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Ok. As long as you keep your camera on, you still will be visible. Got you got, you got you. That's fine. We, we're live now as well. So if anyone joins they'll be able to see us and screen and everything. So. Ok. Got you. Yeah. Uh Are you in fy one? Right? How, how are you finding things like, uh a as, as an fy one kind of thing? Oh, sorry. Are you talking to me? Yeah. Yeah. Yeah. Sorry. My bad. Uh Yeah, it's been quite good man. Um, well, I don't know. Good is a strong word. Uh It's been, it's been a good, like it's been a steep learning curve but it's been, it's been like, uh uh fun is a strong word but I'd say it's just been, it's been one big learning experience. I've been sorry on off on stroke which has not been too bad. But um it's been, it's been good. Um What about yourself? What are you? Are you me? Yeah, I'm finally am me. So hopefully from next year I'll be in your position. Good, good, good. I'm sure you will be, I'm sure you will be and I'm sure things will go. Well, um, fingers crossed. You got finals coming up, don't I assume? Yeah. Yeah. Finals in February. You? Yeah. Um, I'm at UC UCL. So, North Middlesex Hospital. Got, you, got you. Where are you based for, like, your hospital? Uh, well, I'm up north right now. So I'm, it's a hospital called Penfield Hospital. It's just outside leeds. Oh, I see. I see. Yeah. Yeah. Yeah. So, it's a bit far out. But I was in, um, I was at Kings. I went to Kings for UNI. All right. So you did your UNI in London? Yes. Yeah. I've just done my UNI in London. So I'm, well, I know the area fairly well. Um I'm just gonna, one thing I wanted to ask about kings is, is it true? You guys have to do it. I BSC nowadays. We don't have to. No. OK, because there was like rumors of you guys being forced to do it as well. So it's good to hear that you guys aren't, no, we're not forced to do it. We're not forced to do it. Nice. OK. Uh Yeah. Yeah. No, no, we're not forced to. Did you have to do one? Yeah. Yeah. You see. Force you to do an IBC. You. Yeah, they force you others. I wouldn't have done it. So II didn't realize when I was applying others. I would have just gone Kings so much easier. No, IBC. Yeah. To be honest, when when we applied, I guess, like IBC counted for points and stuff and now it doesn't. So, yeah, that's also the problem with it. But II, it's ok. I honestly don't rush through med school. Don't rush through like, your career. Um, take your time with it. Like, there's no rush to be a consultant. You're going to be a consultant for most of your life. So, yeah, 100%. And we've got some people joining as well, so. Oh, brilliant. OK. Uh It looks all good. We'll, we'll start in like five minutes time for anyone who's joined. There's a few people. Um If you got any questions, just put it in the chart kind of thing. Yeah. Yeah, I'll try and look through the chart because I got my, the chat on my phone at the moment. Um So I can't really tell what's going on. Mm If there's anything on it, just give me a shout. And one other thing is that there's a feedback form built in. Um So whenever you're almost about to be finished, just uh let me know or if you go on the feedback thing on the um slides, share o on meal, you can just send a feedback form and we can get responses immediately and anyone who fills in the feedback form want to get a certificate as well. So it's quite nice. Brilliant, brilliant. Um Sounds good. I mean, I've got some questions at the end. So when the questions probably start. You can like, I think there's three or four questions. So probably when we hit that question, two or something, you can probably start sending the feedback form. Yeah. Yeah. Sounds good. Yeah, that works. Sounds good. And by the way, it's being recorded. So, yeah. Um So anyone who's signed up should be able to see the recording? Yeah, no worries. So, do you know what specialities you want to apply to then? Surprisingly, radiology. This is, yeah, makes sense. Uh No, it's a few of us who are trying to run this series that we were thinking of applying for radiology specialty training. So, yeah, it's, it's lots of perks to it. I'm happy to talk to people about it. I mean, obviously I'm not in radiology at the moment. So I can't really say what it is like, but I can give you some perks and pros and cons about. Oh God, you've got five minutes until we start, give some pros and cons of radiology, pros and cons radiology as a specialty. Ok. Well, it really depends on what you really want to do. So, I think first of all, like you kind of got to decide, do you like medicine or surgery or need? Um, because that's a very, that's probably the first question most people need to ask themselves. Um, do you like wards? Like personally wards are just not for me? I just don't like them. They're just, I prefer a clinic based environment so they ruled out most of medicine to me. Um, and then surgery just didn't appeal to me as much. So I started looking into other things. GP sports, med radiology, there's occupational medicine, there's tropical medicine, there's all sorts of other things you can do. Um, so make that decision first. I think folks of radiology otherwise are that it is a five year run through program. So a lot shorter than most of the specialties. Um, it's a run through program. So you don't have to apply again. You don't have to be a med which is terrifying for some people which I am not particularly keen on. You get a good work life balance