Female 58 years old; Reason: hepatobiliary pathophysiology History: Rising Alk Phos and bile seen around G-tube in setting of prior cholestasis LIVER: The liver measures 18.2 cm in length. There is increased, coarse, and heterogenous echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. No ascites.GALLBLADDER/BILIARY TRACT: There is diffuse gallbladder wall thickening measured at 3.8 mm. No stones are seen. There is dependent echogenic material in the lumen of the gallbladder consistent with sludge. No pericholecystic fluid. Sonographic Murphy's sign equivocal. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 13.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.
1. Gallbladder sludge with abnormal diffuse wall thickening raising possibility of chronic inflammation. Equivocal Murphy's sign raises the possibility of acute on chronic inflammation. No ductal dilatation2. Coarse echotexture of the liver consistent with chronic liver disease / parenchymal dysfunction. No mass or ascites.3. Mild hepatomegaly.