Abdominal X-ray - Scenario 3
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering image quality
  • Does not suggest large bowel obstruction as a possible diagnosis or is not able to offer any cause for obstruction
  • Does not know that an erect chest X-ray should be requested

Average candidate

  • Describes all X-ray features succinctly and accurately with a systematic approach and states that the large bowel is dilated, likely indicating obstruction
  • Before being asked suggests performing an erect chest X-ray in this context
  • Is aware of the common causes of large bowel obstruction

Good candidate

  • Succinctly describes the radiological features of large bowel obstruction, suggesting the descending colon as the level of disease
  • Notices the anastomosis artifact on the X-ray image
  • Without prompting offers a management plan of 'drip and suck' (IV fluids and naso-gastric tube insertion) in the context of general resuscitation. (You are not asked directly about initial management in this scenario, but good candidates will offer this information without prompting.)
  • Suggests CT as a definitive radiological test and knows why this is likely to be helpful
  • Shows awareness of the precautions required prior to transferring the
    patient to the Radiology Department for a CT scan, and that monitoring renal function will need to continue following the scan - assuming intravenous contrast material is given

CT of the abdomen

  • Many medical schools now expect a basic understanding of CT imaging at medical finals level. If you are asked to look at a CT in your finals examination then you will likely only be asked about simple concepts and anatomy, and to show an awareness of the process of requesting a CT appropriately and safely

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

Last reviewed: February 2016