What is the reasoning for performing a plain abdominal film in this patient?
Bowel obstruction can often be seen on a plain film and the history of abdominal pain and vomiting might raise that as a possible diagnosis.
Do you think that the cause of the patient's symptoms are demonstrated on this plain film?
No. There is no evidence of perforation or obstruction here and no other cause of pain is identified.
If you were to examine this patient, do you think that the abdominal examination would be normal?
There is no evidence of obstruction or perforation on the plain film, but that doesn't exclude other pathology that might cause pain, e.g. appendicitis, duodenal ulcer, diverticulitis.
When examining her right hypochondrium, you think you can feel a liver edge. Can you see it on the plain film? Is this normal?
The liver edge can be seen on the plain film and while it does extend below the lower pole of the kidney, it's appearance is of a normal variant of liver anatomy with a prominent right lobe.
Sterilisation clips demonstrated in the pelvis. Normal outlines of solid organs - the liver has a prominent lower margin (normal variant - Riedel's lobe). Normal bowel gas pattern. Faeces in ascending colon.
No evidence of obstruction or perforation.