Plain abdominal films

“Four views of the abdomen” (acute abdomen series) includes a upright PA chest, plain abdominal film (“flat plate”), upright film, and a left lateral decubitus view of the abdomen.

Bowel obstruction

Small bowel obstruction may cause multiple air-fluid levels with dilated loops of small intestine but colonic gas.

Colonic obstruction causes colonic dilation which can be distinguished from small intestine by the presence of haustral markings and absence of valvulae conniventes.

Free air is seen on the upright chest x-ray under the hemidiaphragms. Intestinal perforation is the most common cause of free air. A recent laparotomy may also cause free air.

Stones and calcifications. Ninety percent of urinary stones are radiopaque. Only 15% of gallstones are visible on plain film. A fecalith in the right lower quadrant may suggest appendicitis. Vascular calcification may be visible in abdominal aneurysm.

Ultrasonography is useful for evaluation of biliary colic, cholecystitis, pancreatitis, or female reproductive system disorders.

Nuclear medicine studies. Radioisotopic biliary scans (HIDA, DISIDA, PIPIDA) evaluate filling and emptying of the gallbladder and the extrahepatic biliary tree. Gallbladder filling excludes acute cholecystitis. Non-filling is suggestive of cholecystitis

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