as a radiologist, very flexible working hours. Um It's one of the only medical specialties but you can work from home, which is actually like weird when you think about it, but medicine isn't a career where you associate working with home from a radiology is one of them. Um, what are the perks are there? It's, I mean, it's also a specialty where you have to have a lot of knowledge about very different things, which is quite a nice thing rather than being a specialist of one thing. And then you get so good at that one thing that you forget about other things. Whereas I think radiology, you learn, you still are aware about different sort of specialties, which is good. Yeah. So lots of plaques, I think of radiology, I'd say. Oh, God, this has been through things. Yeah. Yeah. Yes. Yeah. Sounds like quite a good speciality. But one question I had was, did you ever consider, like, histopathology or? Because to us, like, as med students they seem kind of similar in terms of, in terms of vibe, like, well, yeah, it was like, yes, I have thought about histopathology. Um, is histopathology. I've, I've thought about his pathology but I'm not looking into it much because I know as a specialty is that different to microbiology. Um, micro, micro, like, um, what do you call it? A micro consultant? II don't know, to be honest, I don't know. But, you know, it, it, it does seem like the same kind of vibe of, you know, there's not much patient contact, it's quite chill, um, kind of thing. Yeah, exactly. I mean, it is quite cool that way. Um, I have thought about it. I think radiologist appealed to me more. I just found them much more interesting. Um, possibly could go look into like histopathology, micro, um, as something, something, uh, to go down if you're into that kind of thing. I radiologist still gives you that option of patient contact though as well, which is a good because you can be doing interventional radiology, you can do ultrasound related stuff and that's all, um, things that you have to do in person. Yeah. Which is good. Um, yeah. No. Feel free. II really like these questions. Shoot any more at me more than that. If anyone has any general questions relating to radiology, just put them in the chart. We, we, we'll be happy to answer them. Yeah. Otherwise we've got like decent number of people like about 12 people. So feel free to start whenever and when people will join on us, you know, you get into the essentially brilliant. Yeah. OK. Thank you so much, Rona. Uh So hi everyone. My name's Raho. I'm one of the F ones. Um I'm currently working at Pinder Fields Hospital which is just outside leeds and I just graduated from Kings. So I'm quite new as an F one, but I'm here to talk to you today about abdominal x rays. So, oh yes, I'm at me. NHS Trust. Cool. OK. So this is briefly what we're gonna be covering today. So when should we think about requesting an abdominal X ray? Um How to interpret your chest X ray, including normal anatomy and abnormal patterns. And we're just gonna go over some questions towards the end as well. So when should we request an abdominal X ray? Cool. Does anyone in the chat or anyone in the audience wanna put any reasons why they would think about requesting an abdominal X ray can be anything. Very simple, very cool, very chill. We're keeping this very informal. So if you can think of anything, that would be a good reason why we should request an abdominal, yes, ob obstruction is good. Brilliant conditions like hiatus, hernia. Cool. Ok. Yeah. So acute abdo pain. Yeah, good. So these are all very good indications of um requesting a chest uh an abdominal x-ray. Yeah, renal stones. Ok. We'll come into a few of these things um and discuss which one would be more appropriate for abdominal x-ray. So in most cases you'd request an abdominal x-ray if a patient has an unexplained nausea or abdominal pain, one thing to be aware of is um a lot of the things that we mentioned were like obstructions or hiatus, hernia, or acute abdomen pain and well, with obstruction and hiatus hernia, we don't know that the patient has it. So we're just suspecting. So an abdominal x-ray can potentially put us in that right direction. Um So if we think or querying um an intestinal obstruction or perforation or we're looking at swallowed objects or looking for kidney stones, yeah, these are good um investigation. It's a good investigation to order. So let's look into how we would go over an abdominal X ray. So an abdominal X ray is broken down into a few steps. So the first step as for AOS is confirm your patient details, then you assess the image type and the quality before looking at the X ray itself. So the first thing is you look at the bowels, look at the other organs, some bones and then also look at the calcification and if there's any artifacts on the abdominal X ray, so confirming patient details. Now, this is something that you have to have to do for every single type of imaging that you do, whether it's in hospital, whether it's in sy, whether it's in med school, just do it because you're gonna get marked on it. Uh make sure that it's the right patient check the date that it was taken, confirm their hospital number or NHS number um which will normally be on the back of the back of the image or in a computer, it'll be associated with the image, what date and time it was taken? And if the previous imaging available, so in an o case scenario, make sure to check. And if it's, if you can't see a name or date, ask the examiner and