METODE PEMERIKSAAN
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Transcript of METODE PEMERIKSAAN
![Page 1: METODE PEMERIKSAAN](https://reader033.fdocuments.net/reader033/viewer/2022061209/548cf12ab47959c1628b46cf/html5/thumbnails/1.jpg)
RADIOIMAGING KELAINAN RADIOIMAGING KELAINAN TRAKTUS URINARIUSTRAKTUS URINARIUS
OLEH:OLEH:
Dr. RAMLI H. ALI, Sp.RadDr. RAMLI H. ALI, Sp.Rad
BAGIAN RADIOLOGIBAGIAN RADIOLOGI
FAKULTAS KEDOKTERANFAKULTAS KEDOKTERAN
UNIVERSITAS SAM RATULANGIUNIVERSITAS SAM RATULANGI
MANADOMANADO
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METODE PEMERIKSAAN
1. PLAIN FOTO
2. IVP/IVU
3. INFUSION PYELOGRAPHY
4. RETROGRADE PYELOGRAPHY
5. ANTEGRADE PYELOGRAPHY
6. CYSTOGRAPHY :
- EXCRETORY CYST.
- RETROGRADE CYST
- VOIDING CYSTO-URETHR.
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7. URETHROGRAPHY :
- EXCRETORY URETHR
- RETROGRADE URETHR
8. TOMOGRAPHY
9. CT-SCAN
10. ULTRA SONOGRAPHY (USG)
11. ISOTOP SCANNING
12. MRI
13. ANGIOGRAPHY - DSA
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PLAIN FOTO ABDOMEN
- BNO, KUB, BOF
- PEMERIKSAAN AWAL
- PERSIAPAN :
1. MAKANAN LUNAK 2.3 HARI
2. LAXANTIA 10-12 JAM /MgS04
3. PUASA
4. LAVEMENT DENGAN 2 L AIR SABUN (PAGI HARI)
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- PEMBUATAN FOTO :
- POSISI AP SUPINE
- BATAS DIAFRAGMA –> SYMPHYSIS
- EXPOSE - AKHIR EXPIRASI – TAHAN NAFAS
- FILM 30X40 CM
- SIMETRIS
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INTERPRETASI : PLAIN FOTO ABDOMEN
- KUB FILM
A.GINJAL
1. UKURAN : ♂ > ♀ .KA < KI
♂. KA – Pjg : 11,3-11,5 cm
Lbr : 5,4 – 7,2 cm
Ki – Pjg : 11,6 – 14,8 cm
Lbr : 4.8 – 6.6 cm
♀. KA – Pjg : 10,7 – 13,9
Lbr : 4.8 – 6.6 cm
Ki – Pjg : 11,1 – 14, 1 cm
Lbr : 5,1 – 6,7 cm
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2. POSISI / LETAK :
- BERVARIASI –> Tgt. HABITUS PDRT
- HILUS KAWAN –> LEVEL PROC. TRANSV.L II
- LONG AXIS –> SEJAJAR BATAS LUAR M. PSOAS.
3. BENTUK :
- DITENTUKAN OLEH “LOBE”. ANAK –> FETAL LABULATION
4. DENSITAS :
- SAMA DGN STRUKTUR / ORGAN SEKITARNYA (HATI. LIEN)
- DENSITAS ↑ – RENAL SIDEROSIS
↓ - LIPOMATOSIS
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B. URETER DISTRIBUSI :
-HANYA DIKIRA-KIRA SAJA
C. BULI – BULI :
- STRUKTUR AGAK MELEBAR DIATAS SYMPHYSIS BILA DALAM KEADAAN TERISI PENUH URINE
D. PSOAS SHADOW :
- SIMETRIS KA = KI
E. FLANK AREA :
- EXTRA PERITONEAL/ PREPERITONEAL FAT LINE.
