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In formalin fxed tissues diet with gastritis cheap 200mcg misoprostol fast delivery, Nile blue (Set 108) and Giemsa (Set 112) stained all granules in livers and heart well gastritis eating plan purchase misoprostol mastercard, gentian violet (Set 109) and haema? toxylin (Set 113) stained the granules in liver cells and heart gastritis symptoms causes and treatment order misoprostol from india, but not the granules in Kupfer and periportal cells gastritis special diet cheap misoprostol 200mcg with mastercard. After prolonged staining (2 hours) the melanins in skin and eye were still unstained gastritis and constipation quality misoprostol 200mcg, while the lipofuscin in the heart showed a very faint and by no means striking reddening. In the liver, a few granules were slightly stained but most were not signifcantly changed. Prolonged staining (2 hours) caused generally a more extensive blue colouration of all the pig? ments. The reason why Victoria blue gave a positive reaction while Ziehl-Neelsen did not, is probably partially because it is easier to recognise a blue than a red dis? colouration of brown granules. Sudan black (Set 119) : the paler granules in both livers and the granules in the heart were distinctly stained, the dark granules in the liver showed a blue tinge. The principle is that fatty acids and metal salts form compounds which can be demonstrated secondarily. He used copper acetate and demonstrated the copper-fatty acid salts with haematoxlyn which causes a bluish-black discolouration. This reaction itself is not specifc, as Kaufmann and Lehmann (1926) as well as Lison (1934) have shown that calcium compounds and iron salts can also be demonstrated by this method; furthermore, the granules of eosinophils and mast cells give a positive reaction. To make the reaction of fatty acids more specifc, it will therefore be necessary to use control sections, in which calcium salts are removed by weak hydrochloric acid and iron is demonstrated by the Prussian or Turnbull blue reaction. The Fischler reaction did not cause any signifcant changes in the examined tissues. He used melanin from the ink sack of Sepia ofjicinalis, from a melanoma and that prepared by the action of tyrosinase on tyrosine. Taft (1949) tried unsuccessfully to dissolve melanin in histological sections exposing the tissues up to 24 hours to ethylene chlorhydrine. In the present experiments, sets of slides, after having been brought to absolute alcohol, were exposed to ethylene chlorhydrine for 19 hours (Set 123), 3 days (Set 124), 6 days (Set 125) and 14 days (Set 126). The granules in skin and eye were signifcantly darkened and appeared almost black. Methenamine Silver Reaction (Gomori, 1948; Burtner and Lillie, 1949, Set 128) : All pigments were signifcantly darkened, more than by the Bielschowsky Silver Reaction. Ferric-FerricyanHle Reduction Test (Schmorl Reaction, Sets 129 to 138) : Reduction of ferric ferricyanide to Prussian blue was originally introduced as a histochemical method by Golodetz and Unna (1909) for the demonstration of reducing structures in tissue sections. Staemmler (1924) showed that melanin gives a positive test and Schmorl (1928) reported it as a method for the demonstration of lipofuscin. Chevremont and Fredericq (1943) modifed the technique for the demon? stration of protein bound suphydril groups. It was further used for the histochemical demonstration of the enterochromafn substance (Gomori, 1948; Laskey and Greco, 1948), the chromafn substance (Lillie, 1950) and the thyroxin in thyroid colloid {Fischer, 1953). In this reaction, ferric ferricyanide is reduced to ferric ferrocyanide (Prussian blue) by strongly reducing groups suchas sulphydryl groups in the epidermis, diphenol groups in melanin, chromafn and possibly also enterochromafn, although indol groups could also be the cause of reduction in the latter. According to Pearse (1953), variation of reduc? tion is caused by the diferent stages of oxidation in which lipofuscin may be found. However, it may also be caused by the varying occurrence of certain amino acids and their derivatives (Lipp, 1956). All pigments gave a very strong positive reaction which was more pronounced in alcohol than in formalin fxed sections (Set 129). Blocking of Ferri-ferricyanide reduction test (Sets 130 to 138) Periodic Acid (Set 130) : Exposure for fve