Learning Issues Presentation

by: Chua, Catherine & Ali, Aliah

Uses of Abdominal Radiography

• Radiographs are often used as a quick first step to help decide what typre of
imaging is needed.

What can be evaluated in on Abdominal Radiography?

• Bowel gas pattern

• Free air
• Abdominal calcifications
• Abnormal masses
 Basic Steps in Reading Radiographs
Step 1: Identifying general data of the patient
*Patient's name & age
*Date/time AXR was taken
*Diagnosis of Patient
*Indication for AXR

Step 2: Determine view (AP supine, PA prone, lateral decubitus, AP upright ,

and lateral cross-table with the patient supine)

Step 3: Assess quality of film

Step 4 & 5: Assess anatomy and determine the presence of abnormalities

 Approach

• Lung Bases
• Free Air
• Bowel Gas Pattern
• Solid organs
• Soft Tissue Masses
• Calcifications
• Bones
Anatomy
Radiographic Anatomy
 Small Bowel
• Located Centrally

• Valvular Markings called

valvulae conniventes, cross
the entire width of the bowel
and spaced closed together

• “Stacked coin” appearance

 Large Bowel
• Located Peripherally
• Contains Hausta which either..
...do not connect from one wall to
the other or..
...are spaced wider apart than
the valvulae conniventes of the
small bowel
 Bowel Gas Pattern
Small Bowel Large Bowel

Normally 2-3 air fluid levels No air Fluid levels

Contains air Contain air

No more than 3 cm in diameter Variable diameter

 Normal Stool in Colon
• Apprears as small bubbles of
gas within a partially solid
appearing density in the colon.
 Upright Abdomen
• Air is gravity dependent
• Used to evaluate for free air
• Used to evaluate for air-fluid levels
which is indicates stasis and ileus
or bowel obstruction
• Obtained with patient sitting or
ideally standing
 Left Lateral Decubitus
• Performed as a substitute for
an upright film in patients who
can't sit or stand
• Allows evaluation of air fluid
levels
• Allows evaluation for free air
which will rise to the right
• Performed with patient lying
on his/her left side
 Supine Abdomen
• Provides an overview of the
abdomen
• Used to look for calcifications and
soft tissue masses
• Best when obtained in conjunction
with an upright and decubitus.
 What is Step Ladder Sign?
Loops proximal to the point of
obstruction will become dilated and
fluid-filled. Usually greater than 2.5-3
cm in size. Loops of small bowel may
arrange themselves in a stepladder
configuration from the left upper to the
right lower quadrant in a distal
obstruction. Absence of, or
disproportionately smaller amount of,
gas in the colon, especially the
rectosigmoid is another reliable sign
Sources:

• European Society of Radiology 2016

• Schrwartz Principles of Surgery 10th Ed
• Harrisons 19th Ed