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ACUTE ABDOMENACUTE ABDOMEN
oleh:oleh:
Dr. Sigit Widodo, Sp. RadDr. Sigit Widodo, Sp. Rad
Bagian RadiologiBagian RadiologiFK. Universitas TrisaktiFK. Universitas Trisakti
J a k a r t a J a k a r t a 2 0 0 72 0 0 7
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ACUTE ABDOMENACUTE ABDOMEN
Foto abdomen 3 posisi Foto abdomen 3 posisi (supine,LLD,setengah duduk)(supine,LLD,setengah duduk)
I.1.Ileus USUS HALUSI.1.Ileus USUS HALUS
1.1. Coiled Spring AppearanceCoiled Spring Appearance
2.2. Herring Bone SignHerring Bone Sign
3.3. Fluid levelFluid level
4.4. Step Ladder PatternStep Ladder Pattern
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2.Ileus Usus Besar (Colon)2.Ileus Usus Besar (Colon)a.Ileocaecal Valve Competenta.Ileocaecal Valve Competent
*Colon dilatasi*Colon dilatasi*Usus halus tidak ada kelainan*Usus halus tidak ada kelainan
b.Ileocaecalvalve In-Competentb.Ileocaecalvalve In-Competent*Colon tidak disfensi*Colon tidak disfensi*Usus halus distensi*Usus halus distensi
Volvulus sigmoidVolvulus sigmoid*Distensi ahaustal*Distensi ahaustal*Sigmoid *Sigmoid ~U terbalik~U terbalik
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II.PERFORASIII.PERFORASI
*Free air sickle*Free air sickle
(SUBDIAPHRAGMA)(SUBDIAPHRAGMA)
III.PERTITONITISIII.PERTITONITIS
1.1. Properitoneal fat hilangProperitoneal fat hilang
2.2. Dinding usus halus > tebalDinding usus halus > tebal
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PNEUMOPERITONEUMPNEUMOPERITONEUM
Pneumoperitoneum.Erect chest film.Free intra-abdominal Pneumoperitoneum.Erect chest film.Free intra-abdominal gas is clearly demonstrated under the right gas is clearly demonstrated under the right hemidiaphragm. Under the left hemidiaphragm a small hemidiaphragm. Under the left hemidiaphragm a small triangular collection of the free gas can be identified triangular collection of the free gas can be identified between loops of gas-filled bowel ( arrow)between loops of gas-filled bowel ( arrow)
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PNEUMOPERITONEUM PNEUMOPERITONEUM
Pneumoperitoneum. Abdomen supine, a triangular collection of free Pneumoperitoneum. Abdomen supine, a triangular collection of free gas is demonstrated in the subhepatic region (arrows).The falciform gas is demonstrated in the subhepatic region (arrows).The falciform ligament is also outline (arrowheads)ligament is also outline (arrowheads)
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Pneumoperitoneum.Abdomen supine.Visualization of both Pneumoperitoneum.Abdomen supine.Visualization of both sides of the bowel wall (Rigler’s sign).Both the inside and sides of the bowel wall (Rigler’s sign).Both the inside and outside wall multiple loops of small bowel can be identified outside wall multiple loops of small bowel can be identified clearlyclearly
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P E R F O R A S IP E R F O R A S I
PENYEBAB PENYEBAB ::1.1. AppendicitisAppendicitis2.2. Typhoid FeverTyphoid Fever3.3. Ulcus PepticumUlcus Pepticum
-Ulcus Ventriculi-Ulcus Ventriculi-Ulcus Duodeni-Ulcus Duodeni
GAMBARAN RADIOLOGI :GAMBARAN RADIOLOGI : Pneumo Peritoneum (Udara / gas bebas)Pneumo Peritoneum (Udara / gas bebas)
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Sigmoid volvulusSigmoid volvulus
Sigmoid volvulus. Supine film.The hugely dilated ahaustral loop of Sigmoid volvulus. Supine film.The hugely dilated ahaustral loop of sigmoid can be seen rising out of the pelvis in the shape of an iverted sigmoid can be seen rising out of the pelvis in the shape of an iverted U. Haustrated ascending and descending colon can be identified U. Haustrated ascending and descending colon can be identified separate from the volved sigmoid loopseparate from the volved sigmoid loop
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PARALYTIC ILEUSPARALYTIC ILEUS
Paralysis ileus. Supine film.There is generalized dilatation Paralysis ileus. Supine film.There is generalized dilatation of both small and large bowel. An 84-year-old woman with of both small and large bowel. An 84-year-old woman with generalized peritonitis perforation of gastric-ulcergeneralized peritonitis perforation of gastric-ulcer
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Large Bowel ObstructionLarge Bowel Obstruction
Large bowel obstruction. Type IA (competent ileocecal valve). Supine Large bowel obstruction. Type IA (competent ileocecal valve). Supine film. There is gaseous distention of the large bowel from the sigmoid film. There is gaseous distention of the large bowel from the sigmoid backwards, including the ascending colon and caecum. The dilated backwards, including the ascending colon and caecum. The dilated caecum lies in the pelvis. There is no visible small-bowel distentioncaecum lies in the pelvis. There is no visible small-bowel distention
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O E S O P H A G U SO E S O P H A G U S
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MODALITAS PEMERIKSAAN RADIOLOGIMODALITAS PEMERIKSAAN RADIOLOGI
1.1. Radiologi Polos :Radiologi Polos :a.Thorax AP (Oesophagus)a.Thorax AP (Oesophagus)
Polos Abdomen (gaster, usus halus,Polos Abdomen (gaster, usus halus, usus besar)usus besar)
2.2. Radiografi Kontras (BARIUM)Radiografi Kontras (BARIUM)Oesophagus. Gaster duodenum,usus halus, Oesophagus. Gaster duodenum,usus halus, usus besarusus besar
