Abdominal X-rays Flashcards
What is the approach to abdominal X-rays? (6)
- projection
- patient details
- technical adequancy
- obvious abnormalities
- systematic review of the film
- summary
What projection is a standard Axray taken in? (2)
- AP
2. in supine projection
What patient details should be present?
- name, age, DOB, date on when the film was taken
How do you assess for technical adequacy?
- make sure the entire abdomen is visible on the film
2. region from the diaphragm down to past the pubis
How do you do a systematic review? (10)
- foreign bodies
- assess bowel
- assess large bowel
- assess small bowel
- assess for extra-luminal gas
- assess for oedema of the bowel wall
- assess for the liver, spleen and gall bladder
- assess the abdominal aorta
- look for kidney stones
- bones
What do you look for in terms of foreign bodies?(2)
- surgical clips
2. indwelling lines
What do you assess for when looking at the bowel? (4)
- type
- size
- cause of abnormalities
- extra - luminal and intra-luminal content
What colour is air and what colour is faeces? (2)
- air is black
2. faeces is mottled grey
What do you look for when assessing the large bowel? (10)
- runs on the outside of the abdomen
- haustra - on partially cross
- large bowel = 5cm width
- caecum = 8cm
- identify rectum first = contains air
- follow up to left edge of sigmoid colon
- then up to descending colon and splenic flexure
- follow transverse colon = middle of the film
- ascending colon = hepatic flexure
- down to caecum
What do you do when assessing for small bowel? (3)
- lies centrally
- no more than 3cm in diameter
- valvulae conniventes - full width
What can be seen at the level of large bowel obstruction?
- level of obstruction is normally clear
What is a common cause for large bowel obstruction?
- malignancy
What is another cause of a large bowel obstruction?
- caecal or sigmoid volvulus = coffee bean sign
What is the cause of small bowel obstruction? (2)
adhesions or hernia
- look for evidence of surgery - adhesions
Where do you look for inguinal hernias?
inguinal hernia orifices
Why would you ask for a Cxray? (2)
- if you suspect bowel perforation
2. as there maybe abnormal air around the diaphragm
What is rigler’s sign?
you can clearly see both sides of the bowel wall as air is also outside the wall
- normal = only inner wall is seen
What is a football sign and who is it commonly found in?
round area of air
usually towards the top of the film
found in neonates
In whom can perforation occur in? (5)
- bowel obstruction
- gallstone disease
- inflammatory condition e.g. Crohn’s
- appendicitis
- trauma
What is thumb printing and who does it tend to occur in? (2)
- thickening of the bowel wall caused by oedema
- occurs in inflammatory bowel disease and ischaemic colitis
What could a massively enlarged bowel be indicative of? (2)
- toxic megacolon
2. inflammatory bowel disease esp. UC
What do you look for when assessing the spleen , liver and gall bladder? (2)
- size
2. gall stones - majority won’t be seen as they are radiolucent
What do you look for when looking at the abdominal aorta? (3)
- calcification
- 2 edges can be seen and measured - aneurysm
- less than 3cm = normal
- greater than 3 cm = aneurysm - dissection
- absent psoas shadows
- suggests blood in the retroperitoneum
How do you assess the kidneys and what do you look for?
- stones
- calcifications along the renal tract
- usually at T12/L2
- classically obstruct - renal pelvis, pelvo-ureteric junction and vesico-ureteric junction
- bladder stones - phlebiths
- calcified renal vessels
- often mistaken for renal or bladder stones
What do you assess for when looking at the bones? (2)
- pelvic and hip fractures
- spine
- osteoporotic fractures
- scoliosis
- metastatic deposits
What do you state in the summary? (3)
- key findings
- diagnosis
- management plan
