XRay

sinSur
ger
y-Vi
nay
akRengan 2019

XRa
ysi
nGe
ner
alS
urg
eryf
orUnde
rgr
adua
tes
Re
adi
ngaXr
ay

AbdomenXra ysa r
eusua
ll
yke
pti
nGene
ralSur
gerye
xaminat
ionsf
orunde
rgradua
tes.
Alwa
ys
st
artbynamingt hety
peofxr
aya
nddet
ail
softhepa
tie
nt.Menti
onthedat
eandtimeofxr
ay
i
ntheintr
oduction.

Sa
mple:Thi
sisa
nxra
yabdome
ne re
ctAPvi
ewofa42yea
roldg
e ntl
emanMrKuma
rta
kenon
r
d
23 Febr
uar
y2018a
t10:
20ama tRaj
i
vGandhi
GovtGe
neral
Hospit
al.

I
fiti
sac
hes
txr
ay–T
hev
iewi
sPAv
iew

Thi
sintr
oducti
onisamustandalwaysmana
gest
oimpre
sst
hee
xami
ner
s.NE
VERs
tar
tby
des
cribi
ngthefi
nding
sabrupt
lywit
houti
ntr
oduc
ti
ons
.

I
nthi
sdocument,
Iwi
llbecov
eri
ngthemos
tcommonl
yas
kedXr
aysi
nge
ner
als
urg
ery
e
xamina
tionsa
ndrel
atedque
sti
ons
.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

PNE
UMOPE
RIT
ONE
UM

T
hemos
tcommonl
yas
kedxr
ays

1.
Fi
ndi
ngs
:Ai
runde
rdi
aphr
agm

2.
Inwhi
chxr
ayi
sits
eenbe
tte
r?

Ans
:Che
stXRa
yPAv
iew,
nota
bdome
nxr
aye
rec
tasma
nypr
esume
?

3.
Wha
tist
hemos
tcommonr
eas
onf
ors
uchaf
indi
ng?

Ans
:Hol
l
owv
isc
ouspe
rfor
ati
onmos
tpr
oba
blyaD1(1stpa
rtofduode
numpe
rfor
ati
on)

4.
Wha
tar
etheot
hers
ignss
eeni
npne
umope
rit
one
um?

Ans
:Thi
sisa
nex
haus
ti
vel
i
stofs
ignsi
npne
umope
rit
one
um.
Reme
mbe
rtheunde
rli
neds
igns

 bowe
l-r
ela
teds
igns
o doubl
​ ewa
lls
ign 
(al
sok
nowna
s Ri
gl
ers
ign 
orba
s-r
eli
efs
ign)
o t
ell
tal
etr
iang
les
ign 
(al
sok
nowna
sthet
ri
ang
les
ignort
ell
tal
etr
iang
le)
 
 pe
rit
one
all
i
game
nt-
rel
ate
dsi
gns
o f
oot
bal
lsi
gn
o f
alc
if
orml
i
game
nts
ign
o l
ate
ral
umbi
l
ica
lli
game
nts
ign 
(al
sok
nowna
s i
nve
rte
d"V"s
ign)
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

o ur
achuss
ign
 r
ightuppe
rqua
dra
nts
igns
o c
upol
asi
gn
o f
is
sur
eforl
i
game
ntumt
ere
ssi
gn
o he
pat
ice
dges
ign
o l
uce
ntl
i
vers
ign
o Mor
is
onpouc
hsi
gn 
(dog
eca
psi
gn)
o pe
ripor
tal
fre
ega
ssi
gn

5.
Wha
tcoul
dca
usea
irunde
rdi
aphr
agmwi
thoutpe
rfor
ati
on?
Ans
:Chi
l
aidi
tis
ign–i
nte
rpos
it
ionofal
oopofc
olonbe
twe
enl
i
vera
nddi
aphr
agm.

