RADIOLOGICAL INVESTIGATIONS IN ACUTE ABDOMEN

1. RADIOLOGICAL
INVESTIGATIONS ACUTE
ABDOMEN
BY :
DR. VINAYAK M NADIGER

2. Acute Abdomen
• Condition characterized by sudden onset of
severe abdominal pain requiring early
medial or surgical treatment.
• Determining exact cause is important for
effective management

3. Abdominal Anatomy

4. Exam Quadrants

5. Differential Diagnosis

7. Common conditions
• Appendicitis
• Cholecystitis
• Pancreatitis
• Intestinal perforation
• Intestinal obstruction
• Ureteric colic
• Ectopic pregnancy
• Testicular /ovarian torsion
• Aortic aneurysm

10. Surgical Anatomy - Position

11. Appendiceal
obstruction/early
appendicitis – visceral
peritoneal irritation
Appendiceal
distension
Irritation of parietal
peritoneum
(localised)
Perforation,
localised/generalised
peritonitis, mass
obstruction
Distention
Distention
causing
Ischemia
Gangrene

13. Appendicitis
• Usually due to
obstruction with
fecalith
• Appendix becomes
swollen, inflamed
gangrene, possible
perforation

20. CHOLECYSTITIS

21. Gallstones . .
• The presence of
gallstones in the
gallbladder is called
cholelithiasis.

22. Those who are most at risk.
• These are all adjectives to describe the person most at
risk of developing symptomatic gallstones.
FAT FORTY FEMALE

23. CHOLECYSTITIS

24. Cholecystitis
• Inflammation of gall
bladder
• Commonly associated
with gall stones
• More common in 30 to 50
year old females
• Nausea, vomiting; RUQ
pain, tenderness; fever
• Attacks triggered by
ingestion of fatty foods

26. U/S of GB pathology

27. CT scan of GB pathology

28. CT scan of GB complications

32. Pancreatitis
• Inflammation of pancreas
• Triggered by ingestion of
EtOH; large amounts of
fatty foods
• Nausea, vomiting;
abdominal tenderness;
pain radiating from upper
abdomen straight through
to back
• Signs, symptoms of
hypovolemic shock

39. Peptic Ulcer Disease- Gastric
perforation
• Steady, well-localized
epigastric or LUQ pain
• Described as a “burning”,
“gnawing”, “aching”
• Increased by coffee,
stress, spicy food,
smoking
• Decreased by alkaline
food, antacids

40. Peptic Ulcer Disease
• Erosion of the lining of the stomach,
duodenum, or esophagus
• May cause massive GI bleed
• Patient lies very still with complaint of
intense, steady pain, rigid abdomen with
exam, suspect perforation

41. Perforated peptic ulcer
morphology related to location
juxta-pyloric ulcer:
small, healthy border
gastric ulcer at lesser curvature:
large, fibrotic edematous border
(ulcus callosum)

42. Perforated peptic
ulcer

45. Perforated peptic ulcer

46. Perforated peptic ulcer

47. Bowel Obstruction
• Blockage of inside of intestine
• Interrupts normal flow of contents
• Causes include adhesions, hernias,
fecal impactions, tumors
• Cramping abdominal pain, nausea,
vomiting (often of fecal matter),
abdominal distension

48. ABDOMINAL XR

49. Bowel Obstruction
• Small Bowel Large Bowel
– Central Peripheral
– Valvulae conniventes Haustrae
– Dia > 5cm > 10cm

50. SBO LBO

58. Kidney Stone
• Mineral deposits form in
kidney, move to ureter
• Often associated with
history of recent UTI
• Severe flank pain
radiates to groin, scrotum
• Nausea, vomiting,
hematuria
• Extreme restlessness

69. Ectopic Pregnancy
• Fertilized egg is
implanted outside the
uterus.
• Growth causes rupture
and can lead to
massive bleeding.
• Patient c/o of severe
RLQ or LLQ pain
with radiation.

79. OVARIAN TORSION

83. Abdominal Aortic Aneurysm
• Localized weakness of
blood vessel wall with
dilation (like bubble on
tire)
• Pulsating mass in
abdomen
• Can cause lower back pain
• Rupture shock,
exsanguination

86. THANK YOU