X-RAY ABDOMEN-APPROACH
Surendra Rayamajhi- Resident
INDICATIONS
◻ Suspected bowel obstruction
◻ Suspected perforation
◻ Moderate to severe undifferentiated abdominal
pain
◻ Renal calculi F/U
◻ Suspected intra-abdominal foreign body
PROJECTIONS
◻ Basic – AP supine X-ray
◻ Additional
Ap erect X-ray
Chest X-ray
Supine X-ray with horizontal beam
Lateral decubitus X-ray with horizontal beam
RADIOGRAPH QUALITY-
◻ INCLUSION
◻ EXPOOSURE
AxR- NORMAL ANATOMY
AxR- NORMAL ANATOMY
AxR- NORMAL ANATOMY
SMALL AND LARGE BOWELS
APPROACH- ABDO X
◻ A – AIR IN THE WRONG PLACE
◻ B - BOWEL
◻ D – DENSE STRUCTURE (BONES) AND
CALCIFICATIONS
◻ O – ORGANS AND SOFT TISSUES
◻ X – eXternal objects, lines and tubes
A- AIR IN THE WRONG PLACE
◻ Pneumoperitoneum
◻ Pneumoretroperitoneum
◻ Pneumatosis intestinalis
◻ Pneumobilia
◻ Portal venous air
◻ Others- emphysematous cholecystitis,
emphysematous cystitis
PNEUMPOPERTIONEUM
◻ Perforated
peptic ulcer
◻ Perforated
appendix/
diverticulum
◻ Post surgery
◻ trauma
AIR UNDER DIAPHRAGM/ CRESCENT
SIGN
4. RIGLER’S SIGN
6.FALCIFORM LIGAMENT SIGN
PNEUMATOSIS INTESTINALIS
PNEUMORETROPERITONEUM
◻ BOWEL
PERFORATION
Pos duodenal
perforation, asc
or desc colon
perforation,
◻ POST-SURGICAL
- residual air
from urological
or spinal surgery
PNEUMOBILIA
◻ RECENT ERCP/
POST
SPHINCTEROTOMY
◻ EXTERNAL BILIARY
DRAIN INSERTION
◻ BILIARY ENTERIC
CONNECTION
POST WHIPPLE-
SURGICAL
ANASTOMOSIS
SPONTANEOUS-
GALL STONE ILEUS
◻ INFECTION
EMPHYSEMATOUS
CHOLECYSTITIS
PORTAL VENOUS GAS
◻ ISCHEMIC
BOWEL
(mc)
◻ NEC IN
INFANTS
◻ SEVERE
INTRAABD
OMINAL
SEPSIS
EMPHYESAMOTOUS CYSTITIS
B- BOWEL
◻ Look at the bowel loops for small or large bowel
dilatation
◻ Look for very large dilated loop of bowel that
could represent sigmoid or caecal volvulus
◻ Look at the rt/lt iliac regions for inguinal or femoral
hernia
◻ Look for thickening of the bowel that suggest
inflammation
DILATED SMALL BOWEL
◻ MECHANICAL
OBSTRUCTION
◻ ILEUS- FAILURE
OF PERISTALSIS
POST-OP,
INTRA-ABDOMIN
AL INFECTION
OR SEPSIS
ANTICHOLINERG
IC DURGS
RADIOLOGICAL SIGNS TO IDENTIFY
SMALL BOWEL OBSTRUCTION
◻ Dilated > 3 cm
(normal adult
vertebra height is
usually 4 cm)
◻ Central location
◻ Valvulae conniventes
SENTINEL LOOP
◻ Localised ileus
from the near by
inflammation
◻ Seen in acute
pancreatitis
RIGLER’S TRIAD
◻ PNEUMOBILIA
◻ SMALL
BOWEL
OBSTRUCTIO
N
◻ GALL STONE
IN RIF, BUT
ONLY VISIBLE
IN20-30% OF
CASES
DILATED ARGE BOWEL
◻ CAUSES
MALIGNANCY-
MCC
STRICTURE DUE
TO
DIVERTICULAR
DISEASE
FECAL
IMPACTION
VOLVULUS
VOLVULUS
DILATED STOMACH
HERNIA- loops of gas filled bowel seen
below inguinal ligament
BOWEL WALL INFLAMMATION
◻ MC IN LARGE BOWEL
◻ COMMON CAUSES- IBD,
ISCHEMIC BOWEL, INFECTION
(PSEUDOMEMBRANOUS COLITIS)
◻ RADIOLOGICAL SIGNS
BOWEL WALL THICKENING
■ THUMB PRINTING- THICK HAUSTRA
■ FEATURELESS BOWEL- CHRONIC
NFLAMMATION- LEAD PIPE
LOSS OF FORMED FECAL MATTER
IN LT SIDE OF COLON
LEAD PIPE APPEARANCE OF BOWEL
TOXIC MEGACOLON
FECAL LOADING N FECAL IMPACTION
ASCITES
D- DENSE STRUCTURS AND
CALCFICATIONS
CHOLELITHIASIS N PORCELAIN GALL BLADDER
UROLITHIASIS
UROLITHIASIS
NEPHROCALCINOSIS
◻ HYPERTHYR
OIDISM
◻ MEDULLARY
SPONGE
DISEASE
◻ RENAL
TUBULAR
ACIDOSIS
PANCREATIC CALCIFICATIONS
ADRENAL CALCIFICATION
◻ INCIDE
NTAL
FINDIN
G;A/W
PREVIO
US TB
OR
ADREN
AL HGE
AAA CALCIFICATION
NORMAL CALIBER AA CALCIFICATION
FRACTURES
SCLEROTIC N LUCENT BONY LESION
PEDILCE
BAMBOO SPINE
ORGANS n SOFT TISSUE
◻ SOLID
ORGAN
ENLARGEMET
◻ ABDOMINAL/
PELVIC
MASSES
X-eXternal objects, lines and tubes
X-eXternal objects, lines and tubes
◻ thank - you