6.
Howwi
l
lyouma
nag
ethi
sca
se?
Ans
:
 I
woul
dli
ket
ore
sus
cit
atet
hepa
tie
nt.
 I
wil
lse
cure2la
rgebor
eIVl
i
nesa
ndr
ushf
lui
ds(c
rys
tal
l
oids)t
ocor
rec
tde
hydr
ati
on
a
ndhypov
olemia.
 I
wil
ldoanArte
ria
lbl
oodgasa
naly
s i
s(ABG)a
ndc
hec
kfora
cidos
is.
Ifa
cidos
isi
spr
ese
nt,
I
wil
lcor
rec
titwit
hbi
car
bonat
einfusi
ons.
 I
will
inse
rtaNas
o-gas
tri
ctube(Ryl
e’
stube
)ands
ecur
eit
.Fol
ey’
sca
the
teri
sal
so
i
nse
rtedtomoni
torur
ineoutput.
 Pat
ientshoul
dbet
akenupfore
mer
genc
yla
par
otomya
nda
bdome
nisope
nedwi
tha
n
adequat
emi dl
i
nei
nci
si
on.
 Mos
tcommonf
indi
ng:
D1pe
rfor
ati
on
 Pe
rfor
ati
oni
scl
ose
dwi
thamodi
fi
edGr
aha
m’sOme
nta
lpa
tchc
los
ure
 I
nga
str
icpe
rfor
ati
ons,
biops
yist
ake
nfr
ome
dget
orul
eoutma
li
gna
ntpe
rfor
ati
on.
 I
nve
ryl
arg
epe
rfor
ati
ons>
2cm,
gas
tre
ctomy
/ant
rec
tomyi
sdone
.
 S
ome
time
s,j
ej
una
lse
ros
alpa
thi
sus
edf
orc
los
ure
.
XRay
sinSur
ger
y-Vi
nay
akRengan 2019
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

OBS
TRUCT
ION

1.
Fi
ndi
ngs
:Mul
ti
pl
eai
rfl
ui
dle
vel
ssug
ges
ti
veofi
nte
sti
nalobs
truc
ti
on.

2.
Whydoy
ous
ayi
tiss
mal
lbowe
lobs
truc
ti
on?

Ans:
Dil
ate
dbowell
oopswit
hmult
ipl
eai
rfl
ui
dlevel
s.Bowe
lloopsa
remor ecent
ral
inl
oca
tion
andval
vul
aec
oni
vant
esaresee
nwhichi
ssugg
est
iveofsmal
lbowelobs
truct
ion.

3.
Howdoy
oudi
ff
ere
nti
atei
tfr
oml
arg
ebowe
lobs
truc
ti
on?

Ans.
Largebowell
oopsaremorec
ent
ral
l
yplac
eda ndvalv
ula
econiv
ant
esar
enots
een.
Haust
rat
ionsar
eseenins
tead.
Thedi
amete
roftheloopsi
smorethan5cm.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

4.
Lis
tthec
aus
esofs
mal
lbowe
lobs
truc
ti
on

Ans
:

75%ofcas
esa r
eduet oadhes
ionsfromprev
ioussurge
ry.
Anumbe rofca
usesar
eli
st
edbe
low.
Theunder
li
nedone sar
ethemos ti
mpor t
ant
.Justsk
imthroug
htheresti
fyouha
veti
me.
Stude
ntsa
imingforgol
dme dalr
e a
dt he
ma l
l.

Cong
eni
tal
 j
ej
una
lat
res
ia
 i
l
eal
atr
esi
a 
ors
tenos
is
 e
nte
ricdupl
i
cat
ion
 mi
dgutv
olv
ulus
 me
sent
eri
ccy
st
 Me
cke
ldi
ver
ti
cul
um

E
xtr
ins
icc
aus
es
 f
ibr
ousa
dhe
sions
o ma
inc
aus
einde
vel
ope
dcount
ri
es(
75%ofc
ase
s)
o al
mosta
llar
ere
lat
edt
opos
t-ope
rat
ivea
dhe
sionswi
thas
mal
lpe
rce
nta
ges
econda
ryt
o
per
it
oni
ti
s
o di
agnos
isofe
xcl
usi
ona
sadhe
siv
eba
ndsa
renots
eenonCT
o a
bruptcha
ngeinc
ali
berwi
thoutma
ssl
esi
on,
inf
lamma
tionorbowe
lwa
llt
hic
keni
nga
t
t
rans
it
ionpoi
nt
 a
bdomi
nal
her
nia
o 10%ofc
ase
sinde
vel
ope
dcount
ri
es
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

o ex
ter
nalher
niar
ela
tedt
oabdomi
nal
orpe
lvi
cwa
llde
fec
t(c
ong
eni
tal
wea
kne
ssor
pr
evi
oussur
gery
)
o i
nte
rna
l he
rnia 
wit
hpr
otr
usi
onofv
isc
erat
hroug
hpe
rit
one
umorme
sent
eryi
ntoa
not
her
a
bdominalcompar
tme
nt
 e
ndome
tri
osi
s
o r
arec
aus
eofS
BO
o e
ndome
tri
ali
mpl
ant
sar
ety
pic
all
yona
nti
-me
sent
eri
cedg
eoft
hebowe
l
o s
oli
denha
nci
ngnodul
econt
iguouswi
thorpe
net
rat
ingt
het
hic
kene
dbowe
lwa
ll
o mayinf
il
tr
atet
hes
ubmuc
osawi
thahy
poa
tte
nua
tingl
aye
rbe
twe
ent
hemus
cul
ari
sand
mucosa
 ma
sse
s
o e
xtr
ins
icne
opl
asm
o i
ntr
a-a
bdomi
nal
abs
ces
s
o a
neur
ysm
o he
mat
oma

