kuliah 4 - gi imaging kls 2 rim
DESCRIPTION
radiology of gastro intestinalTRANSCRIPT
GastrointestiGastrointesti nal nal
ImagingImaging
Rima ZakiyahRima ZakiyahPSPD FK UNISMAPSPD FK UNISMA
Bismillah...
CONVENTIONAL X-RAY FILMS
1-INTRA-ORAL FILMS
2-EXTRA-ORAL FILMS- Panoramic
TYPES OF INTRA-ORAL FILMS
1-PERIAPICAL FILMS
For children&adults with small mouth, anterior teeth in adults, and standard film for anterior&posterior teeth in adults
2-BITEWING FILMS
For posterior teeth in children, young children, adults(most frequent film) and premolar or molar region
3-OCCLUSAL FILMS
To show large areas of upper or lower jaw
EXTRA-ORAL FILMS
INDICATIONS: 1-Px unable to open mouth2-view large area of pathology3-general view of mandible or maxilla4-view more bones of the face(skull or sinuses)5-impacted or unerupted teeth6-fractures of jaws & localization of foreign bodies7-TM joint
PANORAMIC
9
Pemeriksaan radiologi pada abdomen meliputi :
1. Radiologi konvensional :
a. Plain photo abdomen tanpa persiapan
(BOF = Buiek Oversich Film)
b. Plain photo abdomen dengan persiapan
(BNO = Buiek Nier Oversich, / KUB =
Kidney Urinary Bladder)
• Pemeriksaan bisa dengan :• • Foto Polos
•
• BOF foto BNO foto • ( tanpa persiapan ) ( dengan persiapan )
Cara Persiapan pemeriksaan Foto BNO :1. 1 – 2 hari pre X-foto, pasien diberi makan bubur kecap (low residual meal).2. Malam hari diberi laksan, minum 3 – 4 gelas air putih3. Subuh pasien akan diarrhea4. Pagi tidak boleh makan, minum, bicara, tertawa, merokok5. Pasien kemudian di foto
PEMERIKSAAN FOTO POLOS ABDOMEN
FOTO POLOS ABDOMEN
Compare
Haustra
Large bowel
Valvulae conniventes
Small bowel
Know What You’re Looking For
Supine – Double Bowel Wall Sign
PNEUMOPERITONEUM
Outlining of liver/GB
Harus diperhatikan pada BNO
• 1. Bagaimana distribusi gas dalam usus. normal gas dalam gaster, duodenum, colon ( caecum sampai rectum )
• 2. Bagaimana gambaran hepar dan lien.• 3. Bagaimana gambaran/ bayangan kedua ginjal
apakah ada bayangan (batu) radiopaqe disepanjang UG tract
• 4. Gambaran psoas line/ psoas shadow.• 5. Bagaimana keadaan tulang-tulang.• 6. Bagaimana keadaan flank area.
Barium Studies
• (Video) Esophagogram• Barium Swallow• UGI series
ESOPHAGUS
Esophagogram or Barium Swallow
• Evaluates pharynx and esophagus
• Limited evaluation of stomach
• Double or Single Contrast
• Mucosal contour and Motility
Identify gastro esophageal junction.
Describe the course of Esophagus
Locate the starting point of Esophagus
What are the normal impressions in the Esophagus?
What are the normal sites of narrowing of Esophagus?
