Case: A 42 year old female patient with a past medical history significant for diabetes, obesity and hypertension presents to the ED with chief complaint of 4 days of abdominal pain. It is notably worsened by eating, is associated with nausea, and she denies fevers, vomiting, or diarrhea. 

 Vital Signs:

• Blood Pressure 142/82 mmHg
• Pulse 83
• Respiratory Rate 18
• SpO2 98%
• Temperature 98.6 degrees F

Pertinent Physical Exam: Calm and pleasant patient who has RUQ tenderness upon palpation, the remainder of her physical exam is unremarkable.

A bedside ultrasound of the RUQ is obtained in the ED with the following findings:

Which of the following is NOT a chief component in determining cholecystitis on right upper quadrant ultrasound?

1. Gallbladder wall thickening
2. Pericholecystic fluid
3. Dilated bile ducts
4. Pain with pressure from the ultrasound probe when it is directly over the gallbladder
5. Number of gallstones

ANSWER