Gas in

stomach

Gas in a few
loops of
small bowel

Gas in
rectum or
sigmoid

Normal Gas Pattern

Hirschsprung's Disease
(from Grainger)

Hirschsprung's adalah obstruksi fungsional kolon yang terjadi karena

kegagalan migrasi neuroblast bagian kaudal saat perkembangan GIT.

Usus bagian bawah dari tempat berhentinya neuronal sampai anus tidak
terdapat ganglion / aganglionik.

Ultrashort
jarang terjadi dan hanya mengenai anus pada level internal sphincter.
Short segment
pada daerah rektosigmoid( 75%).
Long segment
apabila mengenai kolon dengan berbagai variasi, dari kolon proksimal
sampai sigmoid,
Total aganglionosis coli
seluruh colon dan sebagian terminal ileum.
'Skip lesions'
sangat jarang terjadi.

Alimentary Canal
Mouth
Pharynx
Esophagus
Stomach
Small / Large

Intestine

Accessory
glands
Liver
Gallbladder
Salivary

glands
Pancreas

Originates around
C-6
In thorax, it is
anterior to spine,
posterior to
trachea and heart
Passes through
diaphragm
through
esophageal hiatus

Inferior to diaphragm
curves sharply left
Increases in diameter
Joins stomach at
esophagogastric
junction
At level of xyphoid tip
4 layers of the
esophagus
Outermost - fibrous
Muscular
Submucosal
Innermost - Mucosal

Dilated saclike
portion of
digestive tract
Composed of
same 4 layers as
esophagus

Outermost - fibrous
Muscular
Submucosal
Innermost - Mucosal

Divided into 4 parts

Cardia
Fundus
Body
Pyloric portion

Entrance to stomach
is cardiac orifice
Controlled by cardiac

sphincter

Exit is the pyloric

orifice
Controlled by pyloric

sphincter

Contains same four

layers as stomach
and esophagus
Mucosa contains
projections called villi
to facilitate digestion
and absorption
Divided into 3 parts:
Duodenum
Jejunum
Ileum

8 - 10 inches in length

Widest portion of small intestine

Follows a C-shaped course

Contains 4 regions
Superior, descending,

horizontal, ascending
1st region is known
as the duodenal bulb
4th portion joins
jejunum and is
supported by
ligament of Trietz
Head of pancreas is
contained in
duodenal loop second portion

Jejunum
Upper remaining 2/5 of

small bowel

Ileum
Terminates at ileocecal

valve

Both are gathered into

freely movable loops (gyri)
Attached to posterior
abdominal wall by
mesentary
Generally found in central
and lower part of abd.
cavity within arch of large
intestine

DEFENISI :
Pemeriksaan radiologis dengan
menggunakan kontras media untuk
memvisualisasikan saluran pencernaan
bagian atas secara dinamik dengan
fluoroskopi dan radiografi.

Menggunakan kontras media positif

( kontras ) dan negatif (udara) untuk
menilai abnormalitas pergerakan,
lumen dan mukosa .
Kontras : Barium Sulfat dan
menggunakan evervescent untuk
menghasilkan udara.
Penilaian : esofagus gasterduodenum.

Kelainan mobilitias
Kelainan mukosa (ulkus, divertikel,
inflamasi)
Keganasan
Degeneratif
Kelainan kongenital
Kelainana obstruktif

Perforasi
Alergi kontras
Obstruksi total upper GI

Anamnese pasien adanya obstruksi

Puasa selama 6 jam sebelum
pemeriksaan
Persiapan kontras barium , esofagus 1:
1 dan saluran cerna yang lain 1: 3
Bila curiga perforasi atau fistel
menggunakan kontras water soluble

Kontras diminumkan mll oral ( 1; 1) ,

untuk mengisi esofagus sambil
dilakukan fluoroskopi
Lalu kontras Barium sulfat (1 : 3 )
diminumkan mll oral , namun untuk
mengisi udara di lambung, pasien
menggunakan evervescent .
Posisi pasien supine

Pasien diminta untuk berputar,

terlentang , miring , telungkup , miring
kontralateral dilakukan 2 kali. Lakukan
fluoroskopi untukmelihat kelainan.
Setelah full filling , dapat dinilai mulai
gaster, duodenum saat bulbus terbuka
dan terisi pars descendens dan
ascendens duodenum

Varises esofagus
Achalasia esofagus
Striktur esofagus
Atresia esofagus
Esofagitis
Tumor esofagus
Fistula esofagus
Divertikulum dan spasme esofagus

Congnital : hernia diafragmatika,

sliding hernia, etc
Gastritis
Gastric Ulcer plg sering terjadi pada :
minor curvature , anthrum pyloricum,
corpus, fundus, cardia
Tumor , mis : adeno ca, leiomiosarkoma

