AXRs

Question 1

Small bowel obstruction

Answer 1

Follows anatomical course of small bowel
Multiple dilated loops of gas filled bowel located in the middle of the abdomen
Multiple lines passing across the full width of the bowel representing valvula coniventes
Distal obstruction if all of bowel dilated
PC: N&V, tender and distended abdo, tinkling bowel sounds, constipation
Causes: adhesions from IBD / previous abdominal surgery, known malignancy, hernias
Mx: drip and suck - IV anti-emetics, NG tube, surgical referral

Question 2

Large bowel obstruction

Answer 2

Typically follows the anatomical route of the large bowel
Haustra seen / lost if very dilated
PC: tender, distended abdo, absent/tinkling bowel sounds, constipation, not passing any flatus, faecal vomiting, empty rectum DRE
Cause: colon Ca, stricture from diverticular dx
Mx: drip & suck - IV anti-emetics and NG tube, NBM, analgesia, stenting, surgical referral

Question 3

Coffee bean sign

Answer 3

Volvulus - sigmoid / caecum

Question 4

Toxic megacolon

Answer 4

Dilated loops of bowel seen in patients with IBD

Bowel wall oedema, mucosal islands & thumbprinting

Question 5

Thumbprinting

Answer 5

Thickening of haustral folds due to acute inflammation of bowel (UC)

Question 6

Rigler’s sign

Answer 6

This is seen when there is free intra-abdominal air adjacent to gas filled loops of bowel, making both side of the bowel wall well defined

Question 7

Volvulus definition

Answer 7

Due to a twist at the base of the sigmoid or caecal volvulus

Question 8

Caecal volvulus

Answer 8

Can move, can extend into right hypochondrium. Most likely if RIF is empty

Question 9

Perforation

Answer 9

Pneumoperitoneum, free gas intra-abdominally, sharp points and Rigler’s sign seen on AXR

Question 10

Lead pipe colon

Answer 10

Featureless colon, loss of haustra, seen in longstanding UC

Question 11

Systematic approach

Answer 11

Bowel

- small: valvulae coniventes,