Abdominal xray - imaging and interpretation ArushiGupta119
everythng about abdominal radiograph is discussed from views to obstruction to foreign body.
definetly u r not going to get bored
read and share with your peers.
Abdominal xray - imaging and interpretation ArushiGupta119
everythng about abdominal radiograph is discussed from views to obstruction to foreign body.
definetly u r not going to get bored
read and share with your peers.
acute abdomen conditions in radiology and their evaluation
acute pancreatitis, cholicystitis, pelvic pathology, mri evaluation , intra abdominal abcess, plain radiography evaluation of acute abdomen, vascular causes of acute abdomen, causes of acute abdomen.
Achalasia cardia is a primary oesophageal motility disorder. Barium swallow demonstrates a classic bird beak appearance. This presentation briefly explains the barium swallow procedure and findings in achalasia cardia.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Common Clinical Indications for abdominal x-ray
Abdominal pain+++
•Distention ++
•Vomiting +
•Ingestion of foreign body +++
•Possibility of intestinal obstruction +++
•Possibility of bowel perforation ++
•Placement of lines or tubes +++
•Organomegaly?? +/-
3. Radiographic principles
Series of films for acute abdomen
• Obstruction series/ Acute abdominal series/ Complete
abdominal series
– Supine (almost always)
– Upright or left decubitus (almost always)
– Prone or lateral rectum (variable)
– Chest, upright or supine (variable)
4. Obtaining views
• Supine
– Patient on back, x ray beam directed vertically downward, casette posterior, x
ray tube anterior (AP)
Prone
– Patient on abdomen, x-ray beam directed vertically downward, cassette
anterior, x-ray tube posterior (PA)
• Upright
– Patient stands or sits, x-ray beam directed horizontally, cassette posterior, x-
ray tube anterior (AP)
Upright chest
– Patient stands or sits, horizontal x-ray beam, cassette anterior, x-ray tube
posterior (PA)
5. Acute abdominal series
What to look for
Substitutes: Prone Lateral rectum
Upright Left lateral decubitus
Upright chest Supine chest
VIEW LOOK FOR
SUPINE ABDOMEN Bowel gas pattern
Calcifications
Masses
PRONE ABDOMEN Gas in rectosigmoid
Gas in rectosigmoid
Gas in ascending and
Descending colond
descending colon
UPRIGHT ABDOMEN Free air, air-fluid levels
UPRIGHTUPRIGHT CHEST
CHEST
FrFree air ,lung
pathology to intraabdominal
process
6. Approach to AXR
Bowel gas pattern
Extraluminal air
Soft tissue masses
Calcifications
7. Normal AXR
11th rib
Hepatic flexure
Gas in
stomach
T12
Gas in
caecum
Iliac crest
Femoral head
SI joint
Gas in sigmoid
Transverse colon
Splenic flexure
Psoas margin
Sacrum
Left kidney
Liver
Bladder
8. Gas pattern
Stomach
Almost always air in stomach
Small bowel
Usually small amount of air in
2 or 3 loops
Large bowel
Almost always air in rectum
and sigmoid
Varying amount of gas in rest of large
bowel
What is normal?
9. Normal fluid levels
Stomach
Always (upright, decub)
Small bowel
Two or three levels
acceptable (upright, decub)
Large bowel
None normally
(functions to remove fluid)
10. Large vs small bowel
Large bowel
Peripheral (except RUQ occupied by liver)
Haustral markings don’t extend from wall to wall
Small bowel
Central
Valvulae conniventes extend across lumen and are spaced
closer together
11. Abnormal Gas Patterns
Functional ileus
One or more bowel loops become aperistaltic usually due
to local irritation or inflammation
Localised “sentinel loops” (one or two loops)
Generalised (all loops of large and small bowel)
Mechanical obstruction
Intraluminal or extraluminal
Small bowel obstruction
Large bowel obstruction
12. 3, 6, 9 RULE
Maximum Normal Diameter of bowel
Small bowel 3cm
Large bowel 6cm
Caecum 9cm
13. Localised ileus
Key features
One or two persistently dilated
loops of small or large bowel
(multiple views)
Often air-fluid levels in
sentinel loops
Local irritation, ileus in same
anatomical region as
pathology
Gas in rectum or sigmoid
May resemble early SBO
14. Causes of Localised Ileus
by location
SITE OF DILATED LOOPS CAUSE
Right upper quadrant Cholecystitis
Left upper quadrant Pancreatitis
Right lower quadrant Appendicitis
Left lower quadrant Diverticulitis
Mid-abdomen Ulcer or kidney/ureteric calculi
15. Colon cut off sign
Abrupt cutoff of colonic gas column at the splenic flexure
(arrow). The colon is usually decompressed beyond this point
16. Generalised ileus
Key features
Entire bowel aperistaltic/hypoperistaltic
Dilated small bowel and large bowel to rectum (with LBO
no gas in rectum/sigmoid)
Long air-fluid levels
CAUSE REMARK
*Postoperative Usually abdominal
surgery
Electrolyte imbalance Diabetic ketoacidosis
* almost always
17. Generalised adynamic ileus
The large and
small bowel are
extensively airfilled but
not dilated.
