tract gastro intestinal- kuliah ukm 2004
TRANSCRIPT
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Tract Gastro Intestinal
Dr. Wawan Kustiawan, SpRad, M.Kes, DFM
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GI Tract
• Cavum oris• Oesofagus• Gaster• Usus halus dan kolon• Organ solid : - Hepar dan tract biliaris - Pankreas - Lien
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Pemeriksaan Radiologi
• Non invasif : - Foto polos - Media kontras : . Oesofagograf . Gastroduodenografi . Barium followthrough
. Barium enema/ Colon inloop . Intravenous cholecystografi
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Pemeriksaan Radiologi non-invasif
- USG
- ERCP
- CT Scan
Invasif :- PTC (Percutaneus Transhepatic Cholangiografi)
- Arteriografi
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Foto Polos
• Supine
• Erect/ Tegak
• LLD (Left Lateral Dekubitus)
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Kelainan Esofagus
1. Kongenital
2. Inflamasi/ Peradangan
3. Tumor : Jinak; Ganas
4. Gangguan neuromuskuler
5. Varises Esofagus
6. Ulkus esofagus
7. Hernia esofagus
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• 1. Kongenital : - Atresia esofagus
- Fistula trachea esofagus (4 tipe)
- Stenosis Esofagus
- Divertikel
- Shortened esofagus
• 2. Peradangan : Esofagitis
ec trauma, infeksi jamur,
bakteri, rangsangan berulang
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• 3. Tumor : - Jinak : . Polip
. Lipoma
. MyomaRadiologis : adanya bayangan filling defect, batas tegas
- Ganas: Karsinoma esofagus
ada 3 tipe : papillary
ulcerating
infiltrating
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Tanda umum tumor ganas :
• Filling defek
• Batas ireguler
• Peristaltik : yang defisien
• Obstruksi parsial sampai komplit
• Dilatasi bagian proksimal
• Napkin ring appearance
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4. Gangguan neuromuskuler : - Esofageal spasm : mukosa rata, penyempitan lumen
- Achalasia : . Tipe sigmoid
. Tipe fusiform
- Chalasia esofagus
5. Varises Esofagus :
- Mukosa esofagus terputus-putus
- Tampak cincin pada esofagus :
. Cincin halus honey comb appearance
. Cincin kasar coble stone appearance
- Biasanya di 1/3 distal esofagus
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• 6. Ulcus esofagus Gambaran radiologis :
- additional shadow (bentuk segitiga/ duri)
- divertikel
7. Hernia esofagus
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Lambung-duodenum• Pemeriksaan Maagduodenografi• Bagian lambung : - Cardia
- Fundus - Corpus - Antrum - Pylorus
. Bagian Duodenum : - Bulbus duodeni (berbentuk segitiga) - Duodeni pars descendens - Duodenum pars horizontal - Duodenum pars ascendens
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Lambung
• Peristaltik : biasanya 4 (antara 2-5)
• Mukosa : - Fundus : tidak beraturan (mozaik)
- Corpus : paralel - Antrum : tidak rata - Pylorus : berbentuk konvergen
. 3 tipe lambung : - euthonic, hypotonic dan hypertonic
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Kelainan Lambung
• Kongenital : - Hypertrofis-pylorus stenosis - Atresia duodeni/ stenosis duodeni
• Radang : Gastritis atrofi
hipertrofi
Tumor : - Jinak : adenoma, polip, fibroma - Ganas : karsinoma
Ulkus : Jinak/ ganas
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Hypertrofic pyloric stenosis
• Gambaran radiologi : - Dilatasi gaster (single bubble appearance) - Sedikit gas pada usus halus - Canalis sempit dan memanjang - Umbrella sign - Pengosongan lambat - Beak sign - Teat sign
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Atresia duodeni/ stenosis duodeni
• Gambaran radiologis :
Posisi supine : Double bubble appearance
- (tampak bayangan udara di dua tempat yaitu di fundus lambung dan bulbus duodeni)
Posisi tegak : double fluid level
- (tampak dua bayangan fluid level)
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• Gastritis : tipe atrofi - hypertrofi - Mukosa kasar, menebal, ireguler. - Hipersekresi lambung - Hiperperistaltik
• Karsinoma gaster : tipe fungating, ulcerating, infiltrating - Filling defek - Batasnya ireguler - Tidak rata - Malignant ulcer
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Ulkus Ventrikuli
• Tanda Langsung : - Barium spot/central fleck berbentuk barium bulat - Tampak bayangan halo oedem mukosa - Ulkus niche/crater - additional shadow
Tanda Tambahan : - Gastrospasmus - Hipersekresi - Nyeri setempat - Tanda sikatrik
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• Stadium : - ulcus acut - ulcus subacut
- ulcus chronic
. Lokalisasi : - kurvatura minor 80% - canalis pyloricum 12% - kurvatura mayor : sangat jarang, biasanya ke arah malignant
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DD/ diagnosa ulkus benign dan maligna
Benign Maligna. Lokalisasi luar perm. Mukosa di dlm perk. Mukosa. Filling defect ( - ) ( + ). Hamptons line ( + ) ( - ). Meniscus sign ( - ) ( + ). Ulcus collar ( + ) ( - ). Cartwhell configuration ( - ) ( + ). Besar < 3 cm > 3 cm. Bentuk hemispher setengah bulatan ireguler. Lokasi di kurvatura minor di kurvatura mayor jauh dari pylorus dekat pylorus. Penyembuhan lebih cepat lebih lama/ hilang timbul