minutes to fve per cent periodic acid, inhibited the subse? quent reduction test slightly, more so in eye and skin and less in livers and heart. Chromic Acid (Sets 132, 133 and 134) : Five per cent chromic acid bleached all pigments, so that after 60 minutes only the darkest granules in the livers and the granules in skin and eye were left. Bromination (Set 135) : Particularly carbon-carbon double bonds are blocked by bromination making them more resistant to other oxidizing agents (Lillie, 1954). Benzoylation (Set 136) : Benzoylation, when performed as for Sets 38 to 54, did not inhibit the re? duction test. Mercuric Chloride (Set 137) and Phenyl Mercuric Chloride (Set 138) : To demonstrate that a positive ferric ferricyanide reduction test is due to sulphydril groups, these groups can be blocked by exposure of the slides to a saturated aqueous solution of mercuric chloride (sublimate), for 2-3 hours or to a saturated phenyl mercuric chloride solution in n-butanol for 36 to 48 hours (Chevremont and Fredericq, 1943). Neither of the two reactions inhibited the reduction test of the examined pigments. Fats and fat soluble substances: cerebrosides, steroids, sphingolipoids, (Wolman, 1950) ; kerosin, phrenosin, phosphati

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There is so much variation in guideline value within different countries and institutes gastritis diet treatment medications buy misoprostol 200 mcg low price. The most toxic form is arsine gas gastritis diet 91303 purchase 200mcg misoprostol free shipping, followed by inorganic trivalent compounds gastritis medical definition misoprostol 100mcg otc, organic trivalent compounds chronic gastritis zinc purchase misoprostol 100mcg amex, inorganic pentavalent compounds gastritis treatment home buy 100 mcg misoprostol, organic pentavalent compounds and elemental arsenic. This concentration is too low to induce any noticeable health effects by inhalation. Therefore, inhalation and skin contact are negligible source of entry for arsenic. The ingestion of arsenic containing food and/or water is the most important route of entry. Of the many food categories, fish and shellfish contain the highest level of arsenic. Fortunately, over 90% of the arsenic is in organic form, which is only very mildly toxic. In contrast, for arsenic contaminated drinking water, most of the arsenic is in the more toxic inorganic form. However, in areas with volcanic rock and sulphide mineral deposits, arsenic levels in excess of 3000 ug/L have been measured. Acute arsenic poisoning usually starts with a metallic or garlic like taste, burning lips and dysphagia. These gastrointestinal symptoms are a result of intestinal injury caused by dilatation of splanchnic vessels leading to mucosal vesiculation. After the initial gastrointestinal problems, multi-organ failures may occur, followed by death. Survivors of acute arsenic poisoning commonly incur damage to their peripheral nervous system. Acute poisoning has a mortality rate of 50-75% and death usually occurs within 48 hours. However, in the context of drinking water supply, acute poisoning is less common than chronic exposure. On the other hand, some believe that chronic toxicity at low arsenic levels, as found in most groundwater, is influenced only by total arsenic concentration, not speciation. No matter which hypothesis is correct, long-term exposure to arsenic has proven to cause dermal, vascular, and cancer effects. Hyperpigmentation is an alteration in color resulting in spots on the skin and keratosis is a hardening of skin bulges, usually found in palms and soles. Recent studies from West Bengal, India and Bangladesh in populations showed that that the age-adjusted prevalence of keratosis rose from zero in the lowest exposure level (< 50 g/L) to 8. Studies have consistently shown high mortality risks from lung, bladder and kidney cancers among populations exposed to arsenic via drinking water. The characteristic of arsenicosis study in different stages (Bist, 2000; Shrestha and Maskey, 2001) which are as follows: Pre-clinical stage: Not-detectable by clinical manifestation. The work summarized in the following table: Table 5: Arsenic Level at Different Districts in Nepal as of November 2003 Samples with Arsenic Concentrations Percentage exceeding Max. Districts 0 10 ppb ppb > 50 ppb of tests ppb 10 ppb 50 ppb 1 Illam 4 0 0 4 0 0 2 Jhapa 493 77 1 571 79 14 0 3 