US TIPS- Always ask when the patient last ate (at least 4 hours of fasting is best)
- Have the patient supine or try left lateral decubitus for a better sonographic window
- Have the patient take varying levels of inspiration, especially if the GB is under the rib cage
- Use the ABD preset on the GE machine
- Start with 5 MHz curvilinear transducer
- Don't be shy! really press down with the transducer and use lots of
gel
- One of the reasons the Sonographers get better images is that they press
down harder than us
- If you can't find the common bile duct, use a cine and scan throughout
the gb slowly. To get a cine, hit the
record image button without pausing. This will record the past few
seconds of scanning
- When in doubt, don’t hesitate to recommend a HIDA
RUQ US PROTOCOL- Sagittal and transverse images of the gallbladder
- NECK AND CBD
- CBD < 6mm (+1 mm for each decade after 60)
- Most common reason for an inadequate study on call is no CBD
- Use color to differentiate vessels from ducts in the porta hepatis (both the CBD and hepatic artery have echogenic walls)
- GB Wall Thickening
- If the patient's body habitus allows, use the 9 MHz linear to measure anterior wall thickness in transverse
- Should be 1-3 mm thick
- "Double wall" sign may be GB wall edema
- Pericholecystic fluid
- Look for stones
- Place the focal zone at the stone to demonstrate shadowing
- WES sign (Wall Echo Shadow): stones completely fill GB-completely obscures post wall
- To differentiate adherent stones vs. polyps
- Shake probe
- Use color Doppler
- Demonstrate shadowing
- 1% of cholecystitis is acalculous
- Color doppler can demonstrate hyperemia in an inflamed gallbladder
- Assess for and document a sonographic Murphy's sign
- Max tenderness during compression w/ transducer directly on GB
- False negative sonographic Murphy's sign
- Lack of patient responsiveness
- Pain medication
- Diabetes
- Inability to press directly on GB
- Position deep to liver/protected by ribs
- GB wall necrosis
| Saggital images of the GB
Transverse images of GB
On this sagittal image, the hepatic artery (HA) is anterior to the common duct (CD) |
 Updating...
Ċ RadRez Administrator, Jul 9, 2013, 2:27 PM
|