FACTS & HINTS

High-Yield Facts

Anatomic Points

The porta hepatis is the cross bar of an "H" on the visceral surface of the liver. The right arm of the H is formed bythe inferior vena cava and the gall bladder. The left arm is formed bythe fissure for the ligamentum teres hepatis and the fissure for the ligamentum venosum.

Clinical points

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Gallstones (cholelithiasis)

Stone-like deposits are commonlyseen in the gallbladder

If theyobstruct the cystic duct, can cause pain in the right upper quadrant (RUQ), especiallyafter consumption of a fattymeal. Pain typicallycomes and goes (biliarycolic) and maybe associated with nausea and vomiting.

Secondaryinflammation of the gallbladder leads to constant pain, and is often the trigger to seeking medical attention.

If the gallstones pass further down, theymayobstruct the biliarysystem causing jaundice, or the pancreatic duct causing pancreatitis.

Splenic rupture

Spleen is the most commonlydamaged abdominal organ, despite being protected bythe ribcage.

Trauma causing rib fracture or sudden increases in intra-abdominal pressure (such as being impaled against a steering wheel in a road traffic accident) mayresult in rupture of the spleen.

Bleeding is typicallyprofuse owing to its thin capsule and soft parenchyma.

Subphrenic abscess

Subphrenic recess is a common site for pus to accumulate.

Right-sided abscesses are more common owing to the incidence of perforation of an inflamed appendix.

Pus usuallytracks into the hepatorenal recess in the supine position, and is best drained inferior to the 12th rib (avoiding puncture of the pleura).

Mnemonics

Memory Aids

It measures 1 x3 x5 inches, weighs 7 ounces and lies between ribs 9 and 11

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