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OMD

( OESOPHAGUS MAAG
DUODENI ) /BARIUM MEAL

Departemen Radiologi
FK UNDIP
Anatomy Of Digestive System

⦿ Alimentary Canal
› Mouth
› Pharynx
› Esophagus
› Stomach
› Small and Large
Intestine
Anatomy Of Digestive
System

⦿Accessory
glands
› Liver
› Gallbladder
› Salivary
glands
› Pancreas
Esophagus
⦿ Originates around
C-6
⦿ In thorax, it is
anterior to spine,
posterior to
trachea and heart
⦿ Passes through
diaphragm
through
esophageal hiatus
Esophagus
⦿ Inferior to diaphragm
curves sharply left
⦿ Increases in diameter
⦿ Joins stomach at
esophagogastric
junction
⦿ At level of xyphoid tip
⦿ 4 layers of the
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost -
Mucosal
Stomach
⦿ Dilated saclike
portion of
digestive tract
⦿ Composed of
same 4 layers as
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
Stomach
⦿ Divided into 4 parts
› Cardia
› Fundus
› Body
› Pyloric portion
⦿ Entrance to
stomach is cardiac
orifice
› Controlled by cardiac
sphincter
⦿ Exit is the pyloric
orifice
› Controlled by pyloric
sphincter
Small Intestine
⦿ Contains same four
layers as stomach
and esophagus
⦿ Mucosa contains
projections called villi
to facilitate digestion
and absorption
⦿ Divided into 3 parts:
› Duodenum
› Jejunum
› Ileum
Duodenum
⦿8 - 10 inches in length

⦿Widest portion of small intestine

⦿Follows a C-shaped course


Duodenum
⦿ Contains 4 regions
› Superior,
descending,
horizontal, ascending
› 1st region is known
as the duodenal bulb
› 4th portion joins
jejunum and is
supported by
ligament of Trietz
› Head of pancreas is
contained in
duodenal loop -
second portion
Jejunum And Ileum
⦿ Jejunum
› Upper remaining 2/5 of
small bowel
⦿ Ileum
› Terminates at ileocecal
valve
⦿ Both are gathered into
freely movable loops
(gyri)
⦿ Attached to posterior
abdominal wall by
mesentary
⦿ Generally found in central
and lower part of abd.
cavity within arch of large
intestine
OMD/BARIUM MEAL

⦿DEFINISI :
Pemeriksaan radiologis dengan
menggunakan kontras media untuk
memvisualisasikan esofagus,gaster
dan duodenum secara dinamik dengan
fluoroskopi dan radiografi.
BATASAN

⦿Menggunakan kontras media positif


( kontras ) dan negatif (udara) untuk
menilai abnormalitas pergerakan,
lumen dan mukosa .
⦿Kontras : Barium Sulfat dan
menggunakan effervescent untuk
menghasilkan udara.
INDIKASI
⦿Kelainan mobilitias
⦿Kelainan mukosa (ulkus, divertikel,
inflamasi)
⦿Keganasan
⦿Degeneratif
⦿Kelainan kongenital
⦿Kelainan obstruktif
⦿Corpus alienum
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 melalui oral ( 1;
1) , untuk mengisi esofagus sambil
dilakukan fluoroskopi
⦿Lalu kontras Barium sulfat (1 : 3 )
diminumkan melalui 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
KELAINAN ESOFAGUS

⦿Varises esofagus
⦿Achalasia esofagus
⦿Striktur esofagus
⦿Atresia esofagus
⦿Esofagitis
⦿ Tumor esofagus
⦿Fistula esofagus
⦿Divertikulum dan spasme esofagus
KELAINAN GASTER

⦿Congenital : hypertrophy pyloric


stenosis (HPS), hernia diafragmatika,
sliding hernia, etc
⦿Gastritis
⦿Gastric Ulcer plg sering terjadi pada :
minor curvature , anthrum pyloricum,
corpus, fundus, cardia
⦿Tumor , mis : adeno ca, leiomiosarkoma
KELAINAN DUODENUM

⦿Congenital : atresia duodeni, spasme


duodeni
⦿Duodenitis
⦿Tumor : polip, divertikulum→ benign
maligna : filling defek irreguler ,
umbrella sign
⦿Tumor Caput Pancreas : enlarge C
loop
Single Contrast

