in order to visualize the kidneys better since they are towards the back of our body, the back is the side closest to the IR
what are the two long muscles atttach to the lumbar vertebrae and down the the greater trochanters
psoas muscle
what position do we use if the patient cannot stand for an abdomen
left lateral decub
what is the SID for an erect and supine abdomen
40''
where do we position the CR in a supine and erect abdomen
supine = center directly above the iliac crests
erect abdomen = 2'' above the iliac crests
what is the purpose for ordering an erect abdomen xray
to view free air under the diaphragm
what are the 6 organs of digestion
oral cavity
pharynx
esophagus
stomach
large intest
small intest
what are the accessory organs to the digestive system
gallbladder
pancreas
liver
what organ is part of the lymphatic system located in the abdominal cavity
spleen
how long is the small intestine
23 feet
what is the longest and shortest sections of the small intestine
longest is the ileum
shortest is the duodenum
what does the gallbladder do
stores and concentrates bile
what is bile
substance produced by the liver and gallbladder that emulsifies fat
how are we able to see ureters radiographically
the patient must drink contrast and the kidneys filter it out, since the contrast has a high atomic number it gets absorbed by the xray and appears white on the xray
what is the peritoneum
a large serous double walled membrane
what is the parietal peritoneum
what is the visceral peritoneum
it is the peritoneum adhering to the cavity wall
it is the peritoneum covering an organ
what is the peritoneal cavity
the space between the parietal cavity and visceral peritoneum
what is the mesentary
double fold of peritoneum extending anteriorly from the posterior abdominal wall completely enveloping a loop of small bowel
what is the omentum
a specific double fold of peritoneum extending from the stomach to another organ
what is the lesser omentum
greater omentum?
extends from the liver to the lesser curvature of the stomach
connects and extends from the greater curvature over the colon
what is the mesocolon
it is the peritoneum that attaches the colon to the posterior abdominal wall
what are the 9 abdominal regions
right hypochondria
epigastric
left hypochondriac
rt lateral lumbar
umbilical
lt lateral lumbar
rt inguinal (iliac) region
pubic (hypogastric)
lt inguinal (iliac)
what is the cause of pain arising from the side of the stomach
kidney stones
what patients do we shield when doing a abdomen xray
males
what are the breathing and clothing instructions prior to an abdomen examination
take in a deep breath blow it out and hold it on expiration (this allows diaphragm to move up and allow more space of other anatomy)
all clothing removed except the underpants
for a basic KUB what should the kvp never exceed
80 kvp
list the whole basic procedure for a KUB general
14x17 lengthwise cassette
40'' SID
70-80 kVp
pt is supine w/mid sagittal plane centered to the table
no rotation
CR perpendicular to center of IR
CR directed at the level of the iliac crests
exposure on expiration
may require two 17x14 for a fat person
what are the presence of dark bubbles located under the diaphragm
gas
what position should you do if a patient comes to the department ambulatory or in a wheelchair
do AP erect first
list the steps for a PA or prone abdomen xray
everything is the same as the AP except:
CR is located at the level of the iliac crest
arms up above head
why are PA radiographs ordered
for intestines not kidneys
what are the 7 topographical landmarks
xiphoid process
intercostal margin
iliac crest
ASIS
greater trochanter (double check alignemnt to pubis symphysis)
ischial tuberosity
why do we do left lateral decubs
b/c the patient cannot stand and to see intraperitoneal air over the over shadow of the liver
list all the general requirements for lat decubs
14x17 length wise
70-80 kvp
40'' sid
arms up beside head and knees flexed
ensure true lateral
cr perp. to center of ir
cr 2 in above level of iliac crests
exposure on expiration
lef t lat best visualizes intraperitoneal air in the area of the liver and way from the gastric bubble
on a left lateral decub patient should be on a side of a minimum of how many minutes prior to exposure (what is preferred)
and what is the reason
5mins (10-20 minutes preferred)
this will allow air to rise or abnormal fluids to accumulate
what positions require the CR to be 2'' above the iliac crest and which positions are at level of iliac crest
erect and pa
ap (supine) and pa (prone)
where is CR for dorsal decub abdomen exam
2in above iliac crest
list the general steps for a lateral position (for babies and adults )
14x17 length wise
80-85 kvp
40'' sidearms up beside head and knees flexed
ensure true lateral (rt or lt recumbent)
cr perp. to center of ir
cr 2 in above level of iliac crests
exposure on expiration
what is another name for an acute abdominal series
obstructive or obstruction series
if we cannot do an erect pa abdomen what do we do
perform a left lateral decub
what are all the positions of the acute abdominal series
ap supine
erect or lateral decub (left)
erect pa chest (depending on department protocol)
what are the basic abdomen routine
and special (optional) positions
ap supine (routine)
Special:
pa prone
lateral decub L
ap erect
dorsal decub
Lateral
what are the intraperitoneal organs
liver gallbladder spleen stomach jejunum ileum cecum transverse and sig colon
elongation (hip farther away) of lelft iliac and narrowing (rotation closer to tube) is what positioning error for a KUB
the patient is in a slight lpo so that would make the left iliac farther away and rt iliac closer to the tube
what must you see on an erect abdomen radiograph
must see diaphragm with presence of the lungs in black if not the patient was supine not erect
what pathology is demonstrated with a dorsal decubitus
aneurisms
umbilical hernias
calcification of aorta or other vessels
what pathology is demonstrated in a lateral abdomen with beam coming down straight while patient is in lateral position
abnormal soft tissue masses
umbilical hernia
prevertebral region for possible aneurysms of aorta or calcifications
elongation of an iliac wing indicates roation whhere
in that direction
acute abdominal series is used for what clinical indications
ileus
ascites
perforated hollow viscus
intraabdominal mass
post op
apple core sign pathology is what?
carcinoma
chrons disease:
inflammatory bowel disease
chrons diseas involving the tterminal ileum
intussusception
a telescoping of bowel into another loop creating an obstruction (most common is distal small bowel of children)
volvulus:
twisting of a loop of intestine creating an obstruction
ileus
bowel obstruction
a radiograph of an ap abdomen reveals that the left iliac wing is more narrowed than the right. What specific positioning error caused this
the patient was in a slight rpo causing the left iliac wing to look more narrowed than the right