Abdominal X-rays for Medical Students (eBook)

Christopher Clarke, Anthony Dux (Autoren)

eBook Download: EPUB

2015
John Wiley & Sons (Verlag)
978-1-118-60054-2 (ISBN)

Infos

Highly Commended at the British Medical Association Book Awards 2016

Abdominal X-rays for Medical Students is a comprehensive resource offering guidance on reading, presenting and interpreting abdominal radiographs. Suitable for medical students, junior doctors, nurses and trainee radiographers, this brand new title is clearly illustrated using a unique colour overlay system to present the main pathologies and to highlight the abnormalities in abdomen x-rays.

Abdominal X-rays for Medical Students:

• Covers the key knowledge and skills necessary for practical use
• Provides an effective and memorable way to analyse and present abdominal radiographs - the unique 'ABCDE' system as developed by the authors
• Presents each radiograph twice, side by side: the first as seen in the clinical setting, and the second with the pathology clearly highlighted
• Includes self-assessment to test knowledge and presentation technique

With a systematic approach covering both the analysis of radiographs and next steps mirroring the clinical setting and context, Abdominal X-rays for Medical Students is a succinct and up-to-date overview of the principles and practice of this important topic.

Christopher Clarke is Radiology Registrar and Honorary Lecturer in Human Anatomy, Nottingham University Hospitals

Anthony Dux is a former Consultant Radiologist and Honorary Senior Lecturer, University Hospitals of Leicester

Inhalt

Preface vii

Acknowledgements viii

Learning objectives checklistix

Part 1 About X-rays 1

What are X-rays? 1

How are X-rays produced? 1

How do X-rays make an image? 2

How are X-ray images (radiographs) stored? 3

Radiation hazards 3

The Ionising Radiation (Medical Exposure) Regulations 3

In women of reproductive age 3

Indications for an abdominal X-ray 4

Abdominal X-ray views 5

AP Supine abdominal X-ray 5

Other views 5

Radiograph quality 6

Inclusion 6

Exposure 6

Normal anatomy on an abdominal X-ray 8

Right and left (Figure 7) 8

Quadrants and regions (Figure 8) 8

Abdominal viscera 1 (Figure 9) 8

Abdominal viscera 2 (Figure 10) 9

Skeletal structures (Figure 11) 10

Pelvis (Figure 12) 10

Lung bases (may be visualised at the top of the abdomen) (Figure 13) 11

Bowel 1 (Figure 14) 11

Bowel 2 (Figure 15) 12

Presenting an abdominal radiograph 14

Be systematic! 14

Part 2 Overview of the ABCDE of abdominal radiographs 15

A - Air in the wrong place 16

Pneumoperitoneum (gas in the peritoneal cavity) 21

Pneumoretroperitoneum (gas in the retroperitoneal space) 26

Pneumobilia (gas in the biliary tree) 28

Portal venous gas (gas in the portal vein) 29

B - Bowel 17

Dilated small bowel 30

Dilated large bowel 34

Volvulus 37

Dilated stomach 40

Hernia 41

Bowel wall inflammation 43

Faecal loading 48

Faecal impaction 49

C - Calcification 18

Gallstones in the gallbladder (cholelithiasis) 50

Renal stones (urolithiasis) 53

Bladder stones 56

Nephrocalcinosis 57

Pancreatic calcification 58

Adrenal calcification 59

Abdominal aortic aneurysm (AAA) calcification 60

Fetus 62

Calcified structures of little clinical significance 63

Calcified costal cartilage 63

Phleboliths ('vein stones') 63

Calcified mesenteric lymph nodes 64

Calcified uterine fibroids 65

Prostate calcification 65

Abdominal aortic calcification (normal calibre) 66

Splenic artery calcification 66

D - Disability (bones and solid organs) 19

Pelvic fractures - 3 Polo rings test 67

Sclerotic and lucent bone lesions 68

Spine pathology 69

Solid organ enlargement 71

E - Everything else 20

Medical and surgical objects (iatrogenic) 73

Surgical clips/staples/sutures 73

Urinary catheter 75

Supra-pubic catheter 75

Nasogastric (NG) and nasojejunal (NJ) tubes 76

Flatus tube 77

Surgical drain 78

Nephrostomy catheter 78

Peritoneal dialysis (PD) catheter 79

Gastric band device 79

Percutaneous endoscopic gastrostomy (PEG)/ radiologically inserted gastrostomy (RIG) 80

