Acute abdominal series: Difference between revisions
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==Images== | ==Images== | ||
<gallery mode="packed"> | |||
File:Medical X-Ray imaging ALP02 nevit.jpg|Normal | |||
File:SBO plain.png|[[Small bowel obstruction]] | |||
File:Free air under diaphram.png|Upright chest radiograph demonstrating free intra-abdominal air below the diaphragm. (Black arrows demonstrate the air below the diaphragm) | |||
File:Cecalvolvulus.png|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. | |||
File:Abdominal foreign body.png|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish. | |||
File:Battery in stomach.png|Button battery foreign body in the stomach. | |||
==Interpretation== | ==Interpretation== |
Revision as of 19:34, 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
<gallery mode="packed"> File:Medical X-Ray imaging ALP02 nevit.jpg|Normal File:SBO plain.png|Small bowel obstruction File:Free air under diaphram.png|Upright chest radiograph demonstrating free intra-abdominal air below the diaphragm. (Black arrows demonstrate the air below the diaphragm) File:Cecalvolvulus.png|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. File:Abdominal foreign body.png|Multiple foreign bodies in the bowel; body-packing with multiple "balls" of hashish. File:Battery in stomach.png|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
- 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 bowel obstruction (i.e. to avoid need for 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")