I
ntr
ins
icbowe
lwa
llc
aus
es
 i
nfl
amma
tion,
e.g
. 
Crohn,
 
tube
rcul
osi
s,
 e
osi
nophi
l
icg
ast
roe
nte
rit
is
o s
mal
lbowe
lobs
truc
ti
oni
nCr
ohndi
sea
sema
yre
lat
eto:
 a
cut
efl
arewi
thl
umi
nal
nar
rowi
ngs
econda
ryt
otr
ans
mur
ali
nfl
amma
tion
 c
ica
tri
ci
als
tenos
isi
nlong
-st
andi
ngdi
sea
se
 a
dhe
sionsori
nci
si
ona
lhe
rni
asf
rompr
evi
ouss
urg
ery
 t
umor(
rar
e)
o pri
marys
mallbowe
lne
opl
asmsa
rer
are(
<2%a
llGI
mal
i
gna
ncy
)andus
ual
l
yadv
anc
eda
t
theti
meofS
BO.
 GI
ST,
 
ade
noc
arc
inoma
, 
ly
mphoma
 a
symme
tri
candi
rr
egul
armur
alt
hic
keni
nga
ttr
ans
it
ionpoi
nt
o s
mal
lbowe
linv
olv
eme
ntofme
tas
tat
icdi
sea
sei
smor
ecommon
 peri
tonealc
arci
noma
tos
is 
wit
hex
tri
nsi
cse
ros
aldi
sea
sei
nas
soc
iat
ionwi
tht
he
tr
ansit
ionpoint
o c
eca
lma
li
gna
ncyi
nvol
vi
ngi
l
eoc
eca
lva
lve
 r
adi
ati
one
nte
rit
is
o pr
oduc
esadhe
siv
eandf
ibr
oti
ccha
nge
sint
heme
sent
erywi
thl
umi
nal
nar
rowi
nga
nd
dy
smoti
li
ty
o ma
yca
useobs
truc
ti
oni
nthel
atepha
se(
>1y
eara
fte
rthe
rapy
)
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

 i
nte
sti
nal
isc
hemi
a
o oc
clus
ionors
tenos
isoft
heme
sent
eri
car
ter
ial
orv
asc
ula
rsuppl
y
o pr
oduc
ess
mal
lbowe
lwa
llt
hic
keni
nga
ndobs
truc
ti
on
o pne
uma
tos
is 
and 
por
tal
venousg
as 
i
fadv
anc
ed
 i
ntr
amur
alhe
mat
oma
o t
rauma
,ia
trog
eni
c,a
nti
coa
gul
antt
her
apy
, 
Henoc
h-S
chonl
ei
npur
pur
a
o pr
oduc
esl
umi
nal
nar
rowi
ng
o bet
ters
ee nonnon-
enha
nce
dCTwi
thhomog
enous
,re
gul
ara
nds
pont
ane
ous
lyhy
per
-
at
tenua
tingwal
l
 i
ntus
sus
cept
ion
o r
arei
nadul
ts(
<5%ofS
BO)
o l
eadpoi
ntma
yre
lat
etone
opl
asm,
adhe
sionorf
ore
ignbody
o bowe
l-wi
thi
n-bowe
lwi
thorwi
thoutme
sent
eri
cfa
tandme
sent
eri
cve
sse
ls
o l
eadi
ngmas
sshoul
dbec a
ref
ull
yinte
rpr
ete
da nddi
ff
erent
iat
edf
romt
hes
oft
-t
is
sue
ps
eudot
umort
hatrepr
esent
stheint
uss
uscept
ioni
ts
elf

I
ntr
alumi
nal
caus
es
 s
wal
l
owe
d,e
.g.
for
eig
nbody
, 
bez
oar
 g
all
st
onei
l
eus
o r
arec
ompl
i
cat
ionofr
ecur
rentc
hol
ecy
sti
ti
s
o bi
l
iar
y-i
nte
sti
nal
fi
st
ulawi
thi
mpa
cti
onofag
all
st
onei
nthes
mal
lbowe
l
 me
coni
umi
l
eus
 (
orme
coni
umi
l
euse
qui
val
ent
,di
st
ali
nte
sti
nal
obs
truc
ti
ons
yndr
ome
)
 mi
gra
tionofg
ast
ri
cba
ll
oon

