Abdominal X-rays for Medical Students

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

Preface vii

Acknowledgements viii

Learning objectives checklist ix

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

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