Double Contrast Upper

Gastrointestinal
Radiography

Gastritis
Gastritis adalah peradangan pada dinding
lambung.
Lambung memiliki sel-sel penghasil asam dan
enzim yang berguna untuk mencerna makanan.
Untuk melindungi lapisan lambung dari radang
atau pengikisan asam, sel-sel tersebut juga
sekaligus menghasilkan lapisan lendir. Lapisan
lendir ini berfungsi melindungi dinding lambung
dari iritasi akibat asam yang diproduksi. Gastritis
terjadi ketika lapisan lendir tersebut rusak
sehingga dinding lambung mulai teriritasi.

Ulkus Gaster
Definisi
Ulkus gaster adalah suatu gambaran
bulat atau semi bulat/oval, ukuran >5
mm kedalam sub mucosal pada
mukosa lambung akibat terputusnya
kontinuitas/integritas mukosa lambung.
Ulkus gaster merupakan luka terbuka
dengan pinggir edema diserati indurasi
dengan dasar ulkus ditutupi debris.

 Features suggesting benign gastric ulcer

outpouching of ulcer crater beyond the gastric contour
(exoluminal)
smooth rounded and deep ulcer crater
smooth ulcer mound
smooth gastric folds that reach the margin of ulcer
Hampton's line
Features suggesting malignant gastric ulcer
does not protrude beyond the gastric contour (endoluminal)
irregular and shallow ulcer crater
nodular and angular ulcer mound
nodular gastric folds that do not reach the ulcer margin
Carman meniscus sign

 Benign. lesser curvature gastric ulcer.Red arrows

point toHampton's Line, a thin, straight line at neck of
ulcer in profile view which represents the thin rim of
undermined gastric mucosa. The blue arrows point to the
ulcer mound, a smooth, sharply delineated soft-tissue
mass surrounding a benign ulcer. Note how the ulcer
projects beyond the confines of the expected wall of the
stomach.

 TheCarman meniscus signdescribes the lenticular

shape of barium in cases of large and flatgastric ulcers,
in which the inner margin is convex toward the lumen. It
usually indicates a malignant ulcerated neoplasm.

 Double contrast-enhanced ultrasound imaging of gastric ulceration. A:

Three-dimensional (3D) double contrast-enhanced ultrasound imaging
showed the gastric cavity and wall with a focal defect area consistent with
an ulcer (arrow); B: Another 3D imaging with different angle showed the
ulcerative lesion (arrow) and the folds of gastric wall with pseudo-color
which similar to gastroscopic imaging; C: The ulcerative lesion (arrow) is
seen on gastroscope imaging.

 An ulcerative lesion with larger

ulcer (A), and the ulcerating
tumor (arrow) with a
penetrating, infiltrating ulcer
base (large arrow) (B).

Gastric Polyp
A gastric polyp is an abnormal growth of tissue
projecting from the gastric mucosal membrane.
Encountering a polyp in the stomach prompts concerns
regarding its histology, cause, natural history, and
whether specific therapy is required.
Polyps that reveal a malignancy upon histopathologic
examination lose their polyp status, irrespective of their
initial endoscopic appearance, and we have excluded
them from this review. Furthermore, because it is
impossible to be simultaneously practical and
comprehensive, we also had to neglect lesions (eg,
lipomas, heterotopias, and leiomyomas) because they
are unlikely to cause clinical dilemmas.

 Hyperplastic polyp (inflammatory

polyp) (75-90%)
Proliferated gastric mucosa and
inflammatory cells
Associated with pernicious anemia
Random distribution in stomach
Usually multiple
Usually <1cm with no progression
No malignant potential

 Adenomatous polyp (10-20%)

True neoplasm with very low malignant
potential (<4%)
Associated with Gardners syndrome,
juvenile polyposis and Cronkhite-Canada
syndrome
Occurs more commonly in antrum
Often single
Usually>1.5cm in size
Occurs in patients over 50 years old

 Hyperplastic gastric polyps.Upper photo. Whitearrows

point to multiple filling defects on the anterior and
posterior walls of the stomach, some outlined by the
barium pool, others etched in barium representing
numerous, small gastric polyps. Bottom photo: The
same polyps are again shown (blue arrows).

 Double contrast-enhanced ultrasound imaging of gastric polyp. A: Twodimensional double contrast-enhanced ultrasound (DCUS) imaging
displayed a polyp with a wide base projecting into the gastric cavity.
Contrast enhancement was seen on both polyp and gastric wall; B:
Three-dimensional DCUS imaging of the polyp showed in figure A; C:
The surgical specimen of the polyp confirmed the DCUS finding

HPS
Hipertropi pyloric stenosis (HPS) merupakan
suatu kondisi yang terjadi pada bayi
dengan lambung bagian pilorus
mengalami penebalan yang abnormal.
HPS adalah penyempitan di jalan keluar
lambung sampai bagian pertama dari
duodenum menyebabkan pembesaran
(hipertropi) muskulus sekitar jalan keluar
tersebut (pilorus) dan mengalami spasme
saat lambung kosong.

 An upper GI seriesdemonstrates
pyloric obstruction with a string sign.
The findings are consistent with
pyloric stenosis.

 Figure 1 An
ultrasonographyscans pyloric
region. The markers are measuring
the thickness of pyloric muscle,
which is 3.8 mm.

Gastric Carcinoma
Gastric carcinomais the most common
cancer in the world afterlung cancerand is a
major cause of mortality and morbidity.
Though a marked reduction has been
observed in the incidence of gastric
carcinoma in North America and Western
Europe in the last 50 years, 5-year survival
rates are less than 20%, as most patients
present late and are unsuitable for curative,
radical surgery. Gastric tumors are seen in
the images below.

 Double-contrast barium upper GI examination

is widely recognized as the radiologic technique
of choice for diagnosing early gastric cancers.
These lesions are confined to the mucosa or
submucosa and are classified into 3 types:
Type I - Elevated lesions that protrude more than 5
mm into the lumen (polypoid)
Type II - Superficial lesions that are elevated (IIa),
flat (IIb), or depressed (IIc)
Type III - Shallow, irregular ulcers surrounded by
nodular, clubbed mucosal folds

 Double contrast-enhanced ultrasound imaging of ulcerative gastric

cancer. A: Two-dimensional double contrast-enhanced ultrasound
(DCUS) images (conventional imaging on the right and harmonic
imaging on the left) showed a contrast-enhanced mass with craterlike ulcerative defect (arrow); B: Three-dimensional DCUS imaging
showed distorted nourishing vasculature within the gastric cancer
(arrow).

 CT (C+ portal venous phase) CT axial

Mass in stomach; omental thickening
and intestinal obstruction