Gallbladder U/S

The focused gallbladder ultrasound exam in the emergency department answers 2 simple questions:
  1. Is there gall stones
  2. Is there acute cholecystitis
When gallbladder inflammation is seen, the following criteria are assessed for acute cholecystitis:
  • Is the anterior wall thickened? (>3mm)
  • Is there pericholecystic fluid?
  • Is there sonographyic Murphy's sign?
Anatomy
  • 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
Preparation
  • 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
Scan technique
  • 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
Image Acquisition
  • 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

1 comment:

  1. maggie.danhakl@healthline.com23 June 2014 at 11:15

    Hi,

    Healthline.com recently launched a free interactive "Human Body Maps" tool. I thought your readers would be interested in our body map of the Gallbladder: http://www.healthline.com/human-body-maps/gallbladder

    It would be much appreciated if you could include this tool on http://singem.blogspot.com/p/gallbladder-us.html and / or share with friends and followers. Please let me know if you have any questions.


    Thank you in advance.
    Warm Regards,

    Maggie Danhakl- Assistant Marketing Manager
    p: 415-281-3124 f: 415-281-3199

    Healthline Networks, Inc. * Connect to Better Health
    660 Third Street, San Francisco, CA 94107 www.healthline.com

    ReplyDelete