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

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

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

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

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)

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)

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

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)

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

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

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

O E S O P H A G U SO E S O P H A G U S

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)

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

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

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

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

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

D I V E R T I K E LD I V E R T I K E L

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

PEPTIC PEPTIC OESOPHAGITIS.OESOPHAGITIS.

Comparisson of Comparisson of normal mucosanormal mucosa

A.With severe ulcerative A.With severe ulcerative peptic oesophagitispeptic oesophagitis

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

Tumor :Tumor :

1.1. JinakJinak

2.2. Ganas Ganas

-Primer-Primer

-Sekunder-Sekunder

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

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

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

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

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

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

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

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)

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

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

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

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

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

Ruggal PatternRuggal Pattern

Kelainan - KelainanKelainan - Kelainan

I.I.KONGENITAL KONGENITAL :: Hypertrophic pyloric obstructionHypertrophic pyloric obstruction Atressia duodeniAtressia duodeni

IIII.RADANG :.RADANG : Gastritis : atrophicGastritis : atrophic Chronica : HypertrophicChronica : Hypertrophic

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

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

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

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

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

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

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

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).

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’.

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 %

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

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)

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. ----

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.

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).

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)

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

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)

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

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.

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

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

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

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

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

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

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

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

Crohn’s DiseaseCrohn’s Disease

Crohn’s disease. The iiregular loops demonstrate an Crohn’s disease. The iiregular loops demonstrate an ulceronoudular appearanceulceronoudular appearance

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

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.

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.

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

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

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

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)

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

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

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

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

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

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

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

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

C O L O NC O L O N

Radiograph of the colon after evacuation of bariumRadiograph of the colon after evacuation of barium

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)

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

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

HIRSCHPRUNGHIRSCHPRUNG

Short-segment Hirschprung’s disease. The distal narrowed segment is Short-segment Hirschprung’s disease. The distal narrowed segment is arrowedarrowed

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

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

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

COLITIS TBCCOLITIS TBC

Tuberculosis. There is a short irregular stricture in Tuberculosis. There is a short irregular stricture in the ascending colonthe ascending colon

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

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

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

COLITIS ULCERATIVACOLITIS ULCERATIVA

Ulcerative colitis.Coarse granularityUlcerative colitis.Coarse granularity

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

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)

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%)

Carcinoma ColonCarcinoma Colon

A large proliferative carcinoma of the ascending colon (arrows)A large proliferative carcinoma of the ascending colon (arrows)

Carcinoma ColonCarcinoma Colon

A classic annular carcinoma (arrow)A classic annular carcinoma (arrow)

Ca ColonCa Colon

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

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

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)

VOLVULUS RECTAVOLVULUS RECTA

Radiograph demonstrating volvulus of the cecumRadiograph demonstrating volvulus of the cecum

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

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

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

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)

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.

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.

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.

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.

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.

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.

Terima KasihTerima Kasih&

Selamat BelajarSelamat Belajar