Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
46 - Abdominal x-ray
from Section 11 - Surgical radiology
Published online by Cambridge University Press: 05 July 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- 44 Principles of plain film
- 45 Chest x-ray
- 46 Abdominal x-ray
- 47 Mammogram
- 48 Facial x-ray
- 49 Cervical spine x-ray
- 50 Shoulder x-ray
- 51 Elbow x-ray
- 52 Wrist and distal forearm x-ray
- 53 Pelvis and hip x-ray
- 54 Knee x-ray
- 55 Foot and ankle x-ray
- 56 Principles of CT
- 57 Head CT
- 58 Chest CT
- 59 Abdomen CT
- 60 Aorta CT
- 61 Kidneys, ureter and bladder CT
- 62 Lower limb CT angiogram
- Section 12 Airway, trauma and critical care
- Index
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 SurgeonsAn Aid to the MRCS OSCE, pp. 396 - 403Publisher: Cambridge University PressPrint publication year: 2015