3.3. CT-ScanCT-Scan4.4. USG (Hepar, Tr.Biliaris,Pancreas)USG (Hepar, Tr.Biliaris,Pancreas)
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O E S O P H A G U SO E S O P H A G U S
ANATOMI :ANATOMI :1.1. Phrenic ampula :Phrenic ampula :
-Tepat di atas diaphragma-Tepat di atas diaphragma- Panjang : 3 – 5 cm,- Panjang : 3 – 5 cm,Ø 2 – 4 cmØ 2 – 4 cm
2.2. Cardiac Antrum = esophageal VestibulaCardiac Antrum = esophageal Vestibula-Terletak Intra abdominal-Terletak Intra abdominal- Bilia keluar di atas diaphragma - Bilia keluar di atas diaphragma Sliding Sliding HerniaHernia
3.3. Schatski Ring :Kontraksi Sphincter Oesophagi Schatski Ring :Kontraksi Sphincter Oesophagi InferiorInferior
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4.4. Penyempitan di 3 :Penyempitan di 3 :
a.Setinggi Os.Cricoida.Setinggi Os.CricoidCorpusCorpus
b.Menyilang Bronchus kirib.Menyilang Bronchus kiriAlienumAlienum
c.Masuk diaphragmac.Masuk diaphragma
5.5. Vena:Vena:
a.Distal : V.Coronaria Ventriculi a.Distal : V.Coronaria Ventriculi
V.Porta (Cir.Hepatis V.Porta (Cir.Hepatis Varices) Varices)
b.Proximal : V.Azygos b.Proximal : V.Azygos V.Cava Sup V.Cava Sup
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Kelainan-kelainan pada Kelainan-kelainan pada OesophagusOesophagus
1.1. KongenitalKongenital
2.2. RadangRadang
3.3. Tumor Tumor JinakJinak
GanasGanas
4.4. Gangguan NeuromuskularGangguan Neuromuskular
5.5. Sebab – sebab lain :Sebab – sebab lain : -Ulcus-Ulcus
-Varices-Varices
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K O N G E N I T A LK O N G E N I T A L
1.1. Atresia OesophagusAtresia Oesophagus
2.2. Stenosis OesophagusStenosis Oesophagus
3.3. DivertikelDivertikel
Additional DeffectAdditional Deffect
4. Double Oesophagus4. Double Oesophagus
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ATRESSIA OESOPHAGUSATRESSIA OESOPHAGUS
Radiograph demonstrating Radiograph demonstrating a common type of a common type of esophageal atresia in esophageal atresia in association with a association with a tracheosophageal fistula.In tracheosophageal fistula.In this instance the atressia this instance the atressia occurred in the middle occurred in the middle one-third sector of the one-third sector of the oesophagus oesophagus communicates with the communicates with the tracehobronchial tree near tracehobronchial tree near its bifurcationits bifurcation
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D I V E R T I K E LD I V E R T I K E L
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Radang Radang Oesophagitis Oesophagitis
EtiologiEtiologi : :
- Trauma (Indwelling Tube)- Trauma (Indwelling Tube)
- Bakteri : TBC , Lues- Bakteri : TBC , Lues
- Jamur- Jamur
- Rangsangan berulang - Rangsangan berulang Makanan Panas Makanan Panas OesophagogramOesophagogram : :
- Akut : (-)- Akut : (-)
- Kronis : Lumen sempit, mucosa irreguler- Kronis : Lumen sempit, mucosa irreguler
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PEPTIC PEPTIC OESOPHAGITIS.OESOPHAGITIS.
Comparisson of Comparisson of normal mucosanormal mucosa
A.With severe ulcerative A.With severe ulcerative peptic oesophagitispeptic oesophagitis
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T U M O RT U M O R
1.1. JinakJinakPolyp,Lipoma,MyomaPolyp,Lipoma,Myoma* Ro : FILLING DEFECT,Batas tegas* Ro : FILLING DEFECT,Batas tegas
2.2. Ganas Ganas Carcinoma Carcinoma*Ro :*Ro :• Papillary : Filling Defect,batas tegasPapillary : Filling Defect,batas tegas• Ulcerating : Filling Defect, di dalamnya additional Ulcerating : Filling Defect, di dalamnya additional
defectdefect• Infiltrating : Lumen sempit,dinding irregulerInfiltrating : Lumen sempit,dinding irreguler
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Tumor :Tumor :
1.1. JinakJinak
2.2. Ganas Ganas
-Primer-Primer
-Sekunder-Sekunder
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TUMOR JINAKTUMOR JINAK
Jenis : AdenomaJenis : Adenoma
PolypPolyp
Villous PapillomoVillous Papillomo
Hamartoma = Peuts Jager SyndromHamartoma = Peuts Jager Syndrom
RoRo : Filling Defect, batas tegas: Filling Defect, batas tegas
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SQUAMOUS CARCINOMA OF SQUAMOUS CARCINOMA OF THE OESOPHAGUSTHE OESOPHAGUS
a.Shallow ulcer with tumor rima.Shallow ulcer with tumor rim
b.Small filling defect resembelling an intramural b.Small filling defect resembelling an intramural lesionlesion
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Ca. OesophagusCa. Oesophagus
Carcinoma in the lower portion of the middle one-third of the oesophagus, in association Carcinoma in the lower portion of the middle one-third of the oesophagus, in association with dilatation above the level of the carcinoma,indicating partial obstructionwith dilatation above the level of the carcinoma,indicating partial obstruction
Carcinoma of the lower one-half of the oesophagus showing fistulous communication Carcinoma of the lower one-half of the oesophagus showing fistulous communication with the mediastinum due to an invasion of the mediastinum by the carcinomawith the mediastinum due to an invasion of the mediastinum by the carcinoma
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ACHALASIA = MEGA OESOPHAGUS =ACHALASIA = MEGA OESOPHAGUS =CARDIOSPASMCARDIOSPASM
Spasme di hiatus Spasme di hiatus Obstruksi,dilatasi,elongasi,hipertrofi Obstruksi,dilatasi,elongasi,hipertrofi oesophagusoesophagus
Terjadi : setiap umurTerjadi : setiap umur Etiologi : ??Etiologi : ??
