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NADEEN ISMAHEL FY1 ABDOMINALX -RAYINTERPRET ATIONCONTENTS ABDOMINALX -RAY OSCE Indications Structured approach Common findings and management QuestionstricksABDOMINALX -RAY-OSCE https://www.gla.ac.uk/media/Medihttps://www.scionpublishing.com/book-images/resources/OSCES_5e_MMS.pdfABDOMINALX -RY-OSCEABDOMINALX -RAY-INDICA TIONS There are many indications for an AXR, some are listed below: - Suspected bowel obstruction - Suspected perforation - New or severe abdominal pain - Renal colicABDOMINALX -RY-STRUCTUREDAPPROACHABDOMINALX -RY-STRUCTUREDAPPROACH Details Projection Exposure Air Bowel Dense Organs eXternalABDOMINALX -RA Y-STRUCTUREDAPPROACH Details PE ABDO X Name - Projection - Is the film- Air - pneumoperitoenum, - DOB AP orA? riglers sign - CHI number - spine is visible, are theand large bowelthe small - Date and time the film posts muscles visible, -sDense - Bones and was taken visiblele abdomen calcification   - spleen and kidneysver - eXternal - external and tubesforeign bodiesABDOMINALX -RAY-PROJECTION Supine (AP) Upright ABDOMINALX -RA Y-AIR Pneumoperitoneum Rigler sign Air under the diaphragm Indicating gas within the bowel lumen and within the peritoneal cavityABDOMINALX -RA Y-BOWEL Small bowel Large bowel - Folds (valvular - Usually peripheral - conniventes) usually - do not span the width of bowelthe width of the the bowel - Diameter is < 3cm - colon and < 9cm for the caecum ABDOMINALX -RAY-BOWEL Small bowel obstruction Large bowel obstructionSigmoid volvulusABDOMINALX -RAY-CALCIFICA TIONS Gallstones Renal stones Calcified aortaABDOMINALX -RY-ORGANS ABDOMINALX -RAY-EXTERNAL Bellybutton piercing Key and batteries Surgical clipsABDOMINALX -RY-STRUCTUREDAPPROACH Details Projection Exposure Air Bowel Dense Organs eXternalABDOMINALX -RA Y-COMMONFINDINGS Faecal loading - Laxatives - first-line, adding or switching to anives stimulant laxative if neededtive, adding aABDOMINALX -RAY-COMMONFINDINGS Small bowel obstruction - Herniaons - MalignancyABDOMINALX -RA Y-COMMONFINDINGS Small bowel obstruction - “Drip and suck” - IV fluids - Nil by mouthrtionABDOMINALX -RA Y-COMMONFINDINGS Large bowel obstruction - Neoplasm (benign or malignant) - Stricture (commonly due to radiotherapy) - Inflammatory bowel diseased, cecal) - ImpactionABDOMINALX -RA Y-COMMONFINDINGS Large bowel obstruction - “Drip and suck” - IV fluids - Nil by mouth - Surgical interventionABDOMINALX -RAY-COMMONFINDINGS Sigmoid volvulus - Elderly patients - nursing home - Chronic constipation or laxative useABDOMINALX -RA Y-COMMONFINDINGS Sigmoid volvulus Usually conservative - decompression - using flatus tube - procedureintervention - Hartmanns Colonic ischaemia or perforation - Repeated failed attempts at decompression - Necrotic bowel noted at endoscopyABDOMINALX -RAY-COMMONFINDINGS Toxic megacolon Ulcerative colitis - Thumb-printing on AXR - In severe cases toxic megacolon Thumb-printing - Loss of haustraeABDOMINALX -RAY-COMMONFINDINGS Toxic megacolon IV fluidsve colitis - NG tube - Optimise UC drugs Thumb-printing - Steroids and antibiotics can be used - Surgical resectionABDOMINALX -RA Y-TIPSANDTRICKS - Compare to previous AXR if available If in doubt consider a CT abdomen or USS - - 3, 6, 9 rule “Drip and suck” is typically the answer for most findings - - Always correlate AXR findings with patients clinical findingsABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting nigou are handed over to chase Mr Smith’s abdominal X-ray. Background - NEWS = 0 - 70 y/o male - Admitted 3 days prior with abdominal pain - PMH of inguinal hernia - No current medicationABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting nigou are handed over to chase Mr Smith’s abdominal X-ray. Please label the following structures C A D BABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting nightou are handed over to chase Mr Smith’s abdominal X-ray. Please label the following structures C A - Large bowel A D B - Right iliac crest C - Small bowel B D - Lumbar vertebraeABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night ou are handed over to chase Mr Smith’s abdominal X-ray. You decide to repeat the abdominal