Common Abdo Xray Findings: Investigations, Management, Complications

Question 1

Introduction

Answer 1

This is the abdominal xray of (name, DOB), taken on (date, time) presenting with (PC).
Is there any previous imaging for comparison?
I would like to take you through my findings

Question 2

1. Adequacy

what are you assessing

Answer 2

Adequacy
Projection
-AP supine
-AP erect

Exposure - diaphragm to pelvis visible
-both small and large bowel visible

Question 3

2. Bowel and organs

what are you assessing

Answer 3

Small bowel
-3cm, valvulae conniventes
Large bowel
-6cm colon
-9cm cecum
-haustra (halfway)

Lung bases - lower lobe pneumonia (consolidation)
Liver - large RUQ structure
Gallbladder - calcified gallstones, cholecystectomy clips
Stomach - LUQ, midline with air
Psoas - lateral to spine
Kidney - R lower than L
Spleen - RUQ above L kidney
Bladder - variable depending on fullness

Question 4

3. Bones

- what are you assessing

Answer 4

Ribs
Lumbar vertebrae
Sacrum
Coccyx
Pelvis
Proximal femur

Question 5

4. Calcification and artefacts

Answer 5

Calcification

• gallstones in RUQ
• renalstones
• pancreatic, vascular valcification

Contrast from barium meal

Surgical clips

Question 6

Small bowel obstruction

• possible findings
• most common causes
• presentation
• investigations
• management

Answer 6

SB 3cm+, airfilled
Prominent VC - coil springing
Artefacts from past surgeries

Adhesions
Hernias
Strictures from inflammation

Abdo pain, distention, absolute constipation, N+V

• tinkling sounds
• tympanic percussion
• focal tenderness

Urgent bloods

• FBC, CRP, LFT - baseline
• U&E - electrolyte derangements from fluid loss
• VBG lactate - ischemia
• INR, G&S - prep for surgery

Gastrograffin AXR
Definitive - IV contrast abdo, pelvic CT

Conservative - drip and suck
-IV fluids, correct electrolytes
-NBM, NG tube decompression
-urinary catheter and fluid balance
-analgesia, antiemetics
Surgical if unlikely to settle
-laparotomy

Bowel ischemia, perforation
Dehydration => AKI

Question 7

Large bowel obstruction

• possible findings
• most common causes
• presentation
• investigations
• management
• complications

Answer 7

Dilated bowel - 6cm+sigmoid, 9cm+cecum
Haustra

Sigmoid volvulus - coffeebean
Cecal volvulus - fetal

Colorectal cancer
Diverticular strictures
Volvulus

Abdo pain, distention, absolute constipation, N+V

• tinkling sounds
• tympanic percussion
• focal tenderness

Urgent bloods

• FBC, CRP, LFT - baseline
• U&E - electrolyte derangements from fluid loss
• VBG lactate - ischemia
• INR, G&S - prep for surgery

Gastrograffin AXR
Definitive - IV contrast abdo, pelvic CT

Conservative - drip and suck
-IV fluids, correct electrolytes
-NBM, NG tube decompression
-urinary catheter and fluid balance
-analgesia, antiemetics
Surgical if unlikely to settle
-laparotomy

Bowel ischemia, perforation
Dehydration => AKI

Question 8

Bowel perforation

• possible findings
• presentation
• investigations
• management
• complications

Answer 8

Riglers sign - inner and outer wall visible

Widespread tenderness, guarding
No bowel sounds

FBC, U&E, LFT, CRP - baseline, electrolyte derangements
INR, G&S - surgery needed
VBG lactate - metabolic derangement, ischemia
Erect CXR - pneumperitoneum
CT abdo/pelvis - localise perforation

Initial - fluid resus, ABx, analgesia, NBM
Definitive - surgical repair with midline laparotomy with lavage and irrigation

Sepsis
Ischemia and necrosis
Adhesions postop

Question 9

IBD

• possible findings
• presentation
• investigations
• management
• complications

Answer 9

Thumbprinting - haustral thickening
Leadpiping - loss of haustra
Toxic megacolon - dilation without obstruction

Bloody diarrhoea, abdo pain
Weight loss, fatigue
Abdo distention, tenderness, fever

FBC, U&E, CRP - baseline and electrolyte derangements
CT abdo, pelvis - confirm diagnosis
ABG lactate - ischemia

Initial - analgesia, fluid resus, broad spec ABx, CS, NBM
Surgery if no improvement - abdo colectomy with end ileostomy

Perforation
Sepsis, ischemia
Adhesions, anastomotic leak