-Neuromuskular incordination-Neuromuskular incordination
-Degenerasi plexus-Degenerasi plexus
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Ro Ro :: Tapering bagian bawah oesophagus Tapering bagian bawah oesophagus
obstruksiobstruksi Dilatasi bagian atas Dilatasi bagian atas Tipe :Tipe : 1.Sigmoid1.Sigmoid
2.Fusiform2.Fusiform
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Achalasia with typical tapered of the lower end of Achalasia with typical tapered of the lower end of the oesophagus producing obstruction. On the oesophagus producing obstruction. On fluoroscopy the impaired motility will be evident. fluoroscopy the impaired motility will be evident. Insufficient barium has entered the stomach to Insufficient barium has entered the stomach to distend itdistend it
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Achalasia OesophagusAchalasia Oesophagus
Radiograph demonstrating the esophagus in achalasia.Note the fusiform Radiograph demonstrating the esophagus in achalasia.Note the fusiform tapered distal end of the esophagus and the redudancy and dilatation of the tapered distal end of the esophagus and the redudancy and dilatation of the esophagus above this levelesophagus above this level
A spot film study of the lower esophagus in the same patient, showing the A spot film study of the lower esophagus in the same patient, showing the tapered effect in greater detailtapered effect in greater detail
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GANGGUAN NEUROMUSKULERGANGGUAN NEUROMUSKULER
1.1. SpasmeSpasmeRo : Lumen sempitRo : Lumen sempitFluoroscopy : Peristaltik Fluoroscopy : Peristaltik ↑↑2.2.Ripple oesophagusRipple oesophagusCork Screw / curlingCork Screw / curlingRo :Ro : - Saw tooth appearance- Saw tooth appearance
- Serrated- Serrated3.3.Achalasia ( Cardiospasm)Achalasia ( Cardiospasm)
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SEBAB-SEBAB LAINSEBAB-SEBAB LAIN1.1. VaricesVarices*Etiologi : Cirrosis hepatis *Etiologi : Cirrosis hepatis hipertensi portalhipertensi portal*RO : Mocosa terputus-putus:*RO : Mocosa terputus-putus:a.Cincin halus ( Honey comb app)a.Cincin halus ( Honey comb app)b.Cincin kasar ( Cobble Stone app)b.Cincin kasar ( Cobble Stone app)2.Ulcus oesophagi2.Ulcus oesophagi *Ro : Additional defect*Ro : Additional defect3.Hernia oesophagi3.Hernia oesophagi
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Varices OesophagusVarices Oesophagus
Spot film radiographic Spot film radiographic studies of the lower studies of the lower one-third of the one-third of the esophagus with esophagus with demonstration of demonstration of marked esophageal marked esophageal varicesvarices
Esphagogram Esphagogram demonstrating large demonstrating large indicatins due to indicatins due to esophageal varicesesophageal varices
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Oesophageal Oesophageal varices.Typical worm-varices.Typical worm-like feeling defectslike feeling defects
A.Non-distended A.Non-distended oesophagus following oesophagus following passage of bariumpassage of barium
B.Same case with B.Same case with bariumbarium
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PEMERIKSAAN GASTER PEMERIKSAAN GASTER DAN DUODENUM (MD)DAN DUODENUM (MD)
I.Polos : posisi tegak / supineI.Polos : posisi tegak / supineUntuk : Untuk : -stenosis pylorus-stenosis pylorus
- Atressia duodeni- Atressia duodeniII.KontrastII.KontrastA.Single contrast A.Single contrast
Barium sulfat ( 1 : 2-3 (air))Barium sulfat ( 1 : 2-3 (air))B.Double contrastB.Double contrast
Barium sulfat (positif)Barium sulfat (positif)Udara Udara (negatif) (negatif)1.sonde / catheter1.sonde / catheter2.Tablet effervescent2.Tablet effervescent
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Posisi Posisi :: Tegak Tegak SupineSupine ProneProne
Foto :Foto :
1.Overail view1.Overail view
2.Spot2.Spot
Persiapan : puasa 4-6 jamPersiapan : puasa 4-6 jam
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Ruggal PatternRuggal Pattern
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Kelainan - KelainanKelainan - Kelainan
I.I.KONGENITAL KONGENITAL :: Hypertrophic pyloric obstructionHypertrophic pyloric obstruction Atressia duodeniAtressia duodeni
IIII.RADANG :.RADANG : Gastritis : atrophicGastritis : atrophic Chronica : HypertrophicChronica : Hypertrophic
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III.III.TUMORTUMOR
1.1. Jinak (adenoma,fibroma,polip)Jinak (adenoma,fibroma,polip)
2.2. Ganas ( CA)Ganas ( CA)
IV.IV.ULCUS PEPTICUMULCUS PEPTICUM
1.1. Ulcus ventriculiUlcus ventriculi
2.2. Ulcus duodeniUlcus duodeni
V.V.LAIN-LAIN :LAIN-LAIN :
Prolaps pylorusProlaps pylorus
VolvulusVolvulus
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D U O D E N I T I SD U O D E N I T I S
Radiograph Radiograph demonstrating the demonstrating the widened, irregular widened, irregular rugal pattern of the rugal pattern of the duodenal bulb duodenal bulb associated with associated with duodenitisduodenitis
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G A S T R I T I SG A S T R I T I S
DEFINISI :DEFINISI :
Aneka ragam kondisi yang menimpa Aneka ragam kondisi yang menimpa mucosa,hanya sebagian karena radangmucosa,hanya sebagian karena radang
Kebingungan terjadi karena hubungan yang Kebingungan terjadi karena hubungan yang tidak menentu antara klinis, radiologi, tidak menentu antara klinis, radiologi, endoskopi dan histologi, terutama yang endoskopi dan histologi, terutama yang kronikkronik
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ACUTE GASTRITISACUTE GASTRITIS
Acute erosive (Hemoraghic) gastritis Acute erosive (Hemoraghic) gastritis karateristik : oedema dan erosi mucosakarateristik : oedema dan erosi mucosa
Penyebab :Penyebab :Stress, trauma, analgesic, steroid, alkohol, Stress, trauma, analgesic, steroid, alkohol,
virus, bile refluxvirus, bile reflux KlinisKlinis : : Sangat variasi : asimptomatik , dengan nyeri Sangat variasi : asimptomatik , dengan nyeri
perut, anorema, BB perut, anorema, BB ↓ yang tidak dapat ↓ yang tidak dapat diterangkanditerangkan
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Radiologis : Radiologis :
1.Complete : target lesion / bull’s eye lesion1.Complete : target lesion / bull’s eye lesion
Small central spot barium dikelilingi Small central spot barium dikelilingi Translucent haloTranslucent halo
2.Incomplete : > sulit oleh karena tidak ada 2.Incomplete : > sulit oleh karena tidak ada translucent halotranslucent halo
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CHRONIC GASTRITISCHRONIC GASTRITIS
1.1. CHRONIC ATROPHIC GASTRITISCHRONIC ATROPHIC GASTRITIS
*Radiologis :*Radiologis : Area gastrica besar Area gastrica besar IrrgularIrrgular Area tanpa area gastricaArea tanpa area gastrica
*Diagnosis sensitif : endoskopi dan biopsi*Diagnosis sensitif : endoskopi dan biopsi
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2.2.CHRONIC HYPERTOPHIC GASTRITISCHRONIC HYPERTOPHIC GASTRITIS
Radiologis :Radiologis : Mucosal fold thickening dan tortuosity Mucosal fold thickening dan tortuosity
( Hyperugosity), Normal : sangat ( Hyperugosity), Normal : sangat variasi !!,>0,5 cmvariasi !!,>0,5 cm
Abnormal : antrum fundus, curvatura Abnormal : antrum fundus, curvatura major > 1,5 cmmajor > 1,5 cm
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Erosive GastritisErosive Gastritis
A. Numerous erosions are present in the stomach, best seen in two rows in the antrum. Each A. Numerous erosions are present in the stomach, best seen in two rows in the antrum. Each erosion consist of a small central collection of barium surrounded by transluccent ring ( a small erosion consist of a small central collection of barium surrounded by transluccent ring ( a small ‘target’ lesion). By definition these are ‘complete’ erosions. B. Prominent areae gastricae with ‘target’ lesion). By definition these are ‘complete’ erosions. B. Prominent areae gastricae with several small ‘incomplete’ erosions (two of the erosions are indicated with arrows).several small ‘incomplete’ erosions (two of the erosions are indicated with arrows).
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Antral GastritisAntral Gastritis
A. Two thickened nodular mucosal folds are present (arrowed) and the antrum is conical. The A. Two thickened nodular mucosal folds are present (arrowed) and the antrum is conical. The mucosa in the duodenal cap is also thickened (duodenitis). B. Severe antral gastritis. The mucosa in the duodenal cap is also thickened (duodenitis). B. Severe antral gastritis. The normal antral mucosa is replaced by a mass of thickened nodular mucosal folds. Conical normal antral mucosa is replaced by a mass of thickened nodular mucosal folds. Conical narrowing of the antrum completely obliterates the normal distal ‘shoulders’.narrowing of the antrum completely obliterates the normal distal ‘shoulders’.
