Abdomen and Pelvis Flashcards
What defines an SBO on AXR?
Multiple dilated loops of small bowel
- Bowel contains valvulae conniventes
- bowel is central
Minimal large bowel gas
Air fluid levels +/-
What are the typical findings of an LBO/sigmoid volvulus on AXR?
Coffee bean sign
Very dilated colon
Lack of air fluid levels
What is the flowchart for diagnosing major pelvic fractures?
- Any vertical displacement? Y= Vertical shear fracture
If N move to 2 - Any pubic diastases? Y = anterior posterior compression fracture
If N move to 3 - Other fracture present? Lateral compression fracture
Which pelvic fractures do pelvic binders help with?
- Anterior-posterior compression fractures helps
- Actually makes lateral compression fractures worse
- Unclear in Vertical shear
Regarding retrograde urethrograms, is intra peritoneal or extraperitoneal rupture more common?
- Extraperitoneal more common, seen as vague haziness over the abdomen and pelvis (veil)
- Intraperitoneal has defined fluid type opacity in the paracolic gutters
What is the pelvic xray checklist?
- Assess the pelvic rings
- SI joints
- Pubic symphysis
- Arcuate lines (sacral fractures)
- Acetabulum
- Apophyses in children
- Remember other organs/tissues
How are the different major acute colon pathologies differentiated with CT scan?
Ischaemic Colitis
- pneumatosis intestinalis, pneumatosis portalis (portal vein air)
Toxic Megacolon
- Dilated >6cm
Sigmoid Volvulus
- Volvulus lacking haustra and pointing to pelvis
Acute Diverticulitis
- Segmental bowel wall thickening, diverticulae, +/- abscess
All the above may have pneumoperitoneum, not specific
What injuries on CT AP are commonly missed?
What are the indications for angiography in pelvic fractures?
- Haemodynamically unstable
- Pelvic blush on CT angio
- Haematoma >500mls
- Ongoing bleeding post angiography
- Elderly patients
