Abdominal x-ray review: bowel
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Abdominal x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using ABDO X is a helpful and systematic method for abdominal x-ray review, where B refers to the assessment of the bowel loops.
- stomach, small bowel and large bowel may be differentiated on an abdominal x-ray
- pathological features to detect include bowel dilatation, bowel loop displacement and bowel wall thickening
- the stomach usually appears thick-walled and lies in the left upper quadrant, and may contain the tip of a nasogastric tube
- can you identify the small and large bowel? Use these features:
- the small bowel usually lies centrally, has folds than run all the way across the diameter of the lumen (valvulae conniventes) and usually contains a small volume of air
- the large bowel lies peripherally, has folds that run part of the way across the diameter of the lumen (haustral folds) and usually contains some air and fecal matter
- is the bowel dilated?
- the 3-6-9 rule refers to the approximate allowable diameter (in centimeters) of the small bowel, large bowel and cecum
- are the bowel loops are clustered centrally with hazy homogeneous opacification of the rest of the abdomen?
- this is an indication that there may be ascites
- is the wall of the large bowel thickened and undulating in its contour?
- this is known as thumbprinting and indicates colonic wall edema which may be due to infection, inflammation or ischemia