Morang 339 260 4 603 70 44 1 4 Sunsari 646 241 4 891 75 27 0 5 Saptari 669 94 9 772 98 13 1 6 Siraha 245 235 104 584 90 58 18 7 Udaypur 3 0 0 3 5 0 0 8 Dhanusa 425 64 13 502 140 15 3 9 Mahhotari 177 21 4 202 80 12 2 10 Sarlahi 402 114 16 532 98 24 3 11 Rautahat 814 2289 262 3365 324 76 8 12 Bara 1983 550 51 2584 254 23 2 13 Parsa 1895 253 59 2207 456 14 3 14 Kathamndu 35 20 1 56 141 38 2 15 Chitwan 219 0 0 219 8 0 0 16 Nawalparasi 1385 1340 1108 3833 571 64 29 17 Rupandehi 2191 410 124 2725 2620 20 5 18 Kapilbastu 3471 466 162 4099 589 15 4 19 Palpa 26 0 0 26 0 0 20 Dang 639 25 3 667 81 4 0 21 Banke 2673 645 42 3360 270 20 1 22 Bardiya 472 160 20 652 181 28 3 23 Kailali 149 106 44 299 213 50 15 24 Kanchanpur 167 21 12 200 221 17 6 Total 19522 7391 2043 28956 Total % 67% 26% 7% 100% Source: (National Arsenic Steering Committee, Nepal. In this method coagulation, oxidation, co precipitation followed by filtration occurs to remove arsenic from water. In this filter, a black colored arsenic removal powder is used, which is a specially prepared mixture of coagulant, activated carbon and oxidizing agent for removing arsenic from the water. Agencies working in arsenic have been providing this filter to the arsenic affected community in Terai region. This system does not use any chemicals for arsenic removal but uses locally available material like sand, brick and charcoal. The natural filtration process removes arsenic, iron and other unnecessary chemicals. This filter has been introduced in the Terai region previously 31 for removal of iron and bacteriological contamination. Since this filter system is durable and considering the iron removal efficiency, it is expected that it will also remove arsenic with some modifications. This system removes iron arsenic as well as bacterial contamination without using any chemicals. This filter was introduced at the end of 2002 and is provided to few communities as pilot phase in Terai. Beginning in the early 1800s, sand beds were used in Europe to treat cholera infected waters. Several research studies revealed that the removal rate of fecal coliforms from the drinking water is very good (more than 90%) (Ngai. The arsenic removal unit is consisted of plastic diffuser basin, iron nails and some brick chips. Cross section of Improved Bio Sand Filter is shown in fig; 32 Diffuser Basin Lid Arsenic Iron Nails & Removal Unit Container Brick Chips Air Space Water Fine Sand Pathogen Pipe Removal Unit Coarse Sand Gravel Figure 6: Cross section of Arsenic Biosand Filter. They are: Oxidation/Reduction Precipitation Adsorption In adsorption process, arsenic is strongly attracted to sorption sites on the surfaces of the solid materials like iron and aluminum hydroxide flocs and is effectively removed from the solution by subsequent physical filtration. Arsenic removal technology of ArsenicBio Sand Filter is based upon the adsorption process as it consists of iron nails, which is found to be an excellent adsorbent for Arsenic. In Arsenic Bio Sand Filter, the iron nails are exposed to air and water, and are rust quickly, producing ferric hydroxide particles. When arsenic contaminated water is poured into the filter, 33 arsenic is quickly adsorbed onto the surface of the ferric hydroxide particles. These arsenic loaded ferric hydroxide particles are trapped on top of the fine sand layer. Most of the arsenic is already adsorbed on to the ferric hydroxide, and almost all ferric hydroxide is trapped on the top of fine sand layer, as a result, arsenic is effectively removed from the water. During the process of arsenic removal, iron dissolved in water is also removed through co precipitation and filtration process. A tightly packed bed of the sand grains can detain particles about 5% of the grain diameter. This is extensively larger than many particles to be removed from surface water such as cysts (1-20?m). Viruses are much less than 1 m, so must be removed by other means, such as biological mechanisms. When water is passed through the sand bed, the particles it contains-large and small collide with individual grains of sand. Water that requires filtration usually contains various kinds of organic matter, including living organisms. These particles and organisms accumulate in the uppermost layers of a sand bed, since this is where most of the collision takes place, and eventually develop into a dense biological population, which is