say, where can I find this information? It might be on the back? Um And if there's any previous imaging is another useful thing to usually ask about. Second thing is what type of image is it? So most abdominal x-rays that we see in clinic are an anterior posterior supine, which means the patient is normally lying flat. Um whereas sometimes we'll do erect ones, but they're just very uncommon. So in most cases, the abdominal x rays will be an anterior posterior film uh with the patient lying down when reviewing the exposure of the image, make sure you've got a good amount of um basically from the diaphragm to the pelvis, all of it is visible and you need the penetration to be adequate to allow uh visualization of the small and large bowel as in this image on the right, which is a pretty normal standard chest uh abdominal X ray. Um And you can see some different parts of the large and small bowel. Now, I know it's often quite hard to do, but yeah, sometimes it's a very, um, it's hard to appreciate penetration when it's correct. Um But generally if you can visualize some small and large bowel, that's a good penetration of it, abdominal X ray. So one thing to remember is that if we're suspecting a pneumoperitoneum or a bowel perf, which is a bowel perforation, uh which occurs due to bowel perforation. Rather. Should I say we would like to get an erect chest X ray, not an abdominal X ray? So if you think it's a perforation, so let's say someone's got a peptic ulcer or duodenal ulcer and we think it might have perforated. One thing we'd wanna get is an, is a chest X ray, an erect chest X ray specifically, um rather than abdominal x ray. What we're looking for is that um pneumoperitoneum, which is that free gas sort of sign. So that darker region which we can see um over here in that area below the diaphragm and that's a sign of um a perforation cool. Now, we move on to the third step. So we're gonna be assessing the bowels in the third step. And now, as you guys know, there is the large bowel and there's a small bowel. So it's often quite difficult to see the difference between the two and an abdominal X ray. And usually if you can't see a big difference, it normally means it's ok and there's nothing really wrong with it. Whereas if they're quite abnormal, uh, that's when it's actually easier to, to tell whether this is small or large bowel. The main thing that allows you to visualize the bowels is actually any gas that's present in the lumen of the bowels. So you wouldn't see the bowels themselves if there wasn't any gas present in them, but often fecal matter might have that gas or air that allows it to be visualized. So this is an example of a normal small bowel. So as you can see, it will, it is normally in the center part of the abdomen. Um And usually you have these things called valvulae Conte, which is these straight lines that for that come from one end of the small bowel straight to the other side of the, of the small bowel. And this is only present in the small bowel, not in the large bowel. It's important to know that the valve conven cross the full width of the small bowel as well. One thing to be aware of is the 369 row. So generally the upper limit of a normal diameter of the small bowel is usually three centimeters. So, if this bowel is dilated more than three centimeters, then this could be a sign of, um, an obstruction, um, in the large bowel that is six centimeters in the colon and nine centimeters in the cecum. So now we know this 369 row and this is an example of a large bowel. So this is a large bowel which has lots of gas present in it, but it is normal in appearance. One thing to be aware of is the large bowel often sits on more of the peripheral side of the abdomen. Whereas the small bowel is in the, in the center of the uh abdomen and the 369 rule applies still. So remember the large bowel, if it's tender, more than six centimeters or more than nine centimeters in the cecum, then we're thinking about obstruction or other pathology. Ok. So, yeah, this kind of describes it in more detail. So what we can see is this gas, this gaseous pattern and the feces look a bit mottled. And that's because the feces generally tend to have a lot of gas in them. Large bowels tend to have haustra, which are these circular muscles that we can see around here. Whereas a small bowel, as we said previously has the valve Verda kind of ending. So, yeah, that's generally how we would be able to tell between the two of them. So a small bowel we generally have, it's in the center of the abdomen, they have b Conte, whereas the large bowel is more peripherally, they have haustra and the feces may be present within them. Cool. Now we're gonna move on to other organs. So abdominal x rays provide limited amount of detail for abdominal organs. So if you suspected abdominal organ pathology, abdo x rays aren't really going to tell you much to be honest. Um So it's a pretty rubbish form of mo mo a rubbish form of imaging. If you're looking for most things in most organs, that being said, you can visualize some organs um on an abdominal X ray and it can point to some pathology. So the ones that we wanna be aware of are your liver, your PSAs your kidney, your spleen and your bladder. So your liver on your abdominal X ray and that usually lies in the right upper quadrant which we know of and it's usually like a plain grayish kind of area. So as we can see in this kind of image, there we go. So you can see this. I'm gonna jump back and forth