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ULCUS PEPTICUMULCUS PEPTICUM
Lokasi :Lokasi : 70% duodenum70% duodenum30% gaster30% gaster
Ulcus duodeniUlcus duodeni Lokasi : 90 % bulbusLokasi : 90 % bulbus
4 % Post Bulbar4 % Post Bulbar1 % distal1 % distal
♂ ♂ : 75 %: 75 %♀ ♀ : 25 %: 25 %Single : 80 %, Multiple : 20 %Single : 80 %, Multiple : 20 %
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Ro :Ro :
1.1. Ulcus niche / crater Ulcus niche / crater terutama DD terutama DD posteriorposterior
2.2. Deformity bulbusDeformity bulbus
3.3. Mucosa :Mucosa : -Dasar ulcus duodenum-Dasar ulcus duodenum
-Sekitar ulcus radiating-Sekitar ulcus radiating
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Ulcus ventriculi Ulcus ventriculi 90 % dapat ditunjukkan Ro90 % dapat ditunjukkan RoRo :Ro :1.1. Ulcus niche / craterUlcus niche / crater2.2. Garis radiolucent pada dasar ulcus :Garis radiolucent pada dasar ulcus :
1-2 mm garis hampton1-2 mm garis hampton3.3. Barium fleck dengan jari-jari seperti roda pedati Barium fleck dengan jari-jari seperti roda pedati
= cart wheel= cart wheel4.4. Kontralateral dari ulcus ada kontrast (incisura)Kontralateral dari ulcus ada kontrast (incisura)
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DD /DD /
Ulcus benignaUlcus benigna1.1. Cepat sembuhCepat sembuh2.2. Mucosa sekitar ulcus Mucosa sekitar ulcus
regulerreguler3.3. Ulcus ventrikuli disertai Ulcus ventrikuli disertai
ulcus duodeniulcus duodeni4.4. Dalamnya > lebarnyaDalamnya > lebarnya5.5. Tidak pernah di curvatura Tidak pernah di curvatura
majormajor6.6. Di sekitar ulcus Di sekitar ulcus
oedematousoedematous7.7. Kontralateral : kontraksiKontralateral : kontraksi
Ulcus malignaUlcus maligna1.1. LamaLama2.2. IrregulerIrreguler3.3. Biasanya singleBiasanya single4.4. Lebarnya > dalamnyaLebarnya > dalamnya5.5. Ulcus di curvatura major Ulcus di curvatura major
selalu malignaselalu maligna6.6. Di sekitar ulcus kaku Di sekitar ulcus kaku
(rigid)(rigid)7.7. ----
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Ulkus Gaster - Benign & MalignantUlkus Gaster - Benign & Malignant
Comparison of benign and malignant lesser-curvature gastric ulcers. A. Benign ulcer – projecting, Comparison of benign and malignant lesser-curvature gastric ulcers. A. Benign ulcer – projecting, smooth base, radiating folds to ulcer brim. B. Malignant ulcer – projecting (uncommon), smooth base, radiating folds to ulcer brim. B. Malignant ulcer – projecting (uncommon), irregular base, absence of clearly defined ulcer brim, absence of radiating folds to brim, loss irregular base, absence of clearly defined ulcer brim, absence of radiating folds to brim, loss of normal mucosal surface to area around ulcer.of normal mucosal surface to area around ulcer.
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Ulkus Gaster - BenignUlkus Gaster - Benign
Benign gaster ulcer on the greater curvature (‘sump ulcer’). This ulcer is typical of Benign gaster ulcer on the greater curvature (‘sump ulcer’). This ulcer is typical of those occuring in patients who are taking tablets which produce contact iiritation those occuring in patients who are taking tablets which produce contact iiritation and damage to the gastric mucosa (e. g., nonsteroidal anti-inflammatory drugs, and damage to the gastric mucosa (e. g., nonsteroidal anti-inflammatory drugs, steroid, potassium chloride).steroid, potassium chloride).
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Ulkus gasterUlkus gaster
Radiograph illustrating incisura opposite a gastric Radiograph illustrating incisura opposite a gastric ulcer (Dark arrow, incisura : while arrow, lesser ulcer (Dark arrow, incisura : while arrow, lesser curvature ulcer)curvature ulcer)
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TUMOR GASTERTUMOR GASTER
1.Benigna (Polip, papiloma, fibroma,adenoma)1.Benigna (Polip, papiloma, fibroma,adenoma)
2.Maligna ( carcinoma)2.Maligna ( carcinoma) Poliposis :Poliposis :
Ro :Ro :
1.1. Filling defect,batas tegasFilling defect,batas tegas
2.2. MobileMobile
3.3. Peristaltik masih baikPeristaltik masih baik
4.4. Bentuk lambung masih normalBentuk lambung masih normal
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CA GasterCA Gaster
♂ ♂ :♀ = 3 : 1:♀ = 3 : 1 Umur : 40 – 70 tahunUmur : 40 – 70 tahun 40 – 50 % Ca Traktus Gastro Intestinalis40 – 50 % Ca Traktus Gastro Intestinalis PatologisPatologis1.1. Exophytic : Exophytic : a.Fungating a.Fungating
b.Polipoidb.Polipoid2.2. InfiltrativeInfiltrative3.3. Ulceratif ( di bagian yang nekrotik)Ulceratif ( di bagian yang nekrotik)
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Lokasi Lokasi : - 70% pylorus: - 70% pylorus - 20% corpus- 20% corpus - 8 % Cardia- 8 % Cardia
Ro : Sangat bervariasi tergantung dari ukuran, Ro : Sangat bervariasi tergantung dari ukuran, lokasi, morfologilokasi, morfologi
1.1. Filling defect : polipoid / Filling defect : polipoid / fungating,single/multiplefungating,single/multiple
2.2. Infiltratif : dinding irreguler, rigid, peristaltik Infiltratif : dinding irreguler, rigid, peristaltik lokal (-)lokal (-)
3.3. UlcerasiUlcerasi4.4. Infiltrasi yang luas Infiltrasi yang luas gaster mengkerut + rigid gaster mengkerut + rigid
LINITIS PLASTICA LINITIS PLASTICA
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Gastric CarcinomaGastric Carcinoma
Early gastric carcinoma: mixed types. A. An elevated tumour (between) the black arrowheads) is Early gastric carcinoma: mixed types. A. An elevated tumour (between) the black arrowheads) is outlined by barium. Two small irregular ulcers are present (white arrows). B. The Tumour outlined by barium. Two small irregular ulcers are present (white arrows). B. The Tumour comprise a group of nodules and several small irregular areas of ulceration (arrowed). The comprise a group of nodules and several small irregular areas of ulceration (arrowed). The mucosal folds (on either side of the vertical white line) are amputated at their lower ends. mucosal folds (on either side of the vertical white line) are amputated at their lower ends.
