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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-calcification pancreas kidney Gall bladder Suprarenal glands Pancreatic mass Fibroid uterus Ureteric calculi Calcified phicolith 2 - Gas pattern 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 Always air/fluid level in stomach A few air/fluid levels in small bowel Erect Abdomen Large vs. Small Bowel *Large Bowel – Peripheral – Haustral markings don't extend from wall to wall *Small Bowel -Central -Valvulae extend across lumen Complete Abdomen Obstruction 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 Localized Ileus Key Features • One or two persistently dilated loops of large or small bowel • Gas in rectum or sigmoid Supine Sentinel Loops Prone Generalized Ileus Key Features • Gas in dilated small bowel and large bowel to rectum • Long air-fluid levels • Only post-op patients have generalized ileus Supine Generalized Adynamic Ileus Erect Mechanical SBO Key Features • Dilated small bowel • Multiple fluid levels in small bowel • Little gas in colon, especially rectum SBO Mechanical SBO Causes • • • • • Adhesions Hernia Volvulus Gallstone ileus Intussusception *Cause may be visible on plain film Mechanical LBO Key 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 Prone Supine LBO Mechanical LBO Causes • • • • • Tumor Volvulus Hernia Diverticulitis Intussusception Extra luminal Air Free Intraperitoneal Air Free Air Causes • 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 hernia Extrinsic compression of bowel Right Renal Cyst Coin in esophagus
