Abdo X Ray

Question 1

Approach

Answer 1

Check pt details
Check x ray details (time, date)
Check everything is in view (diaphragm down to hernial orifices)
Large bowel and small bowel (diameter, bowel wall thickness)
Liver, gallbladder, spleen, pancreas and kidneys
Aorta
Bones

Question 2

Describe a normal large bowel

Answer 2

Around edge of abdomen
Has haustra
No wider than 6cm except caecum which can be up to 9cm

Question 3

Describe normal small bowel

Answer 3

Lying centrally
No more than 3cm in diameter
Has valvular conniventes that transverse the full width of the bowel

Question 4

What does bowel obstruction look like?

Answer 4

Dilatation of large bowel
+ small bowel if the ileo-caecal valve is incompetent

Small bowel alone = adhesions or hernia

Question 5

What does extraluminal gas look like?

Answer 5

Rigler’s sign = both sides of bowel wall visible
Free subdiaphragmatic gas = crescent sign
Hyperlucency of the liver
Continuous diaphragm sign

Question 6

Thumbprinting of bowel wall

Answer 6

Thickening of wall due to oedema, haemorrhage or trauma (usually due to IBD)

Question 7

Liver, spleen, pancreas, gallbladder and kidney abnormalities

Answer 7

Enlarged liver or spleen
Gallstones
Calcification of pancreas and kidneys

Question 8

Aorta abnormalities

Answer 8

> 3cm = aneurysm