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Biliary ultrasound can be very rewarding. A rapid, focused exam can help determine if gallstones or gallbladder pathology is the etiology of a patient’s presenting symptoms. In turn, bedside ultrasound can expedite therapy or expedite the pursuit of an alternative diagnosis. While the sonographic identification of gallstones may seem straightforward, the sonographic findings for cholecystitis are often subtle.
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RUQ pain
Jaundice
Epigastric pain
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Views for Emergency Department Biliary Ultrasound
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Equipment: Recommended Transducers for Gallbladder Ultrasound
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Convex array
Phased array
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Initially, the transducer is placed in the subxiphoid region with the indicator directed toward the patient’s head in a sagittal view and swept below the right costal margin to approximately the midclavicular line. The transducer is then rotated (often clockwise) to obtain a view of the gallbladder in its longest axis (Fig. 24.72).
Scan through the gallbladder completely from medial to lateral borders including careful evaluation of the gallbladder neck. A thorough search for gallstones should be made, particularly at the neck where small symptomatic gallstones may be seen.
Identify the liver, gallbladder, portal vein, hepatic artery, main lobar fissure, and the common hepatic duct (Figs. 24.73 and 24.75).
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