Ultrasound is an essential first-line investigation in suspected gallbladder and biliary duct disease. It is highly sensitive, accurate and comparatively cheap and is the imaging modality of choice.1 Gallbladder pathology is common and is asymptomatic in over 13% of the population.
The most commonly and reliably identified gallbladder pathology is that of gallstones (see Table 3.1). More than 10% of the population of the UK have gallstones. Many of these are asymptomatic, which is an important point to remember. When Gallstones—clinical features Often asymptomatic
Biliary colic—RUQ pain, fatty intolerance +ve ultrasound Murphy’s sign (if inflammation is present) Recurring (RUQ) pain in chronic cholecystitis Jaundice (depending on degree of obstruction) Fluctuating fever (if infection is present RUQ=right upper quadrant.
scanning a patient with abdominal pain it should not automatically be assumed that, when gallstones are present, they are responsible for the pain. It is not uncommon to find further pathology in the presence of gallstones and a comprehensive upperabdominal survey should always be carried out. Gallstones are associated with a number of conditions. They occur when the normal ratio of components making up the bile is altered, most commonly when there is increased secretion of cholesterol
in the bile. Conditions which are associated with increased cholesterol secretion, and therefore the formation of cholesterol stones, include obesity, diabetes, pregnancy and oestrogen therapy. The incidence of stones also rises with age, probably because the bile flow slows down. An increased secretion of bilirubin in the bile, as in patients with cirrhosis for example, is associated with pigment (black or brown) stones.
Ultrasound of CHOLELITHIASIS
4/ 5Oleh Habifa