|
|
Diffuse Abdominal Pain
Case: A 41 year old female presents to
the emergency department with moderate diffuse abdominal
pain for 4 hours. This pain came on abruptly but no identified
triggers. The pain is non-descript with associated nausea
but no fever and chills. During her wait to be seen in
the emergency department, the pain has receded to mild
pain. Abdominal Exam shows mild right upper and right
mid quadrant tenderness but is not impressive.
Image Description: The video clip shows
a transverse view of the gallbladder in the right upper
quadrant. Within the gallbladder lumen a hypoechoic layer
can be differentiated from the anecoic (black) bile. Seen
within the hypoechoic layer are some hyperechoic rounded
shapes with posterior shadowing.
Results: The ultrasound shows a gallbladder
with sludge and stones.
Role of Ultrasound: Identifying gallstones
in a patient with abdominal pain does not necessarily
mean that the gallstones are causing the symptoms. A combination
of RUQ pain, fever, elevated white count, right upper
quadrant tenderness and an ultrasound with gallstones
means that the patient likely has acute cholecystitis.
In the patient presented above, finding gallstones allows
the physician to rearrange their differential so that
symptomatic cholelithiasis is more likely. Additional
imaging may be required to arrive at a differential in
this patient. This patient felt better while being observed
in the emergency department and was discharged with instructions
to have a complete RUQ ultrasound be performed by her
primary care doctor.
>NEXT CASE |
|
