Radiography of Abdomen

Question 1

Standard radiographic views of the abdomen

Answer 1

Supine abdomen
Upright abdomen
Upright chest
Need all of these to properly assess the abdomen
All done in AP

Question 2

4 steps in a systematic approach to radiographs

Answer 2

Bones
Soft tissues
Gas (normal and abnormal)
Calcifications (always abnormal)

Question 3

5 bones in the pelvis

Answer 3

Ilum
Sacrum
Coccyx
Pubis
Ischium

Question 4

What 4 shadows are you usually able to see on AXR

Answer 4

Liver
Renal
Splenic (not really)
Psoas

Question 5

3-6-9 rule

Answer 5

Small bowel: 3 cm
Large bowel: 6 cm
Cecum: 9 cm
Should all be less than this to be normal

Question 6

Valvulae conniventes

Answer 6

Can see them in dilated small bowel
Unique mucosal folds that cross the lumen
Way to tell between small and large bowel loops

Question 7

Haustra

Answer 7

Mucosal folds that do not cross the lumen of the bowel

Allows for distinction between small and large bowel loops

Question 8

How can you tell if there is abnormal air in the intestine

Answer 8

Look at air fluid levels
Get patient to stand and lie on side
If there are flat areas of gas/fluid on X-ray that is bad
More than 3 is abnormal (but clinically would get CT if you see any)

Question 9

Intra-peritoneal vs retroperitoneal gas

Answer 9

Pneumoperitoneum is a medical emergency

Pneumoretroperitoneum is not treated surgically

Question 10

What is
1. Supine frontal AXR
2. Upright frontal AXR
3. Upright CXR
best at detecting?

Answer 10

1. Bowel gas pattern
2. Air fluid levels
3. Intra-abdominal air