Radiology

The following tests can be considered according to the clinical presentation:

• plain X-ray abdomen (erect and supine): look for (Fig 30.2)

o renal/uteric stones—70% opaque 2 o biliary stones—only 10-30% opaque o air in biliary tree o calcified aortic aneurysm o marked distension sigmoid ^ sigmoid volvulus o distended bowel with fluid level ^ bowel obstruction o enlarged caecum with large bowel obstruction o blurred right psoas shadow ^ appendicitis o a senital loop of gas in LUQ ^ acute pancreatitis

• chest X-ray: air under diaphragm ^ perforated ulcer

• ultrasound: good for hepatobiliary system, kidneys and female pelvis: look for o gallstones o ectopic pregnancy o pancreatic pseudocyst o aneurysm aorta/dissecting aneurysm o hepatic metastases and abdominal tumours o thickened appendix o paracolic collection

• contrast-enhanced X-rays, e.g. Gastrografin meal: diagnosis of bowel leakage

• HIDA nuclear scan—diagnosis of acute cholecystitis

• CT scan: gives excellent survey of abdominal organs including masses and fluid collection

• ERCP: shows bile duct obstruction and pancreatic disease

Other tests:

• endoscopy upper GIT

• sigmoidoscopy and colonoscopy free gas under diaphragm f gallstones q or kidney stones i arge cval gai shadow OF Sigmoid VcivuluS

ureteric calcul;

free gas under diaphragm f ureteric calcul;

small bûwel ohstruct;ün with ladcter pattern oF Fluid levels

Fig. 30.2 The acute abdomen: signs to watch for on plain abdominal X-ray

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