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

Esophagu
s
Single Contrast
Double Contrast

Double
Contrast

Identation of
A.A

Indentation of
L.main
bronchus

Single Contrast
Single Contrast

Double Contrast

L.
A
Heart .
L.
V.
Double Contrast

Indentation of
L.main
bronchus

Double Contrast

Single Contrast
Single Contrast

Ampulla
Normal Varient

Fundus

Body
Single Contrast

Aortic
Arch
Double Contrast

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

Angular Notch
Incisura
Angularis

Antrum Bod
y
Barium Meal + Follow-Through
(Erect Position)
DJJ: Barium
Normal Position= Left Meal
side
Angular Notch
Incisura Angularis
Duodenal
Cap
Pyloric
Canal
2nd Part of
Duodenum

3rd Part of Body Jejunum:


Duodenum Plica Circularis on the
Antru outer border
m

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

DJJ:
Normal Position= Left
2nd Part of side

Duodenum

3rd Part of
Duodenum
Single Contrast

Esophagus

Proximal
Dilatation
s
Narrowin
g
(Stricture)

Bird Peak Sign


DDx:
Achalasia
Single Contrast
Lower Esophagus

Benign
Stricture:
The transitional Zone
looks smooth and free
of filling defects

Proximal
Dilatations

Distal
Narrowing
Single Contrast

Malignant Stricture:
-The transitional Zone looks
Irregular & ill defined
- Presence of many filling
defects

DDx:
Adeno CA
Sq. Cell
CA

Filling
Defect

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus
Single Contrast
(Oblique)

Filling
Defect

Malignant
Stricture

Long Irregular
Narrowing

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus
Single Contrast
Well Defined
Contrast Filled
(Oblique)
left cervical level
sac

Pharyngeal Pouch
(Zenker's
Diverticulum):
occurs in an area of anatomic
weakness known as Killian's
dehiscence
Single Contrast

Irregular
Multiple Filling
Defects

Differential Diagnosis
Multiple Esophageal
Filling Defects:
1.Fungal Infx
2.Polyps
3.Esophageal Varices
(irregular)
4.Food Particles

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-
contoured filling defects are present in the inferior two thirds of the esophagus. The contour of the
esophagus is irregular and spiculated.
Single Contrast

Irregular
Multiple Filling
Defects
(Esophageal
Varices)
Double Contrast

Contrast Filled
Speculated
Lesion
(Gastric Ulcer)
Double Contrast

Ruga
e

Contrast Filled
Outpouching at
the Greater
Curviture
(Malignant Gastric
Ulcer)
Barium Meal + Follow-Through

Contrast Filled
Speculated
1st Part of Lesion
duodenum (Duodenal Ulcer)

2nd Part of
duodenum

4th Part of
duodenu
m
3rd Part of
duodenum
Barium Meal, Double Contrast

Speculate
d Mass

Ulcer

Pyloru
s

Stomach
Barium Meal, Double Contrast
(Erect Position)

DDx:
Pyloric
Stenosis

Mushroom’s Sign
(or apple core
Sign)
String’s
Sign

Shoulder’s
Sign

For further information refer to “Pediatric Abdomen Radiology” Slides


CORPUS ALIENUM

Coin in esophagus. Frontal view of the neck and upper chest shows a
round metallic foreign body (white arrow) that lies in the midline just
above the aortic knob (red arrow).
Coins in the esophagus are round in appearance on the frontal view
whereas coins in the trachea are usually seen on end and are linear in
shape
ESOPHAGITIS

Penyebab utama esofagitis adalah Gastroesophageal Reflux


Air-contrast esophagram shows thick esophageal mucosal
folds (arrows) and an ulcer (arrowhead) due to GERD.
Single contrast esophagram shows stricture (arrow) and
sliding hiatus hernia
On the left Irregular stricture (arrowhead) and
erosions (arrows) due to GERD.
Infectious esophagitis
Candida esophagitis
a patient with an infectious esophagitis due to candida.
The barium study shows numerous fine erosions and small plaques
due to Candida albicans in immunocompromised patient.
PEMERIKSAAN PANORAMIC

= Orthopantomogram

•Pemeriksaan Radiologi menggunakan


X Ray yang dapat melihat struktur tulang
mandibula, maksila serta seluruh
jaringan gigi dalam satu film
INDIKASI
1.Melihat lesi pada tulang
2.Melihat kondisi gigi sebelum pembedahan
3.Sebelum melakukan perawatan gigi,
untuk melihat keadaan gigi dan benih gigi
4.Melihat ada atau tidaknya fraktur
THANK YOU...