Chapter 4 Abdomen Merrill's Workbook

What are the organs in the abdominal cavity? (8)

stomach, spleen, pancreas, gallbladder, small and large intestines, kidneys, liver

What are the organs in the pelvic cavity? (3)

uterus, rectum, urinary bladder

The name of the double-walled seromembranous sac that lines the abdominal cavity is the?

peritoneum

The 2 layers of the peritoneum are the ___ later and the ____ layer.

parietal; visceral

The outer layer of the peritoneum that contacts the underside of the diaphragm is called the ___ layer.

parietal

The inner layer of the peritoneum that contacts various organs is called the ____ layer.

visceral

The retroperitoneum is the?

cavity behind the peritoneum

List 2 organs located in the retroperitoneum.

kidneys and pancreas

List the 2 folds in the peritoneum.

mesentary and omentum

What are the functions of the 2 folds in the peritoneum?

mesentary and omentum serve to support the viscera in position

Outer layer of the peritoneum

parietal

Cavity that contains reproductive organs, urinary bladder, and rectum

pelvic

Double-walled seromembranous sac that encloses the abdominopelvic cavity

peritoneum

Pathological condition defined as a blockage of the bowel lumen

bowel obstruction

Pathological condition that is a localized dilation of the abdominal aorta

abdominal aortic aneurysm

Fluid accumulation in the peritoneal cavity

ascites

transfer of a cancerous lesion from one area to another

metastasis

Presence of air in peritoneal cavity

pneumoperitoneum

Cavity that contains organs such as the stomach, spleen, pancreas and liver

abdominal

Pathological condition of the abdomen that is defined as the failure of bowel peristalsis

ileus

One of the folds of the peritoneum that serves to support the viscera

mesentary

Inner layer of the peritoneum

visceral

One of the folds of the peritoneum that serves to support the viscera

omentum

Abdominal organs located in the retroperitoneum

kidneys

What is the commonly used acronym that refers to the AP projection of the abdomen with the patient supine?

KUB

What is the meaning of KUB?

kidneys, ureters, and bladder

what three projections usually comprise the three way or acute abdomen series?

supine KUB, AP upright abdomen, and PA chest

Why is an upright chest image included as part of the acute abdomen series?

to demonstrate abdominal free air that may accumulate under the diaphragm

In the acute abdomen series, what image should be substituted for the upright abdomen radiograph when the patient is unable to stand?

left lateral decubitus

What is the size of collimated field for all abdomen projections?

14x17

What is the key patient/part positioning points of an AP abdomen?

supine and upright; shoulders and hips aligned

What are the anatomic landmarks and relation to IR for an AP abdomen?

MSP perpendicular to IR

MCP parallel

What is the CR orientation and entrance point for an AP abdomen?

perpendicular to MSP at iliac crests; CR enters MSP at 2 inches above iliac crests

Which plane of the body should be positioned perpendicular to the IR? Parallel with the IR?

MSP perpendicular

MCP parallel

For the AP projection with the patient supine, which structure should be seen at the bottom of the image?

pubic symphysis

What structure of the upper abdomen should be seen on the abdomen image when the patient is upright? Explain why.

diaphragm; free air

What breathing instructions should be given to the patient in an AP projection?

suspend after expiration

What is the advantage of exposing abdominal images at the suspension of the recommended phase in AP projection of respiration compared with the other respiration phase?

abdominal organs are not compressed

What 2 identification markers should be seen on the image when the patient is upright?

R or L and upright marker

With reference to radiation protection, what is the advantage of the PA projection over the AP projection?

a reduction in radiation exposure to gonads

circle the three evaluation criteria that indicate the patient was correctly positioned without rotation for a KUB image:

a) intervertebral foramina should be open

b) alae or wings of the ilia should be symmetric

c) lumbar vertebrae pedicles should be superimposed

d) if seen, ischial spines of the pelvis should be symmetric

e) spinous processes should be in the center of the lumbar vertebrae

b, d, e

What is the key patient/part positioning points in an AP lateral decubitus?

shoulders and hips aligned and perpendicular; arms elevated out of field

What are the anatomic landmarks and relation to IR in an AP lateral decubitus?