between all of these images. So you can tell where the liver lies. So, yeah, and this patient has had a cholecystectomy. So you can see some of the clips where the gallbladder used to be. Um Usually this is how you'd spot the liver on the abdominal x ray, this is a liver that is normal in size. So no signs of any enlargement. It's usually a grayish area which you can see in the right upper quadrant, moving on to the psoas, the kidneys and the spleen. So again, if you or me, that is so hard to visualize all three of those organs. And if I didn't call them in, it would be so hard to tell that this is the spleen kidney and so that you're looking at and often that's very reasonable. Because if you're looking for a pathology in these regions, it's very hard to see them on an abdominal X ray. It's sometimes just good to be aware that these organs are in these places. And if you see a general hazy gray pattern, which pushes bowels out of the way, think about abnormality in these organs about what could be causing it. So, yeah, I'll move back and forth between them. So the PSAs muscle is the muscle that's often very much closer towards the spinal cord. So it's much more medially and you can see a straight line usually running across the side of the abdomen, abdominal X ray. And that's usually your, your lateral border of your PSAs muscles, whereas your kidneys in your abdominal x ray might be visible. They usually this hazy gray pattern in that kidney, uh kidney being sort of shape and your spleen sits superiorly towards that. Now, we're gonna look at some of the bones. So lots of the times the bones that you can see on an abdominal x ray um are the lower limbs, the lumbar vertebrae and the sacrum. So I'll highlight these as you can see over here. So when you look at the sacrum, the lumbar vertebrae and the lower limbs, you can also tell um the position of the ureters and where they join the bladder. So the bladder is usually joined at this process where this process is here. So you can see these um the what do, what do you call this process as the, oh, the name has just slipped off my head. Anyway, there's these small extension that you can see on the abdominal X ray that often relate to the position where the ureter is usually meet the bladder. And then you can also see the other bones, the sacrum, pelvic bone and the hip joints over here. Cool. This is another abdominal X ray where you can see some artifacts and some calcification present. So here there's loads of abdo um asymptomatic incidental findings on this abdominal X ray. So this patient is recovering from an appendicectomy, which we can see by these clips right here. Patient has got some gallstones which we can see up here and the patient has also got some costochondral calcification um which are some mesenteric lymph nodes which have just been calcified. Uh most of the time that's not really significant but that's what we can see about here. Cool. So now we know what a normal abdominal X ray looks like. Let's look at symp pathology. So the first sign that we might see in an abdominal X ray is this sign called R sign or double wall sign. Now, some of you might have heard of it and this is a sign that we would see in a patient who has per so if there's perforation present, um, what you tend to see is a double wall. Now, what that means is you can see the outside of the wall and the inside of the wall. Whereas in a normal abdominal x ray, as you can see here, you can only generally see the inner wall. Um generally you see the inner wall only because of the, the gas present on the inside. But if there's gas present on the outside as well, that's when that's the reason why you see the both the inner and the outside wall. Normally, you can also see, as you can see over here, the gas that separates the bowel segment forms these sharp angles and you can generally see the gas present here and you can see the inner and outer walls present on both sides here. Now, how would you know someone has had a bowel perforation? So, what would you see in this patient? Well, the patient would generally be in a lot of abdominal pain. They have lots of chills, lots of fevers, nausea, vomiting, they may be in shock and this is a surgical abdomen. So this is one where you, you're thinking about getting an emergency la laparotomy. So you're thinking as an F one, listen, this patient needs an urgent CT scan. I'm calling the surgeons, surgeons need to come and have a look at this patient and basically um send this patient to theater now a small bowel obstruction and this is something that we are worried about in a lot of cases, uh, when we, when we look at patients. So a lot of the time that we, when we're looking at small bowel obstruction, the thing that we are looking at is the bowel distended more than three centimeters. So in the images that you can see on your right, um, at the top is the image without any annotations. And below shows some annotations present. So you can see that there's an evidence of a previous surgery, which is the uh right red ring that you can see it's in an anastomosis site. And that is often a very good indicator that this person is much more prone or much more likely to have a small bowel obstruction. So you're more likely to be like, ok, it raises that differential and puts it much more higher on your differential diagnosis list. Other times to be quite aware or where this small bowel obstruction picture fits into your mind a bit more is with patients with