Gallbladder

Introduction:

Bedside sonography can greatly enhance the evaluation of patients with suspected cholecystitis. Findings of gallstones or a sonographic Murphy sign (maximal tenderness when pressure is applied over the visualized gallbladder) increase the likelhood of cholecystitis. Other sonographic findings which can sometimes be seen include gallbladder wall thickening (greater than 3 to 4mm is a commonly used cutoff), common bile duct dilatation (greater than 5 to 6mm), or the presence of pericholecystic fluid.

Focused Questions:

  1. Are there gallstones?
  2. Is there a sonographic Murphy sign?
  3. Are there other signs of acute cholecystitis?
    • Gallbladder wall >3mm
    • Common bile duct >6mm
    • Pericholecystic fluid

Video Overview:

Required Views:

1. Longitudinal view of gallbladder

Probe position options: Image
gb 1 Gallbladdergb 2 intercostal Gallbladder gb long Gallbladder
Notes
  • Visualize the gallbladder, portal vein, and common bile duct (if visible)
  • The probe orientation (transverse vs. longitudinal) depends on the gallbladder orientation
  • In most patients, oblique probe orientations will be needed to visualize the “long” and “transverse” views
Abnormal Studies (click to enlarge)
gallstone with shadowing.thumbnail Gallbladdergallstone and sludge.thumbnail Gallbladder

2. Transverse view of gallbladder

Probe position options: Image
gb 1 Gallbladdergb 2 intercostal Gallbladder gb short Gallbladder
Notes
  • The probe orientation (transverse vs. longitudinal) depends on the gallbladder orientation
  • In most patients, oblique probe orientations will be needed to visualize the “long” and “transverse” views
Abnormal Studies (click to enlarge)
gallstone with shadowing2.thumbnail Gallbladder

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