X-ray.miting profusely and has a distended abdomen. Is this a normal abdominal X-ray? A - es B - NoABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night ou are handed over to chase Mr Smith’s abdominal X-ray. You decide to repeat the abdominal X-ray.miting profusely and has a distended abdomen. Is this a normal abdominal X-ray? A - es B - NoABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night sou are handed over to chase Mr Smith’s abdominal X-ray. Overnight Mr Smith deteriorates. He is vomiting profusely and has a distended abdomen. You decide to repeat the abdominal X-ray. What is the abnormality in this AXR? A - Small bowel obstruction B - Large bowel obstruction C - Sigmoid volvulus D - Ulcerative colitisABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night sou are handed over to chase Mr Smith’s abdominal X-ray. Overnight Mr Smith deteriorates. He is vomiting profusely and has a distended abdomen. You decide to repeat the abdominal X-ray. What is the abnormality in this AXR? A - Small bowel obstruction B - Large bowel obstruction C - Sigmoid volvulus D - Ulcerative colitisABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night sou are handed over to chase Mr Smith’s abdominal X-ray. Overnight Mr Smith deteriorates. He is vomiting profusely and has a distended abdomen. You decide to repeat the abdominal X-ray. small bowel obstruction?s not a risk factor for A. Adhesions B. Hernia C. Malignancy D. ImpactionABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting night sou are handed over to chase Mr Smith’s abdominal X-ray. Overnight Mr Smith deteriorates. He is vomiting profusely and has a distended abdomen. You decide to repeat the abdominal X-ray. small bowel obstruction?s not a risk factor for A. Adhesions B. Hernia C. Malignancy D. ImpactionABDOMINALX -RA Y-QUESTIONS abdominal X-ray.n FY1 starting nightou are handed over to chase Mr Smith’s Overnight Mr Smith deteriorates. He is vomiting profusely and has a distended abdomen. ou decide to repeat the abdominal X-ray. obstruction? (2)age Mr Smith’s bowelABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 starting nightou are handed over to chase Mr Smith’s abdominal X-ray. You decide to repeat the abdominal X-ray.miting profusely and has a distended abdomen. How will you manage Mr Smith’s bowel obstruction? (2) - “Drip and suck” - IV fluids - NG tube insertion - Nil by mouthABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. Background - NEWS = 0 - Carehome resident - PMH previous C section - Medication - laxativesABDOMINALX -RAY-QUESTIONS has just been admitted.nd have been asked to review Mrs Smith a 90 year old patient who Please label the following structures on her AXR B AABDOMINALX -RAY-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. Please label the following structures on her AXR A - Left total hip replacement B - Large bowel B AABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. What abnormality can be seen in this AXR A - Small bowel obstruction B - Large bowel obstruction C - Sigmoid volvulus D - Ulcerative colitisABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. What abnormality can be seen in this AXR A - Small bowel obstruction B - Large bowel obstruction C - Sigmoid volvulus D - Ulcerative colitisABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. What features from the background correlate with the diagnosis of sigmoid volvulus? (2) Background - NEWS = 0 - 92 y/o female - Carehome resident - PMH previous C section - Medication - laxativesABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. What features from the background correlate with the diagnosis of sigmoid volvulus? (2) Background - NEWS = 0 - 92 y/o female - Carehome resident - PMH previous C section - Medication - laxativesABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. How will you manage this patient conservatively? A - Flatus tube B - Laxatives C - NG tube D - AntibioticsABDOMINALX -RA Y-QUESTIONS Scenario:ou’re an FY1 and have been asked to review Mrs Smith a 90 year old patient who has just been admitted. How will you manage this patient conservatively? A - Flatus tube B - Laxatives C - NG tube D - AntibioticsQUESTIONS?QUESTIONS?