Acute abdominal series: Difference between revisions
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== | ==Technique== | ||
* | 3 Films: | ||
#Upright chest film | |||
#*Rule-out free air | |||
#Upright abdominal film | |||
#*Look for air-fluid levels | |||
#Supine abdominal film (''KUB = just supine film'') | |||
#*Width of bowel loops most visible (estimate of amount of distention) | |||
== | ''If pt does not tolerate upright position, left lateral decubitus abdominal film can substitute'' | ||
==Images== | |||
[[File:Medical X-Ray imaging ALP02 nevit.jpg|thumb|Normal]] | [[File:Medical X-Ray imaging ALP02 nevit.jpg|thumb|Normal]] | ||
[[File:SBO plain.png|thumb|[[Small bowel obstruction]]]] | [[File:SBO plain.png|thumb|[[Small bowel obstruction]]]] | ||
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[[File:Abdominal foreign body.png|thumb|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish.]] | [[File:Abdominal foreign body.png|thumb|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish.]] | ||
[[File:Battery in stomach.png|thumb|Button battery foreign body in the stomach.]] | [[File:Battery in stomach.png|thumb|Button battery foreign body in the stomach.]] | ||
==Interpretation== | |||
===Differentiating large and small bowel=== | |||
*Small bowel has lines (plica circulares) all the way through the bowel | *Small bowel has lines (plica circulares) all the way through the bowel | ||
*Large bowel has lines (haustra) only halfway through the bowel | *Large bowel has lines (haustra) only halfway through the bowel | ||
Bowel Diameters: 3/6/9 rule | Bowel Diameters: 3/6/9 rule | ||
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*Cecum - 9 cm | *Cecum - 9 cm | ||
===[[Small bowel obstruction]]=== | |||
*Air in colon or rectum makes complete obstruction less likely (esp if symptoms >24hr) | |||
Abdominal x-ray has poor Sn and Sp for SBO | Abdominal x-ray has poor Sn and Sp for SBO | ||
*If concerned need CT | *If concerned need CT | ||
==Indications== | |||
*Ruling out free air under the diaphragm (e.g. perforated ulcer) | |||
*Ruling out radio-opaque abdominal foreign body | |||
*Ruling in [[SBO]] (i.e. to avoid need for CT scan) | |||
;Do NOT use as the sole study to rule out [[SBO]] (poor sensitivity) | |||
;Do NOT use to rule out generalized peritonitis (e.g. [[appendicitis]]) | |||
;Do NOT use to diagnose constipation (i.e. "copious stool") | |||
==See Also== | ==See Also== | ||
Revision as of 19:31, 4 May 2015
Technique
3 Films:
- Upright chest film
- Rule-out free air
- Upright abdominal film
- Look for air-fluid levels
- Supine abdominal film (KUB = just supine film)
- Width of bowel loops most visible (estimate of amount of distention)
If pt does not tolerate upright position, left lateral decubitus abdominal film can substitute
Images
Cecal volvulus. Featureless dilated gas filled viscus, representing the volved caecum, in the left upper quadrant (black arrows) and small bowel obstruction (white arrows). No colonic gas is identified.
Interpretation
Differentiating large and small bowel
- Small bowel has lines (plica circulares) all the way through the bowel
- Large bowel has lines (haustra) only halfway through the bowel
Bowel Diameters: 3/6/9 rule
- Small bowel - 3 cm
- Colon - 6 cm
- Cecum - 9 cm
Small bowel obstruction
- Air in colon or rectum makes complete obstruction less likely (esp if symptoms >24hr)
Abdominal x-ray has poor Sn and Sp for SBO
- If concerned need CT
Indications
- Ruling out free air under the diaphragm (e.g. perforated ulcer)
- Ruling out radio-opaque abdominal foreign body
- Ruling in SBO (i.e. to avoid need for CT scan)
- Do NOT use as the sole study to rule out SBO (poor sensitivity)
- Do NOT use to rule out generalized peritonitis (e.g. appendicitis)
- Do NOT use to diagnose constipation (i.e. "copious stool")