Abdominale contrastonderzoeken
Contrastprocedures gastro-intestinaal stelsel ........................................................................................ 5
1. Algemeen..................................................................................................................................... 5
1.1 Buiten- en binnenwereld GI-systeem .................................................................................. 5
1.2 Buiten- en binnenwereld – digestief kanaal (plastische voorstelling) ................................ 5
2. Contraststoffen............................................................................................................................ 6
2.1 Positieve contraststoffen .................................................................................................... 6
2.2 Barium (Ba) .......................................................................................................................... 7
2.2.1 Contra-indicaties ......................................................................................................... 7
2.2.2 Alternatief.................................................................................................................... 7
2.3 Negatieve contraststoffen ................................................................................................... 8
2.4 Enkel of dubbel .................................................................................................................... 8
2.4.1 Enkel ............................................................................................................................ 8
2.4.2 Dubbel ......................................................................................................................... 8
2.5 Absorptieverschil zonder gebruik C+................................................................................... 9
2.6 Absorptieverschillen door gebruik van + en – C+ ................................................................ 9
2.7 Waarom Gastro-intestinale contrastmedia (C+) gebruiken? .............................................. 9
2.8 Morfologische afwijkingen opsporen .................................................................................. 9
2.9 Röntgen vullingsdefecten .................................................................................................. 10
2.10 Contrastmedia gebruik ...................................................................................................... 10
2.11 Nazorg na een onderzoek met Ba ..................................................................................... 10
3. Pathologieën.............................................................................................................................. 11
3.1 Obstructie .......................................................................................................................... 11
3.2 Pneumoperitoneum (vrije abdominale lucht) ................................................................... 11
3.3 Gastro-intestinale fistel ..................................................................................................... 12
3.4 Ziekte van Crohn................................................................................................................ 12
3.5 Colitis ulcerosa................................................................................................................... 12
3.6 Ziekte van Hirschsprung .................................................................................................... 13
3.7 Bariumperitonitis............................................................................................................... 13
3.8 Barium aspiratiepneumonie .............................................................................................. 13
4. Procedures zonder C+ ............................................................................................................... 14
4.1 Quadranten, redionen en landmarks ................................................................................ 14
4.1.1 Quadranten ............................................................................................................... 14
4.1.2 Regionen .................................................................................................................... 14
4.1.3 Landmarks ................................................................................................................. 14
4.2 Body habitus ...................................................................................................................... 15
4.3 Abdomen enkel: supine, prone, erect ............................................................................... 15
1
, 4.3.1 abdomen enkel supine .............................................................................................. 15
4.3.2 Abdomen enkel prone ............................................................................................... 16
4.3.3 Abdomen enkel erect ................................................................................................ 16
4.4 Diafragmakoepels .............................................................................................................. 16
4.5 Abdomen enkel: DLL .......................................................................................................... 16
4.6 Abdomen in DD ................................................................................................................. 16
4.7 Dunne darm (onderste GI-stelsel) ..................................................................................... 17
4.8 Dikke darm (onderste GI-stelsel) ....................................................................................... 17
4.9 Sniff test (diafragma fluoroscopie) .................................................................................... 18
4.9.1 3 Openingen diafragma ............................................................................................. 18
5. Procedures met C+ .................................................................................................................... 18
5.1 Scialografie ........................................................................................................................ 19
5.2 Sliktest ............................................................................................................................... 19
5.3 Slokdarm ............................................................................................................................ 19
5.4 Anatomie Maag ................................................................................................................. 20
5.4.1 Vooraanzicht.............................................................................................................. 20
5.4.2 Lateraal aanzicht........................................................................................................ 21
5.4.3 Waar gaat de pap vs lucht naartoe ........................................................................... 21
5.5 SMD ................................................................................................................................... 22
5.6 SMD – hypotoon duodenum ............................................................................................. 22
5.7 Anatomische verhoudingen: Lever, Gal, Pancreas, Duodenum ........................................ 23
