Abdo X-Rays

Question 1

What does the AXR show?

Answer 1

Colitis (Descending Colon)

• Thickening of descending colon (thick opacity)
• Reduced lumen of descending colon
• Thick white line along side of left bowel lumen = oedema of descending colon

Question 2

What does this AXR show?

Answer 2

Toxic Megacolon

• Sigmoid colon distended to >6cm
• Sigmoid colon appears as upside down U-shape
• Descending colon on left with thickened wall
• Pt requires urgent total colectomy

Question 3

What does this AXR show?

Answer 3

Colitis (Descending Colon)

• Dappled/pixelated appearance in ascending colon indicated build of of stool (which doesn’t appear solid as stool isn’t normally solid until later in colon)
• Pt has colitis in descending colon which causes reduced motility and proximal constipation of ascending colon
• Require laxative therapy

Question 4

What does this AXR show?

Answer 4

Small Intestine Obstruction

• Valvulae extend fully across the visibile organ - confirming that this is small bowel obstruction
• No large bowel (colon) visible - eliminating large bowel obstruction
• Large bowel can cause small bowel obstruction due to dysfunctional ileo-caecal valve –> allowing air to pass backward from large to small bowel
• Large bowel obstruction without small bowel dilation had ↑ risk of perforation as ileo-caecal valve is competent –> thus pressure ↑ in large bowel

Question 5

What does this AXR show?

Answer 5

Sigmoid Volvulus

• Tend to occur in elderly
• Caused by twist in sigmoid colon
• Inverted U-shape appearance = coffee-bean sign
• Apex of sigmoid colon pointing to RUQ
• Significant abdominal distention
• Treat by passing flatus tube per-rectum to decrompress –> alowing twist to untwist