GALLBLADDER & LIVER
RUQ US Pearls & Pitfalls
- Look for a dilated gallbladder, evidence of cholelithiasis or sludge, gallbladder wall thickening >3mm, peri-cholecystic fluid, bile duct dilatation, and a sonographic Murphy’s sign.
- To check for a sonographic Murphy’s sign, place the ultrasound probe at the maximal point of tenderness in the right upper quadrant. If the probe is placing direct pressure on the gallbladder fundus, you have a positive sonographic Murphy’s sign.
- Normal gallbladder wall thickness can be up to 3mm. The most common conditions other than cholecystitis that may cause thickening of the gallbladder wall include hepatitis, hypoalbuminemia, tumor, hyperplastic cholecystosis, adenomyomatosis, and CHF.
- Normal common bile duct inner diameter should be under 4mm, but may be higher, up to 10mm, post-cholecystectomy. In addition the diameter may be higher in older patients, up to 1mm per decade of life.
- Don’t miss a AAA because you didn’t look. It’s not that far away.
- Don’t miss a single obstructing gallstone hidden in the gallbladder neck.
- Polyps do not move upon patient repositioning, and usually do not cause acoustic shadows. Unimpacted gallstones should be mobile and will cause shadowing unless they are too small.
- Gallbladder wall thickening may be noted on patients who are post-prandial and therefore have a contracted gallbladder. Look for other signs that may suggest cholecystitis.
*Want more educational images? Check out the ED Atlas on CD
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Right Upper Quadrant Ultrasound
Single gallstone trapped in gallbladder neck
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Cholecystitis with pericholecystic fluid
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Liver Abscess
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