5.8 ERCP................................................................................................................................... 23
5.8.1 Voorbereiding ERCP................................................................................................... 23
5.8.2 Uitvoering .................................................................................................................. 23
5.8.3 Aandachtspunten nazorg .......................................................................................... 24
5.9 Anatomie dundarm ........................................................................................................... 24
5.10 Dundarmtransit ................................................................................................................. 24
5.10.1 Startopname .............................................................................................................. 25
5.10.2 Transitopnames ......................................................................................................... 25
5.10.3 Transittijd latere fase................................................................................................. 25
5.10.4 Laatste fase ................................................................................................................ 26
5.10.5 Mc Burny point .......................................................................................................... 26
5.11 Overzicht darmanatomie Re.............................................................................................. 26
5.12 Enteroclyse ........................................................................................................................ 26
5.12.1 Plaatsing duodenale sonde (nasojejunal).................................................................. 27
5.12.2 Controle plaatsing nasojejunale sonde ..................................................................... 27
5.12.3 Plaatsing maag-/duodenale sonde procedure .......................................................... 27
5.13 Dikke darm (onderste GI-stelsel) ....................................................................................... 27
2
, 5.13.1 Colon transittijd of pelletstudie................................................................................. 27
5.13.2 Colon-Pellets.............................................................................................................. 28
5.13.3 Colon – Enkelvoudige Sitmarks test .......................................................................... 28
5.13.4 Colon – gesegmenteerde methode ........................................................................... 28
5.13.5 Anus praeter .............................................................................................................. 29
5.13.6 Enkelloopstoma ......................................................................................................... 29
5.13.7 Dubbelloopstoma ...................................................................................................... 29
5.13.8 Colon C+ onderzoek via stoma .................................................................................. 29
5.13.9 Colon C+ onderzoek rectaal....................................................................................... 30
5.13.10 Colon C+ plaatsing rectale sonde .......................................................................... 30
5.13.11 Colon C+ dubbel contrast ...................................................................................... 31
5.13.12 Colon enkel + H²O .................................................................................................. 31
5.13.13 Colon dubbel + H²0 + lucht ................................................................................... 31
5.13.14 Barium – lucht verdeling ....................................................................................... 31
5.14 Fistulografie ....................................................................................................................... 32
5.15 Defaecografie .................................................................................................................... 32
5.15.1 Variant = colpo cysto defaecografie .......................................................................... 33
Contrastprocedures nieren & genitaliën ............................................................................................... 34
1. Anatomie ................................................................................................................................... 34
1.1 Regionen man (Univadis natom 3D).................................................................................. 34
1.2 Regionen vrouw (Univadis natom 3D)............................................................................... 34
1.3 Anatomie urinair systeem ................................................................................................. 34
1.4 Oriëntatie van de nieren in het abdomen ......................................................................... 35
1.5 Microscopische structuur .................................................................................................. 35
1.6 Urineproductie .................................................................................................................. 36
1.7 Urethers............................................................................................................................. 36
1.8 Pelvis vrouw zonder en met ZWS ...................................................................................... 36
1.9 Pelvis man.......................................................................................................................... 37
1.10 Urethra en prostaat ........................................................................................................... 37
1.11 3D-Overzicht man (Univadis Natom 3D) ........................................................................... 38
1.12 3D-overzicht vrouw (Univadis Natom 3D) ......................................................................... 39
1.13 Iodiumhoudende contraststoffen ..................................................................................... 40
1.14 Ongewenste reacties op iodium C+................................................................................... 40
1.15 Acute ongewenste effecten op iodium C+ ........................................................................ 40
1.15.1 Quincke oedeem (angio oedeem) ............................................................................. 41
1.15.2 Extravasatie C+ .......................................................................................................... 41
1.15.2.1 Compartimentsyndroom ...................................................................................... 41
2. Procedures................................................................................................................................. 42
3
, 2.1 Intraveneuze urografie (IVU) ............................................................................................. 42
2.1.1 Indicaties ................................................................................................................... 42
2.1.2 Voorbereiding ............................................................................................................ 42
2.1.3 Start procedure ......................................................................................................... 43
