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Plain abdominal X-ray
Normal plain abdominal X-ray
Structures Normally Seen
• Liver • Spleen• Kidneys• Stomach• Duodenum• Small Intestine
• Cecum• Colon• Bladder• Prostate• Retroperitoneal fat
Structures Not Normally Seen
• Gall bladder• Pancreas• Adrenals• Ovaries• Uterus
• Ureters• Lymph nodes• Mesentery• Vasculature
What to Examine
• Gas pattern• Extra luminal air• Soft tissue masses• Calcifications• Foreign body
1-calcification
1-calcificationpancreas
kidney
Gall bladder
Suprarenal glands
Pancreatic mass
Fibroid uterus
Ureteric calculi
Calcified phicolith
- Gas pattern2
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
• (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
Erect Abdomen
Always air/fluid level in stomach
A few air/fluid levels in small bowel
Large vs. Small Bowel
*Large Bowel– Peripheral– Haustral markings don't
extend from wall to wall
*Small Bowel-Central
-Valvulae extend across lumen
Complete AbdomenObstruction 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
• One or two persistently dilated loops of large or small bowel
• Gas in rectum or sigmoid
Localized IleusKey Features
Sentinel Loops
Supine Prone
• Gas in dilated small bowel and large bowel to rectum
• Long air-fluid levels
• Only post-op patients have generalized ileus
Generalized IleusKey Features
Generalized Adynamic Ileus
Supine Erect
Mechanical SBOKey Features
• Dilated small bowel
• Multiple fluid levels in small bowel
• Little gas in colon, especially rectum
SBO
Mechanical SBOCauses
• Adhesions
• Hernia
• Volvulus
• Gallstone ileus
• Intussusception
*Cause may be visible on plain film
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
LBO
Supine Prone
Mechanical LBOCauses
• Tumor
• Volvulus
• Hernia
• Diverticulitis
• Intussusception
Extra luminal AirFree Intraperitoneal Air
Free AirCauses
• 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
Right Renal Cyst
Extrinsic compression of bowel
Coin in esophagus