Case 33

38 y/o male with no significant PMH presents with nausea, non-bloody emesis, and atraumatic abdominal pain since last night after sharing food with other people, none of whom share symptoms.  The pain is associated with two episodes of non-bloody diarrhea.  He took some honey for pain with minimal relief.  The patient had similar symptoms two months ago that self-resolved.  He didn’t follow up with his doctor.  No prior abdominal surgeries.

VS: T 98.2  P 88  RR 17  BP 117/78  O2 97%

Patient has a normal cardiac and pulmonary exam, with his abdominal exam significant for decreased bowel sounds, distension, and diffuse tenderness.

Q1.  What is this sign called?
Q2.  What condition is this sign highly specific for?
Q3.  What other criteria on ultrasonography point to this diagnosis?

A1. Wall Echo Shadow (WES) sign
A2. Acute cholecystitis
A3. Sonographic Murphy's, pericholecystic fluid, anterior gallbladder wall >3mm, hydrops (>10x5mm)