2.1.4 Urethercompressie→ vulling pyelon ........................................................................ 43
2.1.5 Trendelenburg = alternatief compressie ................................................................... 43
2.1.6 Basis procedure ......................................................................................................... 43
2.1.7 Serie opnames na C+ ................................................................................................. 44
2.1.8 Tomografie ................................................................................................................ 44
2.1.9 Overzichtsopname..................................................................................................... 44
2.1.10 Pathologieën.............................................................................................................. 45
2.1.10.1 Urolithiase ............................................................................................................ 45
2.1.11 Terminologie.............................................................................................................. 45
2.2 Retrograde cystografie ...................................................................................................... 46
2.2.1 Met permictionele opnames ..................................................................................... 46
2.2.2 Start ........................................................................................................................... 46
2.2.3 Serie opnames na C+ toediening = cystografie ......................................................... 46
2.2.4 Serie permictionele opnames (vrouw) voiding cysturethography ............................ 47
2.2.5 Serie permictionele opnames (man) voiding cysturethography ............................... 47
2.2.6 Vesico-urethrale reflux bij kinderen .......................................................................... 48
2.3 Antegrade cystografie met percutane suprapubische punctie ......................................... 48
2.3.1 Indicaties ................................................................................................................... 48
2.4 Antegrade pyelo-/urethrografie ........................................................................................ 48
2.4.1 Tijdens en na procedure ............................................................................................ 49
2.4.2 Serie opnames na C+ ................................................................................................. 49
2.5 Retrograde pyelografie ...................................................................................................... 49
2.5.1 Serie opnames na C+ ................................................................................................. 50
2.6 Retrograde urethrografie .................................................................................................. 50
2.7 Hysterosalpingografie........................................................................................................ 51
2.7.1 Materiaal ................................................................................................................... 51
Zichtbaar ontsmetten ............................................................................................................................ 52
1. Desinfectie van de huid ............................................................................................................. 52
2. Aanbevolen................................................................................................................................ 52
Jodium op de huis (Tinctuur = alcoholische oplossing) ................................................................. 52
4
Contrastprocedures gastro-intestinaal stelsel ........................................................................................ 5
1. Algemeen..................................................................................................................................... 5
1.1 Buiten- en binnenwereld GI-systeem .................................................................................. 5
1.2 Buiten- en binnenwereld – digestief kanaal (plastische voorstelling) ................................ 5
2. Contraststoffen............................................................................................................................ 6
2.1 Positieve contraststoffen .................................................................................................... 6
2.2 Barium (Ba) .......................................................................................................................... 7
2.2.1 Contra-indicaties ......................................................................................................... 7
2.2.2 Alternatief.................................................................................................................... 7
2.3 Negatieve contraststoffen ................................................................................................... 8
2.4 Enkel of dubbel .................................................................................................................... 8
2.4.1 Enkel ............................................................................................................................ 8
2.4.2 Dubbel ......................................................................................................................... 8
2.5 Absorptieverschil zonder gebruik C+................................................................................... 9
2.6 Absorptieverschillen door gebruik van + en – C+ ................................................................ 9
2.7 Waarom Gastro-intestinale contrastmedia (C+) gebruiken? .............................................. 9
2.8 Morfologische afwijkingen opsporen .................................................................................. 9
2.9 Röntgen vullingsdefecten .................................................................................................. 10
2.10 Contrastmedia gebruik ...................................................................................................... 10
2.11 Nazorg na een onderzoek met Ba ..................................................................................... 10
3. Pathologieën.............................................................................................................................. 11
3.1 Obstructie .......................................................................................................................... 11
3.2 Pneumoperitoneum (vrije abdominale lucht) ................................................................... 11
3.3 Gastro-intestinale fistel ..................................................................................................... 12
3.4 Ziekte van Crohn................................................................................................................ 12
3.5 Colitis ulcerosa................................................................................................................... 12
3.6 Ziekte van Hirschsprung .................................................................................................... 13
3.7 Bariumperitonitis............................................................................................................... 13
3.8 Barium aspiratiepneumonie .............................................................................................. 13
