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All right, so acute cholecystitis on ultrasound.

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Acute cholecystitis is about 95% calculus

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cholecystitis, meaning that there are

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gallstones causing the cholecystitis.

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So we're always looking for gallstones.

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Only about 5% of cases are acalculous, and those

0:14

tend to be your ICU players who have other issues.

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Um, so I'd say in the emergency department,

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on your night calls, the vast majority of your

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patients will have calculus cholecystitis.

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The ultrasound features of cholecystitis

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include luminal distension, usually greater

0:28

than 10 centimeters, seven to 10 centimeters.

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You'll see how big the.

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Gallbladder is on that sagittal view.

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The wall thickness should be

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greater than three millimeters.

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You can see that this is eight millimeters

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here, so that is definitely thickened.

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Again, you're going to see gallstones.

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Sometimes you have to look on those sweeps

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'cause those gallstones can be tucked into

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the gallbladder neck or into the Porta hepatis.

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So always be looking for those echogenic.

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Foci with the dense posterior shadowing, the

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patients should have a positive Murphy sign.

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Um, and a positive Murphy sign is quite sensitive

0:57

and specific for cholecystitis, and the pericholecystic

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fluid that you saw with that pericholecystic fluid.

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So the most sensitive findings are the,

1:05

just the presence of gallstones and

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the positive sonographic Murphy sign.

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Now let's talk about the sonographic Murphy sign.

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I will say that in our institution, as in many,

1:15

um, patients are coming to the emergency room when

1:18

they have acute cholecystitis in excruciating pain,

1:21

and the wait time for ultrasound can be a bit.

1:23

So our patients are often medicated, and the

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medication can really, uh, hamper our ability

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to determine whether or not there's a positive.

1:30

Murphy sign.

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So do be aware that if you see all the

1:33

signs of cholecystitis and they say that

1:35

the Murphy sign is negative, um, that your

1:37

patient may have been pretty well medicated.

1:39

I mean, some of those people are seeing Care Bears

1:41

on the walls when they're getting their ultrasounds.

1:43

I mean, good for them and all, but it can make it very

1:45

difficult for us to determine whether or not there's

1:48

a positive sonographic Murphy sign. That pericholecystic

1:51

fluid is a secondary sign and less specific, but.

1:55

Really important in today's emergency room, even

1:57

less specific, is just the distension and sludge.

1:59

You can't have a lot of patients who

2:00

have distension and sludge just because

2:03

they're sick from other entities.

2:04

Our patients are coming in sicker for other

2:06

reasons and may not have quite as much

2:08

mobility of their gallbladder as they once did.

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So acute cholecystitis always look for.

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Luminal dilatation, thickening

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of the wall, pericholecystic fluid.

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Find those gallstones even if they're hidden.

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It is just the fun game of ultrasound and be aware

2:23

that the sonographic Murphy's can be plus minus

2:26

depending on whether or not your patient is medicated.