hernias, tumors or possible Crohn's disease. Um and they often present with like abdominal pain, nausea, vomiting, loss of appetite change in bowel habits. And that's generally when you request an abdominal X ray. Um A management is very similar. So urgent ct abdominal scan, you want um an NG tube to relieve the distention and then you wanna be on the phone to the surgeons um asking them to review this patient and take them off to theater. Um, a lot of the times, um you can get a question on as an M CQ about this. Um And if you're unsure about what to do, if there's a delay in the CT scan, the best, the next best thing to do is probably stick an NG tube in as quickly as possible to suction and relieve any distention that you can cool moving on. So we're gonna go on to the large bowel obstruction. Now, this differentiates the small bowel obstruction because we're looking at a bigger size. So in these images, I know the one on the right, we've kind of made the large bowel very dark. So the one on the left is the original image. And what you can see is that the large bowel is definitely distended here. This is definitely the large bowel because you can't see any valve ra Conte present here. Also, the position fits the position of the ascending and transverse and descending colons as well. So this is definitely a large bowel obstruction. You can technically see a little bit of gas into the in the rectum. So the patient is not completely obstructed. And one thing to be aware of is this is likely to occur in our elderly population because, um, the most common cause of large bowel obstruction are, um, rectal carcinoma or any diverticulitis. Now, patients generally have very similar kind of symptoms. So, abdominal pain, nausea, vomiting, loss of appetite change in bowel habits. But I think with large bowel obstruction, you generally get more bloating, more abdominal distention. And in some cases, you can get uh fecal vomiting, which is basically what it sounds like you're vomiting up feces, which is absolutely awful, but that's what would happen in more severe cases. Um The management of them are fairly similar again, get them, get them an urgent CT, get them an angio tube and call the surgeons cool. Now, we move on to this thing called a sigmoid involved with us. Now, this is where things can get a little bit confusing. So one thing that we're looking for in a sigmoid volvulus is this coffee bean inside for what does that even mean? So one thing to be aware of when looking at a volvulus is that the volvulus always moves away from the area where the volvulus is, I'll explain that one more time. So the bowel moves away from the area where the VV ulus is. So in a sigmoid. That's where the sigmoid colon is in your right iliac fossa, the your left iliac fossa, sorry, your sigmoid, your bowel will move away into the right upper quadrant. And that's a sign of a sigmoid vus. So, patients generally will present with abdominal pain, nausea, vomiting, loss of appetite, they might have change in the bowel habits. Uh some bloating and some distension. Once again, the, the management is very similar for all of these conditions where we call surgeons, get a CT scan and stick an NG tube in. Now we see the opposite a cecal modulus. So a cecal volvulus as similar to a a sigmoid volvulus moves away from the area of the volvulus. So the bowel moves away from the area of the volvulus. So in this case, it moved towards the left, left, upper quadrant, which we can see here. So it moves from the right eye fossa up towards the left, um left upper quadrant, which you can see over here. Um patients will have very similar symptoms and very similar management. So in this case, you can see that there's also possibly a component of the um large bowel that's also probably a bit obstructed here, which you can see with these large patches of uh the haustra. But the most obvious thing that we can see is the cecum which is um definitely definitely understand cool, moving on to some of the pathology. It's a lead pipe or colon or toxic megacolon. Hm. Strange name, but it gets his name for a very, very good reason. So these are patients who this is generally seen in patients with ulcerative colitis. Um And what you generally see is a descending colon which is completely featureless, which you can see in this image on your right here, there's no signs of any haustra, there's no signs of any uh fecal matter. It's just basically like a pipe essentially and it's often full, full of gas. And that's what we see and described as lead pipe appearance. Generally, people will be in abdominal pain, fever, diarrhea, distension and shock. Um Also think about this in a patient um with ulcerative colitis and usually managed with uh IV fluids, IV antibiotics, um and steroids, that's generally what you'd manage them with. And if surgery is indicated, that's when you'd go down that route. Cool. So now we know ab what abdominal abnormal bowel looks like. So let's look into soft tissue bone and calcification abnormalities. So, in this case, we can see that the there's a much more hazier appearance in the right upper quadrant, which I'll go back and forth and you can see that there is a much bigger haziness in that right upper quadrant. And what you can also see is that the bowel is pushed away from that area which suggests that this is a, a patient with Hepatomegaly. Um and I'll move back and forth between the two images. So you can see that. So it's difficult to appreciate and it's difficult