Download - Css Ileus Obstruktif Ijul
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CLINICAL/COMMUNITY SCIENCE SESSION
“ILEUS OBSTRUKTIF”
SMF RADIOLOGIRSUD AL-IHSAN BANDUNG
Zulida Suryafitri (12100112046)
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ILEUS OBSTRUKTIF
Ileus adalah gangguan/hambatan pasase isi usus.
Terdiri dr 2 macam, yaitu :1. Ileus Obstruktif (mekanik)2. Ileus Paralitik (adinamik)
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ILEUS OBSTRUKTIF (Definisi…) Keadaan dimana isi lumen sal.cerna
tdk bisa disalurkan ke distal/anus, karena adanya sumbatan/hambatan mekanik, yg disebabkan kelainan dlm lumen usus, dinding usus/luar usus yg menekan/kelainan vaskularisasi pd suatu segmen usus yg menyebabkan nekrosis segmen usus tsb.
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ILEUS OBSTRUKTIF (cont…)
Oleh karena adanya sumbatan/hambatan mekanik atas jalannya isi usus dr proksimal ke distal, maka isi usus akan terhalang & tertimbun di bag.proximal dr sumbatan tsb, sehingga dpt terjadi distensi/dilatasi dr usus bagian proximal.
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ILEUS OBSTRUKTIF (Klasifikasi…)Ileus dapat dibedakan atas 2 gol.besar :
1. Simple/Intraluminer Obstruction, mis. :- Tumor intraluminer- Intussusception
2. Extrinsic Obstruction, mis. :- Adhesi- Inflamasi- Tumor ekstrinsik
3. Strangulasi (incarcerasi usus)
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ILEUS OBSTRUKTIF (Etiologi…)1. Hernia Inkarserata2. Non Hernia Inkarserata
a. Adhesi/perlekatan ususb. Invaginasic. Askariasisd. Volvuluse. Tumorf. Batu empedu yg msk ke ileum
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ILEUS OBSTRUKTIF (Manifestasi Klinis…)
1. Nyeri kolik abdomen (sekitar umbilikus/epigastrium)
2. Mual & muntah3. Perut distensi & tdk bs BAB
(obstipasi)4. Diare/konstipasi
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ILEUS OBSTRUKTIF (cont…)
5. Physical Diagnostic (PD) :- Demam (menandakan obstruksi strangulate)
- Takikardi- Hipotensi postural- Abdomen tampak distensi, peristaltik
- DRE Feses bercampur darah (kemungkinan keganasan/intussusception)
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ILEUS OBSTRUKTIF (Gmbrn Radiologi…)
Gambaran radiologi akan tampak :
1. Distensi usus di bag.proximal dr sumbatan tampak usus dilatasi o/ timbunan udara intraluminer
2. Dibagian distal dr sumbatan tdk ada bayangan gas, jika sumbatan blm lama, tampak bayangan yg sgt sedikit di bag.distal
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Normal Usus Halus
Dilatasi Usus Halus
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ILEUS OBSTRUKTIF (cont…)
3. Tdk tampak bayangan gas/udara di daerah rektum
4. Akibat adanya sumbatan akumulasi cairan di dalam lumen foto posisi tegak : bayangan air fluid level yg bnyk di be2rapa tmpt (multiple fluid levels) :- Di daerah sentral abdomen (daerah
usus halus) STEP LADDER APPEARANCE (bertangga-tangga)
- Di daerah perifer abdomen (daerah usus besar) “Huruf U terbalik”
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ILEUS OBSTRUKTIF (cont…)
5. Permukaan cairan di dlm loop tdk sama rata & pendek2
6. Akibat distensi usus halus, maka valvulae conniventes (lipatan mukosal) agak teregang bersamaan dgn valvulae conniventes loop jejunum yg bertetangga tampak gambaran sirip ikan (herringbone appearance)
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Step-Ladder Appearance
Herringbone Appearance
Huruf U terbalik
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ILEUS OBSTRUKTIF (cont…)
7. Terjadi penimbunan cairan di dlm rongga peritoneal pada posisi tegak (erect) & terlihat berkumpul di daerah pelvis
8. Lambung akan tampak berisi sedikit udara atau tidak ada sama sekali
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Lambung Normal
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INVAGINASI=INTUSSUSCEPTION Definisi :
Suatu keadaan dimana usus bag.proksimal masuk ke usus bag.distal (kedalam lumen usus bag.distal)
Gambaran Klinik- Biasanya terjadi pd anak2- Mulai dgn sakit perut yg menda2k di daerah
sekitar pusat- Kadang2 disertai muntah- Perdarahan per-anum, berak darah segar- Teraba massa di daerah sekitar pusat
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INVAGINASI (Gambaran radiologi…)
1. Dgn barium kontras yg dimasukkan melalui fluoroskopi dpt terlihat bhw stlh kontras msk dlm kolon (mencapai apex intussuceptum), maka ia akan berhenti & sulit utk msk lbh jauh lagi.
2. Tampak bayangan cupping dr ujung barium yg tertahan tadi
3. Tampak gambaran kolon seperti per/pegas (coiled spring appearance) diujung cupping barium
4. Teraba massa pd tmpt barium berhenti
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