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ATROPHIC GASTERATROPHIC GASTER
A.Relatively hypotonic stomach with thin-walled fundus and absent rugal A.Relatively hypotonic stomach with thin-walled fundus and absent rugal pattern in fundus,B.Smooth greater curvature and sluggish peristaltis, pattern in fundus,B.Smooth greater curvature and sluggish peristaltis, C.”Speckled” appearance of the barium, suggesting flocculatin in gastric C.”Speckled” appearance of the barium, suggesting flocculatin in gastric mucosa,D.”Crumpled paper” appearance of the rugae near the mucosa,D.”Crumpled paper” appearance of the rugae near the cardia,E.Bald,thin,speckled fundus with “crumpled paper” pattern alsocardia,E.Bald,thin,speckled fundus with “crumpled paper” pattern also
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USUS HALUSUSUS HALUS
Pemeriksaan :Pemeriksaan :1.1. Abdomen polosAbdomen polos2.2. Kontras : Ba Follow troughKontras : Ba Follow troughI.Lanjutan Pemeriksaan lambung duodenumI.Lanjutan Pemeriksaan lambung duodenum- 2 gelas barium - 2 gelas barium sekaligussekaligus
sebagian-sebagiansebagian-sebagian- Fluoroscopy : s/d Ileum terminalisFluoroscopy : s/d Ileum terminalisII.PEMERIKSAAN SENDIRIII.PEMERIKSAAN SENDIRISelang karet / plastik s/d pylorus Selang karet / plastik s/d pylorus masukkan masukkan
bariumbarium
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Ba Follow ThroughBa Follow Through
Tujuan:Tujuan:
1.1. Kelainan intriksikKelainan intriksik
2.2. Kelainan ekstrinsikKelainan ekstrinsik
a.Dekata.Dekat Usus halus Usus halus
b.Jauhb.Jauh
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INDIKASI :INDIKASI :
1.1. Anemia yang tidak diketahui kausaAnemia yang tidak diketahui kausa
2.2. Diare yang persistenDiare yang persisten
3.3. Nyeri abdomenNyeri abdomen
4.4. Mass abdomen yang palpabelMass abdomen yang palpabel
5.5. Gas dan cairan banyak di usus halusGas dan cairan banyak di usus halus
6.6. Kehilangan protein yang banyakKehilangan protein yang banyak
7.7. Laboratoris : MALABSORBTIONLaboratoris : MALABSORBTION
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KONTRAINDIKASIKONTRAINDIKASI
1.1. Obstruksi ususObstruksi usus
2.2. Perforasi ususPerforasi usus
3.3. Ileus paralitikIleus paralitik
4.4. PeritonitisPeritonitis
5.5. Infeksi akut saluran cernaInfeksi akut saluran cerna
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KELAINAN PADA USUS HALUSKELAINAN PADA USUS HALUS
1.1. Obstruksi Obstruksi ileus ileus2.2. Inflamasi kronik / granulomatosisInflamasi kronik / granulomatosis
a.Crohn’s diseasea.Crohn’s diseaseb.TBC usus halusb.TBC usus halus
3.3. Malabsorption syndromeMalabsorption syndrome4.4. TumorTumor5.5. DiverticleDiverticle6.6. Gangguan vaskulerGangguan vaskuler7.7. Penyakit endokrin (Zollinger – Ellison Disease)Penyakit endokrin (Zollinger – Ellison Disease)8.8. Penyakit – penyakit parasitPenyakit – penyakit parasit
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CROHN’S DISEASE = REGIONAL CROHN’S DISEASE = REGIONAL ILEITIS = REGIONAL ENTERITISILEITIS = REGIONAL ENTERITIS
♂ ♂ = ♀= ♀ Semua umur,tersering 15-30 th.Semua umur,tersering 15-30 th. Jarang < 4 thJarang < 4 th Lokasi : 85 % di usus halus Lokasi : 85 % di usus halus Ileum distal Ileum distal Klinis :Klinis :1.1. Gejala obstruksiGejala obstruksi2.2. Anemia dengan kausa ?Anemia dengan kausa ?
Occult Blood di fecesOccult Blood di feces3.3. Malabsorbtion SyndromeMalabsorbtion Syndrome
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Ro :Ro :Fase akutFase akut : : Mucosa oedema Mucosa oedema dinding usus menebal dinding usus menebal Cobble stone appCobble stone app Lumen normalLumen normalFase kronik Fase kronik :: Fibrosis Fibrosis obstruksi,dinding striktur, obstruksi,dinding striktur,
kaku (rigid), gambaran mukosa (-)kaku (rigid), gambaran mukosa (-) Hose pipe app : lumen sempit,elongatio, skip area (ada Hose pipe app : lumen sempit,elongatio, skip area (ada
area yang sehat)area yang sehat) String signString sign Scattering dan clumpingScattering dan clumping
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Crohn’s DiseaseCrohn’s Disease
Crohn’s disease. The iiregular loops demonstrate an Crohn’s disease. The iiregular loops demonstrate an ulceronoudular appearanceulceronoudular appearance
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Crohn’s DiseaseCrohn’s Disease
The follow-through shows scaterred areas of ulceration and The follow-through shows scaterred areas of ulceration and narrowing, with almost normal appearance in the terminal ileumnarrowing, with almost normal appearance in the terminal ileum
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Crohn’s DiseaseCrohn’s Disease
Numerous narrowed areas are seen, with fold thickening and Numerous narrowed areas are seen, with fold thickening and pseudosacculation on the antimesentric margin.pseudosacculation on the antimesentric margin.
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REGIONAL ENTERITISREGIONAL ENTERITIS
Coarsened rugal Coarsened rugal pattern of the distal pattern of the distal ileum producing a ileum producing a cobblestone cobblestone appearance. appearance.
