Abdominal X-rays

Question 1

Things to 1st look for on x-ray

Answer 1

• Name
• DOB
• Previous imaging to compare
• Projection - AP erect, AP supine
• Exposure - pelvic, bottom ribs, see vertebrae through

Question 2

System of looking at abdo x-rays

Answer 2

BBC
Bowels + other organs
Bones
Calcification/artefacts

Question 3

Bowel

Answer 3

• Size - dilated? - 369 rule
• Shape - volvulus?
• Bowel wall - thickened (thumb printing), both sides visible (Riglers) loss haustra (lead pipe?)

Question 4

What is thumbprinting?

Answer 4

Sign of thickened bowel wall
Appears as thumbprinting on abdo x-ray
Can appear in UC/Crohns or any chronic inflammation

Question 5

What is Riglers sign?

Answer 5

When you can see both sides of bowel visible
Sign that there is air in peritoneum (pneumoperitoneum) as it acts as a contrast highlighting edges

Question 6

Small bowel appearance on x-ray

Answer 6

• Central
• Valvulae conniventes - full thickness folds

Question 7

Appearance of large bowel on x-ray

Answer 7

• Peripheral
• Haustra - not full thickness folds

Question 8

Sigmoid volvulus sign

Answer 8

Coffee bean sign
From LIF extended to RUQ

Question 9

Caecal volvulus sign

Answer 9

• Fetus sign
• From RIF extending to LUQ

Question 10

What is lead pipe colon?

Answer 10

Smooth colon
Seen in chronic inflammation due to destruction of bowel wall
Like smooth slug of bowel

Question 11

Organs on abdo x-ray

Answer 11

• Base lung pathologies
• Gall bladder - calcified gall stones or cholecystectomy clips
• Stomach - dilated in SB obstruction
• Kidney - R kidney lower than L due to liver - stones?
• Bladder - retention?
• Abdo-aorta - visible if calcified

Question 12

Bones on abdox-rays

Answer 12

• Thoracolumbar spine - compressive fracture/collapsed
• Pelvic - fracture, femoral head and greater trochanter, hip replacement?
• Sclerotic bone lesions - prostate cancer mets
• Lucent bone lesions - osteosarcoma

Question 13

AS sign on abdo x-ray

Answer 13

Bamboo spine - fusion of vertebrae
Increase risk of UC with AS

Question 14

Caclification and artefcts to look for

Answer 14

• Cholecystectomy clips
• Kidney stones - sometimes staghorn
• Dotted spots bowel - faeces, constipation causes fermentation = pockets of air
• Calcified AAA - circular shape

Question 15

How is large bowel obstruction treated?

Answer 15

DRIP AND SUCK
* NBM
* NG tube - suck contents
* IV fluids
* Gastrograffin - radiopaque drink, then do abdo-xray lights up. can do baseline and one at 4-6hrs to see if reversed
* Surgery - if due to twisted hernia maybe

Question 16

Why is gastrograffin diagnostic and therapeutic?

Answer 16

• Sucks water into bowel as acts as solute
• Can untwist/reduce oedema of walls of bowel and stop obstruction

Question 17

What is large bowel obstruction mainly caused by?

Answer 17

Adhesions - reluctant to perform surgery to fix as this could cause more problems

Question 18

Causes of SB obstruction

Answer 18

• Malignancy
• Strictures
• Hernias
• Constipation

Question 19

Treatment for small bowel obstruction

Answer 19

• NBM
• NG tube
• IV fluids
• Surgery - more likely if cancer

Question 20

Emergency procedure to remove cancer of Sigmoid colon

Answer 20

Hartmanns procedure

Question 21

Sigmoid volvulus management

Answer 21

• Decompress via catheter tubing into rectum (flatus tube)
• Therapeutic colonoscopy
• Need to have DNAR conversation as very bad outcomes sometimes

Question 22

What type of patients does sigmoid volvulus often occur in?

Answer 22

Psychiatric patients

Question 23

Treatment for Crohns flair

Answer 23

• corticosteroids - IV/oral
• IV fluids
• Analgesia
• Anti-emetics
• Nutritional support
• DVT PROPHYLAXIS - is inflammatory so increased risk - bloody diarrhoea is not contraindication

Question 24

Acute UC flare treatment

Answer 24

• IV fluids
• Abx prophylaxis
• IV steroids
• Infliximab
• NMB +/- NG
• Analgesia
• Antiemetics
• DVT prophylaxis
• Surgery if no response within 24hrs

Question 25

Why abx prophylaxis in UC flare?

Answer 25

Risk of bacteria translocation
Leaky vessels can cause bowel bacteria to enter bloodstream
+ Fungus infections in blood q

Question 26

Cause of pneumoperitoneum

Answer 26

• Duodenal ulcer
• Anastomotic leak - 4 days post op go into AF

Question 27

Management of pneumoperitoneum

Answer 27

• CT scan
• Surgical input
• NBM
• IV fluids
• Abx
• Analgesia
• Surgery

Question 28

What to do in all cases if you think someone will need emergency surgery?

Answer 28

Make them NBM

Question 29

When is pneumoperitoneum normal?

Answer 29

Up to 7 days post abdo surgery/laparascopic surgery