatifNegatif :Udara,Carbondioksida,Nitrit Oksida

    3.3.DoubleDoubleKontrasKontras :Gabungan kontras positif dan negatif

    Hewan dipuasakan selama1824jam

    Hewan diberi obat sedasiacepromazine 0,1mg/kgBBIMdan dibius Ketamin 10%1520mg/kgBB (*opt)

    Bahan kontras bariumsulfat30%10ml/kgBB dicampur/ bl ff (* )1/8tableteffervecent (*opt),dimasukkan ke lambungmelalui stomachtube.

  • 7/14/2011

    8

    kVp :Lateral50,DVVD52mAs abdomen2.5 (Screen400)Pengambilan Xray:Pengambilan X ray:

    Sebelum menit ke5dengan posisi leftlateraluntuk melihat cardiaclambung,

    Pada menit ke10dengan posisi rightlateraldan DVuntuk pemeriksaan pyloruslambung,

    Pada menit ke 20 dengan posisi VD Pada menit ke20dengan posisi VD Pada menit ke60dengan posisi VDdan LLateral.

    BaSO4for0minute BaSO4for1minute

    BaSO4for30minute BaSO4for60minute

    Metode pemberian bahan kontras untukmenghasilkan struktur gambar ginjal yangjelasg g g j y g jBagian Pyelum ginjalMelalui VenaPerifer (V.Cephalica antibrachiiDorsalis,V.Saphena)atau VenaJugularis

    Bahan kontras TriIodine(Iohexol)M l i di i l Meglumine diatrizoleSodiumdiatrizoat

    Sifat:Soluble(terlarut)

    1. Hewan di puasakan selama 1224jam

    2. Hewan dibiusACP/Acepromazine,Dosis:0,020,1mg/kgBBIM/SC)+Ketamin10%,Dosis:1520mg/kgBB(*opt)

    3 T h ik P k bd3. Tehnik Penekanan abdomen4. Penyuntikan IntraVena

    Menggunakan IVCatether

  • 7/14/2011

    9

    Iodinefor25minutesIodinefor15minutesIodinefor5minutes NegativeContrasDoubleContrasPositiveContras

  • 7/14/2011

    10

    Largestglandinthebody. Softtissueopacityandliesinthecranialabdomen caudal the diaphragm and cranialabdomen,caudalthediaphragmandcranialstomach.

    Dividedintofourlobes:left,right,caudateandquadrate.

    Normalliversizeisemperical bothviewsmustbeused.

    Positionofthestomach aidsinthedeterminationofliversize.

    Axisstomachisparalleltotheribs. Caudal margin is enclosed within the rib cage Caudalmarginisenclosedwithintheribcageorveryclosetocostaemargin.

    Dog Catg

  • 7/14/2011

    11

    Hati

    HatiHEPATOMEGALY MICROHEPATIANORMALLIVER

    Associatedwithrightliverlobes. Softtissueopacity. Notnormallyvisualized. Changesmightbevisualized:mineralopacities,gasopacities

    Normalsize:extremelyvariable. Indog>cat. Drugs such as barbiturate ACP generilized splenicDrugssuchasbarbiturate,ACP generilized splenic

    enlargement. Proximalextremity(headofthespleen) connectedto

    thegastricfundus. Proximalextremity(body) locatedintheleftdorsal

    aspect(Lateralzone1/VDzone2). Distalextremity(tail) locatedintheventralabdomen,

    highly variable locationhighlyvariablelocation. Radiographs:triangularsofttissueopacities remember

    theexactsizeofspleenismuchlarger.

  • 7/14/2011

    12

    Not visualized radiographically , except enlarged Ultrasound is excellent tool to evaluate. Medial iliac lymph nodes (ventral L6 in zone 4). Mesenteric lymph nodes (zone 3). Inguinal lymph nodes (ventral flank, outsideabdominal cavity)abdominal cavity).

    Notvisualizedradiographically ,exceptenlarged.Ult d i f l t l t l t Ultrasoundismoreusefultooltoevaluate.

    Therightlimbliesadjacentandcaudaltothecaudalmarginofstomach.

    Theleftlimbliesmedialandadjacenttothedescendingduodenum.

