ppt acute abdomen radiologi

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Radiology of the AcuteAbdomen

SHEANY LESTATILARADIOLOGI RSUD SEMARANG

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DEFINISI AKU A!DOMEN

A"ut abdomen dide#ni$i"an $eca%a

umum $ebagai $uatu &%o$e$ int%a

abdominal yang menyebab"an %a$a

nye%i yang hebat dan timbul mendada"

 o&e%a$i'

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Human digestive system

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FOO A!DOMEN ( )OSISI

1. Posisi telentang:

•. Dinding abdomen  &%e&e%itonial fat

•. Ga%i$ &$oa$ "anan dan "i%i

•. !atu yang %adioo&a"* "al$i#"a$i atau benda a$ingyang %adioo&a"

•. Kontu% gin+al "anan dan "i%i

•. Gamba%an uda%a u$u$

•. Ke$u%aman yang da&at di$ebab"an oleh cai%an dilua% u$u$ atau ma$$a tumo%'

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)neumo&e%itoneum

Adanya uda%a beba$ di ca-')e%itoneal

 e%da&at &ada/• )e%fo%a$i GI t%act oleh "a%ena tumo%*

$umbatan  ileu$ &a%aliti"  

di$ten$i u$u$'• )o$t o&e%a$i•  %auma

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CupolaSign

An e%ect che$t 01%ay i$ &%obably the mo$t $en$iti-e &lain%adiog%a&h fo% the detection of f%ee int%a&e%itoneal ga$'

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)neumo&e%itoneum

Rigler Sign

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Doge’s Cap Sign

Doge’s Cap Sign 

menun+u""an uda%a

beba$dalam Morrison’s pouch'

Morrison’s pouch bia$anya di %uang&oten$ial anta%a gin+al

"anan dan hepar ' Doge2$ ca& $ign $ulit

ditemu"an

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Diagram kuadran kanan atasmenunjukkan suatu kumpulan udara

 berbentuk segitiga di dalam Morison

 pouch jika dilihat pada foto polos

abdomen posisi telentang, dapat

 berbentuk triangular (doge's cup)

Foto polos abdomen dari pasiendengan pneumoperitoneum 

menunjukkan kumpulan udara

 berbentuk segitiga di dalam

 Morison pouch (panah)

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Football

Sign

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Small !o,el Ob$t%uction

• Mo$t common cau$e   adhe$ion$ %elated to

&%io% $u%ge%y 34567 / a&&endectomy* colo%ectal

$u%ge%y  !o,el may become "in"ed unde% an

adhe$ion'

• .e%nia

•  umo%

• Fo%eign bodie$• Illeu$ gall$tone$ 3mechanical ob$   iilio$ecal

-al-e7

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Clinical fndings:

•8olic Abd &ain

• 8on$ti&ation$

• Nau$ea 9 -omiting

• !i$ing u$u$ ::

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No%mal $mall bo,el ;thi$ &atient a&&ea%$ toha-e a ga$le$$ $mallbo,el' Fluid1#lled loo&$of $mall bo,el a%e

&%e$ent but a%e ne-e% a$,ell -i$uali$ed a$ ai%1

Gamba%an foto &olo$abdomen menun+u"ante%+adinya dilatasi usushalus.

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STEP LADDER APPERANCE

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A/ Duodenum

8/ <e+unum

D/ ileum

E/ Illiocecal -al-e

a%ea

)A/ (5min

Feathe%yA&&e%ance

SMLL !"#$L F"LL"#%&'"()&

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= hou% > hou%

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A delayed #lm f%om a

contrast sall!o"el #ollo"

through $ho,$

dilated $mall bo,el'

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C"L"*+* L""P

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ha$il &eme%i"$aan colon in loo&* tam&a"#lling defect di colon de$cenden$'

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A&&le co%e le$ion in

a$cending colon

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Ileu$ &a%aliti"

 he failu%e of &a$$age of ente%ic content$th%ough $mall bo,el and colon that i$ not

mechanically ob$t%ucted' E$$entially it

%e&%e$ent$ the &a%aly$i$ of inte$tinal motility'

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$tiolog,:

