The plain x-ray abdomen
The standard plain films of the abdomen are
1- supine A.P.for abdominal soft tissue shadow and abnormal calcification
2-erect A.P.to detect fluids levels in case of intestinal obstruction
3- lateral decubitus view (A.P. view taken and the patient lying on his side)taken in patient unable to sit or stand
What to Examine
Gas pattern
Extraluminal air
Soft tissue masses
Calcifications
see the image in the pdf file
What to look
1-gas and fluid levels
fluid levels become abnormal when :three or more small –bowel fluids levels longer than 2.5 cm
2-look for any gas outside the lumen of the bowel
3-identify the liver :seen as ahomogenous opacity in the right upper quadrant usually extending in to the left upper quadrant
4-identify the borders of the spleen ,kidney,bladder and psoas muscles
5-look for any soft tissue masses in the abdomen and pelvis
6-if there is any calcification try to localize it
7- look for vertebrae if any abnormality
Normal Gas Pattern
Stomach
Always
Small Bowel
Two or three loops of non-distended bowel
Normal diameter = 2.5 cm = 1 US quarter
Large Bowel
In rectum or sigmoid – almost always
see the image in the pdf file
Normal Fluid Levels
Stomach
Always (except supine film)
Small Bowel
Two or three levels possible
Large Bowel
None normally
see the image in the pdf file
Large vs. Small Bowel
Large Bowel
Peripheral
Haustral markings don t extend from wall to wall
Small Bowel
Central
Valvulae extend across lumen
Maximum diameter of 2"
Complete Abdomen Obstruction Series
Supine
Prone or lateral rectum
Erect or left decubitus
Chest - erect or supine
Complete Abdomen Supine
Looking for
Scout film for gas pattern
Calcifications
Soft tissue masses
Substitute – none
see the image in the pdf file
see the end of the lucture in the pdf file