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.
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.
CE: neg x 1
BUN-Cr ratio 11.9
Alk phos 223
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?