Gallbladder

1. 1

   Patient fasting ≥4 hours ideally. Use curvilinear probe, right intercostal oblique approach.

2. 2

   Identify GB in long axis: look for the pear-shaped fluid-filled structure under the right lobe of the liver.

3. 3

   Rotate to short axis. Evaluate wall thickness at the anterior wall — measure at the near wall.

4. 4

   Look for stones: hyperechoic foci with posterior acoustic shadowing. Small stones may not shadow.

5. 5

   Roll patient left — confirm mobile echogenic foci = stones (fixed = polyps or sludge).

6. 6

   Apply direct probe pressure over the GB while patient holds breath — positive Murphy's sign = focal tenderness.

7. 7

   Measure CBD at the porta hepatis, anterior to the portal vein. Inner-to-inner >6mm is abnormal.

• Long-axis GB
• Short-axis GB
• CBD measurement
• Murphy's sign assessment

• Stones (hyperechoic + shadowing)
• Wall thickness (>3mm)
• Pericholecystic fluid
• CBD diameter
• Sonographic Murphy's sign

• Fasting state required ideally
• Contracted GB makes assessment difficult
• Polyps vs. stones (stones move with gravity)

Stones move with patient position (roll patient). Wall-echo-shadow (WES) sign = packed stones.