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Review
. 2014 Nov;22(4):223-8.
doi: 10.1177/1742271X14546181. Epub 2014 Aug 4.

My patient has got abdominal pain: identifying biliary problems

Michael Y Woo  1 , Mark Taylor  1 , Osama Loubani  2 , Justin Bowra  3 , Paul Atkinson  4
Affiliations
Review

My patient has got abdominal pain: identifying biliary problems

Michael Y Woo et al. Ultrasound. 2014 Nov.

Abstract

Right upper quadrant and epigastric abdominal pain are common presenting complaints in the emergency department. With increasing access to point-of-care ultrasound, emergency physicians now have an added tool to help identify biliary problems as a cause of a patient's right upper quadrant pain. Point-of-care ultrasound has a sensitivity of 89.8% (95% CI 86.4-92.5%) and specificity of 88.0% (83.7-91.4%) for cholelithiasis, very similar to radiology-performed ultrasonography. In addition to assessment for cholelithiasis and cholecystitis, point-of-care ultrasound can help emergency physicians to determine whether the biliary system is the source of infection in patients with suspected sepsis. Use of point-of-care ultrasound for the assessment of the biliary system has resulted in more rapid diagnosis, decreasing costs, and shorter emergency department length of stay.

Keywords: PoCUS; Point-of-care ultrasound; cholecystitis; cholelithiasis; emergency medicine; gallbladder.

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Figures

Figure 1
Figure 1
Normal gallbladder in longitudinal plane. Asterisk indicates portal vein. Arrow indicates gallbladder
Figure 2
Figure 2
Normal common bile duct (CBD). Calipers indicate a diameter of 0.31 cm. Arrow indicates hepatic artery. PV: portal vein
Figure 3
Figure 3
Gallbladder with multiple gallstones. Arrows indicate stones with associated posterior acoustic shadowing
Figure 4
Figure 4
Gallbladder with sludge. Arrow indicates sludge in most dependent area
Figure 5
Figure 5
Acute cholecystitis. Arrow indicates peri-cholecystic fluid. Asterisk indicates thickened gallbladder wall
Figure 6
Figure 6
Hepatic abscess secondary to gallbladder perforation. Arrow indicates the abscess. Color Doppler highlights the portal vein and flow around the abscess
Figure 7
Figure 7
Dilated common bile duct (CBD). Arrow indicates dilated CBD just distal to hepatic artery indicated with color Doppler
Figure 8
Figure 8
Dilated intrahepatic ducts. Color Doppler highlights the portal vein. Arrows indicate the dilated intrahepatic ducts
Figure 9
Figure 9
Contracted gallbladder. Arrow indicates the thickened contracted gallbladder wall
Figure 10
Figure 10
Gallbladder polyp. Arrow indicates polyp suspended from non-dependent area of the gallbladder wall. Asterisk indicates shadow created by edge artifact
Figure 11
Figure 11
Gallbladder in transverse demonstrating wall–echo–shadow (WES)
See this image and copyright information in PMC

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