The focused gallbladder ultrasound exam in the emergency department answers 2 simple questions:
Comprehensive video on how to perform a hepatobiliary ultrasound
Examples of gallbadder pathology
NORMAL gallbladder
Large gallstone with patient movement
Large gallstone impacted in gallbladder neck
Acute cholecystitis with multiple gallstones
Acute cholecystitis with WES (Wall-echo-shadow) sign
Acute cholecystitis with gallstone in CBD
- Is there gall stones
- Is there acute cholecystitis
- Is the anterior wall thickened? (>3mm)
- Is there pericholecystic fluid?
- Is there sonographyic Murphy's sign?
- The gallbladder is not a fixed organ
- It can move to a variety of locations in the right upper quadrant
- But, the gallbladder neck has a fixed relationship to the main lobar fissure and the portal vein.
- And, the main lobar fissure connects the right portal vein to the gallbladder neck
- Use a C60x transducer, 5-2MHz, curvilinear array with 30cm scan depth, or a C21x transducer, 5-1MHz, phased array, with 35cm scan depth.
- Position the patient either supine or left lateral decubitus position, though siting or standing positions can also be used
- Place the probe under the right costal margin, with the probe marker directed toward the right shoulder
- Sweep along the costal margin until an image of the gallbladder is obtained.
- When difficulty is encountered, look through the intercostal space using a small footprint probe like the C21x, or have the patient take a deep breath,
or turn to left lateral decubitus position if started in supine
- Obtain longitudinal and transverse views of the gallbladder
- Remember to fan through the gallbladder in both views
- Try to demonstrate the relationship with the portal triad
- With a long axis view of the gallbladder, the main lobar fissure, and the right portal vein, will take on the appearance of an exclamation point !
Comprehensive video on how to perform a hepatobiliary ultrasound
Examples of gallbadder pathology
NORMAL gallbladder
Large gallstone with patient movement
Large gallstone impacted in gallbladder neck
Acute cholecystitis with multiple gallstones
Acute cholecystitis with WES (Wall-echo-shadow) sign
Acute cholecystitis with gallstone in CBD
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