BILIARY Dr. John Powell, Christiana Care Health System INDICATIONS: • • • •
Right upper quadrant, epigastric or flank pain Concern for gallstones Jaundice Pancreatitis
KEY QUESTIONS: • •
Are there gallstones? Are there signs of cholecystitis?
TECHNIQUE: • •
•
• • •
A low frequency transducer (2-5 MHz) is ideal for assessment of the gallbladder. Identify the portal triad or main lobar fissure and trace to an anechoic structure, the gallbladder (Figure 1). o Place probe in a sagittal plane in the epigastrium, then sweep transducer along the right costal margin. The indicator should initially be directed towards the patient’s head. After visualizing the gallbladder, the transducer may need to be slightly rotated to obtain true sagittal and transverse views. Scan the entire gallbladder in two planes. o Identify any pericholecystic fluid or gallstones. o If a gallstone is in the gallbladder neck, roll the patient to ensure mobility. Measure the gallbladder wall thickness in the anterior field (transverse or sagittal) (Figures 2 and 3). Identify the common bile duct. o Measure the internal diameter, i.e. inner wall to inner wall (Figure 4). Assess for a sonographic Murphy’s sign. Do this by identifying the gallbladder and placing it in the center of the screen, then applying pressure directly with the transducer onto the region of the gallbladder. Reproduction of exquisite pain is considered positive.