PEMERIKSAAN PENUNJANG

SIROSIS HEPATIS
Septa Tio Emeralda
0961050062
 JENIS PEMERIKSAAN
• USG
• CT-SCAN
• MRI
• ERCP
• LIVER BIOPSY
 NORMAL USG
Figure 2.3 LS through the right lobe of the
liver and right kidney. RPV = right portal vein;
RHV = right hepatic vein.

Right lobe of liver

Branch of RPV
Morrison’s Pouch
Branch of RHV
Right kidney
Quadratus
lumborum
Diaphragm
Figure 4.20 (A) Micronodular cirrhosis in a patient with alcoholic liver disease.
(B) Macronodular cirrhosis in a patient with primary biliary cirrhosis. Cirrhotic
nodules are demonstrated throughout the peripheral hepatic substance with a
lobulated liver outline. Ascites is also present.
 CT SCAN
• You will be asked to lie on a narrow table that slides
into the center of the CT scanner. Usually, you will lie
on your back with your arms raised above the head.
• Certain exams require a special dye, called contrast, to
be delivered into the body before the test startsIf
contrasts is used, you may be asked not to eat or drink
anything for 4-6 hours before the test
• You must be still during the exam, because movement
causes blurred images. You may be told to hold your
breath for short periods of time.
Figure 1. Macroregenerative cirrhosis. Coronal T1-weighted gradient-echo MR image in a
patient with viral hepatitis B-induced cirrhosis shows macronodular regenerative nodules
5–10 mm in diameter, separated by low-intensity fibrotic septa (arrowheads). Note the
presence of a high signal intensity dysplastic nodule (arrow).
Figure 2. Early cirrhosis. Axial image T1-weighted gradient-echo MR image in a patient
with early alcoholic-related cirrhosis shows enlargement of the hilar periportal space
(arrow).
Note the increased fat tissues between the left medial segment of the liver and the right
portal vein.
Figure 3. Advanced cirrhosis. Axial contrast-enhanced CT image in a patient with viral
hepatitis B infection shows marked hypertrophy of the left lateral segment and caudate
lobe, and shrinkage of the right hepatic lobe (arrows).
Note dilated intrahepatic portalvenous tributuaries and ascites.
Figure 4. Cirrhosis with hepatic parenchymal iron deposition. Axial T1-weighted
gradient echo MR image shows the liver with presence of multiple small siderotic
(hypointense) regenerative nodules. Also note presence of hemosiderin deposits
(arrows) in the spleen (Gamma-Ghandi bodies) owing to small hypertensive hemorrhage
Figure 5. Dysplastic nodule.
A, Axial T1-weighted gradient echo MR image in a patient with advanced hepatitis C
cirrhosis shows dominant homogeneous hyperintense nodule (arrow).
B, the lesion (arrow) appears hypointense on T2- weighted turbo spin-echo image.
C, Following intravenous administration of gadolinium chelate, the lesion (arrow) does
not show predomniant arterial enhancement.
 MRI
(Magnetic Resonance Imaging)
• An MRI (or magnetic resonance imaging) scan is a
radiology technique that uses magnetism, radio waves,
and a computer to produce images of body structures
• The magnet creates a strong magnetic field that aligns
the protons of hydrogen atoms, which are then
exposed to a beam of radio waves. This spins the
various protons of the body, and they produce a faint
signal that is detected by the receiver portion of the
MRI scanner. The receiver information is processed by
a computer, and an image is produced.
Figure 1b3: Transverse T1-weighted MR images in 50-year-old woman with cirrhosis
secondary to autoimmune hepatitis. There is marked signal intensity loss throughout
the hepatic parenchyma (arrows) on the (a) in-phase image (repetition time
msec/echo time msec, 170/4.4; 70° flip angle) in comparison with the (b) opposed-
phase image (170/2.2, 70° flip angle), secondary to the presence of siderotic
regenerative or dysplastic nodules.
 ERCP
(Endoscopic Retrograde CholangioPancreatography)
(en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee)