4. Procedures zonder C+ ............................................................................................................... 14
4.1 Quadranten, redionen en landmarks ................................................................................ 14
4.1.1 Quadranten ............................................................................................................... 14
4.1.2 Regionen .................................................................................................................... 14
4.1.3 Landmarks ................................................................................................................. 14
4.2 Body habitus ...................................................................................................................... 15
4.3 Abdomen enkel: supine, prone, erect ............................................................................... 15
1
, 4.3.1 abdomen enkel supine .............................................................................................. 15
4.3.2 Abdomen enkel prone ............................................................................................... 16
4.3.3 Abdomen enkel erect ................................................................................................ 16
4.4 Diafragmakoepels .............................................................................................................. 16
4.5 Abdomen enkel: DLL .......................................................................................................... 16
4.6 Abdomen in DD ................................................................................................................. 16
4.7 Dunne darm (onderste GI-stelsel) ..................................................................................... 17
4.8 Dikke darm (onderste GI-stelsel) ....................................................................................... 17
4.9 Sniff test (diafragma fluoroscopie) .................................................................................... 18
4.9.1 3 Openingen diafragma ............................................................................................. 18
5. Procedures met C+ .................................................................................................................... 18
5.1 Scialografie ........................................................................................................................ 19
5.2 Sliktest ............................................................................................................................... 19
5.3 Slokdarm ............................................................................................................................ 19
5.4 Anatomie Maag ................................................................................................................. 20
5.4.1 Vooraanzicht.............................................................................................................. 20
5.4.2 Lateraal aanzicht........................................................................................................ 21
5.4.3 Waar gaat de pap vs lucht naartoe ........................................................................... 21
5.5 SMD ................................................................................................................................... 22
5.6 SMD – hypotoon duodenum ............................................................................................. 22
5.7 Anatomische verhoudingen: Lever, Gal, Pancreas, Duodenum ........................................ 23
5.8 ERCP................................................................................................................................... 23
5.8.1 Voorbereiding ERCP................................................................................................... 23
5.8.2 Uitvoering .................................................................................................................. 23
5.8.3 Aandachtspunten nazorg .......................................................................................... 24
5.9 Anatomie dundarm ........................................................................................................... 24
5.10 Dundarmtransit ................................................................................................................. 24
5.10.1 Startopname .............................................................................................................. 25
5.10.2 Transitopnames ......................................................................................................... 25
5.10.3 Transittijd latere fase................................................................................................. 25
5.10.4 Laatste fase ................................................................................................................ 26
5.10.5 Mc Burny point .......................................................................................................... 26
5.11 Overzicht darmanatomie Re.............................................................................................. 26
5.12 Enteroclyse ........................................................................................................................ 26
5.12.1 Plaatsing duodenale sonde (nasojejunal).................................................................. 27
5.12.2 Controle plaatsing nasojejunale sonde ..................................................................... 27
5.12.3 Plaatsing maag-/duodenale sonde procedure .......................................................... 27
5.13 Dikke darm (onderste GI-stelsel) ....................................................................................... 27
2
, 5.13.1 Colon transittijd of pelletstudie................................................................................. 27
5.13.2 Colon-Pellets.............................................................................................................. 28
5.13.3 Colon – Enkelvoudige Sitmarks test .......................................................................... 28
5.13.4 Colon – gesegmenteerde methode ........................................................................... 28
5.13.5 Anus praeter .............................................................................................................. 29
5.13.6 Enkelloopstoma ......................................................................................................... 29
5.13.7 Dubbelloopstoma ...................................................................................................... 29
5.13.8 Colon C+ onderzoek via stoma .................................................................................. 29
5.13.9 Colon C+ onderzoek rectaal....................................................................................... 30
5.13.10 Colon C+ plaatsing rectale sonde .......................................................................... 30
5.13.11 Colon C+ dubbel contrast ...................................................................................... 31
5.13.12 Colon enkel + H²O .................................................................................................. 31
5.13.13 Colon dubbel + H²0 + lucht ................................................................................... 31