OESOPHAGUS
Penyempitan yang normal:•Sekitar Cartilago cricoid•Persilangan Arcus Aorta dan Bronchus kiri •Sebelum masuk diaphragma
Gambaran normal dari mukosa :
– Biasanya lurus, parallel, tipis– Uniform
Body Habitus - Effect On Positioning• Hypersthenic
– Horizontal and superior– Dependent portion above umbilicus
• Asthenic– Vertical and inferior
• Sthenic– Generally found between xyphoid process and iliac crest
Contrast media Type of contrast medi
a– Barium sulfate– Water soluble
Single Contrast vs Double Contrast
• Single Contrast– Generally uses just thin Barium– Distends lumen with high density material– Easier for patient but less mucosal detail
• Double Contrast/Air Contrast– Thick barium coats lumen– Effervescent tablets ingested to distend lumen with air– Produces images with greater mucosal detail – Greater sensitivity for small lesions, polyps, ulcers
SINGLE CONTRAST STUDY
DOUBLE CONTRAST
STUDY
BARIUM SULFATE
WATER SOLUBLE
CONTRAST AGENT
PRINCIPLE1. Extrinsic lesion2. Intrinsic lesion
2.1 Protruded lesion mucosal fold, polyp, tumor , varices
2.2 Depressed lesion ulcer, diverticulum, perforation
mucosal mass
A
submucosal or intramural mass
Bextrinsic mass
C
Diagram
Extrinsic lesion
MASS
Protruded lesion
A B mucosal mass
Polyp
A B
submucosal or intramural mass
Diagram
Depressed lesion
A
B
Singlecontrast
Doublecontrast
upright
C
-En face Profile
CARCINOMA
CARCINOMA 2( )
Esophageal carcinoma
- PSEUDO ACHALASIA caused b y direct spread to the distal eso
phagus from gastric carcinoma Radiographic findings :
1. Irregularly, narrowed an d nodular( arrowhead), so
metimes ulcerated (arrow) , lesion at distal esophagus 2 . Rapid transition betwee n normal and abnormal p
art. 3. Dilatation of proximal esoooooooo
STOMACH
Pemeriksaan Gaster & Duodenum
Bentuk mukosa gaster yang normal :•Bentuk mozaik di daerah fundus•Lurus-lurus (magenstrasse) di corpus•Convergeren di pylorus
Bentuk mukosa duodenum yang normal :•Halus seperti bulu ayam•Pd. Pars desc. Ada lekuk kecil=papilla Vateri•Sekitar bulbus duodindentasi vesica felea,
KELAINAN YANG TAMPAKKELAINAN YANG TAMPAKPADA MUKOSAPADA MUKOSA
• Filling defect :
– Bisa dari luar – sudut tumpul, atau dari dalam lumen – tajam
– Bisa massa benigna – tepi halus/ rata,
– atau maligna – tepi irreguler
Additional defect/ Shadow :
- Bayangan tambahan di luar lumen.
- Bentuk menentukan jinak/ ganas
- Ulcus atau diverticle
Radiographic appearances of benign gastric ulcer
Radiographic appearances of benign gastric ulcer
Radiation of smooth thickened folds (arrow) extending directly to the edge of the crater (arrowhead) on profile view(A) and en-face view (B)
Radiographic appearances of benign gastric ulcer
Cart wheel phenomen
Duodenal Ulcer
Duodenal Diverticulum
stomach
bulb
Gastric Diverticulum
Gastric cancer
Polypoid mass
- Produce filling defect (arrow) on barium study
Gastric cancer
Focal constricting lesion: localized infiltrating carcinoma or localized scirrhous carcinoma
• Annular filling defect (arrow)
Focal constricting lesion
: localized infiltrating
carcinoma or localized
scirrhous carcinoma
- circumferential
irregular narrowing of
the lumen with
rigidity (as figure;
involved body and
antrum)
Gastric cancer
bodyantrumbulb
fundus
Radiographic Exams
COLON
Colonic Diverticulosis
Colonic Diverticulosis
76
CARCINOMA COLON
• Ada 3 bentuk
1. Fungative type
2. Polypoid type
3. Annuler type
• Gambaran radiologis : adanya filling defect dan obstruksi, merupakan tanda yang terpenting secara radiologis.
Colonic Carcinoma
• Annular Carcinoma (green arrow) with shelf-like margin (black arrow)
Polypoid Carcinoma (arrow)
Colonic Carcinoma
PEMERIKSAAN PANKREAS
• 1. Foto Polos Abdomen.• 2. UGI foto/ Barium meal (pendesakan o.k. Kelainan Pancreas)• 3. Ultra Sonografi. (USG Abdomen)• 4. Endoscopic Retrograde Cholangio Pancreatography (ERCP)• 5. Computed Tomography Scanning (CT Scan)• 6. Magnetic Resonance Imaging (MRI)• 7. Angiography
86
Kelainan PANCREAS • Tanda radiologis- 67 % menyebabkan pergeseran gaster- 41% invasi ke gaster- 67% menekan gaster dan duodenum- Perubahan mucosa duodenum- Inverted “3” sign - Gangguan fungsi
87
GAMBARAN USG PANCREAS
• Arah probe transversal, anterior pararenal space
• Tergantung pemeriksa, akurasinya bisa 95%
• Reflektivitas hiperechoic homogen, lebih tinggi dari liver
88
TEHNIK USG
• Transabdominal
• Doppler USG
• Endoscopic ultrasonography
• Intra operative ultrasonography
89
Chronic Pancreatitis (horisontal section). Irregular contour (arrowheads); strongly echogenic foci (long curved arrow) and dilated section of main pancreatic duct (straight arrow)
90
Small pancreatic carcinoma in the head with dilatationof the main pancreatic duct (curve arrow). There is a very uniform echo pattern within this small tumour
91
USG LIVER
94
Alhamdulillah...