Clinical suspicion of cholecystitis or biliary colic:

    Abdominal pain, particularly right upper quadrant (RUQ), epigastric

    Right flank pain

    Right shoulder pain

    Nausea/vomiting

    Sepsis without source

CONTRAINDICATIONS

 None: No contrast or radiation

RISKS/CONSENT ISSUES

 Allergy to the ultrasonography gel

LANDMARKS

 RUQ of abdomen at expected location of gallbladder (GB)

TECHNIQUE

 Using a standard 3.5- to 5.0-MHz probe, scan the RUQ of the abdomen in the longitudinal plane under the costal margin using the liver as an acoustic window (FIGURE 34.1)

 If the GB is not readily identified:

    Ask the patient to take slow deep breaths because the GB moves significantly with respiration

    Have the patient move to the left lateral decubitus position

    Place the probe in the intercostal space to avoid bowel gas and rib shadows

 Once the GB is found, confirm by identifying associated structures:

    Echogenic gallstones in the lumen casting echolucent shadows (FIGURE 34.2)

    Main lobar fissure of the liver points toward the GB neck and also connects the portal vein

    Common bile duct (CBD) usually runs between the GB and the portal vein (FIGURE 34.3)

 Identify signs of cholecystitis (TABLE 34.1)

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