33-year-old female patient with right upper quadrant abdominal pain, worse after meals, in patient with obesity and prediabetes. Evaluate for cholelithiasis, cholecystitis, liver pathology. LIVER: The liver measures 21.1 cm in length. Hepatic parenchyma echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. The patient is mildly tender with palpation near the neck of the gallbladder. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. No evidence of hydronephrosis.The spleen measures 8.5 cm in length.
1. No cholelithiasis or sonographic evidence of acute cholecystitis. However, the patient is mildly tender with sonographic palpation of the gallbladder neck; HIDA scan can be considered for further evaluation if clinically indicated.2. Hepatic steatosis. 