4 - Plain Film Evaluation of the Abdomen

Summary

INDICATIONS

By far, the commonest indication for abdominal plain film radiography is abdominal pain. Other indications, as dictated by clinical circumstances, might include vomiting, nonspecific abdominal complaints, history of trauma, or unexplained fever. Because abdominal plain films provide specific information about only a few diseases and give indirect or nonspecific clues about a much larger number, the decision to order abdominal films is subject to a variety of case- and location-specific considerations. Mitigating factors that are case specific might include patient age, altered mental status, distracting injuries, medications (especially steroids and other immunosuppressive agents), and comorbid conditions (diabetes, other immunocompromising illnesses, or those predisposing to abdominal pathology). Location-specific considerations include the availability of alternative tests such as CT, MRI, and ultrasound that are both more sensitive and specific for many abdominal diseases. The availability of these modalities has a significant impact on the indications for, and utilization of, plain films. The use of these more sophisticated imaging modalities is addressed elsewhere in this text. However, in many cases, the more accurate and detailed information they provide comes at the expense of delays and/or the expenditure of personnel or financial resources. For this reason, and because in many locations physicians evaluate abdominal pain without rapid and easy access to advanced imaging, it is still useful to be familiar with significant plain film findings that might tailor the workup, direct supportive care, or mandate surgical interventions that preempt further imaging.