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AbdominalBasic 30–45 min

Right Upper Quadrant (RUQ) Ultrasound

Indication: RUQ pain; abnormal LFTs; jaundice; gallstones; hepatomegaly evaluation

How to Perform

  1. 1

    Patient should be fasting ≥4 hours for optimal GB distension. Use curvilinear probe.

  2. 2

    Begin with liver in sagittal: sweep from right lobe to left lobe, assessing echogenicity, size, and parenchymal texture.

  3. 3

    Locate gallbladder in intercostal oblique view (right mid-axillary line). Survey in long and short axis.

  4. 4

    Roll patient to left decubitus to confirm stone mobility and assess for pericholecystic fluid.

  5. 5

    Measure GB wall thickness at the anterior wall (normal <3mm). Apply direct probe pressure for sonographic Murphy's sign.

  6. 6

    Locate CBD at the porta hepatis (anterior to portal vein). Measure inner-to-inner diameter (normal ≤6mm).

  7. 7

    Scan right kidney longitudinally as comparison for echogenicity assessment vs. liver.

Measurement Guide

Gallbladder Wall Thickness

Where:Anterior GB wall, perpendicular to the wall, in long-axis view. Place calipers at the outer to inner wall margin.
Normal:< 3 mm (fasting state)
Tip:Measure the anterior wall only — posterior wall measurement is artifactually thickened by acoustic enhancement.

Common Bile Duct (CBD)

Where:At the porta hepatis, anterior to the portal vein, in the long axis. Measure inner wall to inner wall.
Normal:≤ 6 mm (≤ 7–8 mm post-cholecystectomy; add 1 mm per decade over 60)
Tip:Do not include the wall itself. Use the widest visible lumen diameter in the oblique subcostal or intercostal view.

Liver Span

Where:Right lobe in the right mid-clavicular line, sagittal view. Measure craniocaudal length from dome to inferior tip.
Normal:≤ 15 cm (mid-clavicular line)
Tip:Include the full craniocaudal extent. A liver >17 cm is strongly suggestive of hepatomegaly.

Gallstone Size

Where:Measure the largest stone in two perpendicular planes. Place calipers at the leading edges of the hyperechoic focus.
Normal:N/A — any stone is abnormal
Tip:Confirm mobility by rolling the patient. Stones >1 cm carry higher risk of complications.

Views to Obtain

  • Liver — longitudinal (right lobe)
  • Liver — transverse (portal vein + hepatic veins)
  • Gallbladder — long axis
  • Gallbladder — short axis
  • CBD measurement at porta hepatis
  • Murphy's sign assessment
  • Right kidney — longitudinal (comparison)

What to Look For

  • Gallstones (hyperechoic + posterior shadowing)
  • GB wall thickness
  • CBD diameter
  • Liver echogenicity and size
  • Sonographic Murphy's sign
  • Pericholecystic fluid

Common Mistakes

  • Fasting ≥4h required — contracted GB obscures stones
  • WES (wall-echo-shadow) sign = packed stones; can be mistaken for gas
  • CBD measured inner wall to inner wall at porta hepatis

Pro Tip

Start in right intercostal oblique, sweep through GB. Roll patient left to confirm stone mobility. CBD >6mm (or >7mm post-cholecystectomy) is abnormal.

AI Detects

CholelithiasisAcute cholecystitis (wall >3mm + Murphy's + stones)CBD dilation (>6mm)HepatomegalyHepatic steatosisPericholecystic fluid
Start Scan — RUQ US

Protocol pre-selected · AI will use this context for analysis