Diagnoses

• Biliary colic
• Cholecystitis
• Choledocholithiasis
• (Ascending) Cholangitis
• Gall bladder cancer

<aside> 💡 USS, CT, MRI, MRCP, ERCP

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Ultrasound upper abdomen

• go-to for gall bladder
• Cholelithiasis/biliary colic
  • Calculous: echogenic focus within the gall bladder with shadowing
• Cholecystitis
  • Lack of movement of impacted echogenic gallstone
  • Sonographic Murphy sign
  • Thickened gallbladder wall
  • Pericholecystic fluid
  • Gallbladder distension
  • Sludge within gallbladder
• Choledocholithiasis
  • As above
  • Dilated common bile duct
  • Inflammatory fat stranding

Normal: fluid filled, anechoic (black)

Gall stone: hyperechoic lesion with peripheral shadowing. Thickened wall consistent with cholecystitis

MRCP - magnetic resonance colangio pancreatography

• if USS not very conclusive → MRCP
• uses bile as contrast
• Choledocolithiasis
  • Good visualisation of intra and extra hepatic ducts
  • No ionizing radiation
  • No IV contrast
  • Non-invasive
  • It’s expensive, and not accessible