71-year-old female with shock, hepatic abnormality, cirrhosis. Evaluate for cholangitis. LIVER: Coarse in echotexture with a nodular contour measuring 13.5 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec. Small amount of perihepatic fluid.GALLBLADDER, BILIARY TRACT: Multiple shadowing stones within the gallbladder. Mild gallbladder wall thickening measuring 4 mm in thickness. No pericholecystic fluid. Unable to assess for sonographic Murphy's sign. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal tail of the pancreas is obscured by overlying bowel gas. The remaining portions of the visualized pancreas are unremarkable.SPLEEN: Not well visualized. KIDNEYS: Right kidney measures 9.0 cm in length and is increased in echogenicity. Left kidney measures 10.2 cm in length and is increased in echogenicity. No shadowing calculi or hydronephrosis is noted. ABDOMINAL AORTA: The visualized aorta appears patent.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Foley catheter within a decompressed bladder limits adequate evaluation.Right pleural effusion. Fluid filled stomach.
1. Cirrhotic liver morphology with no focal hepatic lesions noted. 2. Cholelithiasis with mild gallbladder wall thickening which is nonspecific in the setting ascites, however findings could represent early cholecystitis. 3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. 4. Small amount of perihepatic fluid. Right pleural effusion. 