{"id":2154,"date":"2017-04-17T00:00:00","date_gmt":"2017-04-16T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/pnomoperitoneum-ultrasonografinin-bilinmeyen-alani-midir\/"},"modified":"2022-03-02T17:01:03","modified_gmt":"2022-03-02T14:01:03","slug":"pnomoperitoneum-ultrasonografinin-bilinmeyen-alani-midir","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2017\/04\/17\/pnomoperitoneum-ultrasonografinin-bilinmeyen-alani-midir\/","title":{"rendered":"Pn\u00f6moperitoneum ultrasonografinin bilinmeyen alan\u0131 m\u0131d\u0131r?"},"content":{"rendered":"\r\n\r\n\r\n<p>Andrzej Smereczy\u0144ski, Katarzyna Kolaczyk <strong>Is pneumoperitoneum the terra ignota in ultrasonography? <\/strong><a href=\"http:\/\/dx.doi.org\/10.15557\/JoU.2015.0016\" target=\"_blank\" rel=\"noreferrer noopener\">10.15557\/JoU.2015.0016<\/a><\/p>\r\n\r\n\r\n\r\n\r\n\r\n<p><em>(Okuyucuya not: terra ignota=terra incognita=bilinmeyen diyar; bkz, wikipedi, latin for unknown land)<\/em><\/p>\r\n\r\n\r\n\r\n<p>Makale yazarlar\u0131 makaleye giri\u015fte pn\u00f6moperitoneum bulgusunun s\u0131kl\u0131kla gastrointestinal perforasyon nedeniyle olu\u015ftu\u011funa, bu durumun cerrahi tedavi gerektirdi\u011fine ve h\u0131zla tan\u0131nmas\u0131 gerekti\u011fine vurgu yaparak ba\u015flamay\u0131 tercih etmi\u015fler.<\/p>\r\n\r\n\r\n\r\n<p>Ultrasonografiye bizlere sa\u011flad\u0131\u011f\u0131 faydalar i\u00e7in te\u015fekk\u00fcrle devam eden yazarlar ge\u00e7mi\u015fte asiti olan bir hastada bat\u0131n i\u00e7i havan\u0131n ultrasonografi ile tespit edilebildi\u011fini belirtmi\u015fler. G\u00fcn\u00fcm\u00fczde ise bat\u0131n i\u00e7i havan\u0131n tespit edilebilmesi i\u00e7in asit veya ba\u015fka bir nedenle olu\u015fan s\u0131v\u0131ya gereksinim duyulmad\u0131\u011f\u0131n\u0131; 1 ml hacmindeki k\u00fc\u00e7\u00fck miktarda havan\u0131n bile rahatl\u0131kla tespit edilebilece\u011fini (Fig 1); ve hatta ultrasonografinin bu konuda konvansiyonel radyolojik tetkiklerden daha \u00fcst\u00fcn oldu\u011funu savunan yazarlar\u0131n bulundu\u011funu belirtmi\u015fler.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"wp-image-820\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/volkan-makale1-1.jpg\" alt=\"\" \/>\r\n<figcaption><em>Fig 1: Karaci\u011fer \u00fczerinde iki k\u00fc\u00e7\u00fck hava kabarc\u0131\u011f\u0131 (PMC4579755)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>Bat\u0131n i\u00e7i hava tespiti i\u00e7in E-FAST benzeri br protokol geli\u015ftirme \u00e7abas\u0131na giren makale yazarlar\u0131 3,5-5 MHz\u2019lik konveks probun g\u00f6r\u00fcnt\u00fcleme\u00a0i\u00e7in en uygun se\u00e7enek oldu\u011funu fakat y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc nedeniyle uygun hastalarda 7,5 MHz\u2019lik lineer probun da se\u00e7ilebilece\u011fini belirtmi\u015fler. G\u00f6r\u00fcnt\u00fclemenin s\u0131rt \u00fcst\u00fc yatar pozisyonda yap\u0131labilece\u011fi gibi, sol yan yatar pozisyonda ve sa\u011f yan yatar pozisyonda da yap\u0131labilece\u011fini; bunlar\u0131n aras\u0131ndan en uygun g\u00f6r\u00fcnt\u00fcn\u00fcn hasta sol yan\u0131 \u00fczerine yatarken, probun sa\u011f alt kostalar hizas\u0131na yerle\u015ftirilmesi ile elde edildi\u011fini vurgulam\u0131\u015flar.<\/p>\r\n\r\n\r\n\r\n<p>Bat\u0131n i\u00e7i serbest hava varl\u0131\u011f\u0131nda bu havan\u0131n torakoabdominal s\u0131n\u0131r olarak tarifledikleri diyafram alt\u0131 b\u00f6lgede toplanaca\u011f\u0131n\u0131 hat\u0131rlatan yazarlar uygun g\u00f6r\u00fcnt\u00fcleme i\u00e7in \u00f6ncelikle diyafram\u0131n g\u00f6r\u00fcnt\u00fclenebilmesi gerekti\u011fi ve ultrasonografi uygulay\u0131c\u0131s\u0131n\u0131n bu b\u00f6lgenin topografik g\u00f6r\u00fcnt\u00fcs\u00fcne a\u015fina olmas\u0131 gerekti\u011fini hat\u0131rlatm\u0131\u015flar.<\/p>\r\n\r\n\r\n\r\n<p>Uygulama s\u0131ras\u0131nda esasen g\u00f6rmeyi bekledi\u011fimiz g\u00f6r\u00fcnt\u00fcn\u00fcn reverberasyon artefakt\u0131 oldu\u011funu hat\u0131rlatan yazarlar bu artefakt\u0131n hava miktar\u0131 ile do\u011fru orant\u0131l\u0131 olarak de\u011fi\u015febilece\u011fini belirtmi\u015fler. K\u00fc\u00e7\u00fck hava kabarc\u0131klar\u0131 direk olarak g\u00f6r\u00fclebilirken y\u00fcksek miktarda hava varl\u0131\u011f\u0131nda nerdeyse akci\u011fer ultrasonografisinde oldu\u011fu kadar fazla miktarda reverberasyonla kar\u015f\u0131la\u015fabilece\u011fimizi hat\u0131rlatm\u0131\u015flar (Fig 2).