Abdominal Distension Prior to Abdominal X-ray

Overview

Abdominal distension is a common indication for abdominal radiography, particularly when evaluating acute abdominal conditions such as:

• Bowel obstruction (small or large bowel)

• Perforation with free air

• Severe constipation or fecal impaction

• Ascites or abdominal mass

Distension prior to an abdominal X-ray raises concern for gas accumulation, fluid, or obstruction, and imaging helps differentiate functional bloating from potentially life-threatening surgical conditions.

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Pre-Imaging Management & Treatment Options

1. Immediate Supportive Measures

• Nil per os (NPO) until diagnosis is clearer (avoid worsening obstruction).

• IV fluids: 0.9% sodium chloride or Ringer’s lactate to correct dehydration/electrolyte imbalance.

• Nasogastric tube decompression if severe vomiting or suspected obstruction.

2. Symptomatic Relief (Prior to Diagnosis)

(Used cautiously, after excluding surgical emergencies)

• Analgesics:

  • Paracetamol (acetaminophen): 500–1000 mg PO/IV q6–8h (max 4 g/day).

  • Avoid opioids unless severe pain, as they may mask symptoms and worsen ileus.

• Antiemetics:

  • Ondansetron: 4 mg IV/PO every 8 hours as needed.

• Antispasmodics (if no acute obstruction suspected):

  • Hyoscine butylbromide: 20 mg IV/IM, repeat every 30 minutes if needed (max 100 mg/day).

3. Specific Therapy Depending on Imaging Results

• Small bowel obstruction: NG tube decompression, IV fluids, surgical consult.

• Large bowel obstruction: surgical/colorectal consult, possible urgent intervention.

• Constipation/fecal impaction:

  • Polyethylene glycol (PEG 3350): 17 g in water daily.

  • Lactulose: 15–30 mL PO daily.

• Ascites: diuretics (spironolactone 100 mg PO daily ± furosemide 40 mg PO daily).

• Perforation: urgent surgical management, broad-spectrum antibiotics.

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Supportive & Monitoring Measures

• Monitor vital signs (tachycardia, fever, hypotension may indicate peritonitis/sepsis).

• Baseline labs: CBC, electrolytes, liver and renal function.

• Serial abdominal exams while awaiting imaging.

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Key Notes

• Never delay imaging in acutely distended abdomen when obstruction or perforation is suspected.

• Avoid empiric antibiotics unless infection or perforation suspected.

• Avoid unnecessary laxatives or enemas until obstruction is excluded by imaging.

• Abdominal X-ray is often the first-line test, but CT abdomen with contrast may be required for definitive diagnosis.