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Plain Abdominal Xray

Plain Abdominal Xray

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Published by: viKиҼswAяAи LiиGaM on Jun 20, 2010
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09/03/2013

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PLAIN X-RAY ABDOMEN 63SURGERY-INVESTIGATIONS 1
Plain x-ray abdomen (normal film) after preparationPlain x-ray abdomen (normal film) without preparation
PLAIN X-RAY ABDOMEN
INV-08
Shuja Tahir, FRCSEd
It is the radiological examination of abdomen andits contents.It is used as a screening investigation in variousabdominal problems such as;1.Gastro-intestinal problems2.Inflammations of abdominal viscera3.Abdominal trauma4.Urinary tract problems5.Gynaecological problems.6.Vascular problems7.Retroperitoneal problems.The plain film is exposed with or withoutpreparation. The abdominal x-ray is exposed inappropriate position. The x-ray pictures areexposed in erect or standing position and supineor lying position. Occasionally the films areexposed in lateral position as well.Sometimes the patient is unfit to stand, thenlateral decubitus film is exposed. It is a relativelypoor alternate and does not provide enoughinformation. The areas of lower chest and pelvisare also exposed to have complete visualizationof the abdomen.
 
64 PLAIN X-RAY ABDOMEN2 SURGERY-INVESTIGATIONS
Plain x-ray abdomen showing diverging psoas shadowsPlain x-ray abdomen (normal) KUB film
The clinical data is always critically examinedbefore performing the radiological investigations.It is inspected and interpreted in an organized andstructured manner.
OVER VIEW
Whole of the exposed film is seen over anilluminater and never against sunlight or electriclight to avoid wrong conclusions. Possibleprovisional diagnosis is made and objectiveinterpretation is done.Large amount of gas is seen in stomach andcolon. Stomach is identified because of itsanatomical position and contents. An air-fluid levelis seen under the left hemidiaphragm normally.The presence of gas in the bowel is seen on plainfilm.Gas is normally present in the stomach, small andlarge intestine in small quantities. The gas ispresent as individual bubbles of gas scattered inthe bowel.Peritoneal and extra-peritoneal contents of abdomen and pelvis are examined. Pancreascannot be seen on plain film of abdomen.If a loop of bowel is seen filled with gas, it shouldnot be longer than 5-8 cm and should not bedistended under normal circumstances. The gasdoes not form a loop pattern in healthy persons.Gas shadows outside the intestine alwaysindicate intra-abdominal pathology.Multiple gas-fluid levels in the dilated loops of small or large gut indicate obstruction to thegastrointestinal flow. The level of obstruction is
 
PLAIN X-RAY ABDOMEN 65SURGERY-INVESTIGATIONS 3
X-ray chest showing air under the diaphragm(pneumoperitoneum)
usually looked for.The psoas shadows are visible as diverging lineson both sides of spine starting from first lumbar vertebra towards pelvis.The psoas shadows may be obliterated byinflammatory, neoplastic and hemorrhagic(traumatic) lesions of the organ in front and in thevicinity (pancreas, spleen, liver etc.) Ascities or presence of pus in the peritoneal cavityis identified by typical ground glass appearance.It offers valuable diagnostic information.Radio-opaque shadows and calcifications in thefilm are seen and their anatomical correlation isinterpreted.Soft tissue shadows of liver, spleen, kidneys, andpsoas muscle are visible normaly. Outline of urinary bladder, if filled with urine may be seenon plain film.The plain x-ray film of the abdomen showingcomplete urinary system is called KUB film(Kidney, Ureter, Bladder film).
ABDOMINAL TRAUMA
The injuries of abdomen show various radiologicalfeatures depending upon the type, time and siteof injury.The common features seen on plain x-rayabdomen after various type of trauma are:1.Pneumoperitoneum2.Ground glass appearance3.Psoas shadow obliteration4.Sentinel loopsTrauma may be;a.Penetratingb.BluntThe penetrating injuries are usually visible onclinical examination. But the extent of injury maynot be evaluated specifically on clinicalexamination. It presents with pneumoperitoneumon radiological examination in the earlier part.Similarly blunt injuries of abdomen are diagnosedfrom clinical history and examination but extentof injury can only be assessed by variousinvestigations and sometimes even laparoscopyor laparotomy may be required.
PNEUMOPERITONEUM
Normally no air is present in peritoneal cavity.

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