Findings:
There is a stone at the gallbladder neck, which did not move with patient repositioning. The gallbladder wall is thickened, measuring 8 mm. Murphy sign was negative, but the patient had already received analgesics at the time of examination. 
The liver has diffusely increased echogenicity, suggesting hepatic steatosis.

Impression:
There is a thickened gallbladder wall with an impacted stone in the gallbladder neck. Despite the negative Murphy’s sign, these findings remain concerning for acute cholecystitis.

Recommendations:
For your training purposes, recommendations are not included in this report.