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If there is an impacted stone and a sonographic Murphey's the patient should come in.

4/9/2019

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40yo male came into ED with severe RUQ pain 2 hours duration. Similar previous episodes, nil US, but this time the pain had woken him from sleep.
RUQ tender, but no guarding. 
He was afebrile with normal obs
WCC normal, normal LFTs and lipase. 

​ED US revealed: not dilated, a thick walled GB with a several mobile stones but one stone impacted in the neck of the GB
Picture
Gb long. hyper echoic stone near the neck. The GB wall is thick and has a hypo echoic middle layer which could be GB wall oedema.
Picture
On sitting the patient up, the larger stones fall to the funds, but the stones at the neck remain (impacted)
The patient also had a positive sonographic murphey's.
The patient was admitted to EGS and scanned by radiology in the morning. The subsequent scan showed a severely dilated GB with perforation. 


Without US, this patient may have been dc home...
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  • Courses
    • abc ED Course
    • abc ED Consultant 2 hour
    • ED mass casualty active shooter course
    • Ultrasound Course
  • Home
    • journal watch
  • Ultrasound
    • Topic of the month
    • Ultrasound blog
    • Our Machines
    • US PHYSICS
    • US guided Procedures >
      • IV Access
      • Femoral Nerve Block
    • Abdominal Aortic US >
      • Abdominal Aorta US proforma
      • AORTA cases
    • DVT US Lower Limbs >
      • DVT cases
    • ED ECHO >
      • ED echo proforma
      • Echo Quiz
      • Echo in ED articles
      • Echo cases
      • Echo QUIZ
    • EFAST >
      • EFAST proforma
      • EFAST images
      • EFAST articles
      • EFAST QUIZ
      • EFAST Cases
    • GALLBLADDER >
      • GB Images
    • LUNG >
      • Lung US proforma
      • lung images
    • OCCULAR US
    • RENAL >
      • Renal Cases
      • Renal US Articles
  • Multidisciplinary
    • ALS
    • Case of the Week
  • Medical
    • Registrars >
      • Primary group
      • Tweeenies
      • Fellowship group
      • WBAs
      • Registrar in charge shifts
      • Plaster Practice
      • Registrar Orientation
    • intern and residents >
      • Intern and resident news
    • Medical Students
    • SMS Education
    • Conference Reports
    • CVC Credentialing
  • Nursing
    • Muster
    • inservice calendar
    • Graduate Certificate program
  • Simulation
    • Team Training
    • TT Rapid
  • equipment