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Instructor Top Tips: Abdominal (Biliary/Renal) POCUS

Some of the instructors from the abdominal POCUS workshop (focussing on biliary & renal applications) at the SONIC Conference, share their top tips for the skills they taught.


AAA/eFAST

by: Dr Chris Tang

AAA

  • Use two hands to push gas away

  • Look for the vertebral body

  • Scan from the mid-axillary line if you can’t see the aorta

eFAST

  • eFAST doesn’t have to be FAST (take your time to look for fluid)

  • Don’t stay still, move the probe to scan the whole area

  • Repeat the scan if things change

Common Bile Duct

by: Dr Stephen Risson

  • Scan patient during inspiration in the left posterior oblique position

  • Use Colour Doppler to identify the main portal vein

  • In longitudinal section of the portal vein, look for the CBD anteriorly to the portal vein

  • In transverse section of the portal vein, look for the 'mickey mouse' sign to identify the CBD

Common Bile Duct

by: Carolynne Cormack

  • Roll patient semi-decubitus away from you & raise their right arm to give easier subcostal access to GB fossa

  • Use the MPV as a key landmark

  • Zoom image

  • Use color Doppler to distinguish CBD from Hep A & MPV at porta

  • Place calipers carefully inner-inner walls (normal <6mm)

  • Use a high intercostal approach for difficult pts

Gallbladder

by: Lynne Johnson

  • Roll patient left decubitis with back support

  • Raise right arm if possible

  • Identify right kidney in transverse and slide probe medially to find the gallbladder. This is particularly useful in patients where it is difficult to scan subcostally and an intercostal approach is the only alternative

  • Measure gallbladder wall in the transverse plane at the anterior wall with depth reduced

  • Be aware that there may be other reasons for a thickened gallbladder wall that are not related to cholecystitis eg low albumin, non-fasting. Test for positive Murphy's sign with probe pressure

Gallbladder

by: Dr Allan Whitehead

1. Have multiple strategies to find the gallbladder eg subcostal sweep +/- inspiration +/- L lateral decubitus, RUQ eFAST, X-7/intercostal

2. Must see all of the gallbladder and especially the neck for an impacted stone

3. Focal probe tenderness (compress the gallbladder in a transverse/short axis view) is an excellent indicator of cholecystitis even when the condition is early/mild



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