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7/23/2019 Radiologi - Cholelithiasis
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Refeksi kasus radioloJoovan Naaidu09/280488/KU/13459
24 Oktoer 2014
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!dentitas
Na"a# N$% &
U"ur# 3't(n Jenis Kela"in# &ere")uan
*la"at# Ka)ulogo +enga( R+, Ja-a tenga(
No%R.# 01'0
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Kelu(an uta"a
N$eri di ulu (ati "enalar ke )unggung
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Ri-a$at )en$akit sekarang R&
3 .R, "engelu( n$eri di )erut kanan atas lalu )asien ke
&uskes"as dan di eri oat, teta)i n$eri "asi( "eneta)% 1..R, os ke R 6onosari dengan kelu(an sa"a lalu di ruu
RU& sardito
7.R os ke RU& ardito dengan n$eri )erut kanan "ealar k)unggung lalu di lakukan )e"eriksaan U%
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Ri-a$at &en$akit a(ulu
e"a" , .ual, .unta(, Ri-a$at kuning
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Ri-a$at &en$akit Keluarga
&en$akit seru)a disangkal
. 7+
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&e"eriksaan :sik;ital signs# +# 120/80 Nadi# 84/"enit Res)irasi# 20/"enitu(u# 3e(er# >i"? tt
+(ora# ! # Nor"al, K =or# 12 reg, ising & # onor * # ;esikuler, R( /, 6(ee@ing /
*do"en# ! # Nor"al *# U A , &eristaltik nor"al & # +$")ani A & # .ur)($ sign A , RUB )ain
Ctre"itas # *kral (angat, Nadi kuat
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iagnosis#
=(olelit(iasis
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&e"eriksaan )enunang# >a
6=# 10%3
NCUD# 51%8
>ED# 28%'
.OD# 8%3
COD# 3%0
*D# 0%2
R=#
Klorida# 10
ol dara(# A
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&e"eriksaan )enunang radiologi a)aka( $aakan anda )esanF
U
Goto t(ora )olos
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Goto t(ora &* vie-&osisi ereHti"etris!ns)irasi and kondisi Huku),
+a")ak kedua a)e )ul"otenang+a")ak Horakan ronH(ovanor"al+a")ak kedua dia?rag"a liHdan tak "endatar=or%, =+R 0%49isite" tulang $ang
tervisualisasi intaHt
Kesan #&ul"o tak ta")ak kelainanesar Hor nor"al
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7asil
U# Keterengan Klinis # =(olelit(iasis
# 7asil
# 7e)ar# Ukuran dan eH(ostrukture nor"al, )er"ukaan liHin, siste" "ilier dan vasHulintra(e)atal tak )ro"inen, tak ta")ak "assa/nodul
# ;esiHa Gelea # Ukuran nor"al, dinding tak ta")ak "eneal, tak ta")ak "assa "au)sledge% +a")ak lesi (i)ereH(oiH dengan )osterior aHoustiH s(ado- A, entuk ulat, tegas, ukuran lk% 0%'5H"
# >ien# Ukuran dan eH(ostruktur nor"al, tak ta")ak "assa/nodul, (ilus lienalis tak )ro
# &anHreas# Ukuran dan eH(ostruktur nor"al, tak ta")ak "assa "au)un kalsi:kasi, d)anHreatiHus tak )ro"inen%
# Ren etra # Ukuran dan eH(ostruktur nor"al, atas Horte dan "edulla tegas, +ak ta"assa/atu%
# Ren sinistra # Ukuran dan eH(ostruktur nor"al, atas Horte dan "edulla tegas, +ak t"assa/atu%
;esiHa urinaria # +erisi Hairan, dinding ta")ak reguler tak "eneal, tak ta")ak atu "a"assa%
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&osition o? allladder onogra)
Girst &osition
7ig(/>ateral vie->ooking t(roug( Ris &roe *ngled
.ore *nt +(an ?or G*+ ea"
eHond &osition#
uHostal vie- -it( )atient rolled
to le?t >ateral eHuitus
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=(olelit(iasis
=(olelit(iasis involves t(e )resenHe o? gallstones, -(iH( are
HonHretions t(at ?or" in t(e iliar$ traHt, usuall$ in t(e galllad
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*nato"$ o? gallladder and etra(e)ailiar$ tree
ile
7el)s t(e od$ digest ?ats
.ade in t(e liver tored in t(e gallladder until t(e od$ needs
it
=ontains#
6ater
=(olesterol
ile )ig"ents
&(os)(oli)ids
=onHentrations var$ dierent kinds o? stones"a$ e ?or"ed
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&ig"ent stones
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=(olesterol stones
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.ied stones
.ulti)le
GaHeted
=onsist o?#
=alHiu" salts
&ig"ent
=(olesterol 30D '0D
80D assoHiated -it( H(roniH H(oleH$stitis
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$")to"s
&ain in t(e RUB .ost Ho""on and t$)iHal s$")to"
.a$ last ?or a ?e- "inutes to several (ours
.ostl$ ?elt a?ter eating a (eav$ and (ig(?at "eal
&ain under rig(t s(oulder -(en li?ting u) ar"s
Gever, nausea and vo"iting
JaundiHe ostruHtion o? t(e ile duHt )assage
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Diagnosis Ultrasound
.ost sensitive and s)eHi:H test ?or gallstones
=o")uteri@ed to"ogra)($ =+ sHan
.a$ s(o- gallstones or Ho")liHations, suH( asin?eHtion and ru)ture o? or ile duHts
=(olesHintigra)($ 7!* sHan Used to diagnose anor"al HontraHtion o?
gallladder or ostruHtion o? ile duHts
CndosHo)iH retrogradeH(olangio)anHreatogra)($ CR=& Used to loHate and re"ove stones in ile duHts
lood tests &er?or"ed to look ?or signs o? in?eHtion,
ostruHtion, )anHreatitis, or aundiHe
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U
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7!* Han
Treatment
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Treatment urger$# =(oleH$steHto"$ gallladder
re"oval!ndiHations#
+(ose -it( large L2 H" gallstones +(ose -(o (ave a non?unHtional or HalHi:ed
)orHelain gallladder on i"aging studies and -(oare at (ig( risk o? gallladder HarHino"a
+(ose -it( s)inal Hord inuries or sensor$neuro)at(ies aeHting t(e ado"en
+(ose -it( siHkle Hell ane"ia in -(o" t(e distinHtion
et-een )ain?ul Hrisis and H(oleH$stitis "a$ ediMHult
+-o surgiHal o)tions O)en H(oleH$steHto"$
>a)arosHo)iH H(oleH$steHto"$
NonsurgiHal treat"ent#
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NonsurgiHal treat"ent#
Onl$ in s)eHial situations
6(en a )atient (as a serious "ediHal Hondition )reventing surger$
Onl$ ?or H(olesterol stones
Oral dissolution t(era)$
=ontaHt dissolution t(era)$
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