Bedside Gallbladder Ultrasonography

imagesClinical suspicion of cholecystitis or biliary colic:


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


   imagesRight flank pain


   imagesRight shoulder pain


   imagesNausea/vomiting


   imagesSepsis without source


CONTRAINDICATIONS



imagesNone: No contrast or radiation


RISKS/CONSENT ISSUES



imagesAllergy to the ultrasonography gel


LANDMARKS



imagesRUQ of abdomen at expected location of gallbladder (GB)


TECHNIQUE



imagesUsing 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)


imagesIf the GB is not readily identified:


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


   imagesHave the patient move to the left lateral decubitus position


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


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


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


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


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


imagesIdentify signs of cholecystitis (TABLE 34.1)



images


FIGURE 34.1 Biliary ultrasonography: To locate the gallbladder, do a costal margin sweep first.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Gallbladder Ultrasonography
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