Biliary ultrasound

Technique

• Can use phased array or convex probe
• Look in midclavicular line at Right 11th/12th intercostal spaces or scan anteriorly from Morrison's pouch
• Patient in Left lateral decubitus (if can tolerate)
  • Allow for better visualization of gallbladder (moves gallbladder anteriorly)
  • Better visualization of gallstones

Findings

Evaluate gallbladder for:

1. GB wall measurement
2. Pericholecystic free fluid
3. Gallstones
4. Common Bile Duct (CBD) measurement
5. Sonographic Murphy's (pain with ultrasound probe palpation over gallbladder)

Measurements

• GB wall is normally <3-4mm
  • Measure the ant wall with a short-axis view
  • Causes:
    • 1. Acute cholecystitis
    • 2. Ascites
    • 3. CHF

• Gallstones
  • identify by hypoechoic "shadowing" behind hyperechoic stones
    • if no shadowing, may be polyps, sludge, etc.

• Common Bile Duct
  • Measure from inner to inner
  • Normal is up to 4mm to age 40 (add 1mm per decade thereafter)

• Acalculous cholecystitis
  • GB is >10cm long & >4 cm wide

See Also

• Ultrasound (Main)
• Gallbladder Disease (Main)
• WES sign

Source

Sonoguide