Abdomen Flashcards
What are the four quadrants of the abdomen?
Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant
What are the 9 regions of the abdomen?
Right hypochondriac region
Epigastric region
Left hypochondriac region
Right lumbar region
Umbilical region
Left lumbar region
Right iliac region
Hypogastric region
Left iliac region
What are clinical indication for the Abdomen?
A preliminary evaluation of bowel gas in an emergency
When CT is not suitable
Evaluation of radiopaque tubes and lines, and foreign bodies
Check for postprocedural intraperitoneal/retroperitonealfree gas or bowel gas
Monitoring the passage of contrast through the bowel
Colonic transit studies
Monitoringrenal calculi
Relative Contraindication = Pregnancy
What are routine projections of the Abdomen?
AP Supine (AP)
KUB (Kidneys, Ureters, Bladder)
What is the adequacy of an AP abdomen X-Ray?
Adequacy
Inclusion of diaphragm superiorly
No rotation of the abdomen symmetry of the:
ribs (superior)
iliac crests (middle)
obturator foramen(inferior)
no blurring of the bowel gas due to respiratory motion
What is AP Abdomen collimation?
AP Abdomen collimation
laterally to the lateral abdominal wall
superior to the diaphragm
inferior to the inferior pubic rami
What is collimation?
field size of x-ray
What is KUB collimation
laterally to the lateral abdominal wall
superior to the upper kidney pole
inferior to the inferior pubic rami
What are additional projections for Abdomen?
Contrast Studies
Oesophagram
Upper GI Series
Small Bowel/Small Intestines Series
Barium Enema / Lower GI Series
What are contraindications for contrast studies for abdomen?
Difficulty swallowing
Chest and abdominal pain
Reflux (a backward flow of partially digested food and digestive juices)
Unexplained vomiting
Severe indigestion
Blood in the stool (indicating internal GI bleeding)
What do contrast studied help to detect?
Help detect:
Ulcers
Tumours
Inflammation of the oesophagus, stomach and duodenum
Hiatal hernias
Scarring
Blockages
Abnormalities of the muscular wall of GI tract
Anatomical problems such as intestinal malrotation (a twisting of a baby’s intestine)
What is an Oesophagram?
An examination of the pharynx (throat) and oesophagus using still and fluoroscopic X-ray images. The X-ray pictures are taken after the patient drinks a solution that coats and outlines the walls of the oesophagus (also called a barium swallow).
What is an Upper GI series?
A series of X-rays of the oesophagus, stomach, and small intestine (upper gastrointestinal, or GI, tract) that are taken after the patient drinks a barium solution. (Barium is a white, chalky substance that outlines the organs on the X-ray.)
What is small bowel or small intestine series?
A series of X-rays of the part of the digestive tract that extends from the stomach to the large intestine. - single contrast study (oral contrast, either barium or water-soluble contrast)
What is a barium enema/lower GI series?
A series of X-rays of the lower intestine (colon) and rectum that are taken after the patient is given an enema with a white, chalky solution that contains barium. The barium outlines the intestines on the X-rays. These X-rays permit the detection of colon and rectal abnormalities including diverticulosis, diverticulitis, abnormal colon movement, dilation (widening) of the colon, polyps and cancers of the colon and rectum. Air can be instilled into the colon along with the barium contrast medium to further define structures of the large bowel and rectum. Polyps and small cancers are more readily found using this method which is called an air contrast barium enema or a double-contrast barium enema. This is the only kind of barium enema that is appropriate for detecting colorectal polyps and potentially curable colorectal cancers.
What is the systematic approach to assessing the Abdominal X-ray?
B - Bowel and other organs
small bowel, large bowel, lungs, liver, gallbladder, stomach, psoas muscles, kidneys, spleen and bladder.
B - Bones
ribs, lumbar vertebrae, sacrum, coccyx, pelvis and proximal femurs.
C – Calcification and artefact
What are the Anatomical variants, congenital and acquired abnormalities of the abdomen?
Riedel’s Lobe
Dromedary Hump
Psoas Shadow
Hepatomegaly
Splenomegaly
Porcelain Gallbladder
Cholelithiasis
Urolithiasis
What is Riedel’s Lobe?
What is it?
a tongue-like, inferior projection of the right lobe of the liver beyond the level of the most inferiorcostal cartilage or iliac crest
Not a true lobe – anatomical variant of R lobe
What causes it?
simple anatomical variation; F>M
How is it diagnosed?
X-ray: inferior aspect of the liver projects inferiorly beyond the level of the most inferiorcostal cartilage or into pelvis; liver borders are normal
Clinical Significance
Ddx: hepatomegaly
Incidental finding
Mistaken for pathological mass
What is Dromedary Hump?
What is it?
Bulge in the renal cortex
What causes it?
splenic impression on the superolateral left kidney
How is it diagnosed?
Ultrasound: Focal bulge of normal cortex in the mid-pole of the left kidney
Clinical Significance
mimic a renal mass
What is Psoas Shadow?
Psoas shadow should be visible when viewing an xray of abdomen however positive psoas sign would indicate a lack of that being visible.
What is Hepatomegaly?
What is it?
Increased liver size
What causes it?
A vast amount of causes!
Metastatic cancer; NAFLD; liver cancer; cirrhosis; viral hepatitis…
How is it diagnosed?
X-ray extension of the right lobe inferior to the lower pole of the rightkidney; rounding of the hepatic inferior border
Clinical Significance
Ddx Riedel’s Lobe
Sign of a more serious pathology
What is Splenomegaly?
What is it?
Increased spleen size
What causes it?
A vast amount of causes!
Liver disease; infections mononucleosis; portal or hepatic vein thrombosis; splenic congestion…
How is it diagnosed?
X-ray: increase in size of the spleen in the LUQ – inferior tip projects down towards pelvis
Clinical Significance
Sign of a more serious pathology
What is Cholelithiasis?
What is it?
Aka Gallstones
stone formation at any point along the biliary tree
What causes it?
Genetic
Risk factors:
Obesity; female; middle age; rapid weight loss
How is it diagnosed?
X-ray gallstones are radiopaque only in 15-20% of cases; may belaminated: radiopaque outline with lucent centre; may have a faceted outline; may show aMercedes-Benz sign: triradiate pattern of gas lucency
Clinical Significance
25% cases symptomatic
Can refer to right shoulder – Collins Sign
What is Urolithiasis?
What is it?
Aka Kidney stones that have moved into the ureters, bladder, or urethra.
Stones build up in kidneys
What causes it?
Poor fluid intake; UTIs; exercise (too much or too little);obesity; weight loss surgery; eating food with too much salt or sugar; Infections and family history
How is it diagnosed?
X-ray: calcium containing stones – radioopaque; lucent stones may contain uric acid. Occur somewhere along urinary tract, post-kidneys
Clinical Significance
Painful!
severe pain on either side of your lower back; persistent pain; haematuria; nausea or vomiting; fever and chills; cloudy urine with strong odour