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REGIONAL ENTERITISREGIONAL ENTERITIS
Segmentation or clumping of the small intestines as found in a patient with regional Segmentation or clumping of the small intestines as found in a patient with regional enteritis. It will also be noted, however, that there is a complete distruption of the normal enteritis. It will also be noted, however, that there is a complete distruption of the normal mucosal pattern with evidence of ulceration in the distal ileummucosal pattern with evidence of ulceration in the distal ileum
Scattering of barium in small intestines. This was a patient with regional enteritis, there is Scattering of barium in small intestines. This was a patient with regional enteritis, there is evidence of distruption of mucosal pattern, some evidence of clumping, and loss of evidence of distruption of mucosal pattern, some evidence of clumping, and loss of normal mucosal patternnormal mucosal pattern
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REGIONAL ENTERITISREGIONAL ENTERITIS
A.Regional enteritis of the small intestine. Thhe white arrow points to a “moulage” sign, A.Regional enteritis of the small intestine. Thhe white arrow points to a “moulage” sign, whereas the dark arrow points to a fistulation between two loops of small whereas the dark arrow points to a fistulation between two loops of small intestines.There is an additional fistula between the ileum and sigmoid colon.B,Regional intestines.There is an additional fistula between the ileum and sigmoid colon.B,Regional enteritis with the fistula formation between jejenum and sigmoid colonenteritis with the fistula formation between jejenum and sigmoid colon
Ulceration and sawtoothing in the distal ileum in a patient with regional enteritisUlceration and sawtoothing in the distal ileum in a patient with regional enteritis
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TUMOR USUS HALUSTUMOR USUS HALUS
Insidens : sangat jarangInsidens : sangat jarang Klasifikasi :Klasifikasi : 1.Jinak1.Jinak
2.Ganas2.Ganas
TUMOR JINAKTUMOR JINAK Jenis :Jenis : LeiomyomaLeiomyoma
AdenomaAdenoma
Lipoma,hemangiomaLipoma,hemangioma Ro : Filling defect dengan batas tegas dan rataRo : Filling defect dengan batas tegas dan rata
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TUMOR GANASTUMOR GANAS1.1. CarcinoidCarcinoid
RoRo : : Polypoid filling defect single / multiplePolypoid filling defect single / multiple Mass filling defectMass filling defect2.2. Adeno CaAdeno Ca
Ro :Ro : Filling defectFilling defect Lumen irregulerLumen irreguler Dinding kakuDinding kaku Khas kalsifikasi (PSAMOMA)Khas kalsifikasi (PSAMOMA)
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C O L O NC O L O N
Panjang : 5 – 5,5 kaki (150-160 cm)Panjang : 5 – 5,5 kaki (150-160 cm) Diameter : 5 – 7,5 cmDiameter : 5 – 7,5 cm Bagian Bagian :: CaecumCaecum Colon ascendensColon ascendens Colon transversumColon transversum Colon descendensColon descendens Colon sigmoidColon sigmoid Colon rectumColon rectum
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COLON INLOOPCOLON INLOOP= BARIUM INLOOP= BARIUM INLOOP= BARIUM ENEMA= BARIUM ENEMA
Persiapan:Persiapan:
Harus baik Harus baik colon bersih / kosong : colon bersih / kosong :
1.1. Makan bubur kecap 1 hari sebelumnyaMakan bubur kecap 1 hari sebelumnya
2.2. 10 -12 jam sebelumnya : laxans 10 -12 jam sebelumnya : laxans garam garam inggris ( 30 gr)inggris ( 30 gr)
Dulcolax tab / suppDulcolax tab / supp
3.3. PuasaPuasa
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Kontras : Barium Kontras : Barium * Single contrast (SC)* Single contrast (SC)
* Double contrast * Double contrast (DC)(DC)
Single contrast :Single contrast :
Barium :Barium : Bubuk : air = 1 : 4 ,hangatBubuk : air = 1 : 4 ,hangat ½ - 1 L½ - 1 L Mengisi colon dengan gaya berat : Mengisi colon dengan gaya berat :
standard 1 meter ( tidak lebih) s/ d Ileum standard 1 meter ( tidak lebih) s/ d Ileum terminalisterminalis
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Double contrastDouble contrast Teknis > sukar daripada single contrastTeknis > sukar daripada single contrast Tahapan :Tahapan :1.1. Pengisian s/d Flexura LienalisPengisian s/d Flexura Lienalis2.2. Pelapisan : 1-2 menitPelapisan : 1-2 menit3.3. Pengosongan : miringkan (left decubitus) dan Pengosongan : miringkan (left decubitus) dan
tegakkan (Upright)tegakkan (Upright)4.4. PengembanganPengembangan5.5. Foto : Foto : spot viewspot view
overall viewoverall viewKomplikasi : 1.PerforasiKomplikasi : 1.Perforasi
2.Reflex vagal X sulfas atropin, 022.Reflex vagal X sulfas atropin, 02
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COLON INLOOP DOUBLE COLON INLOOP DOUBLE CONTRASTCONTRAST
1.1. Mengubah pola makanan : lunak, rendah Mengubah pola makanan : lunak, rendah serat,rendah lemakserat,rendah lemak
2.2. Minum sebanyak-banyaknya :Minum sebanyak-banyaknya :
penyerapan air terbanyak di colon penyerapan air terbanyak di colon feces feces lembeklembek
3.3. Pencahar : usia lanjut, rawat baring lama, Pencahar : usia lanjut, rawat baring lama, sembelit kroniksembelit kronik
4.4. Banyak bergerak, jangan merokokBanyak bergerak, jangan merokok
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FOTO COLON INLOOPFOTO COLON INLOOP
1.1. Plain = polosPlain = polos
2.2. Full filling :Full filling : A.SpotA.Spot
B.OverallB.Overall
3.3. Post evakuasiPost evakuasi
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COLON INLOOPCOLON INLOOP
INDIKASI :INDIKASI :1.1. Kongenital Kongenital Hirschprung’sHirschprung’s2.2. Inflamasi kronikInflamasi kronik Diare persitentDiare persitent Perdarahan per anumPerdarahan per anum3.3. TumorTumor4.4. Obstruksi colon Obstruksi colon InvaginasiInvaginasi VolvulusVolvulus
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KONTRAINDIKASI :KONTRAINDIKASI :
1.1. Ileus paralitikIleus paralitik
2.2. Perforasi usus / lambungPerforasi usus / lambung
3.3. Obstruksi ileus yang lama (> 8 jam)Obstruksi ileus yang lama (> 8 jam)
4.4. PeritonitisPeritonitis
5.5. Inflamasi akut G.I.TInflamasi akut G.I.T
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C O L O NC O L O N
Radiograph of the colon after evacuation of bariumRadiograph of the colon after evacuation of barium
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KELAINAN KONGENITALKELAINAN KONGENITAL
I.ATRESSIA ANI = IMPERFORATE ANUSI.ATRESSIA ANI = IMPERFORATE ANUS Ro : posisi RICE WANGENSTEIN = pasien Ro : posisi RICE WANGENSTEIN = pasien
