Abdominal X-Rays Flashcards
Indications of Abdominal X-Rays (supine AP)
Emergent evaluation: suspected small bowel obstruction; pneumoperitoneum; foreign bodies; lines/tubes
If suspected bowel perforation…
order an erect CXR
Haustra
Mucosal folds of the Large bowel (colon, rectum, anus)
Valvullae conniventes
Mucosal folds of the Small bowel (duodenum, jejunum, ileum)
5 causes of Pneumoperitoneum
Perforation (PEPA FOR ME): Peptic ulcer/Endoscopic/Penetrating Abdominal injury/ingestion of FOReign body / imMEdiately post-surgery
“Decubitus abdomen sign”
Pneumoperitoneum (air-fluid level in left lateral decubitus)
“Rigler´s sign”
Pneumoperitoneum (double-wall sign -> we can see both sides of the bowel)
“Apple core sign”
Colorectal cancer (an annular constricting carcinoma of the bowel, usually the colon, from circumferential involvement of the lumen)
Causes of Hydronephrosis
PACT: Pelvic-ureteric obstruction, Aberrant renal vessels, Calculi, Tumours of the renal pelvis
Causes of RUQ pain
“HePA, Ai”: Hepatitis, Pancreatitis, Acute colecistis, Ascending colangitis
Gallstone obstructing distal small bowel + small bowel obstruction + pneumobilia
Rigler´s triad = Gallstone ileus
Patient consumes lots of alcohol, radiopaque area on the pancreas (diffuse)
Pancreatic calcifications
Causes of Pancreatic calcifications
Chronic pancreatitis due to heavy alcohol consumption (if focal/smaller calcifications: cystic fibrosis, pancreatic cancer, senile)
Old patient who had osteoarthrosis of hips, radiopaque area on femur
Hip prosthesis
Patient had fusion of their lumbar spine
Spinal hardware
Intrauterine device correct position
Upright T position, in the midline just inferior to the pelvic rim
Round metallic bright foreign body in the lower abdomen: concern
Foreign body - rule out if its a battery (can cause internal chemical burns leading to perforation, peritonitis and death): take history + review X-Ray with a Radiologist
Causes of obstruction of the small bowel
GATAh: Gallstones, Adhesions (prior surgery), Tumour, Abdominal hernia
Causes of obstruction of the large bowel
VoTu Di DiA: Volvulus, Tumour, Diverticular Disease, Abscess
The 3-6-9 rule
Upper limit of normal diameter: small bowel (3cm), colon (6cm), rectum (9cm)
“Lead pipe” appearance of colon (loss of haustral markings)
Ulcerative Colitis
10y, IBD, proffuse diarrhea or constipation, abdominal tenderness, not able to eat, with a colon >6cm diffusely on ABD X-Ray, labs: leukocytosis, anemia, hypoK, hypoMg, raised CRP, raised ESR
Toxic megacolon (in this case as a complication of IBD - failed treatment)
Causes of Toxic megacolon
3I: IBD (complication), Infection (C. difficile colitis), Ischaemic colitis
Toxic megacolon: next step
Medical Emergency -> URGENT surgical referral (total colectomy) + IV Antibiotics (ampi+metro+cipro), IV Fluids, Steroids (if IBD related: IV hydrocortisone)
