What's Wrong with This Picture?: Abdominal X-rays

Adapted from a lecture by Stas Haciski

Indications

• rule out free air (sens 90% in upright)
• look for foreign bodies
• chronic abd pain with too many prev scans
• constipation?

Basic Approach

• check film position (upright, lateral decub, etc0
• look at dark areas
• look at light areas
• check everywhere else

SBO

Structures on normal XR

Toxic megacolon

Pneumoperitoneum

Small bowel obstruction - coiled spring or slinky sign

Bowel Obstruction

3-6-9 rule

• small bowel should be no larger than 3cm
• colon should be no larger than 6cm
• cecum should be no larger than 9cm

Abdominal Series includes:

• supine abdomen
• uprigt chest
• upright abdomen

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Tips

• don't forget to run through the entire bowel
• check soft tissues: liver, kidneys psoas muscles
• don't get distracted by  foreign bodies and forget to assess other structures