Stoma bag 80

Stents 81

Inferior vena cava (IVC) filter 84

Intra-uterine device (IUD) 85

Pessary 85

Foreign bodies 86

Retained surgical swab 86

Swallowed objects 87

Objects inserted per-rectum (PR) 88

Clothing artefact 90

Piercings 90

Body packer 91

Lung bases 93

Self-assessment questions 94

Self-assessment answers 99

Glossary 107

Index 112

Textauszug

Overview of the ABCDE of abdominal radiographs

It is important to use a systematic approach when looking at an abdominal radiograph. The following ABCDE approach is easy to remember, so when it comes to your exams and you have a moment of panic after being asked to talk about an abdominal X-ray, you can stick to these basics, even if you don’t have a clue what’s going on!

A is for Air in the wrong place

• Look for pneumoperitoneum and pneumoretroperitoneum
• Look for gas in the biliary tree and portal vein

B is for Bowel

• Look for dilated small and large bowel
• Look for a volvulus
• Look for a distended stomach
• Look for a hernia
• Look for evidence of bowel wall thickening

C is for Calcification

• Look for clinically significant calcified structures such as calcified gallstones, renal calculus, nephrocalcinosis, pancreatic calcification and an abdominal aortic aneurysm (AAA)
• Look for a foetus (females)
• Look for clinically insignificant calcified structures such as costal cartilage calcification, phleboliths, mesenteric lymph nodes, calcified fibroids, prostate calcification and vascular calcification

D is for Disability (bones and solid organs)

• Look at the bony skeleton for fractures and sclerotic/lytic bone lesions
• Look at the spine for vertebral body height, alignment, pedicles and a ‘bamboo spine’
• Look for solid organ enlargement

E is for Everything else

• Look for evidence of previous surgery and other medical devices
• Look for foreign bodies
• Look at the lung bases

A – Air in the wrong place

How to look?

• Look for free gas in the peritoneal cavity (pneumoperitoneum). To do this, look for Rigler’s sign (gas present on both sides of the intestinal wall), gas outlining the liver and look to see if the falciform ligament is visible.
• Look for free gas in the retroperitoneum (pneumoretroperitoneum). To do this, look specifically for gas outlining the kidneys.
• Look at the liver (right upper quadrant) for linear areas of increased lucency. Gas seen towards the centre of the liver indicates gas in the biliary tree (pneumobilia), for example within the common bile duct (CBD), hepatic ducts and/or gallbladder. Gas seen towards the periphery of the liver indicates gas in the portal vein.

What to look for in A – Air in the wrong place?

Pneumoperitoneum (gas in the peritoneal cavity)

p. 21

Pneumoretroperitoneum (gas in the retroperitoneal space)

p. 26

Pneumobilia (gas in the biliary tree)

p. 28

Portal venous gas (gas in the portal vein)

p. 29

B – Bowel

How to look?

• Look at the bowel loops for small or large bowel dilatation.
• Look for a very large dilated loop of bowel that could represent a sigmoid or caecal volvulus. If the dilated bowel loop is in the upper abdomen, consider whether it may represent a distended stomach.
• Look at the left and right iliac regions for any bowel gas seen projected below the level of the inguinal ligament suggesting an inguinal or femoral hernia.
• Look for thickening of the bowel wall to suggest bowel wall inflammation. Specifically look for thumbprinting and the characteristic lead pipe colon.

What to look for in B – Bowel?

Dilated small bowel

p. 30

Dilated large bowel

p. 34

Volvulus

p. 37

Dilated stomach

p. 40

Hernia

p. 41

Bowel wall inflammation

p. 43

Faecal loading

p. 48

Faecal impaction

p. 49

C – Calcification

How to look?

