Assessment of Abdominal and Bone X-ray Images for Advanced Practice Providers

00:01 Why don't we change things up and take a look at some abdominal views? Bowel obstructions are common in clinical presentation and something to know what to look for. Here are the radiological findings associated with an obstruction.

00:15 It was going to include multiple dilated loops of bowel air levels when upright.

00:21 I want to mention here when you are viewing the abdomen, you want to make sure you get a supine and upright to be able to compare, to be able to look at the air and the fluid levels.

00:33 You will also see bowel loops stacked on top of each other.

00:37 For small bowel obstruction, you'll see dilated loops greater than three centimeters. You'll notice that the loops are more central and more circular loops.

00:48 You'll see that the valvulae are confluent visibly, so they looked like stacked coins and you will have no gas in the colon.

00:57 The large bowel obstruction.

00:59 You're going to have dilated loops greater than six centimeters.

01:03 You're going to have more peripheral and they're going to appear more squared off loops. The circle refers to the cecum diameter and it's going to be greater than nine centimeters. If you are concerned with a bowel perforation this can also be referred to as the 369 rule if that helps you remember it.

01:23 So we have looked at multiple chest x rays, a common abdominal view, and so I would like to show you two common bone-related concerns.

01:31 The first will be a clavicle fracture.

01:34 Here's the fracture. Let's discuss it.

01:37 If the injury is recent and you have a patient in front of you, you have the benefit of the clinical correlation here.

01:44 On the film, you will see a complete break in the cortical bone: fragment displacement, overlapping fragments, step off deformity, angulation.

01:56 Older injuries may show linear lucency and callus formation.

02:01 You may see a radial head luxation as seen in this image.

02:08 This is a picture of the elbow.

02:11 When you do see changes on radiological images, it is likely because you received a high-quality image.

02:18 In addition to comparing one side to the other, you will see slight widening of the radio capitella joint, minor displacement of the radial head, small increase in the humeroradial distance, and a slight lateral displacement of the radius.

02:38 Now we're going to move on to foreign objects.

02:41 You may have purposeful and non-purposeful.

02:45 And this is the acuity of these can change.

02:48 Purposeful would be more like medical devices that we have placed, such as in G-tubes or ET tubes.

02:56 So let's look at our image.

02:58 Here you can see there was a swallowed foreign body which is not uncommon with a child. You can see the coin.

03:06 There on your right, you can see where contrast was used, and you can see a larger amount of a contrast above the coin and below the coin, the contrast narrows dramatically, meaning that it is stuck.

03:21 You also, particularly in children, will see them swallow magnets.

03:26 This is a medical emergency as this can cause a bowel perforation, so you want to be sure to refer them to a surgeon immediately.

03:36 This is a foreign object as well, but it really is interfering with the imaging. This is a person's braids.

03:43 This is showing up as hazy lines.

03:46 And so this would be a poor image.

03:48 You could also see this with underwires on bras and the collapse in the back.

03:54 You would want to make sure that these are removed so you can review the X-rays appropriately. These, of course, are not all the possible images you might see in your practice.

04:05 We wanted to give you some practice with some of the most common.

04:09 I hope the discussion and practice has been useful to you.

04:13 Thank you for watching.