Plain abdomen

How to look at plain abdomen

Look for dilated loops of bowels Gas outside the lumen of the bowels Ascites or soft tissue masses in abdomen or pelvis Locate any calcifications Assess the size of liver and spleen

Dilatation of bowels
The colon- haustra, incomplete bands across the colonic gas shadows Always present in ascending and transverse colon May be absent in the distal or splenic flexure. In case of dilated jejunum the valvulae conniventies can be seen, with the apperance of stack of coins.

 The presence of solid feaces is a useful indication of the position of the colon The small intestine is usually in the center of the abdomen, but the redundancy of the transverse and sigmoid colon, may place them in the center.

Causes of bowel dilatation

Mechanical obstruction Paralytic ileus Acute ischemia Inflammatory bowel disease

Mechanical obstruction
Of the small bowel causes small bowel dilatation with a normal or reduced caliber to the large bowel. Of the large bowel causes dilatation of the colon up to the point of obstruction , sometimes the small bowel is also dilated.

Paralytic ileus
Large and small bowel are dilated Gas may be present in the rectum Difficult to differentiate it from lower large bowel obstruction.

Local peritonitis
Dilatation of bowel loops close to the inflammation sentinel loop appearance Like in appendicitis or pancreatitis

Gas in the peritoneal cavity

Due to perforation of the GI Might follow surgical intervention in the abdomen The most common cause of spontaneous pneumoperitoneum is perforated peptic ulcer

 Air under the right hemidiaphragm is seen on erect abdomen or chest x-ray as curvelinear collection of gas. A lateral decubitus film solves the dilemma.

Gas in abscess
Variable pattern on plain film Small bubbles or large collections of air Fluid levels seen on horizontal ray film Abscess can displace structures, like elevated diaphragm due to sub phrenic abscess

Ascites
Small amounts cant be detected Large amounts separate loops of bowels and displace ascending and distending colon Little value of plain film Best diagnosed by U/S or CT

Abdominal calcifications
Localize the calcification, even with oblique's or lateral Most common are: - Phleboliths - Calcified lymph nodes - Costal cartilage - Arterial calcifications

 Uterine fibroids: numerous irregular calcifications Adrenal calcifications; after hemorrhage or tuberculosis. Usually asymptomatic patients Malignant ovarian mass might have calcifications, Liver calcifications , in hepatoma

 Pancreatic calcifications in chronic pancreatitis, small calculi within the pancreas Feacolith; calcified feacoliths usually seen in the diverticula or appendix Renal stones Gall stones Splenic calcification; cysts, infarcts, old hematoma or after TB