Ultrasound of gall bladder

Ultrasound of gall bladder... Gallbladder on sonography
Waseem Tariq

1. ULTRASOUND OF GALL BLADDER Presented BY Waseem Tariq Dmit-F16-001

2. A normal Gallbladder should be thin walled (<3mm) and anechoic.It is a pear shaped secular structure for bile storage in the Right Upper Quadrant. Its size varies depending on the amount of bile. Fasted it will be approximately 10cm long.  

3. Patient position Generally the gallbladder is best viewed in the left lateral decubitus position. However it  can be viewed with the patient supine and erect. Erect views may be useful to determine if stones are mobile or impacted in the neck.

4. Patient Preparation Fast for 6 hours. No food or drink. Preferably book the appointment in the morning to reduce bowel gas.

5. TECHNIQUE Patients should fast 8 hours after midnight before gallbladder sonogram Fasting ensure adequate gallbladder distention and reduce upper abdominal bowel gas. Most gallbladder examinations start with the patient in the supine position Using a 3- to 5-MHz sector/curved transducer The gallbladder should be scanned from both sub costal and intercostal approaches whenever possible

6. When scanning from a sub costal view, a deep inspiration will usually allow better visualization. Scanning from a more lateral and superior approach (an intercostal space) using more of the liver as a window. Scans should routinely be obtained with the patient in a variety of positions (left posterior oblique, left lateral decubitus, prone, upright)

7. The prone position is most useful in patients in whom the gallbladder is in a horizontal orientation with the fundus located Anteriorly. Stones that fall into the fundus when the patient is prone can be seen falling back into the neck as the patient rolls from a prone to a supine position.

8. The upright view is most useful in patients in whom the gallbladder is in a vertical orientation with the fundus located inferiorly. Upright views can be obtained in the sitting position, although it is usually easier to scan with the patient standing.

9. Gallstones The most common symptom of gallstones is acute right upper quadrant (RUQ) or epigastric pain lasting for up to 6 hours and ending when the stone disimpacts from the gallbladder neck. Appearence Gallstones appear as mobile, echogenic, intraluminal structures that cast acoustic shadows. Demonstration of shadowing is important. Symptoms

10. A ,Typical small stone with distinct clean acoustic shadow. B, Large Stone C, Multiple small stones

11. Wall–echo–shadow complex (WES) is a reliable sign of a stone-filled gallbladder Fig. The complex varies from a very distinct series of arcshaped lines.

12. Floating stones When the density of bile is unusually high, stones may float. It indicates that the floating stones are cholesterol in nature.

13. Faceted stones. Gallstones are generally either round or ovoid. Faceted stones are also fairly common it looks like a turtle back and has flattened sides. Fig. A. A single large stone with angular margins. B. Multiple smaller stones with angular margins.

14. POLYPS Cholesterol polyps are by far the most common type of gallbladder polyp. They are usually 5 mm or less in size and only rarely get bigger than 10 mm.

15. Gallbladder (GB) polyps in different patients. Fig. A. Longitudinal upright view shows a small (<5 mm) no shadowing polypoid defect along the nondependent portion of the GB typical of a cholesterol polyp. B. Longitudinal view shows multiple small polyps.

16. Adenomyomatosis It is characterized by mucosal hyperplasia and thickening of the muscular layer of the gallbladder. It is unrelated to gallstones. The three most common forms of adenomyomatosis are shown in fig.

17. Adenomyomatosis with severe wall thickening. Fig. A. Transverse view shows severe wall thickening. B. Longitudinal view shows a comet-tail artifact (arrow). C. Color Doppler view shows twinkle artifact in several areas (arrowheads)

18. Any Questions