• ERCP combines the use of x rays and an

endoscope, which is a long, flexible, lighted
tube.
• Enables the physician to diagnose problems in
the liver, gallbladder, bile ducts, and pancreas.
• Through the endoscope, the physician can see
the inside of the stomach and duodenum, and
inject dyes into the ducts in the biliary tree
and pancreas so they can be seen on x rays.
 PRECEDURES of ERCP
• Preparations : Your stomach and duodenum must be empty for the
procedure to be accurate and safe. You will not be able to eat or
drink anything after midnight the night before the procedure, or for
6 to 8 hours beforehand, depending on the time of your procedure
• Patients will lie on their left side on an examining table in an x-ray
room
• And then they will be given some medications
• Swallow the endoscope, and the physician will then guide the scope
through your esophagus, stomach, and duodenum until it reaches
the spot where the ducts of the biliary tree and pancreas open into
the duodenum (At this time, patients will be turned to lie flat )
• Through the tube, the physician will inject a dye into the ducts to
make them show up clearly on x rays.
• X rays are taken as soon as the dye is injected.
 LIVER BIOPSY
• liver biopsy is performed when a liver problem is
difficult to diagnose with blood tests or imaging
techniques, such as ultrasound and x ray.
• More often, a liver biopsy is performed to
estimate the degree of liver damage—a process
called staging. Staging helps guide treatment.
• 3 Main types of Liver Biopsy : Percutaneus,
Transvenues, Laparoscopic.
 Percutaneus Liver Biopsy
• During the procedure, patients lie on their back on a table
with their right hand resting above their head. A local
anesthetic is applied to the area where the biopsy needle will
be inserted. If needed, an IV tube is used to give sedatives and
pain medication.
• The doctor makes a small incision in the abdomen, either
toward the bottom of the rib cage or just below it, and inserts
the biopsy needle. Patients will be asked to exhale and hold
their breath while the needle is inserted and a liver sample is
quickly withdrawn. Several samples may be collected,
requiring multiple needle insertions.
• After the biopsy, patients must lie on their right side for up to
2 hours to reduce the risk of bleeding. Patients are then
monitored an additional 2 to 4 hours after the biopsy before
being sent home.
 Transvenous Liver Biopsy
is used when a person’s blood clots slowly or when excess fl uid is present in the abdomen, a condition called ascites

• During the procedure, patients lie on their back on an x-

ray table
• A small incision is made in the neck and a specially
designed hollow tube called a sheath is inserted into the
jugular vein. The doctor threads the sheath down the
jugular vein, along the side of the heart, and into one of
the hepatic veins, which are located in the liver. To see
the veins, the doctor injects liquid contrast material into
the sheath. The contrast material lights up when x
rayed, highlighting the blood vessels and showing the
location of the sheath.
• The doctor threads a biopsy needle through the sheath
and into the liver and a liver sample is quickly withdrawn
• Patients are monitored for 4 to 6 hours for signs of
bleeding
 Perbedaan antara CT SCAN dengan MRI?

CT SCAN MRI
Menggunakan sinar x ray
Resiko radiasi tp tetap dilihat kalo ada indikasi ya Menggunakan magnet
tetap dikerjakan
Lebih baik untuk menilai tulang
Tidak ada radiasi x ray
Pemeriksaan thorak/dada juga lebih baik dgn ct scan Baik untuk menilai jaringan lunak
Lebih cepat waktu pemeriksaan tgt generasi dan
merk,
Harga lebih mahal tgt jenis
saat ini di Indo umumnya pakai yg gen 3, 64 slices pemeriksaan dan RS
(walau ada beberapa RS yg pakai di atas itu
64 slices sdh cukup karena makin tinggi maka radiasi
Waktu lebih lama pasien harus
juga makin besar diam dan tidak boleh bergerak
Kecuali mau periksa jantung atau vaskular memang
baik pakai yg lebih tinggi
dalam waktu lama.
Harga umumnya relatif murah dibanding MRI tp tgt
jenis pemeriksaan dan RSnya juga
 References
1. Biblio MK, Dotter CT, Lee TG, et al: Complications of
ERCP–a study of 10,000 cases. Gastroenterology
70:314–320. 1976
2. Ros, Pablo R: Clinics & Liver disease:HEPATIC
IMAGING AND INTERVENTION.pg181-185. 2002
3. radiology.rsna.org/content/247/2/311/F2.expansion.
html
4. Bates, Jane: Abdominal Ultrasound, How, Why and
When.32:97. 2004
5. digestive.niddk.nih.gov/ddiseases/pubs/ercp/
6. digestive.niddk.nih.gov/ddiseases/pubs/liverbiopsy/