Case 06

46 yo M w/ h/o colon CA (last chemo 2/2012), DVT (on lovenox), HTN, DM p/w SOB associated with sharp CP radiating across his anterior chest x 6 housr and 3-4 days of diffuse abd pain and distension (last BM this AM). PT found to have low-grade fever.

PHYSICAL:

VS: 100.4  HR 122  RR 25  BP 112/54  O2 97 on 3L

CONSTITUTIONAL: Distress: Mild. Patient appears chronically ill. Patient is alert.
CARDIOVASCULAR: Rate: Tachycardia.
MUSCULOSKELETAL/EXTREMITES: Non-tender, normal ROM, no pedal edema or calf tenderness. NVT intact.
RESPIRATORY: (-) Respiratory distress. Wheezing: Absent. Rales: Absent. Rhonchi: Absent. Diminished BS: None.
GI/ABDOMEN: Palpation: generalized abd tenderness w/ guarding, no rebound Organomegaly/Mass: No organomegaly, or pulsatile mass. Bowel Sounds: normal. Occult Blood: Heme negative stool. brown stool
INTEGUMENTARY: Color normal for race, warm and dry, no rash.
HEME/LYMPH: No adenopathy, no palpable or tender nodes.
EYES: PERRL, lids and conjuntivae are normal on exam.
NEURO: Oriented x3. Cranial nerves II-XII within normal limits. No motor or sensory deficits. no neurological symptoms above or below the diaphragm.
PSYCH: Oriented x3, mood and affect is normal.

LABS:

CE: neg x 1
BNP 42
Glucose 472
BUN 20
BUN-Cr ratio 11.9
Cr 1.68
GFR 44
Na 128
K 6.0
Cl 96
CO2 24
Alk phos 223
AST 19
ALT 22

WBC 19.61
H/H 10.6/34.9
Platelet 450

PT/INR 16.9/1.4
PTT 23.1

Lipase 13

1. What ultrasound exam is being performed and what if any findings do you see below? 

2. What could be the cause of the finding seen in the gallbladder below, what is the finding?