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 by the inferior vena cava and the gall
bladder. The left arm is formed by the 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 commonly seen in the gallbladder
If they obstruct the cystic duct, can cause pain in the right upper quadrant (RUQ), especially after consumption of a fatty meal.
Pain typically comes and goes (biliary colic) and may be associated with nausea and vomiting.
Secondary inflammation of the gallbladder leads to constant pain, and is often the trigger to seeking medical attention.
If the gallstones pass further down, they may obstruct the biliary system causing jaundice, or the pancreatic duct causing pancreatitis.Splenic rupture
Spleen is the most commonly damaged abdominal organ, despite being protected by the 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) may result in rupture of the spleen.
Bleeding is typically profuse 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 usually tracks 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
Spleen: "1, 3, 5, 7, 9, 11"
It measures 1 x 3 x 5 inches, weighs 7 ounces and lies between ribs 9 and 11