1. Plain abdominal X-ray

2. Normal plain abdominal X-ray

3. Structures Normally Seen
Liver
Spleen
Kidneys
Stomach
Duodenum
Small Intestine
Cecum
Colon
Bladder
Prostate
Retroperitoneal fat

4. Structures Not Normally Seen
Gall bladder
Pancreas
Adrenals
Ovaries
Uterus
Ureters
Lymph nodes
Mesentery
Vasculature

5. What to Examine Gas pattern Extra luminal air Soft tissue masses
Calcifications
Foreign body

6. 1-calcification

7. 1-calcification
pancreas

8. kidney

9. Gall bladder

10. Suprarenal glands

11. Pancreatic mass

12. Fibroid uterus

13. Ureteric calculi

14. Calcified phicolith

15. - Gas pattern 2

16. Normal Gas Pattern *Stomach *Small Bowel *Large Bowel Always
Two or three loops of non-distended bowel
Normal diameter = cm
*Large Bowel
In rectum or sigmoid – almost always
Normal diameter= cm

17. Gas in stomach
Gas in a few loops of small bowel
Gas in rectum or sigmoid
Normal Gas Pattern

18. (Gas pattern)
Intra-luminal gas can be normal.
Extra-luminal gas is abnormal.
However, intra-luminal gas can be abnormal if it is in the wrong place or if too much is seen.

19. Normal Fluid Levels *Stomach *Small Bowel *Large Bowel
Always (except supine film)
*Small Bowel
Two or three levels possible
*Large Bowel
None normally

20. Always air/fluid level in stomach
A few air/fluid levels in small bowel
Erect Abdomen

21. Large vs. Small Bowel *Large Bowel Peripheral
Haustral markings don't extend from wall to wall
*Small Bowel
-Central
-Valvulae extend across lumen

22. Complete Abdomen Obstruction Series
*Supine
*Erect or left decubitus
*Chest - erect or supine

23. Abnormal Gas Patterns *Functional Ileus *Mechanical Obstruction
Localized (Sentinel Loops)
Generalized dynamic ileus
*Mechanical Obstruction
SBO
LBO

24. Localized Ileus Key Features
One or two persistently dilated loops of large or small bowel
Gas in rectum or sigmoid

25. Supine
Prone
Sentinel Loops

26. Generalized Ileus Key Features
Gas in dilated small bowel and large bowel to rectum
Long air-fluid levels
Only post-op patients have generalized ileus

27. Generalized Adynamic Ileus
Supine
Erect
Generalized Adynamic Ileus

28. Mechanical SBO Key Features
Dilated small bowel
Multiple fluid levels in small bowel
Little gas in colon, especially rectum

29. SBO

30. Mechanical SBO Causes Adhesions Hernia Volvulus Gallstone ileus
Intussusception
*Cause may be visible on plain film

31. Mechanical LBO Key Features
Dilated colon to point of obstruction
Little or no air in rectum/sigmoid
Little or no gas in small bowel, if…
Ileocecal valve remains competent

32. Supine
Prone
LBO

33. Mechanical LBO Causes Tumor Volvulus Hernia Diverticulitis
Intussusception

34. Extra luminal Air Free Intraperitoneal Air

35. Free Air Causes Rupture of a hollow viscus Post-op 5–7 days
Perforated ulcer
Perforated diverticulitis
Perforated carcinoma
Trauma or instrumentation
Post-op 5–7 days
NOT perforated appendix

36. 3-Soft Tissue Masses

37. Soft Tissue Masses Hepatosplenomegaly Tumor or cyst
Plain films poor for judging liver size
Tumor or cyst
Bowel displacement
*decrease of gas
*Extrinsic compression of bowel

38. Splenomegaly

39. hernia

40. Extrinsic compression of bowel
Right Renal Cyst

41. Coin in esophagus