Kuliah enterohepatik radiologi
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![Page 1: Kuliah enterohepatik radiologi](https://reader035.fdocuments.net/reader035/viewer/2022081503/563dbba6550346aa9aaf0d54/html5/thumbnails/1.jpg)
RADIOLOGI ENTEROHEPATIK
FAKULTAS KEDOKTERAN UNISSULA
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Organ yang berhubungan dengan sistem enterohepatik:
• Hepar
• Sistem biliaris.
• Pankreas.
SISTEM ENTEROHEPATIK
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HEPAR
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ANATOMI
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ULTRASOUNDCT SCAN MRI
JENIS PEMERIKSAAN
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NORMAL :
• Ukuran kraniokaudal 13 – 15 cm (RLL),
9 – 10 cm (LLL).
• Permukaan rata, tepi reguler,ujung lancip,
• Ekogenisitas menengah
( pankreas > hepar > lien > ginjal).
• Parenkim homogen.
USG
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HEPAR NORMAL
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CT SCAN
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MRI
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• Hepar membesar.
• Permukaan berbenjol-benjol.
• Tepi tumpul.
• Struktur parenkim inhomogen.
• Ekogenisitas biasanya meningkat.
KARSINOMA HEPATOSELULER
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KARSINOMA HEPATOSELULER
US
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KARSINOMA HEPATOSELULER
US
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CT
KARSINOMA HEPATOSELULER
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METASTASE
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KISTA HEPAR
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• Ukuran mengecil.
• Kapsul tebal, ireguler.
• Parenkim homogen kasar.
• Ekogenisitas meningkat.
SIROSIS HEPATIS
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SIROSIS HEPATIS
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SISTEM BILIER
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Terdiri dari : Apparatus
biliaris intra hepatik
Apparatus biliaris ekstra hepatik
ANATOMI
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Terdiri dari : Ductus hepaticus
kanan & kiri. Ductus
choledochus. Vesica fellea. Ductus cysticus.
APPARATUS BILIARIS EKSTRAHEPATAL
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Keluar dari hepar pada porta hepatis.
Ductus kanan-kiri bersatu ductus hepaticus communis Panjang 4 cm. Pinggir kanan bersatu
dengan ductus cysticus (dari vesica fellea) Ductus choledochus
DUCTUS HEPATICUS
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Bentuk huruf “S” Panjang 4 cm. Menghubungkan collum vesica fellea dgn
ductus hepaticus communis membentuk ductus choledochus.
DUCTUS CYSTICUS
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Panjang 8 cm. Bersatu dengan
ductus pancreaticus Bermuara pada
ampulla vateri (dinding duodenum).
Bagian distal ductus choledochus & ampulla dikelilingi M. sphincter oddi
DUCTUS CHOLECHUS (CBD)
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Fx. : Reservoir empedu dan memekatkan empedu dialirkan ke duodenum
Tdd : Fundus. Corpus. Collum berlanjut
sbg. ductus cysticus
VESICA FELLEA
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ULTRASOUND ORAL CHOLECYSTOGRAPHY PERCURANEUS TRANSHEPATIC CHOLANGIOGRAPHY
( PTC) OPERATIF & T-TUBE CHOLANGIOGRAM ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY ( ERCP) CT SCAN MAGNETIC RESONANCE
CHOLANGIOPANCREATOGRAPHY ( MRCP) NUCLEAR IDA SCAN ( CHOLECINTIGRAPHY)
JENIS PEMERIKSAAN
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PERSIAPAN :
Puasa 6 – 8 jam, supaya kandung empedu terdistensi maksimal
NORMAL :
Bentuk ovoid, diameter corpus < 8 cm
Dinding reguler tak tebal
ULTRASOUND
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VESICA FELEA NORMAL
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VESICA FELEA NORMAL
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Saat ini sudah sangat jarang dilakukan digantikan oleh imaging lain (ERCP, USG, CT, MRI)
Mungkin gagal bila kadar bilirubin serum > 34 m mol/L
Indikasi :Imaging pada patologi VF bila tidak tersedia
alat USGatau bila USG gagal menampakkan VF
KOLESISTOGRAFI ORAL
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Kontraindikasi : Penyakit hepar atau ginjal yg berat Kolesistitis akut Dehidrasi Dalam 7 hari sebelumnya sudah
dilakukan kolangiografi IV Status pasca kolesistektomi
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Persiapan Pasien
Laksansia 2 hari sebelumnya
Makan bubur tanpa lemak sehari sebelumnya
Makan jam 18.00 hari sebelumnya stl itu minum capsul kontras
Boleh minum (kecuali susu / coklat)
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Radiogram
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PERCUTANEUS TRANSHEPATIC CHOLANGIGRAPHY ( PTC)
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OPERATIF & T-TUBE CHOLANGIOGRAM
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ERCP
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CT SCAN
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MRCP
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NUCLEAR IDA ( IMINO DIACETIC ACID) SCAN
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CHOLESISTOLITHIASIS
US
CT
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• Penebalan dinding, double wall.
• Kadang ada cairan disekelilingnya.
• Sering disertai batu.
KOLESISTITIS AKUT
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KOLESISTITIS AKUT
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• Dinding tebal, ireguler
• Bentuk contracted(dalam keadaan puasa)
• Kadang disertai batu
KOLESISTITIS KRONIS
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KOLESISTITIS KRONIS
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KOLESISTITIS KRONIS
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PANCREAS
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Terdiri dari head, neck & tail Normal : Panjang12 cm dan tebal 2.5
cm
ANATOMI
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• ULTRASOUND
• CT SCAN
• MRI
PEMERIKSAAN
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US. PANKREAS NORMAL
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KARSINOMA PANKREAS
•Pembesaran parsial pankreas.
•Konturnya ireguler, bisa lobulated.
•Ekogenisitasnya rendah/semisolid.
•Bisa disertai pendesakan V. Cava, pelebaran saluran bilier.
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US. KARSINOMA PANKREAS
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PANKREATITIS AKUT
•Ukuran membesar
•Struktur lebih hipoekoik dibanding
hepar
•Kadang ditemukan: abses, nekrosis,
perdarahan
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US .PANKREATITIS AKUT
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CT .PANKREATITIS AKUT
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TERIMA KASIH