Don’t let bilious patients get you down

This patient complained of a really vague lateral LUQ discomfort, possibly post prandial (I got that history after I saw the GB on POCUS). She looked fine and the physical exam was unhelpful. I really didn’t know what was going on (doesn’t sound very inspiring) so I just looked around with the probe. Pleura/Lung/CVS/LKKS/IVC/Aorta all looked fine. When I was looking at the R kidney, a weird looking gallbladder popped into view. It was contracted and filled with big stones.

http://radiopaedia.org/articles/wall-echo-shadow-sign-1

I remembered this sign because I stayed awake during Greg’s lecture. [ed. An example posted below, glad someone actually listened!]

The LFT’s were a bit elevated so I ordered an U/S of the biliary tree which showed an obstructing CBD stone and a Pancreatic Duct stone. She was admitted to arrange an ERCP.