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Abdominal X-Rays for Phase 4

Published byKelly Spencer Modified over 9 years ago

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Presentation on theme: "Abdominal X-Rays for Phase 4"— Presentation transcript:

1 Abdominal X-Rays for Phase 4

2 A Systematic Approach…

3 …with the clinical context always in mind…

4 …avoids pitfalls!

5 General Approach

6 Date of Film Patient Name Patient Age Sex Adequate area covered

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

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

9 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)

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

11 Large or small bowel? Large Bowel Peripheral Only a few loops
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)

12

13 Mucosal folds go all the way across
Small Bowel Obstruction Mucosal folds go all the way across

14

15 Mucosal folds only partly cross bowel wall
Peripheral loop of caecum

16 Large Bowel Obstruction

17 Some reflux of air into terminal ileum

18 Where is the level of obstruction?

19 Distal descending colon cancer proven at barium enema

20

21 32 year old patient, poorly controlled ulcerative colitis, presenting with bloody diarrhoea and severe abdominal pain

22 Very dilated transverse colon
(>6cm)

23 Oedematous mucosa descending colon (“thumbprinting”)

24 Toxic Megacolon SURGICAL EMERGENCY

25

26 Haustral folds do not cross all the way across
Very dilated large bowel Haustral folds do not cross all the way across

27 Normal gas pattern in ascending colon and caecum

28 Apex of loop in left upper quadrant
Sigmoid Volvulus

29

30 Very dilated large bowel

31 Normal descending colon

32 Apex of loop centrally / left upper quadrant

33 Caecal Volvulus

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

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

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

37 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

38

39 Gas outlining peritoneal cavity
Can see both sides of the bowel wall Gas outlining peritoneal cavity

40 Pneumoperitoneum

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

42

43 Pneumoperitoneum Free gas under diaphragm

44 Pneumoperitoneum

45

46 Lateral decubitus view

47 Free intraperitoneal gas

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

49 Normal structures that calcify Abnormal structures containing calcium
Costal cartilage Pancreas Mesenteric lymph nodes Blood vessels/aneurysms Pelvic vein clots (phleboliths) Uterine fibroids Prostate gland Calculi: Biliary Bladder Renal

50

51 Gallstones

52

53 Renal Calcification

54 Calculi also within left ureter

55 BLADDER STONES

56 BLADDER STONES Bladder stones

57

58 Calcified Aortic Aneurysm

59

60 Pancreatic calcification

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

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

63

64 Bowel loops displaced Large pelvic mass

65 2 hours later ….after bladder catheterisation

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

67 …abnormalities may be coincidental
Bone pathology Generalised problem Osteopaenia Paget’s disease Ankylosing spondylitis Localised problem Fractures Osteoarthritis Metastatic deposits …abnormalities may be coincidental

68 Clue : 77 year old with known colon cancer and lower back pain
Lytic sacral met Clue : 77 year old with known colon cancer and lower back pain

69 Sacral metastasis Lytic sacral met

70

71 Fused sacro-iliac joints
Ankylosing Spondylitis Bamboo spine Fused sacro-iliac joints

72 Intraluminal gas Extraluminal gas Calcification Soft tissues Bones Foreign objects

73

74 toothbrush lightbulbs

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

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

77 Periphery of Film Lung bases Hernial orifices Subcutaneous tissues

78

79 Strangulated right inguinal hernia
Small and large bowel obstruction Strangulated right inguinal hernia

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

81 CXR Tutor …series of 9 self-directed learning presentations on Medi-CAL site Includes tubes and lines, lung cancer, pneumothorax, interstitial lung disease and a quiz

82 The End

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