Abdominal Tests

Abdominal Tests

Abdominal X-ray

·        Gas:

o  Normal in colon and stomach, some in small bowel OK

o  Define colon: has haustrations – but don‟t cross tinea coli.  Only part of bowel with faeces

o  If they have ulcerative colitis shouldn‟t be bigger than 5cm – otherwise toxic megacolon

o  Transverse diameter of caecum shouldn‟t be bigger than 9 cm otherwise risk of rupture

o  Small bowel: circularis goes right round. Max diameter 3 cm. Gas if obstructed, diarrhoea, ileus or swallowing gas due to pain

o  Gas under diaphragm = pneumo-peritoneum 

o  Can have gas in bilary tree (esp. after ERCP, or if fistula to bowel), and retroperitoneal from perforated 2^nd part of duodenum

·        Stripes:

o  Edges of psoas: demarcated against fat 

o  Lateral abdominal wall: flank line is peritoneum. If exudate in the paracolic gutter then distance from the colon is increased

o  Renal outline: parallel to upper psoas

o  Edge of liver

o  Edge of spleen (not always seen)

·        Stones:

o  Any extraoscious calcifications

o  Bladder, kidney, gallbladder

·        Bones

Other Abdominal Tests

Endoscopy

·        Complications: Mallory Weiss tear, perforation (1/2000), aspiration pneumonia (rare)

Ultrasound for Ascites

·        Need 1 litre of fluid before it can be detected

Rectal biopsy

·        For ulcerative colitis, microscopic colitis, amyloidosis, cancer

Stool test

·        Occult blood

·        Culture (for bacteria): would either be self-limiting or very sick

·        Ova, parasites & giardia antigen: if high risk, repeat 3 times.  Needs to be warm on arrival in lab

Barium Enema

·        Make sure they got to the caecum (i.e. want to see contrast in the appendix or terminal ileum)

·        Also need to know that bowel was clean enough for them not to miss anything