Case02

A 42-year-old is seen by their primary care physician complaining of intermittent colicky pain (sharp, localized gastrointestinal pain that comes in spasms/waves). The patient describes the pain as being right upper quadrant (RUQ), starting shortly after eating a meal, and lasting about 30 minutes. During these episodes, she says she feels bloated and nauseated. The patient also states that over the past 2 days, her stools have become very light in color, like the color of sand, and her skin and eyes have become yellow. They have not experienced these symptoms before.

Question 4/4 - What would be the most useful anatomic landmarks to use to find the gallbladder?

Click on your selected option(s) below (correct = 2, possible = 3, over-thinking = 4+)

Correct! As the liver and gallbladder are approximately an inch inferior to the costal margin this is an excellent landmark to locate position.

Commonly three window views are used for gallbladder ultrasound.
   A) Intercostal - looking between the lower ribs at the costal margin
   B) Subcostal - looking up below the costal margin
   C) Lateral - looking between the ribs from the lateral side

Correct! While counterintuitive given the distance from the abdomen that the clavicle has, the gallbladder resides almost exactly along the midclavicular line. Thus, this represents a useful landmark for determining lateral-medial position in the abdomen based on this line.

Incorrect. The ASIS is too inferior and lateral to serve as a useful landmark.

Incorrect. The umbilicus is too distant and medial to be a useful landmark, other than determining the upper left quadrant.

Possible. The gallbladder resides in the upper left quadrant along the linear semilunaris line, which would make this a good landmark.

However, few patients have sufficient absence of subcutaneous tissue to allow visualization of the linea semilunaris. So while anatomically correct as a good landmark, it is not practically useful in most patients.

Incorrect. The linea alba is at the midline and too distant from the gallbladder to be useful. Also, few patients have sufficient lack of subcutaneous tissue to readily visualize the linea alba.

Incorrect. While a very useful landmark it is too distant from the gallbladder to be useful for ultrasound examination of this organ

Incorrect. A useful landmark for the end of the sternum, but the gallbladder is to the right so the xiphoid is less useful at finding the gallbladder than other bony landmarks.