Complete Abdomen

Supine

l Looking for
n Scout film for gas
pattern
n Calcifications
n Soft tissue masses
 Complete Abdomen
Erect

l Looking for
n Free air
n Air-fluid levels
 Complete Abdomen
LLD

l Looking for
n Free air
n Air-fluid levels
 Complete Abdomen
Erect Chest

l Looking for
n Free air
n Pneumonia at bases
n Pleural effusions
 Normal Gas Pattern

l Stomach
n Always
l Small Bowel
n Two or three loops of non-distended bowel
n Normal diameter = 2.5 cm
l Large Bowel
n In rectum or sigmoid – almost always
 Gas in
stomach

Gas in a few
loops of
small bowel

Gas in
rectum or
sigmoid

Normal Gas Pattern

Normal Fluid Levels

l Stomach
n Always (except supine film)
l Small Bowel
n Two or three levels possible
l Large Bowel
n None normally
 Always
air/fluid level
in stomach

A few
air/fluid
levels in
small bowel

Erect Abdomen
 Large vs. Small Bowel

l Large Bowel
n Peripheral
n Haustral markings don't
extend from wall to wall
l Small Bowel
n Central
n Valvulae extend across lumen
Abnormal Gas Patterns

l Functional Ileus
n Localized (Sentinel Loops)
n Generalized adynamic ileus
l Mechanical Obstruction
n SBO
n LBO
SBO
 INDIKASI
 Kelainan mobilitias
 Kelainan mukosa (ulkus, divertikel, inflamasi)
 Keganasan
 Degeneratif
 Kelainan kongenital
 Kelainana obstruktif
 KONTRA INDIKASI
 Perforasi
 Alergi kontras
 Obstruksi total upper GI
 PROSEDUR
 Anamnese pasien adanya obstruksi
 Puasa selama 6 jam sebelum pemeriksaan
 Persiapan kontras barium , esofagus 1: 1 dan saluran
cerna yang lain 1: 3
 Bila curiga perforasi atau fistel menggunakan kontras
water soluble
 Kontras diminumkan mll oral ( 1; 1) , untuk mengisi
esofagus sambil dilakukan fluoroskopi
 Lalu kontras Barium sulfat (1 : 3 ) diminumkan mll oral
, namun untuk mengisi udara di lambung, pasien
menggunakan evervescent .
 Posisi pasien supine
 Pasien diminta untuk berputar, terlentang , miring ,
telungkup , miring kontralateral dilakukan 2 kali.
Lakukan fluoroskopi untukmelihat kelainan.
 Setelah full filling , dapat dinilai mulai gaster,
duodenum saat bulbus terbuka dan terisi pars
descendens dan ascendens duodenum
Barium Swallow, Single Contrast

Cricopharyngeus
Muscle
At level of C5-C6,
Part of upper
esophageal
sphincter (UES)

Esophagus
 Barium Swallow, Single Contrast

Main Indication:
Dyshagia
 Barium Swallow, Double Contrast

Double
Contrast

Identation of
A.A

Indentation of
L.main bronchus

Single Contrast
 Barium Swallow, Single Contrast

Double Contrast

Heart
Barium Swallow, Double Contrast

Indentation of
L.main bronchus

Double Contrast

Single Contrast
 Barium Swallow, Single Contrast

Ampulla
Normal Varient

Fundus

Body
Barium Swallow, Single Contrast

Aortic
Arch
 Barium Swallow, Double Contrast

Narrowing:
Could be peristalsis
So other shot is
advised
 Barium Meal, Double Contrast
(Supine Position) Supine Position:
Note Barium Distribution
in the Fundus due to
gravity

Angular Notch
Incisura
Angularis

Antrum Body
 Barium Meal + Follow-Through
(Erect Position)
DJJ: Barium Meal
Normal Position= Left
side
Angular Notch
Incisura Angularis
Duodenal Cap

Pyloric Canal

2nd Part of
Duodenum

3rd Part of Body Jejunum:

Duodenum Plica Circularis on the
Antrum outer border

Ileum

Barium
Follow-Through
 Barium Follow-Through to Cecum
(Erect Position)