5.13.14 Barium – lucht verdeling ....................................................................................... 31
5.14 Fistulografie ....................................................................................................................... 32
5.15 Defaecografie .................................................................................................................... 32
5.15.1 Variant = colpo cysto defaecografie .......................................................................... 33
Contrastprocedures nieren & genitaliën ............................................................................................... 34
1. Anatomie ................................................................................................................................... 34
1.1 Regionen man (Univadis natom 3D).................................................................................. 34
1.2 Regionen vrouw (Univadis natom 3D)............................................................................... 34
1.3 Anatomie urinair systeem ................................................................................................. 34
1.4 Oriëntatie van de nieren in het abdomen ......................................................................... 35
1.5 Microscopische structuur .................................................................................................. 35
1.6 Urineproductie .................................................................................................................. 36
1.7 Urethers............................................................................................................................. 36
1.8 Pelvis vrouw zonder en met ZWS ...................................................................................... 36
1.9 Pelvis man.......................................................................................................................... 37
1.10 Urethra en prostaat ........................................................................................................... 37
1.11 3D-Overzicht man (Univadis Natom 3D) ........................................................................... 38
1.12 3D-overzicht vrouw (Univadis Natom 3D) ......................................................................... 39
1.13 Iodiumhoudende contraststoffen ..................................................................................... 40
1.14 Ongewenste reacties op iodium C+................................................................................... 40
1.15 Acute ongewenste effecten op iodium C+ ........................................................................ 40
1.15.1 Quincke oedeem (angio oedeem) ............................................................................. 41
1.15.2 Extravasatie C+ .......................................................................................................... 41
1.15.2.1 Compartimentsyndroom ...................................................................................... 41
2. Procedures................................................................................................................................. 42
3
, 2.1 Intraveneuze urografie (IVU) ............................................................................................. 42
2.1.1 Indicaties ................................................................................................................... 42
2.1.2 Voorbereiding ............................................................................................................ 42
2.1.3 Start procedure ......................................................................................................... 43
2.1.4 Urethercompressie→ vulling pyelon ........................................................................ 43
2.1.5 Trendelenburg = alternatief compressie ................................................................... 43
2.1.6 Basis procedure ......................................................................................................... 43
2.1.7 Serie opnames na C+ ................................................................................................. 44
2.1.8 Tomografie ................................................................................................................ 44
2.1.9 Overzichtsopname..................................................................................................... 44
2.1.10 Pathologieën.............................................................................................................. 45
2.1.10.1 Urolithiase ............................................................................................................ 45
2.1.11 Terminologie.............................................................................................................. 45
2.2 Retrograde cystografie ...................................................................................................... 46
2.2.1 Met permictionele opnames ..................................................................................... 46
2.2.2 Start ........................................................................................................................... 46
2.2.3 Serie opnames na C+ toediening = cystografie ......................................................... 46
2.2.4 Serie permictionele opnames (vrouw) voiding cysturethography ............................ 47
2.2.5 Serie permictionele opnames (man) voiding cysturethography ............................... 47
2.2.6 Vesico-urethrale reflux bij kinderen .......................................................................... 48
2.3 Antegrade cystografie met percutane suprapubische punctie ......................................... 48
2.3.1 Indicaties ................................................................................................................... 48
2.4 Antegrade pyelo-/urethrografie ........................................................................................ 48
2.4.1 Tijdens en na procedure ............................................................................................ 49
2.4.2 Serie opnames na C+ ................................................................................................. 49
2.5 Retrograde pyelografie ...................................................................................................... 49
2.5.1 Serie opnames na C+ ................................................................................................. 50
2.6 Retrograde urethrografie .................................................................................................. 50
2.7 Hysterosalpingografie........................................................................................................ 51
2.7.1 Materiaal ................................................................................................................... 51
Zichtbaar ontsmetten ............................................................................................................................ 52
1. Desinfectie van de huid ............................................................................................................. 52
2. Aanbevolen................................................................................................................................ 52
Jodium op de huis (Tinctuur = alcoholische oplossing) ................................................................. 52
4