1. Look at the right upper quadrant for calcified gallstones (blue).
2. Look over the course of the kidneys and ureters for renal stones (green) and look specifically in the region of both kidneys for a staghorn calculus or nephrocalcinosis (light green).
3. Look at the suprapubic region for bladder stones (yellow).
4. Look at the upper central abdomen for pancreatic calcification (light blue).
5. Look in the regions of the upper poles of both kidneys for adrenal calcification (pink).
6. Look at the umbilical region for abdominal aortic aneurysm (AAA) calcification (red).

• In a female patient, look for a foetus (‘skeleton with the abdomen’ appearance).

Figure 16: Diagrammatic representation of key areas to review when looking for abnormal calcification.

What to look for in C – Calcification?

Gallstones in the gallbladder (cholelithiasis)

p. 50

Renal stones (urolithiasis)

p. 53

Bladder stones

p. 56

Nephrocalcinosis

p. 57

Pancreatic calcification

p. 58

Adrenal calcification

p. 59

Abdominal aortic aneurysm (AAA) calcification

p. 60

Fetus

p. 62

Also look for clinically insignificant calcified structures such:

Calcified costal cartilage

p. 63

Phleboliths (‘vein stones’)

p. 63

Calcified mesenteric lymph nodes

p. 64

Calcified uterine fibroids

p. 65

Prostate calcification

p. 65

Abdominal aortic calcification (normal calibre)

p. 66

Splenic artery calcification

p. 66

D – Disability (bones and solid organs)

How to look?

• Look at the bony pelvis for a fracture (#). If a fracture is seen, use the 3 Polo rings test to look for a second fracture (or disruption of the pubic symphysis or sacroiliac joints).
• Look for a sclerotic (increased density) or lucent (reduced density) bone lesion.
• Look at the spine for loss of vertebral body height, loss of visualisation of a pedicle, loss of normal alignment (e.g. scoliosis) and bamboo spine (ankylosing spondylitis).
• Look over the whole radiograph for any evidence of solid organ enlargement.

What to look for in D – disability (bones and soft tissues)?

Pelvic fractures – 3 Polo rings test

p. 67

Sclerotic and lucent bone lesions

p. 68

Spine pathology

p. 69

Solid organ enlargement

p. 71

E – Everything else

How to look?

• Look at the whole radiograph for any evidence of previous surgery such as surgical staples, clips, hernia clips or bowel anastomoses.
• Look for any catheters, drains, stents or other tubing (e.g. gastric band or gastrostomy feeding tube).
• Look in the pelvis for an intra-uterine device (IUD) or pessary.
• Look carefully for any foreign bodies.
• Look at the lung bases for lung metastasis or other lung pathology.

What to look for in E – everything else?

Medical and surgical objects (iatrogenic)

p. 73

Surgical clips/staples/sutures

p. 73

Urinary catheter

p. 75

Supra-pubic catheter

p. 75

Nasogastric (NG) and nasojejunal (NJ) tubes

p. 76

Flatus tube

p. 77

Surgical drain

p. 78

Nephrostomy catheter

p. 78

Peritoneal dialysis (PD) catheter

p. 79

Gastric band device

p. 79

Percutaneous endoscopic gastrostomy (PEG)/radiologically inserted gastrostomy (RIG)

p. 80

Stoma bag

p. 80

Stents

p. 81

Inferior vena cava (IVC) filter

p. 84

Intra-uterine device...

Produkt-Details

• Erscheint lt. Verlag: 27.2.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie
• Schlagworte: Abdomen • abdominal xrays x-ray imaging medical student reading presenting radiography radiographs junior doctors nurses trainee radiographer pathologies abnormalities • Medical Science • Medizin • Medizinstudium • Radiologie • Radiologie u. Bildgebende Verfahren • Radiology & Imaging • Röntgenaufnahme • Röntgenaufnahme
• ISBN-10: 1-118-60054-1 / 1118600541
• ISBN-13: 978-1-118-60054-2 / 9781118600542