to clearly demarcate the border of the liver. But one thing that's clearly visible is that the bowel has been pushed away. Um And there's this haziness in the right upper quadrant which will signal to you and this patient has better mag. So now splenomegaly, so splenomegaly is something very similar, but on the other side, so this patient has um both hepato and splenomegaly. Um So you can see there's a general haziness in both the right and left upper quadrant, which suggests that the patient has both heat to and splenomegaly. You can also see that there is no bowel present in those areas which suggests that they've been pushed away again due to the enlargement of both of these organs. Um And generally, you can only really see this because of the more increased hazy pattern in the right upper quadrant and the left upper quadrant as well. 222 cool. Now, looking into bone abnormalities. So, in this case, what can you see on this abdominal X ray? So, one thing to be aware of is that this patient, the thing that sticks out is probably the hip replacement. They've clearly had a rightsided hip replacement, which you can see in this image. Um Now this is uh an elderly patient who has had no history of trauma but is presenting with abdominal pain. Um And now, initially, they thought it was occurring like abdominal obstruction or something like that. But one thing that they found on this abdominal X ray is that this patient has a pubic gra I fracture. And you can see that if I go back and forth because there's lack of continuity um in the pubic area of my region. Yeah, which we can go back and forth, see that. Now, it's very diff difficult to appreciate. But this patient also has osteoarthritic um appearances of the hips and lumbar spine joints. And that's generally seen because of this kind of um you can see bright and darker regions of the uh bones in that in that area, which suggests that this is osteoarthritic changes due to the presence of these um osteophytes which break down bone bone metastases. So, in this case, this patient has numerous white kind of patchy areas as you can see over here, which possibly suggested this is B bone metastases. Now, I can understand that this is very hard to differentiate, differentiate between other forms of uh bone pathology. And probably we'd need a bone ct scan, a bone scan or a ct of the pelvis to figure out what's actually going on. But an Abdo x-ray can give you some signs that the patient is suffering from um a sclerotic um bone cancers and that's what we can see in this case, renal stones. So, yes, I think someone mentioned quite early on that we can use abdominal x rays to see, to look for renal stones. Now, one really funny thing is that renal stones aren't like really stones as such. They're more like very fine like calcifications or grains. So they often have this staghorn appearance, which is as shown here because it's lots of really, really fine particles which are high in calcium which um basically can be seen on the abdominal X ray and they collect in that region and form the staghorn calculus, which is generally what you'd see um in a patient with renal stones. Um and this can be present on either side, but this is what you generally type tend to see cool. And now you've got this kind of picture here where a patient also has gallstone where, where we think a patient might have some kidney stones. But as I've just previously described kidney stones don't have this sort of appearance. Kidney stones have that staghorn um kind of appearance as described earlier. Whereas here we can see more rounded r clear rounded um structures. So what are these? So what those are in the right upper quadrant are the calcified gallstones. Whereas in the left upper quadrant is generally the mesenteric is a calcified lymph node as well. Um And as described, these are more rounded and they cluster together um which is generally what we'd see in gallstones. Um And in a lymph node, this is just somehow a calcified uh lymph node also present cool. And then we move on. This is an NJ tube, which we would see in patients who have had, um, basically they've not, they've had a, they had an NG tube probably not tolerated or there's some pathology in the stomach that needs to be bypassed. So they've had a tube that's pass the stomach and into the juju. And for that, we'd probably need an abdominal X ray. And in this case, we can see that the, that the tube passes through the stomach and forms ac sort of shape, which means it's passed through all the forms, all the parts of the duodenum. Um, and I'll move back and forth to see what this looks like. There we go. Yeah. So as long as it's passed through all the forms, all the part of the duodenum and is into the jejunum, that's where the NJ tube should sit. Cool a ureteric stent. So this is a case where you got an abdominal X ray. And the only thing that sticks out to us is this little tube that runs from the position of the kidneys all the way to the position of the bladder kind of area. And that usually happens when someone's got ureteric obstruction. So usually a kidney stone that's gone with the ureter and kind of blocked it. And this is the type of stent that we'd use, uh to basically open up the ureter and make sure that that obstruction has been relieved which we can see over here. Now, foreign bodies. Now, this is something that we see. I've seen lots of funny, funny images. Um and some of the things that we see are actually hilarious, but this is