known as the biological layer of biofilm. The biofilm consists of threadlike algae, and many other organisms including plankton, protozoa and bacteria. The biofilm needs stability, continuous water environment, diffuser level and basic nutrients, such as organic matter and oxygen. The 5 cm resting water level is the optimum heights as at this height the biology surviving in the biofilm receives maximum oxygen. Moreover, this resting water level serves a constant aquatic environment necessary for the organisms present in the layer to survive. The water should not be allowed to flow freely or directly on to the sand as it disturbs the biofilm, which may results incapability of pathogen removal. To protect the biofilm from this disturbance, water should be always poured through the diffuser basin. When microbiologically contaminated water is poured into the filter, predatory organisms present in the biofilm layer will consume the incoming pathogens. In addition, the biological population in the biofilm produces substances toxic to intestinal bacteria. Many studies and experiments reveal that this process can be a significant cause of bacterial removal in slow sand filters. An one-year technical monitoring of the filter revealed that the removal rate of the filter for Arsenic, Iron and pathogens is very good. The average arsenic removal efficiency of the filter is 93% (Ngai T, 2003), which is very good as compare to the other existing arsenic removal technologies. After the filtration, water with arsenic concentration of 450 ppb dropped to 20 ppb, which is quite remarkable. The diffuser basin must not be touching the surface of the water at resting level. It means the porosity should be small enough to trap particles in the water and large enough to let the water through and allow some room for biological growth. Before the use of the filter, the iron nails at the diffuser basin should be checked so as to ensure that the nail surface is always flat. If the surface is not flat, the basin is taken out and shaken to evenly distribute the iron nails. Water should be poured through the brick chips so that the iron nails could not be dispersed while pouring water. Thus, during that period, the filtered water can be disinfected using chlorine solution (Piyush). If the flow rate through the filter decrease to an unacceptable rate (a trickle that cannot meet household needs), it is time to maintain the filter. As a result of this scraping, the water that sits above the sand will become very turbid. Replace the diffuser basin and slowly add water to replace the water that was just removed. Finally the plastic basin containing the iron nails is shaken to make sure that the iron nails cover the whole surface of the basin and then put back into the filter. Most of the people of these areas are extracting underground water through shallow tube wells for drinking purpose. Different books, magazine related to Arsenic and its removal technologies were also used for the literature review. On the time of my research study I met few researcher and expert during research on Arsenic Biosand filter and discuss with them. But due to lack of time and considering the condition of filter, total 4 filters were selected and those filter selected were in good condition and currently in use. The materials are as follows: 1 Liter Mug this mug was used to measure the filtered water, the mug was filled 2 times so that 2 liter of water was collected and after 2 liter of filtered water collected flow rate was measured. Stop watch the watch was used to measure the time required to fill 100 ml of graduated cylinder. The principle reaction of test includes, the contents of arsenic in the water are converted to arsine gas by the reaction of Sodium Borohydride in acidic medium. The concentration of arsenic in the sample is determined by the comparison of the intensity of the stain with the color chart. A piece of cotton was taken with help of forceps and insert in the wide part of the mercury bromide paper holder tube. Cap of mercury bromide holder tube was opened and a piece of mercury bromide holder was placed with the help of forceps in that cap and was fit in the tube. A piece of tablet 2 was added in water sample and immediately fit the wide part (the cotton inserted part) of the mercury bromide paper holder tightly in Arsine generator flask and was allowed to stay for complete dissolve.

