Advertisement

Gallbladder

  • Huidong Kang
Chapter

Abstract

It is not possible to diagnose gallbladder pathology with a reasonable degree of certainty using history and physical examination alone [1]. Bedside ultrasound (US) is currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis [2]. Bedside US of the biliary system has been shown to decrease the costs [3] as well as emergency department length of stay [4] in patients with cholelithiasis. Bedside US can detect gallstones, a thickened gallbladder wall, pericholecystic fluid, and a sonographic Murphy sign to assist in diagnosis of acute cholecystitis. More than 90% of cases of acute cholecystitis are associated with cholelithiasis (acute calculous cholecystitis) [5] and absence of gallstone alone more reliably excludes acute calculous cholecystitis [6]. Point-of-care ultrasound has been shown to be accurate in diagnosing cholelithiasis [7]. Also, point-of-care US for gallbladder disease is a skill that can be learned by physicians at all levels of training [8]. However, ultrasound findings must be carefully interpreted in the context of the clinical presentation (Figs. 26.1, 26.2, 26.3, 26.4, 26.5, 26.6, 26.7, 26.8, 26.9, 26.10, 26.11, 26.12, 26.13, and 26.14; Videos 26.1, 26.2, 26.3, 26.4, 26.5, and 26.6).

Keywords

Gallbladder Gallstone Cholecystitis 

Supplementary material

Video 26.1

Ultrasound video of the gallbladder in the longitudinal plane. Video courtesy of Bret Nelson (MP4 1045 kb)

Video 26.2

Ultrasound video of the gallbladder in the transverse plane. Video courtesy of Bret Nelson (MP4 953 kb)

Video 26.3

Ultrasound video of acute cholecystitis. Acute cholecystitis with associated gallstone and pericholecystic fluid. Video courtesy of Huidong Kang (MP4 834 kb)

Video 26.4

Ultrasound video of wall-echo-shadow (WES) sign. The gallbladder wall is seen as a thin echogenic line, the echo as a more irregular echogenic line, and the shadow, a dark zone posteriorly. Video courtesy of Huidong Kang (MP4 366 kb)

Video 26.5

Ultrasound video of GB wall thickening. GB wall thickening due to ascites in a patient with liver cirrhosis. Video courtesy of Huidong Kang (MP4 611 kb)

Video 26.6

Color flow Doppler of the portal triad in a longitudinal view. Video courtesy of Pimpa Limphan-udom (MP4 865 kb)

References

  1. 1.
    Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Pinto A, Reginelli A, Cagini L, Coppolino F, Stabile Ianora AA, Bracale R, et al. Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature. Crit Ultrasound J. 2013;5(Suppl 1):S11.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Durston W, Carl ML, Guerra W, Eaton A, Ackerson L, Rieland T, et al. Comparison of quality and cost-effectiveness in the evaluation of symptomatic cholelithiasis with different approaches to ultrasound availability in the ED. Am J Emerg Med. 2001;19(4):260–9.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Blaivas M, Harwood RA, Lambert MJ. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med. 1999;6(10):1020–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008;358(26):2804–11.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Villar J, Summers SM, Menchine MD, Fox JC, Wang R. The absence of gallstones on point-of-care ultrasound rules out acute cholecystitis. J Emer Med. 2015;49(4):475–80.CrossRefGoogle Scholar
  7. 7.
    Scruggs W, Fox JC, Potts B, Zlidenny A, McDonough J, Anderson CL, et al. Accuracy of ED bedside ultrasound for identification of gallstones: retrospective analysis of 575 studies. West J Emerg Med. 2008;9(1):1–5.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37(1):51–6.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Huidong Kang
    • 1
  1. 1.Department of Emergency MedicineUniversity of Ulsan, College of Medicine, Gangneung Asan HospitalGangneungSouth Korea

Personalised recommendations