Continuing on with our X-Ray Refresher course, this week, Dr. Helen Ng will take us through an engaging session on interpreting abdominal X-rays! Learn a structured approach, explore real case examples, and discuss diagnostic challenges in an interactive format. Don’t miss this valuable opportunity!
Y3 Teaching on Abdominal x-rays
Summary
Dive into the world of abdominal X-Rays with Dr. Helen Ng by attending the on-demand teaching session "ABDOX-RAYS". Learn the what, how, when, and why of an AXR, understand how to differentiate between normal and abnormal images, and get a comprehensive overview of how to present AXR findings effectively. The session includes practical instructions on how to take an AXR, examines the pros and cons of the technique, and highlights its application in the diagnosis of various conditions such as acute abdominal pain and inflamed bowel disease. With a detailed look at both BBC and ABDOX approaches, it also covers systemic methods to review bowels, bones, calcification, organs, and more. Medical professionals looking to refine their AXR skills, be sure not to miss it!
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Description
Learning objectives
- By the end of the session, learners should understand the concept and uses of Abdominal X-Rays (AXR) in medical diagnosis.
- Learners should be able to identify the appropriate situations when to initiate an AXR, its limitations, and safety concerns particularly in pregnancy.
- Learners should be capable of discussing and comparing an abnormal AXR from a normal one, highlighting key differences.
- Learners should learn how to accurately present an AXR, noting patient details, indications, image type, quality, any obvious abnormalities, and be able to approach it systematically using techniques such as the BBC or ABDOX approach.
- Learners should gain insights into specific uses of AXR in diagnosing different conditions such as bowel obstruction, post operative ileus, toxic megacolon, and abnormalities in bones and organs.
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A B D O X - R AY S Dr Helen NgO V E R V I E W • What • How • Why 2 2 • When 3 2 2 • Normal vs abnormal 4 • PresentingAXR and approachW H AT I S A N A X R ? 3 1 2 3 2 0 2 4H O W T O TA K E A X R 4 1 2 3 2 0 2 4W H Y A X R ? 5 1 2 3 2 0 2 4W H Y A X R PROS CON S • Quicker and less radiation than CT • Radiationdose... 6 • Image quality 1 / / • Safety inpregnancy 0 4 • DiagnosticvalueW H E N A X R • Acute abdominal pain,if suspected small • Palpablemass (specific circumstances) or large bowelobstruction. • Constipation (specificcircumstances) • Exacerbationof inflammatory bowel • Acute and chronic pancreatitis (specific 7 disease circumstances) 1 / • Foreignbodies • Blunt or stab abdominal injury (specific 2 2 circumstances) 4 N O R M A L / A B N O R M A L ? 8 1 2 3 2 2 4 N O R M A L / A B N O R M A L ? 9 1 2 3 2 2 4 N O R M A L / A B N O R M A L ? 10 1 2 3 2 2 4Liver and spleen Kidneys Bowels 11 1 / / 0 2 412 1 2 / 3 2 0 2 4P R E S E N T I N G A X R • Patient details,dateand time • Previous AXR? Andcurrent AXR indication • Assess imagetype andquality 13 ▪ Projection 2 3 ▪ Rotation 2 2 ▪ Exposure 4 • Obvious abnormality • BBC approach or ABDOX • Summarise andnext management planS Y S T E M AT I C A P P R O A C H BBC ABDOX • Bowels • Air 14 • Bones • Bowels 1 / 2 • Calcification and artefacts • Density (bones) andcalcification 2 4 • Organs • Xternal objects 15 1 2 3 2 0 2 4 BBC ABDOX 16 1 2 3 2 0 2 4 BBC ABDOX18 1 2 / 3 2 0 2 417 1 2 / 3 2 0 2 4 B O W E L S . . . 19 2 3 2 0 4 BBC ABDOX B O W E L S • Small bowel ▪ Central ▪ Valvulae conniventes – spanning the widthof bowel loop 20 • Large bowel 1 / ▪ Peripheral 2 0 ▪ Haustra partiallycrossing the loop 4 ▪ Maycontainfaecal material • 3-6-9 rule BBC ABDOX 21 1 2 3 2 0 2 4 BBC ABDOX 22 2 / / 2 2 4 BBC ABDOX SBO causes: hernias, adhesions,ileus,tumours M A N A G E M E N T O F S B O • Drip and suck – Ryles,IVI • Catheter 23 • Analgesia and anti-emetics 1 2 • NBM and alert surgical team 3 0 2 4 BBC ABDOX 24 1 2 3 2 0 2 4 BBC ABDOXC A US E S O F L B O • Colorectal cancer (60%) • Diverticular stricture (from recurrent diverticulitis) (20%) • Volvulus (sigmoid or caecal) (5%) 25 1 / / 0 4 Sigmoid vs caecal volvulus 26 1 2 3 2 2 4 BBC ABDOX 27 1 2 3 2 0 2 4 BBC ABDOX 28 1 2 3 2 0 2 4 BBC ABDOX 29 1 2 3 2 0 2 4 BBC ABDOX 30 1 2 3 2 0 2 4 BBC ABDOX 31 1 2 3 2 0 2 4 BBC ABDOXS U M M A R Y • Bowelobstruction Smallbowel obstruction adhesions,hernia,gallstoneileus Large bowel obstruction cancer,volvulus,diverticular stricture 29 • Post operative ileus 1 / / • Toxic megacolon inIBD 0 4 • Bones wedge fractures,metastases, sacroiliitis • Calcium andartefacts pancreas,vascular,uterine,lymphnodes, renal calculi,various objects.