The large and
small bowel "look the
same".
18. Mechanical SBO
Dilated small bowel
Fighting loops (visible loops, lying transversely, with air-fluid
levels at different levels)
Little gas in colon, especially rectum
22. String of pearls
sign
Considered diagnostic of obstruction (as opposed to
ileus)
and is caused by small bubbles of air trapped in the
valvulae of the small bowel.
24. Mechanical LBO
Colon dilates from
point of obstruction
backwards
Little/no air fluid
levels (colon
reabsorbs water)
Little or no air in
rectum/sigmoid
25. Large bowel obstruction
Bowel loops tend not to
overlap therefore
possible to identify site
of obstruction
Little or no gas in small
bowel if ileocaecal valve
remains competent*
* If incompetent, large bowel
decompresses into small bowel, may
look like SBO
26. Thumbprinting
The distance
between loops of
bowel is increased
due to thickening of
the bowel wall.
The haustral folds
are very thick,
leading to a sign
known as
'thumbprinting.'
29. When the bowel measures more than the
interpedicular width of L2, it is said to be
dilated.
Massive dilatation is seen in complete
obstruction and is accompanied by fluid
levels on the dorsal decubitus radiograph.
However, fluid levels alone do not
necessarily correspond to dilatation, but
rather reflect abnormal peristalsis.
An unchanging bowel gas pattern over time
indicates absence of perstalsis.
IN CASE OF NEONATES
31. Closed loop obstruction
Two points of same loop of bowel obstructed at a single
location
Forms a C or a U shape
Term applies to small bowel, usually caused by
adhesions
Large bowel, called a volvulus
32. Note on volvulus
Sigmoid colon has its own mesentry therefore prone to
twisting
Caecum usually retroperitoneal and not prone to
twisting; 20% people have defect in peritoneum that
covers the caecum resulting in a mobile caecum
33. Volvulus
A volvulus always extends away from the area of
twist.Sigmoid volvulus can only move upwards and usually
goes to the right upper quadrant. Caecal volvulus
can go almost anywhere.
35. Hernia
Lateral decubitus of value
The advantage is that there may be a greater chance of
air entering the herniated bowel because it is the least
dependent part of the bowel in the supine position.
36. Extraluminal air
• TYPES
– Pneumoperitoneum/free air/intraperitoneal air
– Retroperintoneal air
– Air in the bowel wall (pneumatosis intestinalis)
– Air in the biliary system (pneumobilia)
37. Upright film best
The patient should be positioned sitting upright for 10-20
minutes prior to acquiring the erect chest X-ray image.
This allows any free intra-abdominal gas to rise up, forming a
crescent beneath the diaphragm. It is said that as little as 1ml
of gas can be detected in this way.
38. Free Air
Causes
Rupture of a hollow viscus
Perforated peptic ulcer
Trauma
Perforated diverticulitis (usually seals off)
Perforated carcinoma
Post-op 5-7 days normal, should get less with
successive studies
39. Signs of free air
Crescent sign
Riglers (and False Rigler’s)
Football sign
Falciform ligament sign
Triangle sign
Cupola sign
Lesser sac sign
40. Crescent Sign
Free air under the diaphragm
Best
demonstrated on
upright chest x
rays or left lat
decub
Easier to see
under right
diaphragm
41. Chilaiditis sign
May mimic air under
the diaphragm
Look for haustral folds
Get left lat decub to
confirm
42. Rigler’s Sign
Bowel wall visualised on both sides due to intra and
extraluminal air
Usually large amounts of free air
May be confused with overlapping loops of bowel, confirm
with upright view
43. False Rigler’s Sign
The Rigler sign can sometimes be simulated by contiguous
loops of bowel, whereby intraluminal air in one loop of bowel
may appear to outline the wall of an adjacent loop, which
results in a misdiagnosis of free air.
Measure distance of interface if unsure
44. Football SIgn
Seen with massive
pneumoperitoneum
Most often in children
with necrotising
enterocolitis
Paediatric
Adult
In supine position
air collects anterior
to abdominal
viscera
47. Inverted V sign
On the supine radiograph, an inverted "V" may be seen over
the pelvis in a patient with pneumoperitoneum.
While in infants this is produced by the umbilical arteries, in
adults it appears to be created by the inferior epigastric
vessels
49. Lesser sac Sign Cupola Sign
Lesser sac
sign
(black
arrows)
The lesser sac is positioned
posterior to the stomach and
is usually a potential space.
There is free connection
between the lesser sac and
the greater sac through the
foramen of Winslow
Cupola
sign
– (white
arrows)
Air
superior
to left
lobe of
liver
Double Bubble Sign
50. Cupola Sign
The term cupola comes from a dome such as
this famous dome of the Duomo in Florence.