a case of a patient who swallowed loads and loads of things. So what you can see is here, there's some batteries, there's some glass nails, some screws, um and is also wearing some navel jewelry. So these are all sorts of things that you can see. It's very difficult for us to tell what exactly the foreign body is. Um But one thing to be aware of is if you can see some foreign bodies just say foreign bodies are present. Um You're not expected to know what exactly the foreign body is because often you really don't know until unless the patient can tell you cool and moving on. So we've got, so we're going to do some questions now, before we start any questions. Does anyone else have any questions for me regarding anything we discussed? Also, I've, I've sent in the feedback form um in the meantime, while people are thinking of any questions, please feel free to just fill in the feedback form. Sounds good. Um I've got a set of questions to run through as well. So um which are the next few slidess. So if people can have a practice of interpreting abdominal x rays and finding common pathology, I'll go through the questions if anyone has any uh any if they wanna fill out the feedback form, fill out the form. If you wanna go through some questions, we can do that as well. So, yeah, this is the first question. So you've got an 80 year old man. He's got a three day history of not opening his bowels and he's just got a bit of tummy distension. This is his abdominal x-ray. You're the f one who's looking at this and you're thinking what in the world is going on. So what can you see here? Mhm So you've got sigmoid volvulus, two sigmoid volvulus. I like you guys thinking. So there is a volvulus. Um And it's a sigmoid. OK. Do you go to any other takers or anything else? Cool. OK. So we, I don't think we got any more answers. So I'm gonna go on. This is in fact a sigmoid ovulist. So we hold on to you guys who said sigmoid ovular because this is a pattern where a patient where this is moving away from the sigmoid region, which is what we'd expect to see. So it's moving away from um our area, our left ileac fossa and towards the um right upper quadrant, which is what we see in a sigmoid wall of this. Mhm Cool. We've got another question here. You, you've got a 40 year old female this time, generalized abdominal pain and fullness, nausea, but no vomiting. She's passing flatus later. Sorry. Um what can you see on this abdominal X ray? So you got normal ABDO X ray. Anyone else impaction possibly. Yeah. Foreign body at the bottom of the X rays. Good. Yep. So this is actually a normal abdominal x-ray. So you're correct. There is a fo foreign body in the bottom of the X ray. That's something to be aware of something to point out. That's probably a naval piercing. So something to note in your osc case, um You are looking at the bowel pattern, this is a normal bowel pattern. This is what you'd expect in the bowel with impaction. You generally see it in the larger bowel, especially where you will see this mottled appearance. It is very similar to this, but you generally see it in the larger bowel. So this there is slight um impaction, but generally you would see that in the transverse and the descending colon. Whereas here, um you can mainly see in the ascending colon which is um less, less likely to be infection. Cool. What have we got here? So we've got a 65 year old female, got uh pyri nephrosis, sorry, um of a nonfunctioning left kidney and now she's developed a distended abdomen and this is her rhabdo x-ray. So there's a couple, there's a few things going on here. Any takers, any guesses feel free just to give a guess if you're unsure. Caco Volvulus. Ok. Come on, guys, you guys got this and your legs. Frightening. Yeah, bowel obstruction. Good. You wanna specify a little bit more which type of bowel large mole? Ok. We'll, we'll, we'll have a look at this X ray. So this is a patient who has cecal volvulus and a small bowel obstruction. Um, the reason why you can see this, this coffee bean shaped area here and it is moving away from your right eye fossa up to your left upper quadrant, which shows that this is a cecal volvulus. And what you can see here in this area is you can see your valvulae conven, which means this is small bowel that's been obstructed here. It's been moved peripherally because of the cecal vvs. The CECAL vvs has pushed a small bowel all the way to the edges and the reason you, that's why it's in, it's not in the correct position. Um, because it's more peripheral, which is why you think it's large bowel. But the valvulae even basically tell you that this is a small bowel. Uh, one thing to also be aware of is this patient has a drain in possibly post surgery. Just an abdominal drain as well. Go a 70 year old female distended abdomen, um, absolute constipation for 24 hours. So, no feces and no flatus. It was not passing gas. What do we think is going on? Yes. Mohammed said large bowel obstruction. How many people are with him on that? Two. Yeah. Ok. Go on to the answers. Yeah, there's two large bowel obstructions. Yes. So I can explain why is it in the middle? Good. Ok. So basically, one thing to be aware of with the large bowel obstruction is that we got to remember the anatomy of the large bowel. So a large bowel runs peripherally. So it's got the ascending colon and transverse colon. And then you've got your descending colon when it becomes enlarged. In this case, it is very, very much enlarged. Um It's got nowhere to go. So