Liver, Biliary Ducts, and Gallbladder

Question 1

one way to palpate liver

Answer 1

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

Question 2

abscesses

Answer 2

collections of purulent exudate/ pus

Question 3

what is a common place that pus collects?

Answer 3

right or left subphrenic recess or space

Question 4

on which side are subphrenic abscesses more common?

Answer 4

right b/c of the frequency of ruptured appendices and perforated duodenal ulcers

Question 5

how are subphrenic abscesses drained?

Answer 5

incision inferior to, or through, the bed of the 12th rib

Question 6

how are anterior subphrenic abscesses drained?

Answer 6

subcostal incision located inferior and paralle to the right costal margin

Question 7

hepatic lobectomies

Answer 7

removal of the right or left (part of the) liver

Question 8

what part of the liver do most liver injuries involve?

Answer 8

right liver

Question 9

hepatic segmentectomies

Answer 9

remove only the segments that have sustained a severe injury or are affected by a tumor of the liver

Question 10

what serve as guides to the planes b/w hepatic divisions?

Answer 10

right, intermediate, and left hepatic veins

Question 11

why is the liver easily injured?

Answer 11

it is large, fixed in position, and friable (easily crumbled)

Question 12

most common source of an aberrant right hepatic artery

Answer 12

SMA

Question 13

most common source of an aberrant left hepatic artery

Answer 13

left gastric artery

Question 14

normal relationship of right hepatic artery to hepatic portal vein and common hepatic duct

Answer 14

right hepatic artery anterior to hepatic portal vein and posterior to common hepatic duct

Question 15

hepatomegaly

Answer 15

enlarged liver

Question 16

what causes runner’s stitch

Answer 16

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

Question 17

causes of hepatomegaly

Answer 17

• rise in central venous pressure
• bacterial, viral infection (hepatitis)
• tumors
• CHF

Question 18

what is a common site of metastatic carcinoma?

Answer 18

liver

Question 19

hepatic cirrhosis

Answer 19

progressive destruction of hepatocytes and replacement of these cells by fat and fibrous tissue

Question 20

alcoholic cirrhosis

Answer 20

cirrhosis due to chronic alcoholism - hepatomegaly and hobnail appearance of liver surface

Question 21

what is the most common cause of portal hypertension?

Answer 21

alcoholic cirrhosis

Question 22

portal hypertension

Answer 22

when fibrous tissue surrounds the intrahepatic blood vessels and biliary ducts, making the liver firm and impeding circulation of blood through it

Question 23

what is one treatment for advanced hepatic cirrhosis?

Answer 23

creation of a portosystemic or portocaval shunt

Question 24

liver biopsy

Answer 24

obtaining liver tissue for diagnostic purposes

Question 25

where is needle inserted for liver biopsy?

Answer 25

right 10th ICS in the midaxillary line - PT holds breath in full expiration

Question 26

mobile gallbladders

Answer 26

gallbladder is suspended from liver by a short mesentery - subject to vascular torsion and infarction

Question 27

cholecystectomy

Answer 27

surgical removal of gallbladder

Question 28

accessory hepatic duct

Answer 28

normal segmental duct that joins the biliary system outside the liver instead of within

Question 29

what are in danger during cholecystectomies?

Answer 29

accessory hepatic ducts

Question 30

gallstones/cholelithiasis

Answer 30

concretion in the gallbladder, cystic duct, or bile duct composed chiefly of cholesterol crystals

Question 31

incidence of gallstones

Answer 31

increases w/ age - more common in females

Question 32

what are the common sites for impaction of gallstones?

Answer 32

• distal end of the hepatopancreatic ampulla
• hepatic and cystic ducts
• Hartmann pouch

Question 33

what does a gallstone cause when lodged in the cystic duct?

Answer 33

biliary colic - intense, spasmodic pain
cholecystitis - inflammation of gall bladder
enlargement of gallbladder - bile accumulation

Question 34

Hartmann pouch

Answer 34

abnormal sacculation that appears in diseased states at the junction of the neck of the gallbladder and the cystic duct

Question 35

where is pain from impaction of the gallbladder?

Answer 35

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

Question 36

where is pain from cholecystitis?

Answer 36

posterior thoracic wall or right shoulder - due to irritation of diaphragm

Question 37

cholecysto-enteric fistula

Answer 37

inflammation of gallbladder -> adhesions w/ adjacent viscera -> continues to ulcerate tissue boundaries -> fistula

Question 38

where are cholecysto-enteric fistulas most likely to form?

Answer 38

• superior part of duodenum

- transverse colon

Question 39

gallstone ileus

Answer 39

when a large gallstone becomes trapped in the ileocecal valve, producing a bowel obstruction

Question 40

what is a diagnostic radiographic sign of cholecysto-enteric fistula?

Answer 40

gas from GI tract in the gallbladder

Question 41

calot triangle/cystohepatic triangle

Answer 41

-inferior: cystic duct
-medial: common hepatic duct
-superior: inferior surface of liver
dissected early during cholecystectomy

Question 42

caput medusae

Answer 42

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

Question 43

common methods to reduce portal hypertension

Answer 43

• portosystemic shunt

- splenorenal shunt

Question 44

portosystemic shunt

Answer 44

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

Question 45

splenorenal shunt

Answer 45

join the splenic vein to the left renal vein after splenectomy