Transcript Plain abdominal X

Plain abdominal X-ray
Normal plain abdominal X-ray
Structures Normally Seen
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Liver
Spleen
Kidneys
Stomach
Duodenum
Small Intestine
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Cecum
Colon
Bladder
Prostate
Retroperitoneal fat
Structures Not Normally Seen
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Gall bladder
Pancreas
Adrenals
Ovaries
Uterus
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Ureters
Lymph nodes
Mesentery
Vasculature
What to Examine
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Gas pattern
Extra luminal air
Soft tissue masses
Calcifications
Foreign body
1-calcification
1-calcification
pancreas
kidney
Gall bladder
Suprarenal glands
Pancreatic mass
Fibroid uterus
Ureteric calculi
Calcified phicolith
2 - Gas pattern
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
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.
Normal Fluid Levels
*Stomach
– Always (except supine
film)
*Small Bowel
– Two or three levels
possible
*Large Bowel
– None normally
Always
air/fluid level
in stomach
A few
air/fluid
levels in
small bowel
Erect Abdomen
Large vs. Small Bowel
*Large Bowel
– Peripheral
– Haustral markings don't
extend from wall to wall
*Small Bowel
-Central
-Valvulae extend across lumen
Complete Abdomen
Obstruction Series
*Supine
*Erect or left decubitus
*Chest - erect or supine
Abnormal Gas Patterns
*Functional Ileus
– Localized (Sentinel
Loops)
– Generalized dynamic
ileus
*Mechanical Obstruction
– SBO
– LBO
Localized Ileus
Key Features
• One or two persistently dilated loops
of large or small bowel
• Gas in rectum or sigmoid
Supine
Sentinel Loops
Prone
Generalized Ileus
Key Features
• Gas in dilated small bowel and
large bowel to rectum
• Long air-fluid levels
• Only post-op patients have
generalized ileus
Supine
Generalized Adynamic Ileus
Erect
Mechanical SBO
Key Features
• Dilated small bowel
• Multiple fluid levels in small bowel
• Little gas in colon, especially
rectum
SBO
Mechanical SBO
Causes
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Adhesions
Hernia
Volvulus
Gallstone ileus
Intussusception
*Cause may be visible on plain film
Mechanical LBO
Key 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
Prone
Supine
LBO
Mechanical LBO
Causes
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Tumor
Volvulus
Hernia
Diverticulitis
Intussusception
Extra luminal Air
Free Intraperitoneal Air
Free Air
Causes
• Rupture of a hollow viscus
– Perforated ulcer
– Perforated diverticulitis
– Perforated carcinoma
– Trauma or instrumentation
• Post-op 5–7 days
• NOT perforated appendix
3-Soft Tissue Masses
Soft Tissue Masses
• Hepatosplenomegaly
– Plain films poor for judging liver
size
• Tumor or cyst
– Bowel displacement
*decrease of gas
*Extrinsic compression of bowel
Splenomegaly
hernia
Extrinsic compression of bowel
Right Renal Cyst
Coin in esophagus