5.
Howwi
l
lyouma
nag
eac
aseofs
mal
lbowe
lobs
truc
ti
on?
Ans
:
 I
fpa
tie
nti
she
mody
nami
cal
l
yuns
tabl
e,I
wil
lre
sus
cit
atet
hepa
tie
nt(a
sinpe
rfor
ati
on)
 I
fthepa
tie
ntisst
abl
e,Iwil
ldoanUSGa
bdomenf
oll
owe
dbyaCont
ras
tEnha
nce
dCT
s
can(Or
al+IVcontr
ast
)toloc
ali
zet
hec
ause
.
 I
fnec
essar
y,Iwi
llt
akethepat
ientf
orsur
geryandtr
eatt
hecaus
e .
Ifthec
aus
eis
a
dhesi
ons,Iwil
ldoadhesi
ol
ysi
s.I
tcanbedoneeit
hervi
aope
ns urg
eryor
l
apa
rosc
opica
ll
y.
 Manyc
a s
esofsma
llbowelobstr
ucti
ons
ettl
ewit
hconser
vat
ivema
nag
eme
ntc
ons
ist
ing
ofc
ont
inuousNGt
ubea s
pirat
ionandcl
osemoni
tor
ing
.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

6.
Wha
tar
esomec
aus
esofl
arg
ebowe
lobs
truc
ti
on?
Ans
:
T
oxi
cme
gac
olon
Di
ver
ti
cul
i
tis
Ma
li
gna
cy–Col
oni
corr
ect
al
E
xtr
ins
icc
ompr
ess
ionduet
ope
lvi
cma
sse
s.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

S
IGMOI
DVOL
VUL
US

1.
Fi
ndi
ngs
:Si
gmoi
dVol
vul
us
2.
Whydoy
ous
ayi
tisas
igmoi
dvol
vul
us?
Ans:Cla
ssi
caldi
l
ate
dl a
rgebowe
lloopswi
thc
off
eebe
ana
ppe
ara
nce
/be
nti
nne
rtube
appea
rance
/omegasi
gn.
3.
Howwi
l
lyouma
nag
ethi
sca
se?
Ans
:
 Anuns
tabl
epa
tie
ntwi
l
lber
esus
cit
ate
dfi
rs
t.
 S
urg
eryc
anbepl
anne
dus
ingag
ene
rousmi
dl
inel
apa
rot
omyi
nci
si
on.
 Rese
cti
onoftheinvolv
edsegmenti
sdoneifg
ang
renousandpr
oxi
malcol
onbroug
ht
outassi
gmoi
dc ol
ostomy.I
fthe
reisnoede
maofbowe l
,pri
mar
yanas
tomosi
scanbe
done.
4.
Ist
her
eanyr
olef
orc
ons
erv
ati
vema
nag
eme
nt?
Ans
:Col
onos
copi
cde
rot
ati
onofbowe
lca
nbea
tte
mpt
ed.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

UROL
OGI
CALXRAY
S
I
MPORT
ANT
:Re
membe
rthe
seXr
aysa
reXRa
yKUB(Ki
dne
y,Ur
ete
r,Bl
adde
r)

DJS
tent
Th i
nt ubeinsertedintot he 
uret
e r
 t
opr eventort r
eatobstruc
ti
onoft he 
uri
ne 
fl
ow fr
om
the ki
dney.Lengthisabout24t o30c m.Usedasat empor
arymeasure,t
oprev
entdamaget
oa
blockedki
dney,unti
laprocedur
etoremovethestonecanbeperfor
med.

S
TAGHORNCAL
CUL
US
Thes
eareStr
uvit
es t
ones(Magnesi
um,Ammonium, Phospha
te)areusua
ll
yseeni
ntheset
ti
ng
ofr
ecur
renturi
narytr
acti
nfec
ti
onwithur
eas
e-producingbact
eri
a(e.
g.Pr
oteus
,Kl
ebsi
el
la
,
Pse
udomonasandE nte
roba
cter)
.
Be
stt
rea
tedbyPe
rcut
ane
ousne
phr
oli
thot
omy
.
 XRay
sinSur
ger
y-Vi
nay
akRengan 2019

CRE
DIT
S:
 Ma
dra
sMe
dic
alCol
l
ege
-Ins
ti
tut
eofGe
ner
alS
urg
ery

 www.
radi
ope
dia
.com