radiologi - cholelithiasis

7/23/2019 Radiologi - Cholelithiasis

1/37

Refeksi kasus radioloJoovan Naaidu09/280488/KU/13459

24 Oktoer 2014


2/37

!dentitas

Na"a# N$% &

U"ur# 3't(n Jenis Kela"in# &ere")uan

*la"at# Ka)ulogo +enga( R+, Ja-a tenga(

No%R.# 01'0


3/37

Kelu(an uta"a

N$eri di ulu (ati "enalar ke )unggung


4/37

Ri-a$at )en$akit sekarang R&

3 .R, "engelu( n$eri di )erut kanan atas lalu )asien ke

&uskes"as dan di eri oat, teta)i n$eri "asi( "eneta)% 1..R, os ke R 6onosari dengan kelu(an sa"a lalu di ruu

RU& sardito

7.R os ke RU& ardito dengan n$eri )erut kanan "ealar k)unggung lalu di lakukan )e"eriksaan U%


5/37

Ri-a$at &en$akit a(ulu

e"a" , .ual, .unta(, Ri-a$at kuning


6/37

Ri-a$at &en$akit Keluarga

&en$akit seru)a disangkal

. 7+


7/37

&e"eriksaan :sik;ital signs# +# 120/80 Nadi# 84/"enit Res)irasi# 20/"enitu(u# 3e(er# >i"? tt

+(ora# ! # Nor"al, K =or# 12 reg, ising & # onor * # ;esikuler, R( /, 6(ee@ing /

*do"en# ! # Nor"al *# U A , &eristaltik nor"al & # +$")ani A & # .ur)($ sign A , RUB )ain

Ctre"itas # *kral (angat, Nadi kuat


8/37

iagnosis#

=(olelit(iasis


9/37

&e"eriksaan )enunang# >a

6=# 10%3

NCUD# 51%8

>ED# 28%'

.OD# 8%3

COD# 3%0

*D# 0%2

R=#

Klorida# 10

ol dara(# A


10/37

&e"eriksaan )enunang radiologi a)aka( $aakan anda )esanF

U

Goto t(ora )olos


11/37

Goto t(ora &* vie-&osisi ereHti"etris!ns)irasi and kondisi Huku),

+a")ak kedua a)e )ul"otenang+a")ak Horakan ronH(ovanor"al+a")ak kedua dia?rag"a liHdan tak "endatar=or%, =+R 0%49isite" tulang $ang

tervisualisasi intaHt

Kesan #&ul"o tak ta")ak kelainanesar Hor nor"al


12/37


13/37


14/37


15/37


16/37

7asil

U# Keterengan Klinis # =(olelit(iasis

# 7asil

# 7e)ar# Ukuran dan eH(ostrukture nor"al, )er"ukaan liHin, siste" "ilier dan vasHulintra(e)atal tak )ro"inen, tak ta")ak "assa/nodul

# ;esiHa Gelea # Ukuran nor"al, dinding tak ta")ak "eneal, tak ta")ak "assa "au)sledge% +a")ak lesi (i)ereH(oiH dengan )osterior aHoustiH s(ado- A, entuk ulat, tegas, ukuran lk% 0%'5H"

# >ien# Ukuran dan eH(ostruktur nor"al, tak ta")ak "assa/nodul, (ilus lienalis tak )ro

# &anHreas# Ukuran dan eH(ostruktur nor"al, tak ta")ak "assa "au)un kalsi:kasi, d)anHreatiHus tak )ro"inen%

# Ren etra # Ukuran dan eH(ostruktur nor"al, atas Horte dan "edulla tegas, +ak ta"assa/atu%

# Ren sinistra # Ukuran dan eH(ostruktur nor"al, atas Horte dan "edulla tegas, +ak t"assa/atu%

;esiHa urinaria # +erisi Hairan, dinding ta")ak reguler tak "eneal, tak ta")ak atu "a"assa%


17/37

&osition o? allladder onogra)

Girst &osition

7ig(/>ateral vie->ooking t(roug( Ris &roe *ngled

.ore *nt +(an ?or G*+ ea"

eHond &osition#

uHostal vie- -it( )atient rolled

to le?t >ateral eHuitus


18/37

=(olelit(iasis

=(olelit(iasis involves t(e )resenHe o? gallstones, -(iH( are

HonHretions t(at ?or" in t(e iliar$ traHt, usuall$ in t(e galllad


19/37

*nato"$ o? gallladder and etra(e)ailiar$ tree

ile

7el)s t(e od$ digest ?ats

.ade in t(e liver tored in t(e gallladder until t(e od$ needs

it

=ontains#

6ater

=(olesterol

ile )ig"ents

&(os)(oli)ids

=onHentrations var$ dierent kinds o? stones"a$ e ?or"ed


20/37

&ig"ent stones


21/37

=(olesterol stones


22/37

.ied stones

.ulti)le

GaHeted

=onsist o?#

=alHiu" salts

&ig"ent

=(olesterol 30D '0D

80D assoHiated -it( H(roniH H(oleH$stitis


23/37

$")to"s

&ain in t(e RUB .ost Ho""on and t$)iHal s$")to"

.a$ last ?or a ?e- "inutes to several (ours

.ostl$ ?elt a?ter eating a (eav$ and (ig(?at "eal

&ain under rig(t s(oulder -(en li?ting u) ar"s

Gever, nausea and vo"iting

JaundiHe ostruHtion o? t(e ile duHt )assage


24/37

Diagnosis Ultrasound

.ost sensitive and s)eHi:H test ?or gallstones

=o")uteri@ed to"ogra)($ =+ sHan

.a$ s(o- gallstones or Ho")liHations, suH( asin?eHtion and ru)ture o? or ile duHts

=(olesHintigra)($ 7!* sHan Used to diagnose anor"al HontraHtion o?

gallladder or ostruHtion o? ile duHts

CndosHo)iH retrogradeH(olangio)anHreatogra)($ CR=& Used to loHate and re"ove stones in ile duHts

lood tests &er?or"ed to look ?or signs o? in?eHtion,

ostruHtion, )anHreatitis, or aundiHe


25/37

U


26/37


27/37


28/37


29/37


30/37


31/37


32/37


33/37


34/37


35/37

7!* Han

Treatment


36/37

Treatment urger$# =(oleH$steHto"$ gallladder

re"oval!ndiHations#

+(ose -it( large L2 H" gallstones +(ose -(o (ave a non?unHtional or HalHi:ed

)orHelain gallladder on i"aging studies and -(oare at (ig( risk o? gallladder HarHino"a

+(ose -it( s)inal Hord inuries or sensor$neuro)at(ies aeHting t(e ado"en

+(ose -it( siHkle Hell ane"ia in -(o" t(e distinHtion

et-een )ain?ul Hrisis and H(oleH$stitis "a$ ediMHult

+-o surgiHal o)tions O)en H(oleH$steHto"$

>a)arosHo)iH H(oleH$steHto"$

NonsurgiHal treat"ent#


37/37

NonsurgiHal treat"ent#

Onl$ in s)eHial situations

6(en a )atient (as a serious "ediHal Hondition )reventing surger$

Onl$ ?or H(olesterol stones

Oral dissolution t(era)$

=ontaHt dissolution t(era)$

radiologi - cholelithiasis

Documents