    Radiographicidentificationofpancreaticdiseaseisdifficult.

    Locatedintheretroperitonealspace. CranialpoleoftheRKisoftendifficulttoCranial pole of the RK is often difficult tovisualize superimposedwiththeliver.

    LKmorecaudalthanRK,anditslocationmorevariable.

    Sizeindog:2.53.5timesthelengthofL2(rec:VD view)VDview).

    Sizeini cat:2.43.0timesthelengthofL2(rec:VDview).

  • 7/14/2011

    13

    R. KidneyR.KidneyL.Kidney

    VU

    GINJAL ANJING: 2,5-3,5 KALI PANJANG VERTEBRAE LUMBALIS KE-2 GINJAL KUCING: 2 KALI PANJANG VERTEBRAE LUMBALIS KE-2

    Locatedintheretroperitonealspace. Notnormallyvisualizedonradiographs. Usingivcontrastmediummaxdiameter23mm.

  • 7/14/2011

    14

    PRM

    C

    VU

    AplikasiAplikasi IVP(intravenousIVP(intravenouspyelogrampyelogram))dengandengan bahanbahan kontraskontraspositifpositif terionisasiterionisasi preparatpreparat iodine,iodine,1515menitmenit..

    PR

    M

    C

    U

    VU

    AplikasiAplikasi IVP(intravenousIVP(intravenouspyelogrampyelogram))dengandenganbahanbahan kontraskontras positifpositif terionisasiterionisasi preparatpreparatiodine,5iodine,5menitmenit..

    Thesizeishighlyvariable. Ifemptymaynotbevisible. Maybelocatedeithertotheleftortotherightofmidline,orcentered(VDview).

    Male:comprisesthreeparts. Prostatic confinedtotheprostategland. Membranous extendsfromtheprostatetotheos penis.

    Penile shorterincatthanindog. Female:theurethraisshorterandwider.

  • 7/14/2011

    15

    Positif kontras cystogram dilkakukan dengan mengaplikasikan mediakontras secararetrogradeke dalam kantung kemih

    Notvisualizedradiographically,exceptl denlarged

    Normalprostatediameter:max2/3thewidthofthepelvicinletonVDview.

    Normalprostateincatisnotvisible. Prostatic disease in the cat is very rare Prostaticdiseaseinthecatisveryrare.

    Notvisualizedradiographically ,exceptl d idenlargedorgravid.

    Stumpislocatedbetweenthebladderandcolon.

    Gravid:fetalskeletonsbecomevisibe atday4545.

  • 7/14/2011

    16

    Liescaudaltotheliverandcranialtotransversecolon.transversecolon.

    Theaxisparalleltotheribs. Dog:pylorusisgenerallytotherightofmidline.

    Cat:pylorusisgenerallyonmidlineorslightlypy g y g ytotheleftofmidline.

    Thesizeandopacityisextremelyvariable.

    Located at the mid abdomen

    Dog : Normal SI should be no wider than thecentral portion of the body lumbarvertebrae and it should not exceed thediameter of twice the width of a rib.

    Cat : Gas accumulation are typicaly lest thanCat : Gas accumulation are typicaly lest thanin normal dog.

    Cecum : Located to the right of midline onVD i d i th t l bdVD view and in the central abdomenon lateral view.

    Dog : It has a CShaped appereance.Cat Very small and usually not seenCat : Very small and usually not seen.

    Ascending colon : Is to the right of midline.

    Tranverse colon : At the hepatic flexure, theascending colon turns to the leftand continues across the midline tothe left.

    Desending colon : At the splenic flexure theDesending colon : At the splenic flexure, thecolon turns caudaly and continues into the pelvic canal.

  • 7/14/2011

    17

    Fundus

    Caecum

    P l

    Duodenum ColonDesc

    Pylorus

    FundusPylorus

    Asc.col

    Tranv.col

    desc.col

    GINJAL

    FUNDUS

    COSTAE

    KOLON

    FEMUR

    PYLORUSDUODENUM

    USUSHALUS

    ABDOMEN(120MENITKONTRASPOSITIF)

  • 7/14/2011

    18