From the Guidelines
An abdominal X-ray is not the primary diagnostic tool for patients admitted with suspected ascites, and its use should be limited due to its limitations in detecting ascites and potential underlying causes. The X-ray may show increased abdominal density, loss of psoas muscle shadows, and widening of the distance between bowel loops due to fluid accumulation, but it can only detect ascites when there is a significant amount of fluid present (typically more than 500 mL) 1. For more accurate assessment of ascites, an ultrasound is preferred as it can detect as little as 100 mL of fluid and provide information about potential underlying causes. CT scans or MRI may be necessary for more detailed evaluation. The abdominal X-ray should be ordered as a supine and upright (if patient can stand) or left lateral decubitus view to better visualize fluid levels. While obtaining the X-ray, also consider ordering liver function tests, serum albumin, and other relevant blood work to help determine the cause of ascites, which commonly includes liver cirrhosis, heart failure, nephrotic syndrome, or malignancy. According to the most recent guidelines, abdominal paracentesis with ascitic fluid analysis is the most rapid and efficient test to diagnose ascites and determine its cause 1. In patients with new-onset ascites, a diagnostic paracentesis should be performed to ensure the cause of ascites and to check for infection. The use of abdominal X-ray as an initial diagnostic tool is not recommended due to its low sensitivity and specificity in detecting ascites, and it should be replaced by more accurate diagnostic methods such as ultrasound and abdominal paracentesis. It is essential to prioritize the use of more accurate diagnostic tools to ensure timely and effective management of ascites, which can significantly impact patient outcomes in terms of morbidity, mortality, and quality of life. The guidelines recommend that patients with ascites should be managed by a multidisciplinary team, and the treatment should be individualized based on the underlying cause of ascites, the severity of symptoms, and the patient's overall health status 1. In summary, the use of abdominal X-ray as a primary diagnostic tool for ascites is not recommended, and more accurate diagnostic methods such as ultrasound and abdominal paracentesis should be prioritized.
From the Research
Abdominal X-ray on Admission for Acute Abdominal Pain
- The use of abdominal x-ray on admission for acute abdominal pain is not explicitly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, study 6 mentions that plain radiography has limited utility in diagnosing the cause of abdominal pain.
- Study 5 recommends the use of imaging studies such as computed tomography (CT) with intravenous contrast media, ultrasonography, and magnetic resonance imaging (MRI) based on the location of pain and index of suspicion for specific etiologies.
- Study 6 also suggests that CT is the imaging modality of choice for undifferentiated abdominal pain, while ultrasound and MRI may be helpful in specific scenarios.
Diagnostic Considerations
- Study 2 highlights the importance of history, physical examination, and sonography in diagnosing acute abdominal pain.
- Study 5 recommends a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing as part of the diagnostic workup.
- Study 3 emphasizes the importance of clinical evaluation and intra-abdominal pressure measurement in assessing abdominal problems in critically ill patients.