Pneumoperitoeum Nia

8/16/2019 Pneumoperitoeum Nia

1/47

PNEUMOPERITONEUM

YOHANNA TANIA 42150020

DOSEN PEMBIMBING : Dr. Merari Panti Astti!S". Ra#


2/47

DE$INISI

• %ea#aan a#an&a #ara 'e'as #a(a)r*n++a "erit*ne).

• Pen&e'a' "a(in+ )) #ari"ne)*"erit*ne) a#a(a, "er-*rasisa(ran "enernaan /0.


3/47

ETIO3OGI

1. R"tr iss 'er*n++a /&ait "er-*rasi(s "e"ti)! ner*ti6in+ enter**(itis!)e+a*(*n t*si! "en&ait ss in7a)asi

2. $at*r iatr*+eni /&ait "e)'e#a,an "erttera,ir! tra)a a'#*)en! "er-*rasien#*s*"i! #ia(isis "erit*nea(! "araentesis

8. In-esi r*n++a "erit*ne) #en+an

*r+anis)e )e)'ent +as #an ata"ea,n&a a'ses &an+ 'er#eatan


4/47

PATO$ISIO3OGI

• Per-*rasi siste) +astr*intestina( 920 )enit #ara e(ar #i(e"asan e a) "erit*ne) "ne)*"erit*ne)

• Pne)*"erit*ne) #a"at ter;a#i"a#a re+i* s',e"ati! 'er'ent

se+iti+a #i M*rris*n


5/47

TEMPAT PREDI3E%SI

PNEUMOPERITONEUM

Te)"at Pre#i(esi Pne)*"erit*ne)"a#a P*sisi S"ine /a s',e"ati= /'M*rris*n


6/47

MANI$ESTASI

• Ga)'aran (inis "asien #en+an "ne)*"erit*ne)ter+antn+ "a#a "en&e'a'n&a.

• Pen&e'a' &an+ ti#a 'er'a,a&a #a"at )e)'erian+a)'aran &an+ asi)"t*)atis! ata n&eri "ert &an+

,i(an+ ti)'(.• Se#an+an &an+ #ise'a'an *(e, "er-*rasi *r+an

'er*n++a a'#*)en ter+antn+ "a#a "ere)'an+an"erit*nitis.

• Ge;a(a #an tan#a "a#a 'er'a+ai "en&e'a' "er-*rasi#a"at 'er"a tan#a "erit*nea( se"erti a #ante+an+ "a#a a'#*)en! ,i(an+n&a 'isin+ ss! n&erie"i+astri &an+ ,e'at sa)"ai s&*


7/47

PEMERI%SAAN $ISI%

• Ins"esi

Distensi

• As(tasi Bisin+ ss )enrn

• Persi

Ti)"aniHi"erti)"ani• Pa("asi

N&eri tean


8/47

ANATOMI ABDOMEN


9/47

GAMBARAN NORMA3 RADIO3OGIABDOMEN


10/47

POSISI $OTO PO3OSABDOMEN

• S"ine

%e'an&aan "asien #en+an *n#isi e)er+ensi

• Eret

Men++naan sinar > ara, ,*ri6*nta(! arena a"a'i(a a#a

#ara aan )ene)"ati te)"at tertin++i "a#a a)"erit*ne).

• 3e-t 3atera( De'its

3e'i, sensiti- #a(a) )en#etesi -ree air &an+ 'era#a

antara te"i 'atas ,e"ar #en+an #in#in+ (atera( a)"erit*ne) )esi"n #a(a) ;)(a, ei(. Tenin&a

,ars 'enar! #i)ana "asien ,ars #i"*sisian 'er'arin+)irin+ #en+an sisi iri #i'a?a, se(a)a 10 )enit


11/47

$OTO PO3OS ABDOMEN


12/47

NORMA3 BO@E3 GASPATTERN


13/47

Anak panah :

Putih: Psoas line dan

udara di rectosigmoid

Hitam : Udara di

lambung dan sedikit

udara di usus kecil tidak

melebar


14/47

NORMA3 STOMAH BUBB3E


15/47


16/47

Gambaran normal air fluid yang sering menyertai

pada foto abdomen posisi tegak


17/47

GAMBARAN ABNORMA3 RADIO3OGI


18/47

AP ERET

• U#ara +as #i'a?a,#ia-ra+)a )ini)a( "*st

(a"ar*s*"i


19/47

AP ERET

• Ga)'aran #ara/ra#i*(sen 'e'as #i'a?a, #ia-ra+)a 'er"a#aera, 'er'ent '(an

sa'it /Semilunar Shadow#iantara #ia-ra+)a ananC ,e"ar ata #ia-ra+)airi C (ien.

• Pasien ini )e)i(ii (s

#*#en).


