Interpretations of abdominal X-Rays Flashcards

1
Q

How to confirm patient details on AXR?

A
  • Name
  • Hospital Number
  • DOB
  • Date and time of X-ray
  • Establish whether previous imaging is available
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2
Q

How to assess the image type?

A
  • Assess projection of image
  • Anterior-posterior (supine)
  • Anterior-Posterior (erect)
  • Exposure•Is the whole abdomen visible? (Diaphragm to pelvis)
  • Are you able to see small bowel/large bowel?
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3
Q

What is this?

A

Normal AXR

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4
Q

Explain the interpretation of AXR

A
  • Structured approach (BBC)

Bowel (and other organs – SB, LB, Lungs, Liver, GB, Stomach, psoas, Kidney, spleen, Bladder)

Bones (Ribs, vertebrae, sacrum, coccyx, pelvis)

Calcification (eg renal stones, Gallstones, aorta)•

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5
Q

What is the difference between the small bowel and large bowel?

A
  • Distribution (SB usually lies centrally, with the large bowel ‘framing’ it)
  • SB mucosal folds (Valvulae conniventes) – visible across full width of bowel
  • Large bowel wall features haustra (thicker than valvulae conniventes and typically does not appear to traverse the width of the bowel)
  • Faeces (mottled appearance in large bowel, due to air trapping in solid faeces)
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6
Q

What is circled in the AXR?

A

Faeces

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7
Q

What are the different diameters of the bowel?

A
  • Upper limits
    • Small bowel (3cm)
    • Colon (6cm)
    • Caecum (9cm)
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8
Q

What are the features of small bowel obstruction?

A
  • Features:
    • Dilatation of small bowel (>3cms)
    • Prominent valvulae conniventes
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9
Q

What are the causes of small bowel obstruction?

A
  • Causes:
    • Adhesions (75%)
    • Abdominal hernias
    • Intrinsic/extrinsic compression (eg tumours)
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10
Q

What is this?

A

Small bowel obstruction

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11
Q

What are under-exposed AXR’s look like?

A

Lighter → harder to read

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12
Q

What does an over-exposed AXR look like?

A

Darker

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13
Q

What is this?

A

Gallstone ileus

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14
Q

What are the causes of large bowel obstruction?

A

Causes:

  • Colorectal Cancer
  • Diverticular stricture
  • Hernia
  • Volvulus
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15
Q

What is this?

A

Large bowel obstruction

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16
Q

What is this?

A

Sigmoid volvulus

17
Q

What is the characteristic appearance of sigmoid volvulus?

A

Sigmoid volvulus:

a characteristic ‘coffee bean’ appearance

18
Q

What is this?

A

Sigmoid volvulus

19
Q

What is this?

A

Rigler’s sign

20
Q

What is Rigler’s sign?

A

In healthy individuals, only the inner wall of the bowel should be visible on an abdominal X-ray. The presence of free air within the abdomen (pneumoperitoneum) can result in both sides of the bowel wall becoming visible (this is known as Rigler’s sign)

21
Q

What is this?

A

Perforation (free air under the diaphragm)

22
Q

What does a perforation cause?

A

Free air under the diaphragm

23
Q

What are some inflammatory bowel diseases & their features?

A
  • Crohn’s disease
  • Ulcerative colitis
    • Thumbprinting
    • Lead-pipe (featureless) colon
    • Toxic megacolon
24
Q

What is thumbprinting?

A

Thumbprinting: mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprints projecting into the lumen.

25
Q

What is lead-pipe (featureless) colon?

A

Lead-pipe (featureless) colon: loss of normal haustral markings secondary to chronic colitis.

26
Q

What is a toxic megalocolon?

A

Toxic megacolon: colonic dilatation without obstruction associated with colitis.

27
Q

What is this?

A

Ulcerative colitis showing ‘lead piping’

28
Q

What is this?

A

Thumb-printing in ulcerative colitis

29
Q

What are some other organs to see on AXR (or look out for)?

A
  • Lungs: inspect the lung bases for pathology (e.g. consolidation) as abdominal pain can, in some cases, be caused by basal pneumonia.
  • Liver: a large right upper quadrant structure.
  • Gallbladder: rarely visible on an abdominal X-ray, however, you should quickly inspect for calcified gallstones and cholecystectomy clips.
  • Stomach: visible between the left upper quadrant and midline, containing a variable amount of air.
  • Psoas muscles: the lateral edge is marked by a relatively straight line either side of the lumbar vertebrae and sacrum.
  • Kidneys: both are often visible, the right kidney is lower than the left due to the presence of the liver on the right.
  • Spleen: located in the left upper quadrant, superior to the left kidney.
  • Bladder: has a variable appearance depending on the fullness of the bladder.
30
Q

What bony structures can be seen on an AXR?

A
  • Bony structures commonly visible on abdominal X-ray include:
    • Ribs
    • Lumbar vertebrae
    • Sacrum
    • Coccyx
    • Pelvis
    • Proximal femurs
31
Q

How can bony metastasis be seen on AXR?

A
  • From prostate cancer can be seen as either more white on AXR or sometimes more dark
32
Q

What can be seen as high density (white) areas on AXR?

A
  • Various high density (white) areas of calcification or artefact may be noted on abdominal X-ray including:
    • Calcified gallstones in the right upper quadrant
    • Renal stones/staghorn calculi
    • Pancreatic calcification
    • Vascular calcification
    • Costochondral calcification
    • Contrast (e.g. following a barium meal)
    • Surgical clips
    • Jewellery
33
Q

What is this?

A

Renal stent

34
Q

What is this?

A

Renal stone

35
Q

What is this?

A

Belly-button piercing

36
Q

What is this?

A

Adhesions - small bowel dilation