DJJ:
Normal Position= Left
2nd Part of side

Duodenum

3rd Part of
Duodenum
 Small Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the bowel
is more distended here
This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject barium,
methylcellulose and water into the small bowel. This allows for better visualization of the small bowel than can be
seen during a small bowel follow-through
Fluoroscopy
 Persiapan Pasien
 48 jam sebelum pemeriksaan pasien makan makanan lunak
rendah serat
 18 jam sebelum pemeriksaan ( jam 3 sore ) minum tablet
dulcolax
 4 jam sebelum pemeriksaan ( jam 5 pagi ) pasien diberi
dulkolak kapsul per anus selanjutnya dilavement
 Seterusnya puasa sampai pemeriksaan
 30 menit sebelum pemeriksaan pasien diberi sulfas atrofin
0,25 – 1 mg / oral untuk mengurangi pembentukan lendir
 15 menit sebelum pemeriksaan pasien diberi suntikan
buscopan untuk mengurangi peristaltic usus.
 Persiapan Bahan
 Media kontras BaSO4 = 70 – 80 % W/V ( Weight /
Volume ), banyaknya sesuai panjang pendeknya kolon
kurang lebih 600 – 800 ml dengan perbandingan 1: 8
 Air hangat
 Vaselin atau jelly
 Teknik Pemasukan Media Kontras
 Metode Kontras Tunggal
 Pemeriksaan hanya menggunakan BaSO4 sebagai media
kontras.
 Kontras dimasukkan ke kolon sigmoid, desenden,
transversum, ascenden sampai daerah seikum.
 Dilakukan pemotretan full fillng
 Evakuasi, dibuat foto post evakuasi
 Metode Kontras Ganda
 Kontras Ganda Satu Tingkat
 Kolon diisi BaSO4 sebagian selanjutnya ditiupkan udara
untuk mendorong barium melapisi kolon
 Selanjutnya dibuat foto full filling
 Kontras Ganda Dua Tingkat
 Tahap pengisian
 Kolon diisi BaSO4 sampai kira 2 fleksura lienalis atau
pertengahan kolon transversum
 Pasien disuruh merubah posisi agar barium masuk ke seluruh
kolon
 Tahap pelapisan
 Menunggu 1 – 2 menit supaya barium melapisi mukosa kolon

 Tahap pengosongan
 Pasien disuruh BAB
 Tahap pemotretan
 Pemotretan dilakukan apabila yakin seluruh kolon
mengembang semua
 Posisi pemotretan tergantung dari bentuk dan kelainan serta
lokasinya.
 Proyeksi PA, PA oblig & lateral ( rectum )

 Proyeksi AP, AP oblig ( kolon transversum termasuk fleksura)

 Proyeksi PA, PA oblig pasien berdiri ( fleksura lienalis dan

hepatica)
Radiography Of Colon

 Barium Enema

 Pneumo Colon
Single or double contrast

 Single
demonstrates
anatomy and
tonus (contraction)
of colon, along
with most
abnormalities
Feces
Double Contrast
 Double allows
visualization of
lumen along with
any polyps or
lesions
AP Projection - Barium Enema
 Supine
 MSP centered to
cassette
 CR at iliac crest
 Entire colon must be
included
 Two cassettes are
sometimes necessary
PA Projection - Barium Enema
 Pt. prone
 MSP centered to film
 CR at iliac crest
 Entire colon must be
visualized
 Barium should be
sufficiently penetrated
with surrounding
structures visible
PA Axial Projection - BE
 Pt. prone
 MSP centered to film
 CR directed 30 - 40
degrees caudal to ASIS
 Demonstrates
rectosigmoid area of
colon
 Area must be centered
to film
PA Axial Projection - BE
AP Oblique Projection - BE
 Pt. supine
 Body rotated 35 - 45
degrees
 CR 1 - 2 in. lateral to
midline at iliac crest
AP Oblique Projection - BE
LPO - Right colic
flexure, ascending and
sigmoid portions of
colon
RPO - Left colic
flexure, descending
colon
Must demonstrate
entire colon
Which oblique is
this?
THANK YOU,,,