it's basically moved from the peripheries all the way to the middle as well. Because if you notice this is the ascending colon, this is your transverse colon. This is the flexure that you see here. This and here is your descending colon, but because it's so enlarged, um It's basically been moved to the middle and that's why it's basically gone to the middle as well. Also one more thing. Um This is also typically what, sorry, this is typically large bowel because of the pattern. So again, this bowel does not have any vente. So it is unlikely to be small bowel. You can see that this is generally got Haustra because you can see this pattern, these muscles all along the walls here, but there's no valve kind of antidepressant. Cool. I think this might be the last question. So you've got a patient here who's got this three week history of bloody diarrhea and she's only 30 years old. So you've done an abdominal X ray and this comes up. Mhm What are we thinking? Any takers? I understand it's probably the end of the presentation and getting a bit tired. So this is a patient with toxic colon. So this is where you can see that typical um lead piping kind of appearance. So, uh as you can see towards the end here, the the the large, the descending colon, especially in this section here has sort of lost its um lost, its basically structure looks like a lead pipe. Um There's no sort of muscles that you can see. It's generally quite dark because there's a lot of gas present in it. It's quite dilated, that's what you'd expect. And it fits in with a picture of a bloody diarrhea, which is what you'd expect in ulcerative colitis cool. And this is a bit of an idea of. OK. So I've got a good question on how can I differentiate between uh this image and the previous image. So yes, the key difference is that in lead piping appearance, you get loss of um the features of the large bowel, um especially the descending colon, which is this area here. Whereas if you see in this case, the large bowel still has those features present, it still has the muscular walls features present. Another thing to be aware of is the history tells you massive amounts of things. So aside from just the image itself, I mean, someone who's presenting with b bloody diarrhea, much more likely to be, um, a colitis picture. Whereas a patient who is not passing stool at all, much more likely to be a large bowel obstruction. I hope that helps. And yet so, summary abnormal x-rays can be used to diagnose or rule out various conditions. Uh, we've learned a bit about the basics of how to interpret an X ray, an abnormal x-ray. Hopefully you're a bit more competent on it and can definitely have a bit of an idea of what's going on next time. You look at one and you've learned how to look at no uh common pathology. So these are few really good, really, really good um resources. I'd highly, highly um recommend you guys use them radiology, mass class is really good for any sort of imaging learning that you wanna learn. Radio pia is really good resource for uh radiological images as well. Medics. I'm sure all of you are aware of them by now. Uh Really good for med students and learning the basics of everything. Cool. Uh Got some questions. Um I think there's a feedback form on the chart. So probably fill that one out and this is just my personal one. But yeah, happy to take any questions if you guys have any. Yeah, thanks for doing the lecture. And just to say if you fill in the feedback form, you get a certificate and the recording. No worries, guys. Hope you is useful. Yeah, I'll hang around if there's any more questions. If anyone wants to ask anything about F one exams, finals, ays electives, career choices. Happy to talk about anything by the way. So, where did you do your elective? I did mine in Australia. Loved it. Where in Australia I did mine in Sydney. Um, I was there for two whole months in, like traveling and doing my active. Absolutely loved. It would highly, highly recommend, would highly recommend going go out there. Have a good time. Go somewhere, do something in your life. Yeah. And definitely I'd say spend time traveling as well. Not just like studying the entire time because you do take your, you take for granted the amount of free time you have and when you come to F one, you realize you don't have any. So it's just good to know, do it when you can. Yeah. Yeah, of course. I'm also going to Australia so I'm going to Melbourne. Uh No way. Yeah. So exciting. What's yours in? Uh mine's in neurology and endocrinology. So, neurology and endocrinology. Interesting. Yeah, because I, I'm going to Royal Melbourne Hospital and they let you do two different specialities. Got you. Sorry. Got you. No, no, no. Yeah. So that's the reason like, what speciality did you do at? Um Sidney? I did a sports and exercise medicine one. That's nice. Which was, which is really cool. Really, really cool. Um Yeah, lots of packs lots of really cool things. No. Well, enjoy your elective. I'm sure it'll be fun. Um, when are you going? I'm going, uh, II think it's end of March. So not long. No. Um, um, and it's nicer weather like, well, Melbourne gets a bit cold by the time you like, may rolls around. So, yeah, I'll be gone by then. Yeah. So, so it's fine. Enjoy it in, in March, which is nice. Yeah. Yeah, I guess there's no questions for anyone. No, it doesn't seem like it uh which is completely fine. Yes, sir. Thanks for running the lecture. Thank you for having me. Um See you. Thank you. Take care.