• )o$t o&e%a$i

• In?ama$i

• )e%itoniti$ 3::7

Clinical fndings:• Nau$ea 9 -omiting

• !i$ing u$u$ 317

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bd

'adiog-aph,:• Dilata$i u$u$ be$a%

@ "ecil

• Multi&le ai% ?uid

le-el

• SENINEL LOO)  

localiing $ou%ce of

in?amation

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 he a&&ea%ance of

gene%ali$ed adynamic ileu$

on &lain #lm i$ Buite

cha%acte%i$tic 3$ee left7'

 he la%ge and

$mall bo,el a%e

e0ten$i-ely ai%#lled

but not dilated' Iha-e hea%d thi$

de$c%ibed a$ the

la%ge and $mall

bo,el Cloo"ing the$ameC'

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Late%al decubitu$ -ie, of the abdomen* $ho,ingai%1?uid le-el$ con$i$tent ,ith inte$tinal ob$t%uction

K l i i i K l li i i

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Kole$i$titi$* Kolelitia$i$

Kole$i$titi$ a"ut 3%adang "andung em&edu7

adalah %ea"$i in?ama$i a"ut dinding "andung

em&edu yang di$e%tai "eluhan nye%i &e%ut"anan ata$* nye%i te"an dan demam'

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Foto polos abdoen

tapak batu0batu

epedu be-uku-an

kecil

C%0scan abdoentapak batu0batuepedu dan penebalan

dinding kandungepedu.

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$ERCEDES %EN& SI'N'

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RL/ A&&endiciti$

• A&&endi$iti$ adalah &e%adangan da%i

a&endi"$ -e%mifo%mi$ oleh "a%ena ob$t%u"$i

lumen a&endi"$*yang me%u&a"an &enyebab

a"ut abdomen yang &aling $e%ing

• Etiologi /Ob$t%u"$i lumen oleh "a%ena /

hi&e%&la$ia limfoid 34567* a&&endicolith*benda a$ing'

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Anatomi A&&endi0

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)o$i$i anatomi$ a&&endi0

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Maniestasi klinis:

• *,e-i pada titik Mc !u-ne,'

• Demam %ingan 3(*1(* H87 dan

malai$e'• Leu"o$ito$i$

• Nau$ea @ -omiting

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Foto &olo$

• Foto &olo$ tida"

mam&u

menegga""an

diagno$i$* teta&i

da&at

mengindenti#"a$i

ada nya fecalith

atau a&&endicolith'

Gamba%an a&&endiciti$ di RL %adioo&a"

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USG

• U$g adalah &ilihan utama untu" &a$ien mudadi"a%ena"an &eme%i"$aan %adiologi lain nyamengguna"an $ina% atau %adia$i  menying"i%"an DD'

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In?amed a&&endi0 at $onog%a&hy' Longitudinal 3A7 andt%an$-e%$e 3!7 c%o$$1$ection $ho, a di$tendednoncom&%e$$ible a&&endi0* $u%%ounded bi+ hy&e%echoicin?amed fat 3a%%o,head$7'

Gamba%an a&&endiciti$

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Gamba%an a&&endiciti$&ada USG

Gamba%an be%u&a /Diamete% a&&endi0 : 4mm ebal dinding a&&endi0 :>mm)enggum&alan cai%an&e%ia&&endiceal

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81Scan

8 i$ the mo$t $en$iti-e modality to detecta&&endiciti$ highly $en$iti-e 3J1J67 and$&eci#c 3u& to J67 fo% the diagno$i$ of acute

a&&endiciti$ and allo,$ fo% alte%nati-e cau$e$ ofabdominal &ain to al$o be diagno$ed'

Gamba%an A&&endiciti$

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Gamba%an A&&endiciti$&ada 81Scan

Figu%e =' Acute a&&endiciti$'Dilated ?uid1#lled tubula%a&&endi0 ,ithin the %ight iliacfo$$a ,ith $mall a&&endicolithand e0ten$i-e $u%%oundingin?ammation'

APPENDIC('RA$

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 APPENDIC('RA$ 

3No%mal A&&endi07

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Teuan appendicogra pada

appendicitis )

Non #lling a&&endi"$

I%%egula%ita$ nodula%ita$ da%i a&&endi"$

yang membe%i"an gamba%an edema

mu"o$a in?ama$i a"ut

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