October 18, 2023

Point-of-Care Biliary Ultrasound in the Emergency Department is Highly Predictive of the Need for Surgical Intervention

Written by: Mark Swanson RDMS, RVT

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Point-of-Care Biliary Ultrasound in the Emergency Department is Highly Predictive of the Need for Surgical Intervention

POC biliary ultrasound performed by emergency physicians provides timely access to diagnostic information. Positive findings of gallstones with increased gallbladder wall thickness are highly predictive of the need for surgical intervention.

Targeted abdominal POCUS is quick and easy to perform with a high percentage of emergency studies being completed in less than 10 minutes. After a comprehensive Hands-On training course, novice ultrasound users with little or no prior ultrasound experience were able to attain moderate to high degree of agreement with a radiology performed study when looking at the characteristics of biliary ultrasound. POCUS is also effective in decreasing the length of stay of patients in the emergency department when compared with those who received a radiology performed ultrasound examination.


Acute cholecystitis is usually initiated by obstruction of the cystic duct or outlet of the gallbladder. The gallbladder contents become purulent and the gallbladder wall thickens (>3mm). In 95% of cases, inflammation or acute cholecystitis of the gallbladder, results from obstructive stones within the neck of gallbladder or cystic duct. The most sensitive sonographic finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy’s sign (abdominal tenderness from pressure of the transducer over visualized gallbladder). Both gallbladder wall thickening and pericholecystic fluid are secondary findings. Infrequently, acute cholecystitis may present itself without gallstones and this is referred to as acute acalculous cholecystitis. The patient presents with RUQ & epigastric pain, fever, nausea, vomiting, and constipation with a mild ileus. Gangrenous cholecystitis differs from acute cholecystitis due to the presence of intramural hemorrhage, micro abscesses, and necrosis. Extreme pain is experienced when the gallbladder is compressed. Stones or fine gravel are frequently seen. Emphysematous cholecystitis is a rare (<1%) form of cholecystitis where gas-forming bacteria invades the gallbladder wall, lumen, and occasionally the bile ducts. Chronic cholecystitis is caused by repeated acute attacks that results in thickening of the wall and gallbladder contraction. Sonographically, chronic cholecystitis will appear as a small contracted gallbladder containing stones.

At Gulfcoast Ultrasound Institute, our POC Ultrasound Scanning Skills Workshop Live Training Course provides participants a strong foundation to perform and/or interpret the core and advanced ultrasound applications in an emergency setting as outlined in the ACEP and WINFOCUS ultrasound practice guidelines.

Dates: November 16 - 17, 2023

  • Most comprehensive introduction and advanced point-of-care emergency medicine ultrasound course, featuring a self-paced online course with fifteen (15) months of unlimited access and a two (2) day (12 hours) hands-on scanning workshop
  • All content based on the current core and advanced ACEP, ACGME, & WINFOCUS ultrasound guidelines
  • Hands-on scanning workshop features a 3:1 participant to faculty ratio with standardized models
  • Course covers in-demand applications such as focused abdomen, cardiac, trauma, DVT, ultrasound for shock & hypotension, soft-tissue/MSK, and ultrasound-guided vascular access & nerve block applications
  • GCUS is a POCUS Certification Academy Preferred Education Provider – All attendees receive 40% off Fundamentals Certificate and 20% off ANY POCUS Clinical Certificates (discount code provided during the course)

   Intro and Advanced Emergency Medicine Blended Course


About the Author

Mark Swanson RDMS, RVT

Mark is the Senior Clinical Instructor and Product Specialist at Gulfcoast Ultrasound Institute, Inc.

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