dibalik : kepala di bawah,daerah anus diberi dibalik : kepala di bawah,daerah anus diberi marker ditentukan jarak (udara s/d marker)marker ditentukan jarak (udara s/d marker)
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ATRESIA RECTUMATRESIA RECTUM
Prone cross-table lateral view showing a high rectal Prone cross-table lateral view showing a high rectal atresia. The arrow points to the uppermost air shadow and atresia. The arrow points to the uppermost air shadow and the site of the atresiathe site of the atresia
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II.Hirschprung disease = MegacolonII.Hirschprung disease = Megacolon congenitalcongenital
Insidens : anak-anakInsidens : anak-anak
♂ ♂ : ♀: ♀ Klinis : Obstipasi, perut kembung / besarKlinis : Obstipasi, perut kembung / besar Ro : Penyempitan lumen yang aganglionikRo : Penyempitan lumen yang aganglionik
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HIRSCHPRUNGHIRSCHPRUNG
Short-segment Hirschprung’s disease. The distal narrowed segment is Short-segment Hirschprung’s disease. The distal narrowed segment is arrowedarrowed
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C O L I T I SC O L I T I S
I.NON SPESIFIKI.NON SPESIFIK
1.1. Colitis ulcerativaColitis ulcerativa
2.2. Crohn’s diseaseCrohn’s disease
3.3. Ischamic colitisIschamic colitis
II.SPESIFIKII.SPESIFIK
Colitis TBCColitis TBC
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COLITIS TBCCOLITIS TBC
Lokasi : Lokasi : 1.Ileocecal ( 90%)1.Ileocecal ( 90%)
2.Kadang-kadang meluas2.Kadang-kadang meluas
3.Appendix3.Appendix Insidens :Insidens :
- 30% atau lebih pada KP- 30% atau lebih pada KP
- Jarang primer- Jarang primer
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RoRo : : Teknik : 1.Barium follow throughTeknik : 1.Barium follow through
2.Barium Enema2.Barium Enema Tanda-tanda :Tanda-tanda :1.1. HypermortilityHypermortility2.2. Irregular ileocecal filling defectIrregular ileocecal filling defect3.3. Spasme Regio ileocecalSpasme Regio ileocecal4.4. Plastic peritonitisPlastic peritonitis5.5. Segmentation,dilatation,stasis di ileal loopsSegmentation,dilatation,stasis di ileal loops6.6. STIERLIN’S SIGN :STIERLIN’S SIGN :
Ileum dan colon transversum terisi barium, Ileum dan colon transversum terisi barium, tetapi caecum dan colon ascendens tidak terisitetapi caecum dan colon ascendens tidak terisi
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COLITIS TBCCOLITIS TBC
Tuberculosis. There is a short irregular stricture in Tuberculosis. There is a short irregular stricture in the ascending colonthe ascending colon
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COLITIS ULCERATIVACOLITIS ULCERATIVA
Klinis :Klinis : Umur 20-40 tahun, Umur 20-40 tahun, ♀ : ♂♀ : ♂ Patologi : infeksi akut Patologi : infeksi akut ulcerasi mucosa, ulcerasi mucosa,
dinding usus terkena difus fibrosis, dinding usus terkena difus fibrosis, kontraksikontraksi
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Ro:Ro:1.1. Haustra hiloang, spasme, irritability, saw tooth Haustra hiloang, spasme, irritability, saw tooth
Colon transversumColon transversum2.2. Post evakuasi : String sign = Hose pipe Post evakuasi : String sign = Hose pipe 3.3. Ulcer craterUlcer crater4.4. Ileocecal terbuka (patent) , DD/TBCIleocecal terbuka (patent) , DD/TBC5.5. Colon transversum : kontraksi,memendek dan Colon transversum : kontraksi,memendek dan
lumen menyempitlumen menyempit6.6. Caecum : kontraksi irreguler, mucosa MARBLECaecum : kontraksi irreguler, mucosa MARBLE
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COLITIS ULCERATIVACOLITIS ULCERATIVA
A.B.Ulcerative colitis, showing a fine granularity throughout the colon, A.B.Ulcerative colitis, showing a fine granularity throughout the colon, which is shortened and totally devoid of haustrationwhich is shortened and totally devoid of haustration
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COLITIS ULCERATIVACOLITIS ULCERATIVA
Ulcerative colitis.Coarse granularityUlcerative colitis.Coarse granularity
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COLITIS AMUBACOLITIS AMUBA
Lokasi : -IleocaecalLokasi : -Ileocaecal-Colon ascendens-Colon ascendens-Rectum sigmoid-Rectum sigmoid
Patologi : Ulcerasi Patologi : Ulcerasi fibrosis – adhesi fibrosis – adhesi annular annular ConstrictionConstriction
Ro: Ro: Mula-mula (-)Mula-mula (-) Progress : segmenting haustra di cecum dan colon Progress : segmenting haustra di cecum dan colon
ascendens ascendens cicatrix cicatrix Pemendekkan dan penyempitanPemendekkan dan penyempitan Saw toothSaw tooth Tidak patognomonisTidak patognomonis
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CARCINOMA COLONCARCINOMA COLON
Lokasi : ½ - ¾ kasus sigmoid, rectum, Lokasi : ½ - ¾ kasus sigmoid, rectum, recto sigmoid, jarang multiplerecto sigmoid, jarang multiple
Patologi : Adeno Ca (50-75 %)Patologi : Adeno Ca (50-75 %) Fibro Ca (20%)Fibro Ca (20%)
Metastasis : hepar, regional lymphnodeMetastasis : hepar, regional lymphnode Ro :Ro :1.1. Polypoid Polypoid Bertangkai (Pedunculated)Bertangkai (Pedunculated)
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Ro :Ro :
1.1.Polypoid Polypoid Bertangkai (Pedunculated)Bertangkai (Pedunculated)
(23%)(23%) Tidak bertangkai (sessile)Tidak bertangkai (sessile)
2.Fungating = apple score (asimetris)2.Fungating = apple score (asimetris)
3.Annular = napkin ring ( simetris)3.Annular = napkin ring ( simetris)
(75%)(75%)
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Carcinoma ColonCarcinoma Colon
A large proliferative carcinoma of the ascending colon (arrows)A large proliferative carcinoma of the ascending colon (arrows)
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Carcinoma ColonCarcinoma Colon
A classic annular carcinoma (arrow)A classic annular carcinoma (arrow)
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Ca ColonCa Colon
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DIVERTICULA COLONDIVERTICULA COLON
♂ ♂ : ♀ = 2 : 1: ♀ = 2 : 1 Umur > 40 tahunUmur > 40 tahun Lokasi : sigmoid, colon descendensLokasi : sigmoid, colon descendens Keluhan : -PerdarahanKeluhan : -Perdarahan
-Bila terinfeksi-Bila terinfeksi Ro : ADDITIONAL DEFECTRo : ADDITIONAL DEFECT
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VOLVULUSVOLVULUS
DEFINISIDEFINISI : Mesenterium Colon berputar pada : Mesenterium Colon berputar pada axisnya axisnya Strangulasi (hambatan sirkulasi) Strangulasi (hambatan sirkulasi)
Lokasi : Sigmoid (75%)Lokasi : Sigmoid (75%)CaecumCaecum
PredisposisiPredisposisi : : Sigmoid terlalu panjangSigmoid terlalu panjang Fecal stasisFecal stasis MegacolonMegacolon InsidensInsidens : : ♂ : ♀ = 2 : 1♂ : ♀ = 2 : 1