<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" class=\"wp-image-821\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/2\/2021\/10\/volkan-makale-2.jpg\" alt=\"\" \/>\r\n<figcaption><em>Fig 2: Sa\u011f tarafta diyafram alt\u0131 (oklar).\u00a0P &#8211; havalanan akci\u011fer; G &#8211; gaz; L &#8211; karaci\u011fer\u00a0(PMC4579755)<\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>Uygulama s\u0131ras\u0131nda klasik E-FAST\u2019den farkl\u0131 olarak hastaya yan yatarken g\u00f6r\u00fcnt\u00fcleme yap\u0131p, hava tespit edilen hastalar\u0131n s\u0131rt \u00fcst\u00fc yat\u0131r\u0131larak g\u00f6r\u00fcnt\u00fclemenin tekrarlanmas\u0131n\u0131n daha faydal\u0131 oldu\u011fu ve serbest havan\u0131n yerinin de\u011fi\u015fmesi sayesinde bat\u0131n i\u00e7i abse, kist veya Chilaiditi sendromu (kolonun karaci\u011fer ve diyafram aras\u0131nda yerle\u015fmesi) gibi di\u011fer olas\u0131 tan\u0131lar\u0131n da d\u0131\u015flanabilece\u011fi yine yazarlar taraf\u0131ndan bahsedilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p><strong>Yorumlar:\u00a0<\/strong>G\u00fcn\u00fcm\u00fcz ultrasonografi prati\u011finde acil hekimleri olarak bir\u00e7ok uygulama yapmakta ve bir\u00e7ok hastal\u0131\u011f\u0131\/durumu ba\u015far\u0131l\u0131 olarak tan\u0131yabilmekteyiz. Makalede tan\u0131t\u0131lan y\u00f6ntem ile birlikte pn\u00f6moperiteneumda ultrasonografik olarak tan\u0131mlayabilece\u011fimiz durumlar aras\u0131nda yerini alacakt\u0131r. Bu y\u00f6ntemle intestinal perforasyondan \u015f\u00fcphelendi\u011fimiz hastalar\u0131m\u0131za iyonize radyasyon maruziyeti olmaks\u0131z\u0131n tan\u0131 koyabilece\u011fiz. Hatta direk grafide g\u00f6r\u00fcnt\u00fclenemeyen k\u00fc\u00e7\u00fck miktarlardaki serbest havalar\u0131 bile tan\u0131mlayabilece\u011fiz ve bu sayede hastan\u0131n tomografiye gitmesinin \u00f6n\u00fcne ge\u00e7ebilece\u011fiz. Buna ek olarak tecr\u00fcbeli uygulay\u0131c\u0131lar perferasyonun tam lokalizasyonunu bile tan\u0131mlayabileceklerdir. Bu makale ultrasonografi prati\u011fimize yeni bir heyacan getirmesi nedeniyle olduk\u00e7a \u00f6nemil bir yay\u0131n halini alacakt\u0131r.<\/p>\r\n\r\n\r\n\r\n<p>Fakat makale bahsi ge\u00e7en y\u00f6ntemi sadece tan\u0131mlam\u0131\u015f, yeterlili\u011fi konusunda veri sunamam\u0131\u015ft\u0131r. Bahsi ge\u00e7en y\u00f6ntemin ne kadar yeterli ve g\u00fcvenilir oldu\u011fu, uygun hastalarda hem ultrasonografi hem de bir di\u011fer g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi kullan\u0131larak test edilmelidir. Elde edilen veriler sonucunda, \u00f6zg\u00fcll\u00fck, duyarl\u0131l\u0131k, pozitif ve negatif prediktif de\u011fer gibi verilerin okuyulara sunulmas\u0131 y\u00f6ntemin ba\u015far\u0131s\u0131 konusunda daha ikna edici olacakt\u0131r.<\/p>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4579755\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4579755\/<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Andrzej Smereczy\u0144ski, Katarzyna Kolaczyk Is pneumoperitoneum the terra ignota in ultrasonography? 10.15557\/JoU.2015.0016 (Okuyucuya not: terra ignota=terra incognita=bilinmeyen diyar; bkz, wikipedi, latin for&hellip;<\/p>\n","protected":false},"author":1500,"featured_media":2157,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,12],"tags":[47,78,84],"class_list":["post-2154","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-gastrointestinal-sistem-usg","tag-perforasyon","tag-pnomoperitoneum"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2154","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1500"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2154"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2154\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2157"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2154"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2154"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}