Air beneath the central tendon of the diaphragm
51. Triangle Sign
The triangle sign refers
to small triangles of free
gas that can typically be
positioned between the
large bowel and the
flank
52. Retroperitoneal Air
• Recognised by:
– Streaky, linear appearance outlining retroperitoneal
structures
– Mottled, blotchy appearance
– Relatively fixed position
• May outline:
– Psoas muscles
– Kidneys, ureters, bladder
– Aorta or IVC
– Subphrenic spaces
53. Causes of retroperitoneal air
Bowel perforation (appendix,
ileum, colon)
Trauma (blunt or penetrating)
Iatrogenic
Foreign body
Gas producing infection
54. Pneumoretroperitoneum
This patient has free air in the
retroperitoneal space. The air is seen
surrounding the lateral border of the
right kidney (white arrow). There is
other evidence of free gas including
Rigler's sign.
If you are not confident that the
appearance is pneumoretroperitoneum,
you can try an erect and decubitus view
to see if the gas moves. If the gas is
seen to move, it's not in the
retroperitoneum.
55. Air in the bowel wall
– Best seen in profile producing a linear lucency that
parallels the bowel
– Air en face has a mottled appearance resembling gas
mixed with faeculent material
56. Causes of air in bowel wall
Primary Pneumatosis cystoides intestinalis (rare)
usually affects left colon
Produces cyst-like collections of air in the submucosa or
serosa
Secondary
Diseases with bowel wall necrosis
Obstructing lesions of the bowel that raise intraluminal
pressure
Complications
Rupture into peritoneal cavity
Dissection of air into portal venous system
58. Air in the biliary tree
One or two tube-like branching lucencies in the RUQ, conform to location of
major bile ducts
59. Causes
“Normal” if Sphincter of Oddi incompetence
Previous surgery including sphincterotomy or
transplantation of CBD
Pathology (uncommon)
Gallstone ileus: gallstone erodes through wall of GB
into the duodenum producing a fistula between the
bowel and the biliary system.
Stone impacts in small bowel = mechanical SBO.
“ileus” misnomer
60.
61. Biliary vs Portal Venous Air
Portal venous air
usually associated
with bowel necrosis
Air is peripheral
rather than central
Numerous
branching
structures
62. Soft tissue masses
Organomegaly
Know normal landmarks
2 ways to identify soft tissue masses/organs:
Direct visualisation of edges of structure
Indirect by displacement of bowel
CT, US and MRI have essentially replaced conventional
radiography in the assessment of organomegaly and soft
tissue masses
71. Lamellar or laminar
Formed around a nidus inside hollow lumen
Concentric layers due to prolonged movement of stone inside
hollow viscus
Renal stones
Gallstones
Bladder stones
73. Staghorn Calcification
Renal stones are often small, but if large can fill the renal
pelvis or a calyx, taking on its shape which is likened to a
staghorn.Tubular
74. Nephrocalcinosis
Uncommonly the
renal parenchyma can
become calcified.
This is known as
nephrocalcinosis, a
condition found in
disease entities such
as medullary sponge
kidney or
hyperparathyroidism.
Renal calculi
Parenchymal calcification
Flocculent
75. Putty Kidney
"Putty kidney" – sacs of
casseous, necrotic
material (TB)
Autonephrectomy –
small, shrunken kidney
with dystrophic
calcification
Flocculent
77. Conclusion
Approach to AXR should include gas pattern, extraluminal air, soft tissue and
calcifications
Named radiological signs are a useful way of remembering, identifying and
reporting on films
For acute abdominal pain in adults, an abdominal x-ray has a
low sensitivity and accuracy in general, as well as for specific conditions such
as gastrointestinal perforation, bowel obstruction, ingested foreign body, and
ureteral stones. particularly computed tomography after negative abdominal
ultrasonography, provides a better workup than projectional abdominal
radiography alone. Computed tomography provides an overall better surgical
strategy planning, and possibly less unnecessary laparotomies. Abdominal x-
ray is therefore less recommended for adults with acute abdominal pain
presenting in the emergency department.
Lung pathology – pacreatitis assoc with left pleural effusion, ovarian tumour assoc with right or bilateral effusion, subphrenic abscess assoc with right pleural effusion
Explanation:
Inflammatory exudate in acute pancreatitis extends into the phrenicocolic ligament via lateral attachment of the transverse mesocolon
Infiltration of the phrenicocolic ligament results in functional spasm and/or mechanical narrowing of the splenic flexure at the level where the colon returns to the retroperitoneum.
Distinguish bowel obstruction from ileus, because patient with mechanical obstruction should be on surgical service and may need surgery, but not ileus
Both have dilated bowel and air-fluid levels, but ileus lacks a transition (tends to have dilatation and levels throughout
Known case of ulcerative colitis on acute exacerbation
On the limage the bowel is dilated and the diameter exceeds L2 interpedicular distance in case of ileal atresia
For pneumoperitoneum ct is investigation of choice
Ruptured appendix usually not causes free air under dome of diaphragm it seals off
Rt sub phrenic abscess child with melorisim,linear atelectasis,subdiaphragmatic fat
55 yr old male patient with rt hypochondrial pain .features suggestive of gall stone ileus