20 – 50 tahun20 – 50 tahun
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Ro :Ro :I.Polos :I.Polos : 1.Dilatasi colon1.Dilatasi colon
IleusIleus 2.Fluid level2.Fluid levelObstruksiObstruksi 3.U terbalik di hipochondria3.U terbalik di hipochondria
kiri kiriII.Colon inloop :II.Colon inloop :1.1. Barium stopBarium stop2.2. Dilatasi hebat colon proximalDilatasi hebat colon proximal3.3. Barium sebagian dapat melewati penyempitan Barium sebagian dapat melewati penyempitan
~ Kipas (fan Share)~ Kipas (fan Share)
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VOLVULUS RECTAVOLVULUS RECTA
Radiograph demonstrating volvulus of the cecumRadiograph demonstrating volvulus of the cecum
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INVAGINASI = INVAGINASI = INTUSSUGCEPTIONINTUSSUGCEPTION
DEFINISI :DEFINISI : Usus proximal masuk ke dalam usus distalUsus proximal masuk ke dalam usus distal Proximal IntussusceptumProximal Intussusceptum Distal IntussuspiensDistal IntussuspiensTIPE :TIPE :1.1. IleoilealIleoileal2.2. IleocolicIleocolic3.3. ColocolicColocolic
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Insidens : anak-anak oleh karena Insidens : anak-anak oleh karena perubahan pola makanan : cair perubahan pola makanan : cair padat padat
Gejala Gejala :: Sakit perut mendadak sekitar pusatSakit perut mendadak sekitar pusat Perdarahan peranumPerdarahan peranum Teraba massa di sekitar pusatTeraba massa di sekitar pusat
Diagnosis :Diagnosis :Colon in loop (< 10 jam)Colon in loop (< 10 jam) Kamar operasiKamar operasi Juga untuk terapiJuga untuk terapi
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IRRITABLE COLON SYNDROME = IRRITABLE COLON SYNDROME = COLON SPASMCOLON SPASM
Definisi : Spasm ColonDefinisi : Spasm Colon EtiologiEtiologi : :
1.1. PsikologisPsikologis
2.2. ReflexReflex
3.3. Keracunan (Pb)Keracunan (Pb)
4.4. Inflamasi lokalInflamasi lokal
5.5. IdiopatikIdiopatik
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Lokasi : 1.Colon DescendensLokasi : 1.Colon Descendens2.Colon sigmoid2.Colon sigmoid
Ro :Ro :1.1. Lumen sempitLumen sempit2.2. Haustra hilangHaustra hilang3.3. Mucosa rataMucosa rata4.4. Bila mengenai sebagian besar colon Bila mengenai sebagian besar colon
Ribbon-Like Structure (Ribbon-Like Structure (~ Pita / pipa)~ Pita / pipa)
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NECROSTISING ENTERO COLITISNECROSTISING ENTERO COLITIS ( NEC ) ( NEC )
Sering terjadi pada bayi premature,yang Sering terjadi pada bayi premature,yang
mengalami tambahan stress. mengalami tambahan stress.
Ini berhubungan dengan respiratory Ini berhubungan dengan respiratory
distress, passage umbilical catheter, distress, passage umbilical catheter,
obstruksi intestinal (terutama penyakit obstruksi intestinal (terutama penyakit
Hirschsprung) atau setelah Hirschsprung) atau setelah
pembedahan.pembedahan.
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Breast feeding tampaknya memberi Breast feeding tampaknya memberi
semacam proteksi, di duga stress semacam proteksi, di duga stress
mengakibatkan ischaemi dinding usus mengakibatkan ischaemi dinding usus
dengan mekanisme reflex. dengan mekanisme reflex.
Ini mengakibatkan necrosis mucosa Ini mengakibatkan necrosis mucosa
dan prolifersi organisme pathogen.dan prolifersi organisme pathogen.
Biasanya permulaannya dalam 2-5 Biasanya permulaannya dalam 2-5
hari bayi menjadi sakit, muntah-hari bayi menjadi sakit, muntah-
muntah dan sering terjadi perdarahan muntah dan sering terjadi perdarahan
rectal serta distensi abdomen. rectal serta distensi abdomen.
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Foto polos abdomen menunjukkan Foto polos abdomen menunjukkan
distensi usus, pada fase awal distensi usus, pada fase awal
terutama pada kwadran kanan bawah.terutama pada kwadran kanan bawah.
Kemudian tampak gelembung-Kemudian tampak gelembung-
gelembung di caecumini harus gelembung di caecumini harus
dibedakan dengan meconium ileus.dibedakan dengan meconium ileus.
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Gambaran klinik dan umur dapat Gambaran klinik dan umur dapat
membantu untuk membedakannya. membantu untuk membedakannya.
Kemudian timbul gas di dinding usus Kemudian timbul gas di dinding usus
dan dapat dikenal sebagai dan dapat dikenal sebagai
“longitudinal translucent streaks” atau “longitudinal translucent streaks” atau
sebagai cincintransluency bila usus sebagai cincintransluency bila usus
terlihat end on.terlihat end on.
NEC dapat menyerang setiap bagian NEC dapat menyerang setiap bagian
usus, tetapi terutama menyerang ileum usus, tetapi terutama menyerang ileum
terminalis dan colon.terminalis dan colon.
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Dan gas dapat dilihat dengan jelas pada Dan gas dapat dilihat dengan jelas pada
dinding colon. Gambaran ini harus dibedakan dinding colon. Gambaran ini harus dibedakan
dengan garis properitonea fat. Diagnosis dengan garis properitonea fat. Diagnosis
yang pasti dapat dibuat pada stadium ini. yang pasti dapat dibuat pada stadium ini.
Gas dapat di lihat pada sistem portal, suatu Gas dapat di lihat pada sistem portal, suatu
tanda kegawatan. tanda kegawatan.
Tanda tanda kegawatan lain adalah Tanda tanda kegawatan lain adalah
unchanging loop, karena ini meliputi unchanging loop, karena ini meliputi
gangrene, ascites, oedema dinding abdomen gangrene, ascites, oedema dinding abdomen
dan perforasi usus. dan perforasi usus.
Yang tersebut terakhir ini dapat tanpa gejala Yang tersebut terakhir ini dapat tanpa gejala
(asymptomatic) maka pada prakteknya (asymptomatic) maka pada prakteknya
dibuat foto supine dan lateral setiap 6 jam dibuat foto supine dan lateral setiap 6 jam
pada fase akut.pada fase akut.
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Karena bahaya perforasi colon, maka Karena bahaya perforasi colon, maka
dihindari pemeriksaan dengan kontras dihindari pemeriksaan dengan kontras
(colon inloop).(colon inloop).
Sering terjadi stricture hanya setelah Sering terjadi stricture hanya setelah
3 - 4 minggu. Pada fase ini 3 - 4 minggu. Pada fase ini
pemeriksaan dengan kontrs perlu pemeriksaan dengan kontrs perlu
dilakukan dan aman. dilakukan dan aman.
Harus diingat beberapa egen yang Harus diingat beberapa egen yang
sempit dapat di sebabkan oleh sempit dapat di sebabkan oleh
temporary spasm, bukan oleh temporary spasm, bukan oleh
permanent firous stricture.permanent firous stricture.
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Terima KasihTerima Kasih&
Selamat BelajarSelamat Belajar