Investigation - Abdominal X-ray

From CambridgeNotes

  • Patients name, date of birth, date of abdominal film

1. Assessment

  • Position: PA or AP; View: supine, erect (rectal and sigmoid gas), or lateral (free air, air-fluid levels) – also erect chest X-ray
  • Inadequate area (ribs), Exposure, Rotation

2. Air (intra-luminal)

  • Stomach: always air; always fluid level except supine
  • Small bowel (central, valvulae extend across lumen, (diameter 3cm): usually 2-3 loops bowel; 2-3 fluid levels
  • Large bowel (peripheral, haustra don’t extend wall-to-wall, diameter 6 cm): usually air in rectum or sigmoid; no fluid level
  • Functional or ileus: air in rectum or sigmoid
    • Local: 2-3 loops small bowel distended ("sentinal loops" e.g. appendicitis)
    • General: multiple loops small bowel in post op patient, no bowel sounds
  • Mechanical: no air in rectum sigmoid
    • Small bowel obstruction: multiple loops small bowel distended
    • Large bowel obstruction: dilated large bowel (small bowel not distended)

3. Air (extra-luminal)

  • Air beneath diaphragm; Both sides of bowel wall

4. Bones and Soft tissue masses

  • Hepatosplenomegaly: plain films poor for judging size
  • Bowel displacement: extrinsic compression

5. Calcifications

  • Rimlike: wall of hollow viscus e.g. renal cysts
  • Linear or track like: wall of tube e.g. ureters, arteries
  • Lamellar: formed in lumen or hollow viscus e.g. stones
  • Cloudlike: formed in solid organ or tumour

6. Iatrogenic or incidental objects; Impression