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The approach of polypectomy and colonscopic follow up is the standard of care gastritis icd 9 code buy discount misoprostol 100 mcg, as long as the adenoma has been completely removed gastritis burning pain in back cheap 100mcg misoprostol with mastercard, the margins are free of dysplasia gastritis diet sugar cheap misoprostol 100 mcg free shipping, and there is no flat dysplasia anywhere in the colon either close to gastritis diet לאזמנ purchase 200mcg misoprostol with visa or away from the polyp gastritis urination buy misoprostol american express. Introduction this chapter presents an overview of colonic physiology and the diseases that affect the colon. It discusses lower gastrointestinal bleeding, infectious diseases affecting the colon and diseases specifically involving the anus. Function the colon contributes to three important functions in the body: (1) concentration of fecal effluent through water and electrolyte absorption, (2) storage and controlled evacuation of fecal material and (3) digestion and absorption of undigested food. Although the colon is not essential for survival, its functions contribute significantly to the overall well-being of humans. The colon can be functionally divided through the transverse colon into two parts, the right and left colon. The right colon (cecum and ascending colon) plays a major role in water and electrolyte absorption and fermentation of undigested sugars, and the left colon (descending colon, sigmoid colon and rectum) is predominantly involved in storage and evacuation of stool. Functional Anatomy the human colon is a muscular organ measuring approximately 125 cm in length in vivo. The mucosa lacks the villous projections found in the small intestine and presents a relatively smooth surface, but numerous crypts extend from its surface. Cell types lining the surface and the crypts resemble those in the small intestine but are composed of significantly greater numbers of goblet cells. These cells secrete mucus into the lumen, and mucus strands can often be identified in association with stool. This observation is misconstrued by some patients as a response to underlying colonic pathology. The haustral folds, which help define the colon on barium x-ray, are not a static anatomical feature of the colon but rather result from circular muscle contractions that remain constant for several hours at a time. The outer or longitudinal muscle is organized in three bands, called taeniae coli, which run from the cecum to the rectum where they fuse together to form a uniform outer muscular layer. These muscular bands and elongated serosal fat saccules, called appendices epiploicae, aid in the identification of the colon in the peritoneal cavity. The colon is innervated by the complex interaction of intrinsic (enteric nervous system) and extrinsic (autonomic nervous system) nerves. The cell bodies of neurons in the enteric nervous system are organized into ganglia with interconnecting fiber tracts, which form the submucosal and myenteric plexi. These nerves are organized into local neural reflex circuits, which modulate motility (myenteric), secretion, blood flow and probably immune function (submucosal). Their receptor subtypes provide pharmacological targets for the development of drugs designed to alter colonic functions such as motility. Shaffer 315 Infants typically present with bowel obstruction or severe constipation. Barium x-rays identify the affected region as a constricted segment because the excitatory effects of the neurotransmitter acetylcholine are unopposed as a result of the absence of inhibitory neurotransmitter. The autonomic nervous system comprises sensory nerves, whose cell bodies are found in the dorsal root ganglia, and motor nerves, the sympathetic and parasympathetic nerves. Parasympathetic nerves innervating the right colon travel in the vagus nerve, and those innervating the left colon originate from the pelvic sacral nerves. Parasympathetic nerves are predominantly excitatory, and sympathetic nerves are inhibitory. Autonomic nerves modulate the enteric neural circuits within the colon and participate in neural reflexes at the level of the autonomic ganglia, spinal cord and brain. Brain?gut connections are important both for perception of visceral stimuli (sensory) and in modifying colonic function (motor) in response to central stimuli. An example of a central stimulus that can evoke significant changes in colonic activity through this connection is acute stress. This stimulus provokes release of central hormones, such as corticotropin releasing factor. These hormones activate parasympathetic pathways that stimulate motility patterns in the colon, and can result in diarrhea. The fundamental feature of colonic electrolyte transport that enables this efficient water absorption is the ability of the colonic mucosa to generate a large osmotic gradient between the lumen and the intercellular space. In contrast to the small intestine, where sodium in the intercellular space can diffuse back into the lumen and become iso-osmotic, hypertonic solutions are maintained in the intercellular space of the colon because the tight junctions are much less permeable to sodium diffusion. The net result is that the hypertonic fluid within the intercellular space draws water passively into the mucosa from the colonic lumen. In the colon there is also a highly efficient + + absorption of sodium (Na): of the 150 mEq of Na that enters the colon each day, less than 5 + mEq is lost in the stool. In contrast to Na, the tight junctions of the colon are highly permeable + + + to potassium (K), allowing K to move from the plasma to the lumen. K is normally secreted into the lumen unless intraluminal potassium rises above 15 mEq/L. This handling of potassium may account for hypokalemia seen with colonic diarrhea and may play a role in maintaining potassium balance in the late stages of renal failure. Other transport mechanisms, similar to those found in the small intestine (see