Abdomen Anatomy + Positioning & Technical Factors

AP Abdomen (KUB)

demonstrates borders of psoas major muscles

• right under diaphragm

• next to spine

• stretches out to the top of the femur

Digestive Tract Accessory Organs

not very visible on X-ray

• liver

• gallbladder

• pancreas

• spleen

Stomach & Parts of the Small Intestine

Stomach

• has rugae or folds

Small Intestine

1. duodenal bulb

2. duodenum - shortest and widest

3. jejunum (2/5 of SI)

4. ileum (3/5 of SI)

5. ileocecal valve

Large Intestine

1. ileocecal valve

2. cecum

3. appendix (vermiform)

4. ascending colon

5. right colic (hepatic) flexure

6. transverse colon

7. left colic (splenic) flexure

8. descending colon

9. sigmoid colon

10. rectum

11. anus

Order All 11 Parts of the Large Intenstine

1. ileocecal valve

2. cecum

3. appendix (vermiform)

4. ascending colon

5. right colic (hepatic) flexure

6. transverse colon

7. left colic (splenic) flexure

8. descending colon

9. sigmoid colon

10. rectum

11. anus

Urinary System Organs

will need contrast to see in an intravenous urogram (IVU)

• kidneys

• ureter

• bladder

• urethra

• suprarenal/adrenal glands

Label the 9 Parts of This Cross Section

• mesentery (double fold)

• small bowel

• peritoneal cavity

• parietal peritoneum

• visceral peritoneum

retroperitoneal

• right & left kidneys

• inferior vena cava

• aorta

Retroperitoneal Organs

Nine Organs

• adrenal glands

• kidneys

• pancreas

• duodenum

• ascending colon

• inferior vena cava

• aorta

• descending colon

• ureter

• (upper rectum)

Infraperitoneal Organs

Three Organs

• bladder

• lower rectum

• male reproductive (closed sac) or female reproductive (open sac) organs

Intraperitoneal Organs

Eight Organs

• liver

• gallbladder

• spleen

• stomach

• jejunum

• ileum

• cecum

• transverse colon and sigmoid colon

Abdominal Quadrants & Organs in Each

RUQ

• liver

• galbladder

• right colic (hepatic) flexure

• duodenum

• head of pancreas

• right kidney

• right supradrenal gland

LUQ

• spleen

• stomach

• left colic (splenic) flexure

• tail of pancreas

• left kidney

• left supradrenal gland

RLQ

• ascending colon

• appendix

• cecum

• 2/3 of ileum

• ileocecal valve

LLQ

• descending colon

• sigmoid colon

• 2/3 of jejunum

Abdominal Regions

1. right hypochondriac

2. epigastric

3. left hypochondriac

4. right lateral (lumbar)

5. umbilical

6. left lateral (lumbar)

7. right inguinal (iliac)

8. pubic (hypogastric)

9. left inguinal (iliac)

Planes Dividing the Abdominal Regions

1. right lateral plane

2. left lateral plane

3. transpyloric plane

4. transtubercular plane

Label the Abdominal Regions & Planes

1. right hypochondriac

2. epigastric

3. left hypochondriac

4. right lateral (lumbar)

5. umbilical

6. left lateral (lumbar)

7. right inguinal (iliac)

8. pubic (hypogastric)

9. left inguinal (iliac)

1. right lateral plane

2. left lateral plane

3. transpyloric plane

4. transtubercular plane

Topographic Landmarks

felt by palpation

mid & upper abdomen landmarks

• xiphoid process (T9-T10)

• inferior costal margin (L2-L3)

• iliac crest (L4-L5)

lower abdomen and pelvic landmarks

• ASIS (anteriorsuperior iliac spine)

• greater trochanter

• symphysis pubis

• ischial tuberosity

Label Everything Besides the Middle One

• ASIS (anteriorsuperior iliac spine)

• greater trochanter

• symphysis pubis

• ischial tuberosity

Positioning of Abdomen

KUB

Acute Abdomen Series

• AP Supine Abdomen

• AP Erect Abdomen

• PA Erect Chest

Decubitus Positions

• Lateral Decubitus

• Dorsal Decubitus

Routine & Special Abdomen Positionings

Routine

• AP supine abdomen (KUB)

Special

• PA prone

• Lateral decubitus (AP) abdomen

• AP erect abdomen

• Dorsal decubitus (lateral) abdomen

Patient Preparation

• all clothing removed

• opaque objects removed

• hospital gown worn

• pillow for head, clean linen on table

• cover patient for warmth & modesty

Positioning Considerations

• exposure on expiration

• IR markers

• collimation

Positioning Factors

• kVp (70-85)

• short exposure time

• adequate mAs

What is this projection?

AP Supine Abdomen

AP Supine Abdomen

• CR center to iliac crest

Evaluation Criteria

• symphysis pubis visible (just clip the top)

• kidneys & lower liver margin included

• no rotation

• no motion

• exposures factors optimal

What is this projection?

AP Erect Abdomen

AP Erect Abdomen

• CR 2 inches (5 cm) above iliac crest

• top of IR in the axilla region

• patient erect for at least 5 mins.

Evaluation Criteria

• diaphragm included (unless PA chest taken)

• no rotation

• no motion

• exposures factors optimal

What projection is this?

PA Prone Abdomen

PA Prone Abdomen

• CR & IR to iliac crest

• abdominal tissue will be more compressed than on AP projection

Evaluation Criteria

• symphysis pubis visible

• kidneys & lower liver included

• no rotation

• no motion

• exposures factors optimal

What position is this?

Left Lateral Decubitus Position

Left Lateral Decubitus Position

• CR 2 inches (5 cm) above iliac crest @ midsagittal plane

• patient lateral recumbent on left because air collects between liver & diaphragm

• gastric bubble down

• left for 5 mins. for air-fluid levels

• include upside marking

Evaluation Criteria

• diaphragm demonstrated

• both sides of body included

• no rotation (of shoulders & pelvis)

• no motion

• exposures factors optimal

What is this position?

Dorsal Decubitus Right Lateral Position

Dorsal Decubitus Right Lateral Position

• CR 2 inches (5 cm) above iliac crest @ midcoronal plane

• patient supine

• BARELY USED

Evaluation Criteria

• diaphragm demonstrated

• no rotation

• no motion

• exposure factors optimal

What is this projection?

Right Lateral Abdomen Position

Right Lateral Abdomen Position

• CR perpendicular to table & centered at iliac crest

• patient lateral & recumbent with no tilt

Evaluation Criteria

• diaphragm included

• no rotation

• no motion

• exposure factors optimal

Clinical Indications for Acute Abdomen Series

• ileus (parastalsis stops)

• ascites (accumulation of fluid in peritoneal cavity)

• perforated hollow (bowel) viscus

• intra-abdominal mass (neoplasms)

• post-op (abdominal surgery)

Acute Abdomen Series 3-Way & 2-Way

3-Way

• AP supine

• AP erect

• PA chest

2-Way

• AP Supine

• AP erect or left lateral decubitus

  • must include diaphragm