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F. DISTRIBUSI GAS
G. TULANG VERTEBRAE + PELVIS
H. APAKAH TAMPAK GBR “ KALSIFIKASI “
- PANKREAS –> SPECKLING CALSIUM
- GINJAL –> PELVIOCALYCEAL – BATU (STAGHORN)
- URETER –> BATU
- GALL BLADDER –> MULTIPLE
- KALSIFIKASI LAIN:- PLEBOLITH
- FIBROMYOMA
- KGB MESENTERIUM
- A. RENALIS/AORTA
- DLL
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I. APAKAH TAMPAK GBR “ TUMOR ABDOMEN “
DIDALAM ORGAN
DILUAR ORGAN :
- APAKAH TAMPAK KALSIFIKASI TUMOR
- TANDA-TANDA PENDORONGAN ORGAN SEKITAR
SUBPHRENIC ABSCESS :
- FLUOROSCOPY
- FOTO : SUPINE+ TEGAK –>- ABDOMEN
- THORAX
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INTRAVENOUS PYELOGRAPHY / IVP
-PERSIAPAN : BNO
-KONTRAS MEDIA : - NA. DIATRIZOAT
- MEGLUMINE DIATRIZOAT
→ UROGRAFIN 76%, 60%
UROVISON 50%. HYPAQUE 50%
TELEBRIX 300, IOPAMIRO 300 dll.
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-INDIKASI : MEMPERLIHATKAN - RENAL PARENCHYM
- PELVIOCAL.SYSTIM
- URETER
- BULI-BULI
- URETHRA
-KONTRA INDIKASI :
- RENAL INSUFICIENCY
- MULTIPLE MYELOMA
- ALLERGI
- ANXIETY
- THYROID SCANNING
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-PROSEDUR PEMERIKASAAN
- CHECK FOTO BNO
- INJEKSI KONTRAS : SELAMA 15-30 DETIK MELALUI V. MEDIANA CUBITI
- EXPOSURE : - WAKTU : 1, 5, 10, 20, 30 MNT POST INJEKSI KONTRAS
- FILM : 18X24 CM. 24X30 CM, 30X40 CM
- POSISI : - SUPINE
- PRONE
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- EVALUASI INTRAVENOUS PYELOGRAPHY
MELIPUTI :
- NEPHROGRAM
- CALYX MINOR, MAJOR & PELVIS RENALIS
- URETER
- VESICA URINARIA
- URETHRA
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NEPHROGRAM- KOSENTRASI KONTRAS DIDALAM NEPHRON
- DENSITAS SEDIKIT MENINGKAT DIBANDING BNO
- BISA UNTUK MENILAI BENTUK & UKURAN GINJAL, KONTUR , POSISI DAN KELAINAN PARENCHYM
CALYX- BENTUK CALYX NORMAL SEPERTI “PIALA”
- KELAINAN CALYX :
- HYDRONEPHROSIS → CALYX MELEBAR/ DILATASI
- CHRONIC PYELONEPHRITIS → FRAYING
- KISTA GINJAL → TIPIS & MEMANJANG
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PELVIS RENALIS
- BAGIAN YG LEBAR DARI PELVIO CALYCEAL
- KELAINAN PELVIS RENALIS
- TUMOR –> FILLING DEFEK
- BATU
- BEKUAN DARAH, dll
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URETER
- URETER NORMAL: - DIAMETER SEKITAR 8,0 mm - BAGIAN YANG MENYEMPIT: - URETERO PELVIC JUNCTION - URETERO VESICAL JUNCTION
- KELAINAN URETER- DUPLIKASI- ACHALASIA- URETEROCELE- BATU- DLL
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BULI-BULI
- BULI-BULI NORMAL → BENTUK BULAT ATAU LONJONG
- KELAINAN BULI-BULI :
- DUPLIKASI
- EXTROPHY
- CYSTITIS
- TUMOR
- NEUROGENIC BLADDER
- BATU
- DIVERTIKEL
- HYPERTROPHY PROSTAT, Tu.GINEKOLOGIS
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URETHRA
- EPISPADIA / HYPOSPADIA
- DUPLIKASI
- BATU
- STRIKTURA / STENOSIS