Abdominal X-rays

Question 1

What is the approach to abdominal X-rays? (6)

Answer 1

1. projection
2. patient details
3. technical adequancy
4. obvious abnormalities
5. systematic review of the film
6. summary

Question 2

What projection is a standard Axray taken in? (2)

Answer 2

1. AP

2. in supine projection

Question 3

What patient details should be present?

Answer 3

1. name, age, DOB, date on when the film was taken

Question 4

How do you assess for technical adequacy?

Answer 4

1. make sure the entire abdomen is visible on the film

2. region from the diaphragm down to past the pubis

Question 5

How do you do a systematic review? (10)

Answer 5

1. foreign bodies
2. assess bowel
3. assess large bowel
4. assess small bowel
5. assess for extra-luminal gas
6. assess for oedema of the bowel wall
7. assess for the liver, spleen and gall bladder
8. assess the abdominal aorta
9. look for kidney stones
10. bones

Question 6

What do you look for in terms of foreign bodies?(2)

Answer 6

1. surgical clips

2. indwelling lines

Question 7

What do you assess for when looking at the bowel? (4)

Answer 7

1. type
2. size
3. cause of abnormalities
4. extra - luminal and intra-luminal content

Question 8

What colour is air and what colour is faeces? (2)

Answer 8

1. air is black

2. faeces is mottled grey

Question 9

What do you look for when assessing the large bowel? (10)

Answer 9

1. runs on the outside of the abdomen
2. haustra - on partially cross
3. large bowel = 5cm width
4. caecum = 8cm
5. identify rectum first = contains air
6. follow up to left edge of sigmoid colon
7. then up to descending colon and splenic flexure
8. follow transverse colon = middle of the film
9. ascending colon = hepatic flexure
10. down to caecum

Question 10

What do you do when assessing for small bowel? (3)

Answer 10

1. lies centrally
2. no more than 3cm in diameter
3. valvulae conniventes - full width

Question 11

What can be seen at the level of large bowel obstruction?

Answer 11

1. level of obstruction is normally clear

Question 12

What is a common cause for large bowel obstruction?

Answer 12

1. malignancy

Question 13

What is another cause of a large bowel obstruction?

Answer 13

1. caecal or sigmoid volvulus = coffee bean sign

Question 14

What is the cause of small bowel obstruction? (2)

Answer 14

adhesions or hernia

• look for evidence of surgery - adhesions

Question 15

Where do you look for inguinal hernias?

Answer 15

inguinal hernia orifices

Question 16

Why would you ask for a Cxray? (2)

Answer 16

1. if you suspect bowel perforation

2. as there maybe abnormal air around the diaphragm

Question 17

What is rigler’s sign?

Answer 17

you can clearly see both sides of the bowel wall as air is also outside the wall

• normal = only inner wall is seen

Question 18

What is a football sign and who is it commonly found in?

Answer 18

round area of air

usually towards the top of the film

found in neonates

Question 19

In whom can perforation occur in? (5)

Answer 19

1. bowel obstruction
2. gallstone disease
3. inflammatory condition e.g. Crohn’s
4. appendicitis
5. trauma

Question 20

What is thumb printing and who does it tend to occur in? (2)

Answer 20

• thickening of the bowel wall caused by oedema

- occurs in inflammatory bowel disease and ischaemic colitis

Question 21

What could a massively enlarged bowel be indicative of? (2)

Answer 21

1. toxic megacolon

2. inflammatory bowel disease esp. UC

Question 22

What do you look for when assessing the spleen , liver and gall bladder? (2)

Answer 22

1. size

2. gall stones - majority won’t be seen as they are radiolucent

Question 23

What do you look for when looking at the abdominal aorta? (3)

Answer 23

1. calcification
   - 2 edges can be seen and measured
2. aneurysm
   - less than 3cm = normal
   - greater than 3 cm = aneurysm
3. dissection
   - absent psoas shadows
   - suggests blood in the retroperitoneum

Question 24

How do you assess the kidneys and what do you look for?

Answer 24

1. stones
   - calcifications along the renal tract
   - usually at T12/L2
   - classically obstruct - renal pelvis, pelvo-ureteric junction and vesico-ureteric junction
   - bladder stones
2. phlebiths
   - calcified renal vessels
   - often mistaken for renal or bladder stones

Question 25

What do you assess for when looking at the bones? (2)

Answer 25

1. pelvic and hip fractures
2. spine
   - osteoporotic fractures
   - scoliosis
   - metastatic deposits

Question 26

What do you state in the summary? (3)

Answer 26

1. key findings
2. diagnosis
3. management plan