Abdominal X-Rays for Phase 4. A Systematic Approach…

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Presentation transcript:

Abdominal X-Rays for Phase 4

A Systematic Approach…

Date of Film Patient Name Patient Age Sex Adequate area covered

Topics Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of film

Normal Intraluminal Gas Stomach : Always Small Bowel : Two or three loops of non- distended bowel –Normal diameter < 3.5 cm (jejunum) –Normal diameter < 2.5 cm (ileum) Large Bowel : Almost always in rectum/sigmoid –Normal diameter < 5 cm (colon) –Normal diameter < 9 cm (caecum)

Stomach gas Gas in a few loops of small bowel Gas in rectum Gas in ascending colon

Large or small bowel? Small Bowel Centrally placed Narrow angle of curvature Multiple loops Mucosal folds cross the full width of the bowel (valvulae conniventes) Large Bowel Peripheral Only a few loops Mucosal folds only cross part of the bowel width (haustra)

Some reflux of air into terminal ileum

Where is the level of obstruction?

Distal descending colon cancer proven at barium enema

32 year old patient, poorly controlled ulcerative colitis, presenting with bloody diarrhoea and severe abdominal pain

Very dilated transverse colon (>6cm)

Oedematous mucosa descending colon (“thumbprinting”)

Normal gas pattern in ascending colon and caecum

Sigmoid Volvulus Apex of loop in left upper quadrant

Caecal Volvulus

Management of Volvulus Sigmoid Trial of flatus tube / sigmoidoscopy Caecal Surgical

Faecal Material Mottled appearance Wide range of normal amount Within large bowel

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of film

Extraluminal Gas Invariably abnormal Exceptions –Recent laparotomy / laparoscopy (<5 days) –Gas in biliary tree after biliary intervention Only seen if large (>1 litre) amount of gas

Pneumoperitoneum

Erect Chest X-ray is the best initial test for excluding perforation

Free gas under diaphragm Pneumoperitoneum

Lateral decubitus view

Free intraperitoneal gas

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of film

Gallstones

Bladder stones

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of film

Soft Tissues AXR relatively insensitive unless very large enlargement May see bowel displacement

2 hours later ….after bladder catheterisation

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of film

Clue : 77 year old with known colon cancer and lower back pain

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects

Other foreign objects Sterilisation Clips –Should both lie in the pelvis Surgical Clips –Cholecystectomy Hip prostheses Retained swabs / needles very rare

Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects Periphery of Film

Lung bases Hernial orifices Subcutaneous tissues

Summary Clinical context is very important Remember to have a systematice approach