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AXR Teaching X-posure CatherineOgbechie (Y5) Overview • AbdominalAnatomyRecap • AXR Breakdownwith radiologicalsigns • Interactivecasepresentations • QuizRegions of the Abdomen AXR Positioning Supine- Anterior Posterior A SupineAbdomen B C F D E G H Right and Left Kidney SupineAbdomen Liver Psoas muscle Bowel Gas Iliac crest Iliac bone Sacrum PubicAny questions before we move on? (no such thing as a silly question) Indicationsfor an AXR • Clinical suspicion of obstruction • Acute exacerbation of inflammatory bowel disease • Palpable mass • Constipation • Acute and chronic pancreatitis • Sharp/poisonous foreign body • Smooth and small foreign body, e.g., coin, battery • Blunt or stab abdominal injury (specific circumstances) As with the CXR session last week Introduce self, wash hands, don PPE Check demographics: Name DoB ID number Note date/time of film + reason for film Seek previous films for comparison Systematic Approach to AXR Interpretation A: air - where it should and shouldn't be B: bowel - position, size and wall thickness D: calcification and bones O : organs and soft tissues X: eXternal objects and artefactsAir belongs only in the stomachand bowel. Anywhere else is abnormal Gas/air= low density= low attenuation This formsa natural contrastagainstthe surrounding denser tissues A: air - whereit shouldand shouldn'tbe AIR B: bowel- position,sizeand wallthickness D: densestructures,calcificationandbones O: organsandsofttissues Rigler’s sign: The double-wallsign,is a sign X: eXternalobjectsand artefacts of pneumoperitoneum seen on an abdominalradiograph when gasis outlining both sides of the bowel wall LFootball Sign Occurs dueto a massive peritoneumwhich outlines the abdominalcavity It is most frequentlyseen in childrenwith advancednecrotising enterocolitis. Othercauses include: Bowel obstructionwith secondary perforation • Malrotationwithmidgut volvulus • Hirschsprungdisease • Meconiumileus • intestinalatresia pepticulcer disease Iatrogenic:endoscopicperforation A :air -where it should and shouldn't be B : bowel -position, sizeandwall thickness Bowel D : dense structures, calcificationandbones 3/6/9/rule O : organs and soft tissues X : eXternal objects and artefacts 3cm SB 6cm LB Valvulaeconniventes:mucosal foldsthat Smallpouches caused by sacculation (sac formation), which give the colon its segmented cross the abdomen appearanceAny questions before we move on? (no such thing as a silly question) Clinical Presentation: Abdominal pain – colickyor cramping in nature (secondarytothe bowel peristalsis) Vomiting – occurring early in proximal obstructionand late in distalobstruction Abdominal distension Absolute constipation – occurring early in distalobstructionand late in proximal obstructionSBO Causes: Adhesions Ileus Hernias TumoursLBO Causes: Colorectalcarcinoma,Diverticularstrictures , Hernias & VolvulusSigmoid VolvulusInflammatory Bowel DiseaseInflammatory Bowel Disease Thumbprinting:mucosalthickeningof the haustradue to inflammationand oedemacausingthem to appearlike thumbprintsprojectingintothe lumen.Lead-pipe (featureless)colon: lossof Toxicmegacolon:colonicdilatationwithout normalhaustralmarkingssecondaryto obstructionassociatedwith colitis. chroniccolitis. Density Examine carefully all of the bones visible on abdominal radiographs: • Lowest ribs • Vertebral column • pelvic bones • Femoral heads and necks Calcification within organs may be detected - in particular, look carefully for calcified renal tract or gallbladder stones. A :air -where it should and shouldn't be B : bowel -position, sizeandwall thickness D : Calcificationandbones O : organs and soft tissues X : eXternal objects and artefactsComment on the X-ray (please)CalcificationAny questions before we move on? (no such thing as a silly question) Organs Examine carefully all of the organs on the abdominal x- ray The fat surrounding organs provides an interface which allows their contour to be seen. Remember to examine the lung bases for consolidation (which can cause abdominal pain) and the inguinal regions for signs of herniae. A :air -where it should and shouldn't be B : bowel -position, sizeandwall thickness D : Calcificationandbones O : organs and soft tissues X : eXternal objects and artefacts A:air -where it should and shouldn't be Artefacts B: bowel -position, sizeandwall thickness D: Calcificationandbones O: organs and soft tissues X: eXternal objects and artefactsSpot the ArtefactKahoot Time Summary Slide ▪Good tool to rule out obstruction ▪Can look for signs of perforation ▪Remember if you are getting any investigation, be able to interpret it ▪For any more detail would want a CT scan ▪Stick to a structure: doesn’t have to be abdo x, find what works for you!