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Kelainan posisi dan bentuk duodenum
• Post bulbar duodenum impression :
dilatasi dari common bile duct
. Frostberg inverted “3: sign/ capital sign :
pada Ca caput pankreas
. Case’ s pad sign :
pembesaran pada corpus pankreas
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. Foppel’s sign : pembengkakan papilla Vateri. Divertikel yg terdorong ke atas : tumor pankreas. C loop sign : tumor caput pankreas. Brush sign : pankreatitis
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Barium follow through
untuk melihat kelainan pada usus halus
Yang dinilai pd pem. Barium follow through :
1. Passage contrast, sampai ke kolon
normal 2 – 3 jam
2. Mukosa usus halus
3. Ada/tidak massa
4. Ada/tidak fistel/perlengketan
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Kelainan pada jejunum dan ileum
1. Obstruksi usus yg menyebabkan ileus2. Inflamasi : Crohn disease, Tbc usus3. Malabsorbsi sindrom4. Tumor5. Divertikel6. Gangguan vaskuler7. Penyakit kolagen (skleroderma)8. Penyakit endokrin (Zollinger –Ellison disease)9. Penyakit parasit
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Crohn disease/ Regional ileitis/ regional enteritis
. 85% di usus halus, terutama di ileum bag. Distal
. Pada fase akut : udem submukosa, hiperemi kongesti, eksudasi yg hebat memberikan gambaran Cobble stone appearance
. Pada fase selanjutnya : permulaan fibrosis dan penyempitan kaliber lumen usus
. Pada fase akhir : ulserasi, peritoneal abses dan fistula enteroenteral
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Gambaran radiologis
• Fase akut : - udem mukosa
- gbran cobble stone appearance
. Fase kronik : - fibrosis
- obstruksi
- dinding striktur dan kabur
- gbran mukosa menghilang
- hose pipe appearance
- string sign
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Gambaran radiologis
- Adhesi (terlihat perlengketan usus dgn jar. sekitarnya)
- Lesi yg terisolasi biasanya menempati sebagian segmen usus
- Fistula. - Skip area/ skip lession, kelainan yg
meloncat-loncat sebag. normal sebag. abnormal
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Tumor usus halus
• Benign : leiomyoma, adenoma• Maligna :
1. Carcinoid/ submukosal argentaffinoma
2. Adenocarcinoma tu mengenai jejunum
3. Limfosarkoma biasanya pd jejunum & ileum
4. Hodgkin’s
5. Sarcoma
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Pem. Colon in loop / Barium enema
• Bisa dilakukan dgn 2 cara :
• 1. Single barium picture
• 2. Doubble contrast
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Kelainan Kolon
• Kongenital :
- Atresia ani
- Hirschsprung disease
Inflamasi/ peradangan : - Colitis - Crohn’s disease
Karsinoma kolon Obstruksi kolon : - Invaginasi - Volvulus - Ileus : obstruktif dan paralitik
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Atresia ani
• Pem. Salomo/ wangesteen foto/ inverted foto
• Penderita dibalik dgn kepala si bawah dan daerah anus diberi marker kemudian nilai jarak antara udara dlm rektum dgn marker yg dipasang, apakah atresia ani letak tinggi atau rendah.
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Hirschprung disease
• Tidak ada ganglion parasimpatik pd fleksus Meissner & Auerbach
• Gambaran radiologis :1. Adanya penyempitan (Rat tail sign)2. Dilatasi di atas bag. Yg menyempit3. Zona transisi 4. Rectosigmoid index < 15. Sering disertai dgn kolitis
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Inflamasi kolon/ kolitis
• Macam:
1. Kolitis non-spesifik
a. Kolitis ulserativa
b. Kolitis iskhemik
c. Crohn disease
d. Kolitis katartika
2. Kolitis spesifik :
a. Kolitis tbc
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Karsinoma kolon
• Gambaran radiologis ;
1. Filling defect
2. Apple bite/ apple core
3. String sign
4. Cotton role sign
5. Shoulder sign
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Karsinoma kolon
• Lokasi terbanyak daerah rektosigmoid
• Tipe-tipe : 1. Fungating
2. Polipoid
3. Anular
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Invaginasi
suatu keadaan dimana usus bag. proksimal masuk ke usus bag. Distal
• Bag. Yg masuk/proksimal : intususeptum• Bag. Yg menerima/distal : intusupien
• Gambaran radiologis :
1. Cuffing sign
2. Coil spring
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Volvulus
keadaan dimana segmen mesenterium usus berputar pd aksis mesenterium sehingga menimbulkan lipatan bahkan strangulasi.
• Gambaran radiologis : 1. Dilatasi usus yg sangat besar 2. Ganbaran coffe bean/ huruf u terbalik
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Illeus
• Bisa obstruktif / paralitik• Pd ileus paralitik hampir semua usus baik
usus halus maupun kolon menempati sebag. besar abdomen.
• Pd ileus obstruktif, distal dr obstruksi tidak tampak bayangan udara usus atau minimal sedangkan pd proksimal obstruksi tampak berdilatasi.
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Ileus• Gambaran radiologis :
1. Step ladder appearance
2. Coil spring
3. Dinding usus menebal
4. Herring bone appearance
5. Air fluid level (+)
6. Kadang disertai dgn pneumo peritoneum jika
sudah terjadi perforasi