Congenital : atresia duodeni, spasme

duodeni
Duodenitis
Tumor : polip, divertikulum benign
maligna : filling defek irreguler ,
umbrella sign
Tumor Caput Pancreas : enlarge C
loop

Barium Swallow, Single Contrast

Cricopharyngeu
s Muscle
At level of C5-C6,
Part of upper
esophageal
sphincter (UES)

Esophagu
s

Barium Swallow, Single Contrast

Main
Indication:
Dyshagia

Double
Contrast

Identation of
A.A

Indentation of
L.main
bronchus

Single Contrast

Barium Swallow, Single Contrast

Double Contrast

L.
A
.

Heart

L.
V.

Barium Swallow, Double Contrast

Indentation of
L.main
bronchus

Double Contrast

Single Contrast

Barium Swallow, Single Contrast

Ampulla
Normal Varient

Fundus

Body

Barium Swallow, Single Contrast

Aortic
Arch

Barium Swallow, Double Contrast

Narrowing:
Could be peristalsis
So other shot is
advised

Barium Meal, Double Contrast

(Supine Position)
Supine

Position:

Note Barium
Distribution in the
Fundus due to gravity

Angular Notch
Incisura
Angularis

Antrum

Bod
y

Barium Meal + Follow-Through

(Erect Position)
DJJ:

Barium
Meal

Normal Position= Left

side

Angular Notch
Incisura Angularis

Duodenal
Cap
Pyloric
Canal
2nd Part of
Duodenum
3rd Part of
Duodenum

Ileu
m

Body
Antru
m

Jejunum:
Plica Circularis on the
outer border

Barium
Follow-Through

Barium Follow-Through to Cecum

(Erect Position)

DJJ:
2nd Part of
Duodenum
3rd Part of
Duodenum

Normal Position= Left

side

Small Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the
bowel is more distended here
This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject
barium, methylcellulose and water into the small bowel. This allows for better visualization of the small bowel
than can be seen during a small bowel follow-through

Barium Swallow, Single Contrast

Esophag
us

Proximal
Dilatations
Narrowing
(Stricture)

Bird Peak
Sign
DDx:

Barium Swallow, Single Contrast

Benign
Stricture:
The transitional Zone
looks smooth and free
of filling defects

Proximal
Dilatations

Distal
Narrowing

Barium Swallow, Single Contrast

Malignant Stricture:
-The transitional Zone looks
Irregular & ill defined
- Presence of many filling
defects

DDx:
Adeno CA
Sq. Cell
CA

Filling
Defect

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus

Barium Swallow, Single Contrast

(Oblique)

Filling
Defect
Malignant
Stricture

Long Irregular
Narrowing

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus

Barium Swallow, Single Contrast

(Oblique)
Irregular Wall & Dilatation:
Tertiary Contraction (Pathological non-propulsive
Contraction)

Funnel
Shape
(Achalasia)

Barium swallow in this patient with achalasia reveals a

smooth distal tapering caused by the hypertensive lower
esophageal sphincter that straddles the diaphragm, and
multiple non-Peristaltic contractions throughout the body of
the esophagus. This radiographic appearance sometimes has
been called "vigorous achalasia". This term has little value,
however, because recent studies suggest that patients with
so-called vigorous achalasia cannot be distinguished clinically

Barium Swallow, Single Contrast

Well Defined
(Oblique)
Contrast Filled
left cervical level
sac

Pharyngeal Pouch
(Zenker's
Diverticulum):
occurs in an area of anatomic
weakness known as Killian's
dehiscence

Barium Swallow, Single Contrast

Irregular
Multiple Filling
Defects

Differential Diagnosis
Multiple Esophageal Filling
Defects:
1.Fungal Infx
2.Polyps
3.Esophageal Varices
(irregular)
4.Food Particles

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-contoured
filling defects are present in the inferior two thirds of the esophagus. The contour of the esophagus

Barium Swallow, Single Contrast

Irregular
Multiple Filling
Defects
(Esophageal
Varices)

Barium Meal, Double Contrast

Contrast Filled
Speculated
Lesion
(Gastric Ulcer)

Barium Meal, Double Contrast

Ruga
e

Contrast Filled
Outpouching at
the Greater
Curviture
(Malignant Gastric
Ulcer)

Barium Meal + Follow-Through

1st Part of
duodenum

Contrast Filled
Speculated
Lesion
(Duodenal Ulcer)

2nd Part of
duodenum
4th Part of
duodenu
m
3rd Part of
duodenum

Barium Meal, Double Contrast

Speculate
d Mass
Ulcer

Pylorus

Stomac
h

Barium Meal, Double Contrast

(Erect Position)

DDx:
Pyloric Stenosis
Mushrooms Sign
(or apple core
Sign)
Strings
Sign
Shoulders
Sign

For further information refer to Pediatric Abdomen Radiology Slides