px. Abdomen radiologi

7/27/2019 px. Abdomen radiologi

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ABDOMEN

Mellissa

PPDS I Radiologi FK UNDIP / RSUP Dr. Kariadi

Semarang2010


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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


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Sinar X arah horizontal

Foto abdomen supine,

pasien telentang,sinar tegak

lurus/vertikal.

LLD


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Foto abdomen tegak, pasien berdiri, sinar horizontal.


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Gas in

stomach

Gas in a few

loops of

small bowel

Gas in

rectum or

sigmoid

Normal Gas Pattern


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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.


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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


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Diameter usus bervariasi

Small bowel : < 3 cm

Colon transversum : < 6 cm

Caecum : < 9 cm

Caecum paling distensible


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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


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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.


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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


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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.


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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.


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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.


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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.


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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.


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Abnormal Gas Patterns

l Functional Ileus

n Localized (Sentinel Loops)

n Generalized adynamic ileus

l Mechanical Obstruction

n SBOn LBO


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Udara / gas memberi gambaran bentuk usus

Jejunum

Upper Ileum

Lower Ileum

Colon


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Perbedaan dilatasi Usus Halus & Besar

Usus Halus Kolon

Haustra _ +

Valvula

conniventes

+ _

Jumlah loop >>>>


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Adynamic Ileus


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Ileus Paralitik


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Adynamic Ileus


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Small Bowel Obstruction


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Ileus Obstruktif


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Ileus Obstruktif


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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


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STRING OF BEADS /

STRING OF PEARLS


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Localized Ileus


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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.


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Free Air (Pneumoperitoneum)


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Free Air (pneumoperitoneum)

R

R


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Free air

(pneumoperitoneum)


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Pneumoperitoneum


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Riggler sign


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ASCITES


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Appendicolith


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Atresia Ani


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Ureterolitiasis

sinistra


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Duodenal atresia


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Bayi sungsang


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Vesikolitiasis

A MK / 8 th Il b t ktif


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An MK / 8 thn. Ileus obstruktif


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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.

px. Abdomen radiologi

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