20/47

GAMBARAN %HASPNEUMOPERITONEUM


21/47

URAHUS SIGN

• Ura,s ta)"ase"erti +aris ti"is(inier #i ten+a,'a+ian 'a?a,a'#*)en #iantaraU #an )'i(ia(


22/47

RIEG3ER


23/47

TRIANG3E SIGN

• Ta)"a +a)'aran

se+iti+a ei(#iantara ss'esar #an "an++(&an+ )er"aan

sat #ara 'e'as


24/47

Gas )e)isa,an se+)en ss #an )e)'ent s#t #an

se+iti+a ta;a)


25/47

3IER SIGN

U#ara 'e'as #i seitar,e"ar


26/47

$OOTBA33 SIGN

• A#an&a"en)"an #ara

&an+ 'an&a "a#a"erit*ne) +a)'aran se"erti'*(a "er-*rasi

ret) "en++naan reta(t'e


27/47

$OOTBA33 SIGN


28/47

DOGES AP SIGN /-ree air in M*rris*n


29/47

ONTINOUS DIAPHRAGMSIGN

• Ga)'aran #ara

'e'as #i 'a?a,#ia-ra+)a "ne)*"erit*ne) &an+ )asi-.


30/47

ABSES GAS

• Ga)'aran+e(e)'n+ +as.


31/47

UPO3A SIGN

• Ga)'aran (sen 'entarata 'atas atasn&a te+as!'atas 'a?a, ti#a te+as

• U#ara "a#a a)"erit*ne) ini aan (e'i,'an&a 'er)"( "a#a'a+ian anteri*r! #i'a?a,entra( ten#*n #ia-ra+)a

#an #i #a(a) ran+ s'-reni)e#ian.


32/47

3ESSER SA GAS

• Ga)'aran #ara 'e'as"a#a "*steri*r (a)'n+.

• Pana, "ti, "*(a si+n

• Pana, ,ita) (esser sa+as


33/47

DOUB3E BUB3E SIGN

• Ga)'aran #ara"a#a 'a+ians'#ia-ra+)a #an#ara n*r)a(

-n#s +aster.


34/47

3IGAMENT $A3I$ORM SIGN

Ga)'aran "ita (rs

3i+a)ent) $a(i-*r)is

)er"aan (i+a)ent

&an+ )en+,'n+an#in#in+ anteri*r

a'#*)en #en+an

,e"ar &an+ aan

ter(i,at a"a'i(ater#a"at #ara 'e'as

"a#a r*n++a a'#*)en.


35/47

• Pne)*"erit*ne))asi- (i+a)ent)-a(si-*r)e /"ana,!te"i ,e"ar /e"a(a"ana,! #an esia

-e(ea /GB#ie(i(in+i *(e, -reeair


36/47

INERTED F SIGN

• Ga)'aran"ne)*"erit*ne))e)"er(i,atan inerte#

si+n &an+ 'erasa( #ari(i+a)ent) )'i(ia((atera(


37/47

DEUBITUS ABDOMEN SIGN

• P*sisi 33D)e)"er(i,atana#an&a -ree airantara #in#in+

a'#*)en #an,e"ar /"ana,"ti,

• Ta)"a "(a

a#an&a airan'e'asintra"erit*ena(/"ana, ,ita)


38/47

USG


39/47

USG

• U#ara 'e'as #iran+ s'",renianteri*r


40/47

T SAN

• Pana, "ti, -reeair et asa"er-*rasi (s

+aster


41/47

• $a(i-*r) (i+a)entsi+n


42/47

DIAGNOSIS BANDING


43/47

HI3AIDITI


44/47

ABSES SUB$RENI%

• Me)'erian +a)'aran )(ti"e((sen #i 'a?a, #ia-ra+)a!ter(*a(isir! 'er'ent '(at#en+an te"i ire+(er! #an ti#a'era#a #a(a) strtr (**"ss.

• A'ses s'-reni ini 'iasan&ati)'( "asa "r*ses"e)'e#a,an! "a#a asse(eti- )a"n a'#*)en at.

• Pa#a 0 ass

)e)"er(i,atan +a)'aran#ia-ra+)a (eta tin++i! 0 #isertai *ns*(i#asi ata *(a"s"a#a 'asa( "ar! #an 0 #isertai e-si "(era


45/47


46/47

DA$TAR PUSTA%A

• M**re %3. Essentia( (inia( anat*)&. Da(a)"erit*ne) an# "erit*nea( ait&. $*rt,e#iti*n. 3i""in*tt. 2011: "185J42.

• @eera*#& ! Yran+a #an Kere)& K*nes.Pne)*"erit*ne). Din#, #ari,tt":ra#i*"ae#ia.*r+arti(es"ne)*"erit*ne) "a#a 28 Mei 201

• %,an! A(i Na?a6. 2011. Pne)*"erit*ne)I)a+in+ : A K*rna(. Din#, #ari,tt":e)e#iine.)e#sa"e.*) ! "a#a 28 Mei201


47/47

TERIMA%ASIH

Documents

Pneumoperitoeum Nia