GI Course

Evaluating for Gallbladder and Biliary Disease

 
For patients presenting with right upper quadrant (RUQ) or epigastric abdominal pain suggestive of gallbladder or biliary disease, ultrasound can be used to further evaluate the patient. RUQ or epigastric abdominal pain associated with nausea, vomiting, fever, jaundice and/or lab abnormalities (AST, ALT, ALK phos, Bili, Lipase, WBCs with epigastric pain) further increases suspicion for disease.
 
Watch the following video: Basic Biliary Ultrasound
 

Normal Anatomy on Ultrasound

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REVIEW: pages 54-65   Biliary RUQ POCUS Exam

Sonographic Signs of Cholecystitis

· Positive sonographic Murphy’s sign: pain while visualizing compression of the gallbladder.

· Gallstones: hyperechoic structures within the gallbladder lumen (posterior shadowing)

· Gallbladder wall thickening: Normal thickness is <3mm, thickness >5mm is abnormal, thickness 3-5mm may be abnormal

· Pericholecystic Fluid: hypoechoic stripe between liver and gallbladder

· Common Bile Duct (CBD) Dilation: CBD diameter: Normal is <7mm & >10mm is usually pathologic

                          Obstruction is the most common cause of CBD dilation: impacted stone, obstructing masses, or stricture.