Kuliah 4 - GI Imaging Kls 2 RIM

GastrointestiGastrointesti nal nal

ImagingImaging

Rima ZakiyahRima ZakiyahPSPD FK UNISMAPSPD FK UNISMA

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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

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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


Radiation of smooth thickened folds (arrow) extending directly to the edge of the crater (arrowhead) on profile view(A) and en-face view (B)


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

Colonic Diverticulosis

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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

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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

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GAMBARAN USG PANCREAS

• Arah probe transversal, anterior pararenal space

• Tergantung pemeriksa, akurasinya bisa 95%

• Reflektivitas hiperechoic homogen, lebih tinggi dari liver

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TEHNIK USG

• Transabdominal

• Doppler USG

• Endoscopic ultrasonography

• Intra operative ultrasonography

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Chronic Pancreatitis (horisontal section). Irregular contour (arrowheads); strongly echogenic foci (long curved arrow) and dilated section of main pancreatic duct (straight arrow)

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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

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USG LIVER

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Alhamdulillah...

Kuliah 4 - GI Imaging Kls 2 RIM

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