RUQ

Required: Review AEUS Lecture on Biliary Ultrasound below.

Additional Recommended Material

BILIARY Minimal Imaging Criteria

  1. Longitudinal gallbladder to include neck

  2. Transverse gallbladder

  3. Anterior gallbladder wall measurement (normal is 3mm or less)*

  4. Common bile duct (measure inner to inner wall, normal is < 6mm)**

  5. Assess for a Sonographic Murphy Sign***

*When measuring GB wall be sure to measure any areas of focal thickening in addition to the anterior wall as cholecystitis is not a symmetric process. 

** The common bile duct may be >6mm in older patients (you can add 1mm for each decade of life). Additionally post cholecystectomy patients will have an enarged gallbladder.

*** A Sonographic Murphy Sign is when you visualize the gallbladder on ultrasound and then direct light pressure directly over the gallbladder. You then move the probe to a location where there is no gallbladder visualized and apply similar pressure. A positive Sonographic Murphy Sign is when the pain is highest directly over the gallbladder. If pain is equal everywhere or less over the gallbladder you should report a negative Sonographic Murphy Sign.