Abdominal Radiological Procedure

Overview

An abdominal radiological procedure refers to imaging studies used to evaluate the abdominal cavity, including plain X-ray, ultrasound, CT scan, MRI, and contrast studies. These procedures are performed to assess pain, distension, suspected obstruction, perforation, tumors, ascites, or trauma.

They help distinguish between functional gastrointestinal disorders and serious organic pathologies (e.g., bowel obstruction, perforation, malignancy, abscess).

---

Treatment & Management in the Context of Radiology

1. Preparation Prior to Imaging

• Plain abdominal X-ray: No special preparation needed.

• Ultrasound: Often requires fasting for 6–8 hours to reduce bowel gas and improve visualization of liver, gallbladder, pancreas.

• CT abdomen:

  • May require oral contrast (e.g., diatrizoate meglumine or iohexol solution, 500–1000 mL PO).

  • IV contrast (iodinated, e.g., iohexol 300 mg iodine/mL) given at 1–2 mL/kg (max ~100 mL) unless contraindicated (renal impairment, allergy).

• MRI abdomen: Often requires IV gadolinium contrast (e.g., gadobutrol 0.1 mmol/kg IV).

---

2. Symptomatic Treatment While Awaiting Imaging

• Analgesics:

  • Paracetamol: 500–1000 mg PO/IV q6–8h.

  • Avoid opioids before imaging if possible, as they can mask peritonitis signs.

• Antiemetics:

  • Ondansetron 4 mg IV/PO q8h as needed.

• Hydration:

  • IV crystalloids (0.9% NaCl or Ringer’s lactate) if dehydrated or NPO.

---

3. Post-Imaging Treatment (Based on Findings)

• Intestinal obstruction: NG tube decompression, IV fluids, possible surgical intervention.

• Perforation (free air): Broad-spectrum antibiotics (e.g., piperacillin-tazobactam 4.5 g IV q8h) and urgent surgery.

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

• Malignancy: Referral to oncology, surgical resection, or palliative therapy.

• Inflammatory conditions (e.g., appendicitis, diverticulitis): Antibiotics and/or surgery.

---

Supportive & Safety Measures

• Check renal function before IV contrast (serum creatinine, eGFR).

• Premedicate with steroids and antihistamines in patients with prior contrast allergy.

• Monitor for adverse reactions: anaphylaxis, contrast-induced nephropathy.

• Radiation precautions: Use ultrasound or MRI in children and pregnant women when possible.

---

Key Notes

• Choice of radiological procedure depends on clinical suspicion:

  • X-ray: quick, initial evaluation for obstruction, perforation.

  • Ultrasound: safe, first-line in children/pregnancy, good for hepatobiliary.

  • CT: gold standard for acute abdomen.

  • MRI: best for liver lesions, biliary/pancreatic evaluation without radiation.

• Always correlate imaging with clinical findings before treatment decisions.

• Symptom relief may be started, but definitive therapy depends on radiological results.