Abdominal X-ray - Scenario 2
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering image quality
  • Does not suggest small bowel obstruction as a possible diagnosis or does not know to request an erect chest X-ray
  • Does not mention digital rectal examination

Average candidate

  • Describes all X-ray features succinctly and accurately with a systematic
    approach and states that the small bowel is dilated likely indicating obstruction
  • Suggests performing an ERECT chest X-ray in this context
  • Is aware of the causes and management of bowel obstruction starting with appropriate resuscitation

Good candidate

  • Succinctly describes the radiological features of small bowel obstruction, mentioning that in this case the whole small bowel is dilated suggesting a distal level of obstruction
  • Without prompting offers a management plan of 'drip and suck' (IV fluids and naso-gastric tube insertion) in the context of general resuscitation
  • Notices the urinary catheter and notices there is no visible naso-gastric tube on the image
  • Notices the pubic symphysis is abnormal
  • Suggests CT as a definitive radiological test
  • Shows awareness of the precautions required prior to transfer the patient to the Radiology Department for a CT scan

Small bowel obstruction

  • If you can't diagnose small obstruction radiologically from the image provided, then you will fail this examination station.
  • Remember you are not only being tested on radiology skills but also on your awareness of the clinical scenario and your ability to plan management.
  • Don't wait to be asked what you would do in this setting, go ahead and tell the examiner your differential diagnosis and how you and your team would proceed.
  • Listen to the questions carefully. In this scenario you are asked the possible clinical findings rather than what you would expect to find. You should show the ability to think about the clinical scenario, not just the findings relating to the image shown.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2016