Expanding Access to Bedside Diagnosis: Implementation of POCUS to Identify Gallstones in Rural Healthcare Settings

Abstract

Gallstones affect 10-15% of adults and are a common cause of right upper quadrant (RUQ) pain. Current literature increasingly supports point-ofcare-
ultrasound (POCUS) for biliary assessment, but its real-world implementation in low-resource environments remains underreported. Although ultrasound is the first-line diagnostic modality, access may be limited in rural settings. Handheld POCUS may help bridge this gap and provide rapid evaluation when cart-based systems are unavailable. A 71-year-old woman presented with one day of acute RUQ pain to a rural clinic. Physical examination demonstrated positive Murphy’s and Lloyd’s signs. Laboratory testing was unavailable. Bedside POCUS revealed multiple gallstones with posterior acoustic shadowing, gallbladder wall thickening, and a positive sonographic Murphy’s sign, without biliary ductal dilation. Findings were most consistent with symptomatic cholelithiasis versus early cholecystitis. The patient received analgesia with symptomatic improvement and was discharged with expedited referral for cholecystectomy. This case highlights the utility of handheld POCUS in low-resource settings, supporting timely diagnosis and reducing barriers to care.