Chapter 6, Section 5), are also found on colonocytes, which maintain electrical neutrality, intracellular pH and the secretion of salt and water. Shaffer 316 the regulation of water and electrolyte transport in the colon also involves the complex interplay between humoral, paracrine and neural regulatory pathways (see Chapter 6). One important difference is the effect of the hormone aldosterone, which is absent in the small intestine. Aldosterone is secreted in response to total body Na+ depletion or K+ loading, and in the colon, aldosterone stimulates sodium absorption and potassium secretion. The movement of fecal material from cecum to rectum is a slow process, occurring normally over 3-4 days. Functionally, the contraction patterns in the cecum and ascending colon cause mixing, which facilitates the absorption of water, whereas in the sigmoid colon and rectum the contraction slow the movement of formed stool, forming a reservoir until reflexes activate contractions to advance and evacuate stool. Several contractile patterns exist within the circular and longitudinal muscle of the colon. Ring contractions are due to circular muscle contraction, and these are either tonic or rhythmic. Tonic contractions are sustained over hours, form the haustral markings evident on barium x-rays and play a role in mixing. Regular contractions are nonocclusive, occur over a few seconds, and migrate cephalad (right colon) and caudad (left colon). Intermittent ring contractions occur every few hours, occlude the lumen, and migrate caudad. They result in the mass movement of stool, particularly in the sigmoid colon and rectum. Contractions of the longitudinal muscle produce bulging of the colonic wall between the taeniae coli, but the physiological importance of this action remains poorly understood. The origin of the contractions of the longitudinal muscle is not completely understood, but it depends upon the slow wave frequency of smooth muscle. Action potentials occur on the peaks of these membrane oscillations and hence they control the frequency of contractions. The nature of the contractile patterns within the colon depends upon the fed state. This is best exemplified during eating when the gastrocolic reflex? is activated. Food in the duodenum, particularly fatty foods, evokes reflex intermittment rhythmic contractions within the colon, and corresponding mass movement of stool. This action, which is mediated by neural and humoral mechanisms, accounts for the observation by many individuals that eating stimulates the urge to defecate. These bacteria digest a number of undigested food products normally found in the effluent delivered to the colon, such as the complex sugars contained in dietary fiber. They are passively and actively transported into the colonocytes where they become an First Principles of Gastroenterology and Hepatology A. Examination of this area devoid of luminal content typically reveals signs of inflammation, termed diversion colitis. Fermentation of sugars by colonic bacteria is also an important source of colonic gases such as hydrogen, methane and carbon dioxide. These gases, particularly methane, largely account for the tendency of some stools to float in the toilet. Nitrogen gas, which diffuses into the colon from the plasma, is the predominant gas. However, the ingestion of large quantities of undigested complex sugars such as found in beans of the maldigestion of simple sugars such as lactose can result in large increases in production of colonic gas. View of the normal submucosal vessels visible through the healthy transparent mucosa overlying the vessels. Normal transverse colon with a triangular appearance to the normal colon fold pattern Figure 2. Normal ileocecal valve seen in the bottom left of the image, looking down at the cecal pole. When bile salts or long-chain fatty acids are malabsorbed in sufficient quantities, their digestion by colonic bacteria generates potent secretagogues. Shaffer 318 Bile salt malabsorption typically occurs following resection of less than 100cm of the terminal ileum, usually for management of Crohn disease. When the resection involves segments greater than 100 cm of ileum, the liver cannot sufficiently increase the synthesis of bile acids from cholesterol. A deficiency of bile acids enters the duodenum and if the concentration of bile acids is below the critical micellar concentration, bile salf micelles do not form, lipids are malabsorbed, and fatty" Diarrhea (known as steatorrhea) develops. The mechanisms by which multiple metabolites of bile salts and hydroxylated metabolites of long-chain fatty acids act as secretagogues provide an example of how multiple regulatory systems can interact to control colonic function. These mechanisms include disruption of mucosal permeability, stimulation of chloride and water secretion by activating enteric secretomotor neurons, enhancement of the paracrine actions of prostaglandins by increasing production, and direct effects on the enterocyte that increase intracelluar calcium. Non-pathogenic bacteria also signal to mucosal cells and can evoke cytokine signaling from colonocytes to effector cells. Some species of bacteria stimulate pro-inflammatory responses whereas others are anti-inflammatory. These signaling pathways are enhanced when the tight junctions between epithelial cells are altered. This increased leakiness or permeability of the colon allows bacteria greater access to the epithelium and immune cells in the lamina propria. This bacterial-epithelial signaling underlies the rationale for the use of probiotics where healthy? or anti-inflammatory bacteria are ingested. Traditionally, patients presenting acutely with abdominal pain would have conventional radiographs (views of the abdomen) before any further cross sectional imaging was performed. Conventional Radiography/Plain Films Conventional radiography, or the abdominal series, includes a supine, erect or decubitus view and an image that includes the lung bases.

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