MCP perpendicular to IR

MSP parallel

What is the CR orientation and entrance point for an AP lateral decubitus?

horizontal and perpendicular to midpoint of IR

What is the advantage of the left lateral decubitus position compared with the supine position in AP projection of abdomen?

it demonstrates air/fluid levels

Why is the left lateral decubitus position preferred over the right lateral decubitus position when the patient is unable to stand?

to enable free air to rise and be seen

Why is it advisable to let the patient remain in the lateral recumbent for several minutes before making the exposure?

to allow air to rise to its highest level

Which side of the abdomen (the "up" side or the "down" side) should be demonstrated if only one side can be imaged and the patient is suspected to have fluid levels within the abdomen cavity?

side down

Which side of the abdomen (the "up" side or the "down" side) should be demonstrated if only one side can be imaged and the patient is suspected to have free air in the abdomen?

side up

What structure of the abdomen should be demonstrated on the image?

diaphragm

What identification markers should be seen on the image?

side up and an arrow up

What are the key patient/part positioning points in a lateral abdomen?

shoulders and hips aligned and perpendicular; knees flexed, arms elevated out of field

What are the anatomic landmarks and relation to IR in lateral abdomen?

MCP perpendicular to IR

MSP parallel

What is the CR orientation and entrance point for lateral abdomen?

vertical and perpendicular to MSP at 2 inches (5cm) above iliac crests to include diaphragm

True or false. A lateral projection of the abdomen can be performed with the patient placed in either the right lateral recumbent position or the left lateral recumbent position.

true

True or false. The midsagittal plane should be perpendicular and centered to IR.

false; MCP

True or false. The exposure should be made after the patient has suspended respiration after full inspiration.

false; expiration

Which body plane is perpendicular to IR?

across pelvic at MCP

What 2 areas of the image can be closely examined to determine if the patient was rotated?

lumbar vertebrae, pelvis

What is the key patient/part positioning points for lateral dorsal decubitus?

supine, shoulders and hips are aligned; vertical grid device at MCP

What are the anatomic landmarks and relation to IR in lateral dorsal decubitus?

MCP perpendicular

MSP parallel to IR

What is the CR orientation and entrance point for a lateral dorsal decubitus?

horizontal and perpendicular to MCP at 2 inches above iliac crests

What is the name of the radiographic position that produces a lateral image of the abdomen with the patient in the supine position?

dorsal decubitus

What purpose is served by having the patient slightly flex his or her knees?

to relieve strain on patients back by reducing lordotic curvature

To what level of the patient should the long axis of the IR be centered?

MCP

How far above the level of the iliac crests should the central ray enter the patient?

2 inches (5 cm)

True or false. Anatomists define the 'true pelvis' as the potion of the abdominopelvic cavity inferior to a plane passing through the sacral promontory posteriorly and the superior surface of the public bones anteriorly.

true

True or false. The central ray should be directed horizontally and perpendicular relative to the center of the IR.

true

circle the three evaluation criteria that indicate the patient was correctly positioned for a lateral projection while placed in the dorsal decubitus position:

a) the wings of the ilia should be symmetric

b) the ilia should be superimposed

c) the lumbar vertebrae pedicles should be superimposed and intervertebral foramina should be open

d) as much of the remaining abdomen as possible when the diaphragm

e) the spinous processes should be seen in the center of the lumbar vertebrae

f) the ribs and pelvis should be equidistant to the edge of the IR on both sides

b, c, d

The abdomen is divided into 2 cavities. The inferior cavity is the:

a. abdominal cavity

b. pelvic cavity

c. gonadal cavity

d. retroperitoneal cavity

b. pelvic cavity

The liver, stomach, and pancreas are located in the:

a. abdominal cavity

b. pelvic cavity

c. digestive cavity

d. retroperitoneal cavity

a. abdominal cavity

The portions of the peritoneum that function to support the vicsera of the abdomen in position are the:

a. retroperitoneal viscera and omentery

b. diaphragm and visceral folds

c. abdominal aorta and diaphragm

d. mesentery and omenta folds

d. mesentery and omenta folds

Which structure forms the mesentery and omenta folds?

a. liver

b. pancreas

c. gallbladder

d. peritoneum

d. peritoneum

Which 3 projections usually comprise the acute abdomen series for ambulatory patients?

