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46 - Abdominal x-ray

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Clinical Radiology, Royal Free Hospital, London Deanery, London, UK
Petrut Gogalniceanu
Affiliation:
Postgraduate School of Surgery
John Curtis
Affiliation:
University Hospital Aintree
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Introduction

‘This is an abdominal x-ray with the entire abdomen and pelvis imaged.’ Although unlikely, mention if there are any intra-abdominal areas not imaged.

Summary

ABCS:

A Address

A Adequacy

A Artefacts

A Air

B Bowel

B Bone

C Calcification

S Soft tissues and viscera

Checklist

Address

• Name and date of birth

Adequacy

• Lung bases to pubic bone

• Lateral edges of abdominal wall

Artefacts

• Intrauterine devices

• Surgical instruments

• Intrabdominal drainage tubes

• Stents (biliary tree/ureteric/aortic/colonic)

• Foreign objects: buttons, coins, body piercings

Air (extraluminal gas)

• Pneumoperitoneum: free air under the diaphragm; evidence of hollow viscus perforation

• Rigler ’ s sign

• Biliary tree (pneumobilia):

• normal after biliary surgery

• fistula between bowel and biliary tree

• biliary sepsis, e.g. cholangitis

• Bowel wall:

• bowel ischaemia or necrotising enterocolitis (pneumatosis coli/intestinalis)

• toxic megacolon

• Portal vein: the presence of gas in the portal vein indicates bowel ischaemia or mesenteric sepsis. Portal venous gas is unlike biliary tract gas in that it is more difficult to see on AXR and will branch out to the periphery of the liver. Biliary tract gas tends to be more central in position.

• Pseudopneumoperitoneum: intraluminal (usually colonic) gas in a loop of intestine interpositioned between liver and right hemi-diaphragm (Chiliaditi's sign).

Bowel (bowel gas pattern)

• Obstruction:

• distended bowel loops

• volvulus/closed loop obstruction

• Faeces and constipation:

• mottled appearance within lumen of the bowel

• Toxic megacolon

Bone

• Vertebrae: crush fractures, bamboo spine, Paget's disease, malignancy

• Hips: fractures, osteoarthritis

• Pelvis: fractures of pelvis, femoral heads and necks, metastases or primary malignancy, Paget's disease

Calcifications

• Kidneys and ureters: staghorn calculus, renal, ureteric and vesical stones

• Gallstones

• Appendicolith

• Aorta, iliacs and splanchnic vessels: atherosclerosis

• Pancreas: chronic calcific pancreatitis

• Fibroids

• Prostate

Soft tissues

• Liver contour

• Spleen contour

• Kidney contour (between T12 and L2)

• Psoas muscle shadows: if one is obliterated, it suggests retroperitoneal pathology (abscess, haemorrhage)

• Bladder: calcified or containing air (schistosomiasis, TB)

• Soft tissue: loss of peritoneal lines, surgical emphysema, bacterial infection with gas-forming organisms

Examination notes

What are the principles of fluoroscopy?

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 396 - 403
Publisher: Cambridge University Press
Print publication year: 2015

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