1. Introduction to Surgical Department AXR
Presented by
Dr.MOHAMMED MAREE
Surgical Department
Al- Makassed Hospital

2. Abdominal X-Ray Views Anteroposterior (AP) supine
Anteroposterior (AP) erect, or horizontal beam view
KUB (kidneys, ureters, bladder)—follow-up passage of renal tract calculi.
Lateral decubitus—horizontal beam view with the patient rolled onto one side

4. A systematic approach to AXR interpretation
Name and date of birth of the patient and date radiograph was performed.
Projection.
Posture (e.g. supine or erect).
Adequacy of exposure. Look for ‘gases, masses, bones and stones’.

6. Gases Small bowel Large bowel
Look for normal or abnormal intraluminal and extraluminal gas distribution
Small bowel
Intraluminal gas is usually minimal, centrally located within numerous tight loops of small diameter (2.5–3.5 cm), distinguished by valvulae conniventes (Stack of coins).
Large bowel
Has a mixture of gas and faeces located within loops of larger diameter (3–5 cm) around the periphery, with haustra.

8. Abnormal findings Dilated loops of small or large bowel
Air–fluid levels on erect AXR
Intramural gas
Intraperitoneal gas—perforated viscus or penetrating abdominal injury. Rigler’s sign (double-wall sign) occurs when both sides of the bowel wall can be visualized and is a good indication of free intraperitoneal gas. However the sensitivity for detecting perforation on AXR is low and is best confirmed as sub diaphragmatic air on erect CXR or with a CT scan.
Extra peritoneal gas—within the soft tissues, retroperitoneal structures or chest in infection or trauma.

9. Air–fluid levels

10. Air–fluid levels

11. Intraperitoneal gas

12. Extraperitoneal gas

13. Intramural gas

14. Masses
Look for the size and position of the solid organ shadows of the liver, spleen, kidneys and bladder
Identify the retroperitoneal shadow of the psoas muscles. Bulging of the lateral margin or obliteration of the psoas shadow may indicate retroperitoneal pathology. Look for the dilated, calcified sac of a ruptured aortic aneurysm, or adjacent bony trauma (e.g. transverse process fractures).

17. Calcify aortic aneurysm

18. Bones
Look for abnormalities of the visible bones such as the ribs, spine, sacrum and pelvis (e.g. fractures, scoliosis, degenerative disease, tumours and metastatic deposition).

19. Bones

20. Bones

21. Stones Look for renal, ureteric and bladder stones/calcification.
Trace the course of the ureter from the pelvis of the kidney, along the tips of the lumbar spine transverse processes, over the sacroiliac joint, down to the ischial spine and medially to the bladder; 80–90% of renal tract stones are radio-opaque, but will require non-contrast CT or USS to confirm their position in the ureter.
Examine the RUQ and transpyloric plane at the level of L1 for evidence of gallstones (15% radio-opaque) or pancreatic calcification. Again, confirmation with USS or CT is indicated.

22. renal, ureteric and bladder

24. KUB