Liver, Biliary Ducts, and Gallbladder Flashcards
one way to palpate liver
place left hand posteriorly behind the lower rib cage, then put right hand on the PTs RUQ, lateral to rectus abdominis and inferior to costal margin; PT takes breath, examiner pushes both anteriorly w/ left and posteriorly w/ right hands
abscesses
collections of purulent exudate/ pus
what is a common place that pus collects?
right or left subphrenic recess or space
on which side are subphrenic abscesses more common?
right b/c of the frequency of ruptured appendices and perforated duodenal ulcers
how are subphrenic abscesses drained?
incision inferior to, or through, the bed of the 12th rib
how are anterior subphrenic abscesses drained?
subcostal incision located inferior and paralle to the right costal margin
hepatic lobectomies
removal of the right or left (part of the) liver
what part of the liver do most liver injuries involve?
right liver
hepatic segmentectomies
remove only the segments that have sustained a severe injury or are affected by a tumor of the liver
what serve as guides to the planes b/w hepatic divisions?
right, intermediate, and left hepatic veins
why is the liver easily injured?
it is large, fixed in position, and friable (easily crumbled)
most common source of an aberrant right hepatic artery
SMA
most common source of an aberrant left hepatic artery
left gastric artery
normal relationship of right hepatic artery to hepatic portal vein and common hepatic duct
right hepatic artery anterior to hepatic portal vein and posterior to common hepatic duct
hepatomegaly
enlarged liver
what causes runner’s stitch
any rise in central venous pressure is directly transmitted to the liver -> enlarges, becomes engorged w/ blood -> with increased/sustained diaphragmatic activity -> pain in right side
causes of hepatomegaly
- rise in central venous pressure
- bacterial, viral infection (hepatitis)
- tumors
- CHF
what is a common site of metastatic carcinoma?
liver
hepatic cirrhosis
progressive destruction of hepatocytes and replacement of these cells by fat and fibrous tissue
alcoholic cirrhosis
cirrhosis due to chronic alcoholism - hepatomegaly and hobnail appearance of liver surface
what is the most common cause of portal hypertension?
alcoholic cirrhosis
portal hypertension
when fibrous tissue surrounds the intrahepatic blood vessels and biliary ducts, making the liver firm and impeding circulation of blood through it
what is one treatment for advanced hepatic cirrhosis?
creation of a portosystemic or portocaval shunt
liver biopsy
obtaining liver tissue for diagnostic purposes
where is needle inserted for liver biopsy?
right 10th ICS in the midaxillary line - PT holds breath in full expiration
mobile gallbladders
gallbladder is suspended from liver by a short mesentery - subject to vascular torsion and infarction
cholecystectomy
surgical removal of gallbladder
accessory hepatic duct
normal segmental duct that joins the biliary system outside the liver instead of within
what are in danger during cholecystectomies?
accessory hepatic ducts
gallstones/cholelithiasis
concretion in the gallbladder, cystic duct, or bile duct composed chiefly of cholesterol crystals
incidence of gallstones
increases w/ age - more common in females
what are the common sites for impaction of gallstones?
- distal end of the hepatopancreatic ampulla
- hepatic and cystic ducts
- Hartmann pouch
what does a gallstone cause when lodged in the cystic duct?
biliary colic - intense, spasmodic pain
cholecystitis - inflammation of gall bladder
enlargement of gallbladder - bile accumulation
Hartmann pouch
abnormal sacculation that appears in diseased states at the junction of the neck of the gallbladder and the cystic duct
where is pain from impaction of the gallbladder?
epigastric region and later shifts to the right hypochondriac region at the jxn of the 9th costal cartilage and the lateral border of the rectus sheath
where is pain from cholecystitis?
posterior thoracic wall or right shoulder - due to irritation of diaphragm
cholecysto-enteric fistula
inflammation of gallbladder -> adhesions w/ adjacent viscera -> continues to ulcerate tissue boundaries -> fistula
where are cholecysto-enteric fistulas most likely to form?
- superior part of duodenum
- transverse colon
gallstone ileus
when a large gallstone becomes trapped in the ileocecal valve, producing a bowel obstruction
what is a diagnostic radiographic sign of cholecysto-enteric fistula?
gas from GI tract in the gallbladder
calot triangle/cystohepatic triangle
-inferior: cystic duct
-medial: common hepatic duct
-superior: inferior surface of liver
dissected early during cholecystectomy
caput medusae
when the veins of the anterior abdominal wall (normally caval) that anastamose w/ the para-umbilical veins (normally portal) become varicose and look like snakes radiating under skin around umbilicus
common methods to reduce portal hypertension
- portosystemic shunt
- splenorenal shunt
portosystemic shunt
divert blood from the portal venous system to the systemic venous system by creating a communication b/w the hepatic portal vein and the IVC
splenorenal shunt
join the splenic vein to the left renal vein after splenectomy
