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Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
The liver occupies the right hypochondrium and a portion of the epigastrium. It is almost completely covered by the peritoneum and the suspensory ligaments of the liver: the falx ligament,4 the coronary ligament,5 and the lesser omentum, which fix the liver in place. The inferior vena cava is also fixed to the liver’s dorsal ligament6 (Figures 2.99 and 2.100). To remove the liver, move it laterally and medially, up and down, to free it from its suspensory ligaments (Figure 2.99). Then, cut each of the ligaments by first placing traction on the ligament to be incised and making an incision inclined at 90° perpendicular to the ligament and parallel to the hepatic surface curvatures. First, incise the right triangular ligament, then the coronary ligament, orientating the scalpel posteriorly and parallel to the inferior surface of the liver. Take great care to preserve the right adrenal gland as it is immediately adjacent. The lesser omentum and the ileocecal folds are then divided with a crescent-shaped incision. The same procedure is followed with the triangular left ligament and the coronary ligaments. Lower one hand below the right dome of the diaphragm and stretch the fingers like a fan, thereby separating the dome itself of the liver from the diaphragm. Finally, separate the remaining ligaments and inferior vena cava, freeing the organ.
Hypochondria
Published in Francis X. Dercum, Rest, Suggestion, 2019
Special indications in the treatment of hypochondria must be dealt with as they arise. Especially is it important to give our attention to the digestive tract, so frequently disordered in hypochondria. Atony, catarrh, and constipation should be treated, as in the case of neurasthenia, by a suitable diet and appropriate medication. The principles already laid down (see p. 48) should be followed. We should diminish the amount of the red meats and of the starchy foods, and, other things equal, should add milk to the diet. The rôle played by a possible gouty diathesis should be borne in mind. Again, the tendency to constipation and the great amount of thought which the hypochondriac gives to the condition of his bowels suggests the necessity of adopting methods for producing easy, and, as far as possible, normal evacuations. The hypochondriac is always in better spirits when the bowels are freely moved. In the average case two movements a day are better than one.
Endocrinology and metabolic medicine
Published in Shibley Rahman, Avinash Sharma, MRCP Part 2 Best of Five Practice Questions, 2018
Shibley Rahman, Avinash Sharma
A 42-year-old female presented with acute back pain after lifting a chair from her office to the storage cupboard. The pain is described as intense, increasing upon movement, and radiating bilaterally around the hypochondrium. Upon questioning she denied previous fractures, but admitted to a gradual loss of height (5 cm from her young adult height) and occasional self-limiting back pain. Past medical history included spontaneous menopause at the age of 37. She had never taken any regular medications in the past, calcium or vitamin D supplements. Examination revealed a thin woman who had a dorsal hyperkyphosis. Severe back pain was elicited on movement and local percussion. Investigations (which involved bone mineral density (BMD), assessed by dual-energy x-ray absorptiometry (DEXA) at the hip and the lumbar spine (L1–L4)) showed a BMD T-score at lumber spine: −3.0 and a BMD T-score at total hip: −2.8.
Gallbladder agenesis
Published in Acta Chirurgica Belgica, 2023
A 34-year-old man without previous medical history was admitted for right hypochondrium pain with nausea and vomiting. Blood tests were normal and abdominal echography described a difficult-to-find gallbladder but suspected biliary lithiasis. The diagnosis of uncomplicated symptomatic cholelithiasis was proposed and laparoscopic cholecystectomy was indicated. At laparoscopy, the gallbladder could not be found (Figure 1) allowing the diagnosis of gallbladder agenesis. A later gastroscopy showed erythematous gastritis successfully managed with an oral proton pump inhibitor. Gallbladder agenesis was confirmed one month later with magnetic resonance cholangiopancreatography (Figure 2) which also showed a slightly enlarged common bile duct (13 mm).
From hypochondrium to hypochondria
Published in Journal of the History of the Neurosciences, 2023
During the second half of the seventeenth century, Danish anatomist Thomas Bartholin (1616–1680) wrote that the abdominal cavity’s “superolateral portion is called hypochondrium” (Bartholin 1677, 13). More precisely, the hypochondrium is one of nine topographical regions of the abdominal cavity. Located on both sides of the epigastric region, it is limited medially by the paramedian lines that extend from the mid-clavicular point to the mid-inguinal point, and caudally by the subcostal plane that joins the lowest point of the tenth costal cartilages. The spleen lies in the left hypochondrium, and the liver and gallbladder in the right.
Bilateral spontaneous renal artery dissection and antiphospholipid antibodies
Published in British Journal of Biomedical Science, 2020
F Del Porto, N Cifani, G Orgera, M Taurino, M Proietta
A 46-year-old man was admitted to our emergency department due to a sudden abdominal pain prevalently localized to right hypochondrium. The pain started in the morning and was followed by diarrhoea. Physical examination of the abdomen showed diffuse tenderness at palpation. Bowel sounds were present. Vital parameters were within normal limits. The pain was of intensity 7.5 on a scale ranging from 0 to 10. His past medical history was unremarkable, with the exception of smoking, and he was not taking any medication.