plain abdominal x-ray. normal plain abdominal x-ray
TRANSCRIPT
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Plain abdominal X-ray
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Normal plain abdominal X-ray
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Structures Normally Seen
• Liver • Spleen• Kidneys• Stomach• Duodenum• Small Intestine
• Cecum• Colon• Bladder• Prostate• Retroperitoneal fat
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Structures Not Normally Seen
• Gall bladder• Pancreas• Adrenals• Ovaries• Uterus
• Ureters• Lymph nodes• Mesentery• Vasculature
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What to Examine
• Gas pattern• Extra luminal air• Soft tissue masses• Calcifications• Foreign body
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1-calcification
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1-calcificationpancreas
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kidney
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Gall bladder
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Suprarenal glands
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Pancreatic mass
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Fibroid uterus
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Ureteric calculi
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Calcified phicolith
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- Gas pattern2
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Normal Gas Pattern
*Stomach– Always
*Small Bowel– Two or three loops of non-distended
bowel– Normal diameter = 2.5 - 3.5 cm
*Large Bowel– In rectum or sigmoid – almost always– Normal diameter=5.5 - 7.5cm
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Gas in stomach
Gas in a few loops of small bowel
Gas in rectum or sigmoid
Normal Gas Pattern
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• (Gas pattern)
• Intra-luminal gas can be normal.
• Extra-luminal gas is abnormal.
• However, intra-luminal gas can be abnormal if it is in the wrong place or if too much is seen.
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Normal Fluid Levels
*Stomach– Always (except supine
film)
*Small Bowel– Two or three levels
possible
*Large Bowel– None normally
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Erect Abdomen
Always air/fluid level in stomach
A few air/fluid levels in small bowel
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Large vs. Small Bowel
*Large Bowel– Peripheral– Haustral markings don't
extend from wall to wall
*Small Bowel-Central
-Valvulae extend across lumen
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Complete AbdomenObstruction Series
*Supine
*Erect or left decubitus
*Chest - erect or supine
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Abnormal Gas Patterns
*Functional Ileus– Localized (Sentinel
Loops)– Generalized dynamic
ileus
*Mechanical Obstruction– SBO– LBO
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• One or two persistently dilated loops of large or small bowel
• Gas in rectum or sigmoid
Localized IleusKey Features
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Sentinel Loops
Supine Prone
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• Gas in dilated small bowel and large bowel to rectum
• Long air-fluid levels
• Only post-op patients have generalized ileus
Generalized IleusKey Features
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Generalized Adynamic Ileus
Supine Erect
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Mechanical SBOKey Features
• Dilated small bowel
• Multiple fluid levels in small bowel
• Little gas in colon, especially rectum
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SBO
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Mechanical SBOCauses
• Adhesions
• Hernia
• Volvulus
• Gallstone ileus
• Intussusception
*Cause may be visible on plain film
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Mechanical LBOKey Features
• Dilated colon to point of obstruction
• Little or no air in rectum/sigmoid
• Little or no gas in small bowel, if…– Ileocecal valve remains competent
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LBO
Supine Prone
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Mechanical LBOCauses
• Tumor
• Volvulus
• Hernia
• Diverticulitis
• Intussusception
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Extra luminal AirFree Intraperitoneal Air
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Free AirCauses
• Rupture of a hollow viscus– Perforated ulcer– Perforated diverticulitis– Perforated carcinoma– Trauma or instrumentation
• Post-op 5–7 days
• NOT perforated appendix
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3-Soft Tissue Masses
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Soft Tissue Masses
• Hepatosplenomegaly– Plain films poor for judging liver
size
• Tumor or cyst– Bowel displacement
*decrease of gas
*Extrinsic compression of bowel
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Splenomegaly
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Right Renal Cyst
Extrinsic compression of bowel
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Coin in esophagus