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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