Radiology of the Acute Abdomen Flashcards
What is the acute abdomen?
Sudden, severe abdominal pain caused by something
- loss of blood supply
What kinds of imaging can be done?
What are the four main densities on plain abdominal film?
Gas - black
Fat - dark grey
Muscle, bowel wall, solid organ and blood vessel - light grey
Bone - white
Which organs should it be possible to see on a plain abdominal X-Ray?
Kidneys Liver Bladder Small bowel Large bowel Spleen Stomach
Can you see gallstones on X-Ray?
Sometimes (20% of of gallstones are calcified)
The edges of which muscle can be seen on X-Ray?
- from the transverse processes of the lumbar vertebrae to combine with the iliacus muscle
What is a poreclain gallbladder?
Calcification of the gallbladder, believed to be brought on by excessive gallstones
- as the gallbladder is calcified, the stones are not normally visiable
Why can some of the bowel be seen on X-Ray?
- if the whole bowel can be seen, this is pathological
What is Chilaiditi’s syndrome and how is it diagnosed?
A condition where a portion of the bowel is located between the liver and the diaphragm
- can obstruct the small bowel
- appears as gas where there isn’t usually on X-Ray
How can an inguinal hernia be suspected on X-Ray?
There is a loop of bowel seen below the level of the inguinal ligament
What is biliary gas an indicatory of?
Biliary stent in situ
Is imaging useful for identify inflammation?
- useful for colitis
- non-specific in other inflammatory conditions
- cholecystitis (and appendicitis if they are young and slim)
CT is the first choice in every other inflammatory condition
What are the identifying features of colitis on abdominal X-Ray?
Thumbprinting - thickening of the wall of the colon - thickening of the haustral folds leads to thumbprinting Mucosal islands - dark patches along the bowel Toxic megacolon - extremely dilated colon
Which imaging modalities are best for identifying a perforation?
Chest X-Ray - sensitive for free gas Abdominal X-Ray - less sensitive (very subtle) CT to confirm and look for cause
What signs of obstruction are abdominal X-Rays good at identifying?
Small and/or large bowel dilation How much gas is in the colon If there is any gas in the rectum If there are any complications - ischaemia - perforation