Source: Xinxiang Medical Imaging
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Observation points of each body position of the acute abdomen series
Supine position in the acute abdomen series
■Advantages.
Observe the overall distribution of gas in the intestinal tract. Knowing how much air and liquid there is and where they are most likely to be is more important than identifying each small bubble on the x-ray.
Identify the presence or absence of calcification.
Identify the presence or absence of soft tissue masses.
■Inspection method.
The patient lies flat with his back pressed against the x-ray examination bed, and the x-ray harness is projected downwards vertically.
■Replaceable examination position.
In fact, there is little to replace the position of the supine abdominal flat sheet, and basically all patients can tolerate the examination of this position.
Prone position in the acute abdomen series
Recognizes gases in the rectum and/or sigmoid colon.
If the patient is prone on an x-ray examination bed, the colon and rectum will be in a higher position than other segmental colons, and the gas will be mainly distributed in the sigmoid and rectum.
By the way, in a routine rectal examination, the sigmoid colon and rectum do not artificially introduce gas.
Identify gases in the ascending and descending colons.
Because in addition to the sigmoid colon and rectum, the ascending and descending colon positions are also close to the posterior side, so if the patient is prone to position, gas will accumulate here.
The patient lay flat on the x-ray bed with his stomach attached to the x-ray, and the x-ray harness was projected vertically downward.
Patients often become physically unable to tolerate prone positions (e.g., recent surgery, severe abdominal pain).
These patients can be left in the recumbent position to obtain a lateral image of the rectum, x-ray or vertical projection, which is used to replace the flat flake in the prone position.
Lateral rectal images usually show the presence or absence of gas in the rectum and sigmoid colon.
Acute abdomen series of standing abdominal flat tablets
Free gases in the abdominal cavity (i.e., extraintestinal gases) are found.
The gas-fluid level in the intestinal lumen is discovered.
The patient is in a standing or upright position, and the x-ray tube ball is shot horizontally, that is, parallel to the ground.
Patients often cannot stand or sit upright due to acute abdominal pain to obtain a flat flank of the upright abdomen.
In this case, the left recumbent position can be used instead of a standing ventral plain. The left recumbent position is when the patient lies on the side of the bed with the left side of the body pressed against the x-ray, and after the patient takes such a position, the "free gas" will accumulate at the highest part of the abdominal cavity, that is, the right side of the patient.
If the free gas is located on the outside of the edge of the liver, there is no interference from intestinal gas here, so it is easy to find.
If the patient takes the right recumbent position, the free gas will accumulate on the left side of the body, and the left side of the body normally has gastric vesicles and colonic spleen flex, which is easy to interfere with the observation of free gas.
In order to observe the free gas, the x-ray harness must be projected horizontally when shooting the lateral recumbent film, that is, in a parallel direction to the ground.
Acute abdomen series of positional chest x-ray
Observe the gases downstream of the diaphragm.
The presence or absence of pneumonia at the base of the lungs is found, and the clinical manifestations of pneumonia sometimes resemble acute abdomen.
Pleural effusions are found, sometimes secondary to celiac disease, so the discovery of pleural effusions suggests further identification of celiac disease.
As in pancreatitis, there may be a left pleural effusion.
Some ovarian tumors may cause a right or bilateral pleural effusion.
If there is an abscess (subphragm abscess) in the right subdiaphragm, it may cause a pleural effusion on the right side.
The patient is standing or sitting upright, with the x-ray harness treaded horizontally toward the chest.
■It can replace the examination position of the erect chest x-ray.
Patients often cannot stand or sit upright for erect chest x-rays due to acute abdominal pain, and in this case, a recumbent chest x-ray is taken and the patient lies flat on an x-ray examination bed.
When shooting chest x-rays in the supine position, the x-ray harness is projected vertically downwards, and free gases, especially small amounts of gas, are easily missed.
Reading films is a compulsory course for doctors and one of the watersheds of doctors' level. What should be observed on a plain abdominal film? How to distinguish between the large intestine and the small intestine? Today, let the experts help us answer it
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