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6 Cards in this Set
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Abdominal X rays Two main types Indications |
The two most commonly requested films are: - Anteroposterior (AP) supine - Anteroposterior (AP) erect, or horizontal beam view. Indications for ABX - good for detecting 'gases, masses, bones and stones' May be useful in undifferentiated abdominal pain with a provisional diagnosis of: - Toxic megacolon in acute IBD. Colonic diameter >6 cm - Bowel obstruction (50% sensitive for acute obstruction) - Bowel ischaemia - Perforation of a viscus with abdominal free air (ask for an erect CXR as well). (USS has higher sensitivity and specificity for perforation) - KUB for renal tract calculi: 80–90% sensitivity if radiolucent stone >3 mm diameter. - Foreign body—following ingestion (radiodense tablets such as iron; illicit wrapped drugs i.e. ‘body packers’), penetrating injury. [Plain AXR has 90% sensitivity for foreign body identification.]'
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General description of xray before interpretation of ABX |
General - Name and date of birth of the patient and date radiograph was performed. - Projection. - Posture (e.g. supine or erect). - Adequacy of exposure. Look for ‘gases, masses, bones and stones’. |
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Gases interpretation on ABX |
Gases - Dilated loops of small or large bowel—obstruction, ileusor inflammation - Air–fluid levels on erect AXR—more than 5 fluid levels, greater than 2.5 cm in length is abnormal and associated with obstruction, ileus, ischaemia and gastroenteritis. - Intramural gas—ischaemic colitis - Intraperitoneal gas—perforated viscus or penetrating abdominal injury. Rigler’s sign (double-wall sign) occurs when both sides of the bowel wall can be visualised and is a good indication of free intraperitoneal gas. However the sensitivity for detecting perforation on AXR is low and is best confirmed as subdiaphragmatic air on erect CXR or with a CT scan. - Extraperitoneal gas—within the soft tissues, retroperitoneal structures or chest in infection or trauma |
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MAsses interpretation on ABX |
Masses - Look for the size and position of the solid organ shadows of the liver, spleen, kidneys and bladder - Identify the retroperitoneal shadow of the psoas muscles. Bulging of the lateral margin or obliteration of the psoas shadow may indicate retroperitoneal pathology. Look for the dilated, calcified sac of a ruptured aortic aneurysm, or adjacent bony trauma (e.g. transverse process fractures). |
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Bones interpretation on ABX |
Bones - Look for abnormalities of the visible bones such as the ribs, spine, sacrum and pelvis (e.g. fractures, scoliosis, degenerative disease, tumours and metastatic deposition). - These may be incidental or provide additional information on the cause of the abdominal pain. |
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Stones interpretation on ABX |
Stones - Look for renal, ureteric and bladder stones/calcification. - Trace the course of the ureter from the pelvis of the kidney, along the tips of the lumbar spine transverse processes, over the sacroiliac joint, down to the ischial spine and medially to the bladder; 80–90% of renal tract stones are radio-opaque, but will require non-contrast CT or USS to confirm their position in the ureter. - Examine the RUQ and transpyloric plane at the level of L1 for evidence of gallstones (15% radio-opaque) or pancreatic calcification. Again, confirmation with USS or CT is indicated. |
