POCUS Learning Modules

MODULE 3:  Right Upper Quadrant Abdominal Ultrasound

Curriculum Location: Surgery / Total Time: 2 hours

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family MedicineEvernote Notebook, found here. 

Learning Module Objectives:

  1. Understand how to perform a RUQ US Exam for cholelithiasis and cholecystitis

  2. Know common gallbladder measurements and pathological findings

  3. Understand how to perform a RUQ US Exam to assess liver span

  4. Describe common liver pathology findings that may be encountered in low resource settings where formal imaging may not be available

  5. Identify the pancreas and surrounding structures using ultrasound

RUQ Gallbladder US (Time: 40 minutes)

  1. Background Case:  Patient with RUQ Pain

    1. Introduction:  Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding gallbladder ultrasound

    2. Case Summary:  A 47y female presents to the FMC with abdominal pain.  Her pain is intermittent in the RUQ and often related to meals, such as after eating pizza.  It’s been going on for around 3 months and seems to be getting more frequent. She denies fever, chills, or jaundice. She has not had any abdominal surgeries in the past.  You suspect biliary colic.  On PE, her vital signs are normal, she appears well, without any jaundice, and her abdominal exam shows mild RUQ tenderness, without acute abdomen findings. You decide to augment your exam with a RUQ Ultrasound Scan.

    3. Case Questions:  How do you perform a bedside RUQ US scan of the gallbladder?  How do you evaluate the gallbladder for stones or gallbladder inflammation (cholecystitis)? 

  2. Assignments:

    1. Watch the following SUSME introductory video:  Gallbladder and Biliary Tree Ultrasound(12m).

    2. Take notes as helpful in the corresponding Note in your Ultrasound/POCUS for Family Medicine Notebook: “2 Applications: Abd RUQ Gallbladder”  

    3. Review and refine your basic RUQ Gallbladder scanning knowledge by visiting Ultrasoundpaedia’s review of the following (Hover over pictures to reveal highlights): 

      1. Ultrasoundpaedia: Normal Gallbladder

      2. Ultrasoundpaedia: Common Bile Duct (CBD) anatomy

    4. Finally, read/review the following to learn about common abnormal findings and see key abnormal images:

      1. Sonosite Soundbytes Cases: Cholelithiasis (9m)

      2. Sonosite Soundbytes Cases: Cholecystitis (6m)

RUQ Liver US (Time: 20 minutes)

  1. Background Case:  Patient with jaundice

    1. Introduction:  Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding gallbladder ultrasound

    2. Case Summary: A 50y male presents to you in Clinica Miller in rural Guatemala with jaundice and fatigue.  He has a history of moderate alcohol use.  He has had abdominal fullness, fatigue, and jaundice that is worsening over the past 2 months.  He denies fevers.  He has not had any abdominal surgeries in the past.  On PE, his vital signs are normal, he appears mildly jaundiced, with hepatomegaly and possible ascites, but without acute abdomen findings.  You decide to augment your exam with a RUQ Ultrasound Scan to evaluate his gallbladder and liver.

    3. Case Questions:  How do you perform a bedside RUQ Ultrasound scan of the liver and measure its span?  How do you evaluate the liver for pathology?

  2. Assignments:

    1. Watch the introductory SUSME video on how to evaluate the liver with ultrasound:  Liver

    2. Now visit Ultrasoundpaedia (UP)’s overview of a normal liver US.  Review the labeled anatomy of the left liver lobe view by hovering over the picture.  Note the 2 approaches to liver span measurement mentioned.  

    3. Review the following abnormals and note the characteristic findings of each:

      1. UltrasoundCases.Info: Hemangioma (a common benign lesion)

      2. UltrasoundCases.Info: Cirrhosis with Hepatocellular Carcinoma

      3. Sonoworld: Metastatic cancer

      4. Sonoworld: Amoebic liver abscess (ALA) (OPTIONAL)

      5. Sonoworld: Hydatid cyst disease (Echinococcus) (OPTIONAL)

RUQ Pancreas US (Time: 10 minutes)

  1. The pancreas is more difficult to image and evaluation of the pancreas is not considered a core curriculum for family medicine POCUS by the AAFP.  Nevertheless, it is helpful to be familiar with knowing how to identify the pancreas.  Watch this summary video from USC on how to examine the pancreas using US:  Pancreas 

  2. Next, visit Ultrasoundpaedia’s review of the normal pancreas. Note tips for improving visualization when the pancreas is hard to see.  Hover over pictures to see labeled anatomy.

Module QUIZ (Yo ho!) (Time: 10 minutes)

Congratulations on completing your first module.  Please click HERE to take your Module Quiz and provide Module feedback.