a. supine KUB, AP upright abdomen, and upright PA chest

b. supine KUB, right lateral decubitus abdomen, and upright PA chest

c. left lateral decubitus abdomen, dorsal decubitus abdomen, and upright PA chest

d. right lateral decubitus abdomen, left lateral decubitus abdomen, and dorsal decubitus abdomen

a. supine KUB, AP upright abdomen, and upright PA chest

To which level of the patient should the central ray be centered for the KUB when the patient is supine?

a. T10 vertebral body

b. L3 vertebral body

c. 2 inches (5 cm) above iliac crests

d. iliac crests

d. iliac crests

For the AP upright abdomen radiograph of an adult of average size, why should the centering be slightly higher than the centering level used for the supine KUB radiograph?

a. to include the bladder

b. to include the diaphragm

c. to visualize gallstones

d. to visualize kidney stones

b. to include the diaphragm

For the KUB image, when should respiration be suspended, and what effect will that have on the patient?

a. on full expiration; elevate the diaphragm

b. on full expiration; depress the diaphragm

c. on full inspiration; elevate diaphragm

d. on full inspiration; depress the diaphragm

a. on full expiration; elevate the diaphragm

Why is it desirable to include the diaphragm in the upright abdomen image?

a. to demonstrate free air in the abdomen

b. to demonstrate fluid levels in the thorax

c. to demonstrate fluid levels in the abdomen

d. to demonstrate calculi in the gallbladder and kidneys

a. to demonstrate free air in the abdomen

Which projection should be used to demonstrate free air within the abdominal cavity when the patient is unable to stand for an upright abdomen image?

a. AP projection with the patient supine

b. lateral projection, dorsal decubitus position

c. AP projection, left lateral decubitus position

d. AP projection, right lateral decubitus position

c. AP projection, left lateral decubitus position

Which projection does not demonstrate free air levels within the abdomen?

a. AP projection with the patient supine

b. AP projection with the patient upright

c. lateral projection, dorsal decubitus position

d. AP projection, left lateral decubitus position

a. AP projection with the patient supine

What is the major advantage of the PA projection of the abdomen over the AP projection of the abdomen?

a. the PA projection reduces the exposure dose to the gonads

b. the PA projection magnifies gallstones for better visualization

c. the PA projection demonstrates the pubic rami below the urinary bladder

d. the PA projection reduces the object-to-image receptor distance of the kidneys

.a. the PA projection reduces the exposure dose to the gonads

Which radiographic position of the abdomen requires that the patient be placed in the lateral recumbent position on his or her left side and that the horizontal central ray be directed along the midsagittal plane, entering the anterior surface of the patient's abdomen at the level of the iliac crests?

a. dorsal decubitus

b. ventral decubitus

c. left lateral decubitus

d. right lateral decubitus

c. left lateral decubitus

Which radiographic position of the abdomen requires that the patient be supine and that the central ray be directed to a lateral side of the patient, entering slightly anterior to the midcoronal plane?

a. dorsal decubitus

b. ventral decubitus

c. left lateral decubitus

d. right lateral decubitus

a. dorsal decubitus

Which radiographic position of the abdomen requires that the patient be placed in the lateral recumbent position on his or her left side, that the IR be placed under the patient centered to the abdomen at the level of the iliac crests, and that the central ray be directed to enter the right side of the patient slightly anterior to the midcoronal plane?

a. left lateral

b. right lateral

c. left lateral decubitus

d. right lateral decubitus

a. left lateral

The lateral projection with the patient placed in the dorsal decubitus position, the left lateral projection, and the left lateral decubitus position of the abdomen all require which of the following?

a. the central ray should enter the left side of the patient

b. the patient should suspend respiration after expiration

c. the patient should suspend respiration after inspiration

d. the central ray should enter the anterior side of the abdomen

b. the patient should suspend respiration after expiration

For the lateral projection with the patient placed in the dorsal decubitus position, where should the central ray enter the patient?

