Acute abdominal series: Difference between revisions
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==Interpretation== | ==Interpretation== | ||
<gallery mode="packed"> | |||
File:Medical X-Ray imaging ALP02 nevit.jpg|Normal | |||
File:SBO plain.png|[[Small bowel obstruction]] | |||
File:Cecalvolvulus.png|Large bowel obstruction (Cecal [[volvulus]]; black arrows), with small bowel obstruction (white arrows). | |||
File:Free air under diaphram.png|Free intra-abdominal air below the diaphragm. | |||
File:Abdominal foreign body.png|Body-packing with multiple foreign bodies ("balls" of hashish). | |||
File:Battery in stomach.png|Button battery in stomach. | |||
</gallery> | |||
===Differentiating large and small bowel=== | ===Differentiating large and small bowel=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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*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== | ==Indications== | ||
Revision as of 19:56, 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
Interpretation
Normal
Large bowel obstruction (Cecal volvulus; black arrows), with small bowel obstruction (white arrows).
Free intra-abdominal air below the diaphragm.
Body-packing with multiple foreign bodies ("balls" of hashish).
Button battery in stomach.
Differentiating large and small bowel
| Location | Size | Lines |
| Small bowel | 3 cm | All the way through the bowel (plica circulares) |
| Colon | 6 cm | Only halfway through the bowel (haustra) |
| 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 (e.g. swallowed battery)
- Ruling in bowel obstruction (i.e. to avoid need for subsequent CT scan)
- Do NOT use as the sole study to rule out bowel obstruction (poor sensitivity)
- Do NOT use to rule out generalized peritonitis (almost no sensitivity for diagnoses such as appendicitis)
- Do NOT use to diagnose constipation (many patient with acute abdomen will have "copious stool")