a. 2 inches (5 cm) anterior to the midcoronal plane at the level of the iliac crests

b. 2 inches (5 cm) anterior to the midcoronal plane and 2 inches (5 cm) above the level of the iliac crests

c. 2 inches (5 cm) posterior to the midcoronal plane at the level of the iliac crests

d. 2 inches (5 cm) posterior to the midcoronal plane and 2 inches (5 cm) above the level of the iliac crests

b. 2 inches (5 cm) anterior to the midcoronal plane and 2 inches (5 cm) above the level of the iliac crests

For the lateral projection with the patient placed in the dorsal decubitus position, which procedure should be performed to ensure that the entire abdomen is included on the image?

a. use support cushions to elevate the patient

b. center the IR to the level of the xiphoid process

c. center the IR to the anterior surface of the abdomen

d. direct the central ray to a point 2 inches (5 cm) below the iliac crests

a. use support cushions to elevate the patient

Which structures should be examined to see whether the patient was rotated for a lateral projection of the abdomen

a. pelvis and lumbar vertebrae

b. pelvis and thoracic vertebrae

c. diaphragm and lumbar vertebrae

d. diaphragm and thoracic vertebrae

a. pelvis and lumbar vertebrae

How is proper patient alignment evaluated on an AP projection, supine position (KUB) image of the abdomen?

a. the spinous processes are seen in the midline of the lumbar vertebrae

b. the transverse processes of the lumbar vertebrae are visible

c. the vertebral column is centered in the collimated field

d. the psoas muscles are clearly demonstrated on each side of the lumbar spine

c. the vertebral column is centered in the collimated field

Which of the following is evaluated to check for rotation on an AP projection, supine position image of the abdomen?

a. the vertebral column is centered in the collimated field

b. the ala of the ilia are symmetric

c. the transverse processes of the lumbar vertebrae are visible

d. ribs, pelvis, and hips are equidistant to the edge of the image on both sides

b. the ala of the ilia are symmetric

Which side must be demonstrated on an AP abdomen with the patient positioned left lateral decubitus when pneumoperitoneum is suspected?

a. anterior

b. posterior

c. right

d. left

c. right

Which side must be demonstrated on an AP abdomen with the patient positioned left lateral decubitus when fluid accumulation is being evaluated?

a. anterior

b. posterior

c. right

d. left

d. left

The exposure factors for an AP projection image of the abdomen must be sufficient to demonstrate the soft tissues of the:

1. lower border of the liver

2. kidneys

3. psoas muscles

a. 1 and 2 only

b. 2 and 3 only

c. 1 and 3 only

d. 1, 2 and 3

d. 1, 2 and 3

An acute abdominal series may be ordered for all of the following reasons except to:

a. check for pneumoperitoneum

b. evaluate the presence of free fluid in the abdominopelvic cavity

c. use as preliminary examination before contrast agent administration

d. rule out bowel obstruction or infection

c. use as preliminary examination before contrast agent is administration

What is the recommended sequence for performing an acute abdomen series when the patient cannot stand?

1. seated upright chest

2. supine AP abdomen

3. upright AP abdomen

4. left lateral decubitus abdomen

a. 1, 3, 4

b. 2, 3, 1

c. 4, 2, 1

d. 4, 1, 2

d. 4, 1, 2

To which level of the patient should the central ray be centered for the KUB when the patient is upright and the diaphragm is of interest?

a. T10 vertebral body

b. L3 vertebral body

c. 2 inches (5 cm) above iliac crests

d. iliac crests

c. 2 inches (5 cm) above the iliac crests

To which level of the patient should the central ray be centered for the KUB when the patient is upright and the bladder is of interest?

a. T10 vertebral body

b. L3 vertebral body

c. 2 inches (5 cm) above the iliac crests

d. iliac crests

d. iliac crests

What is the recommended exposure field or CR plate size when performing a KUB?

a. 10 x 12 inches (25.4 x 30.5 cm) lengthwise

b. 10 x 12 inches (25.4 x 30.5 cm) crosswise

c. 14 x 17 inches (35.6 x 43.2 cm) lengthwise

d. 14 x 17 inches (35.6 x 43.2 cm) crosswise

c. 14 x 17 inches (35.6 x 43.2 cm) lengthwise

If free intraperitoneal air is suspected when performing a left lateral decubitus abdomen, how long should the patient lie on their side before exposure?

a. 0 minutes

b. 2 minutes

c. 5 minutes

d. 25 minutes

c. 5 minutes