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The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
This lies transversely beneath the right lobe of the liver in Rutherford Morison’s pouch. It is bounded on the right by the right lobe of the liver and the diaphragm. To the left is situated the foramen of Winslow and below this lies the duodenum. In front are the liver and the gall bladder, and behind are the upper part of the right kidney and the diaphragm. The space is bounded above by the liver and below by the transverse colon and hepatic flexure. It is the deepest space of the four and the most common site of a subphrenic abscess, which usually arises from appendicitis, cholecystitis, a perforated duodenal ulcer or following upper abdominal surgery.
Gallbladder disease
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
N Alexander Jones, Onyebuchi Ukabiala
It is of prime importance to quickly convert laparoscopic cholecystectomy to open under some circumstances including unclear anatomy of either the vascular or ductal structures. In about 10%–25% of cases the bile ducts will have major variations especially on the right side. In up to 40% of all biliary procedures, either the arterial system or the biliary anatomy will be anomalous. It is therefore crucially important to be mindful of these variations to avoid significant morbidity. If the operation has been uneventful and precise, a spot bile leak from the gallbladder fossa will most likely represent a divided supravesicular duct of Luschka. This usually resolves with simple drainage of Morison’s pouch. Whenever in doubt or in the face of unexplained difficulty, the discerning surgeon should have a low threshold to convert to an open operation.
Trauma
Published in Tarina Lee Kang, John Bailitz, Clinical Ultrasound, 2015
Left to right of image: ThoraxDiaphragmLiverMorison’s pouchRight kidney
Prehospital Ultrasound Diagnosis of Massive Pulmonary Embolism by Non-Physicians: A Case Series
Published in Prehospital Emergency Care, 2023
Aaron E. Robinson, Nicholas S. Simpson, John L. Hick, Johanna C. Moore, Gregg A. Jones, Michael D. Fischer, Seth Z. Bravinder, Kolby L. Kolbet, Robert F. Reardon
Hennepin EMS is a third-service, urban, advanced life support provider with an annual run volume of approximately 83,000. It covers a primary service area of 266 square miles and an approximate population of 1.2 million people. Hennepin EMS employs a handful of specialized teams that support areas such as technical rescue, law enforcement support, and advanced critical care. The Hennepin EMS Advanced Paramedic Program selects paramedics who demonstrate outstanding critical care skills and leadership, and provides them with tools and skills that require significant extra training. These paramedics represent a subset of the overall total number of paramedics. Part of this training includes prehospital ultrasound. Paramedics undergo significant didactic and hands-on training both in the classroom and the emergency department environment that includes 4 h of lecture, 4 h of lab on healthy subjects, and 4–12 h of emergency department ultrasound scanning under the supervision of ultrasound certified emergency medicine faculty. They are trained to assess global cardiac function, right ventricular dilation, the presence of a pericardial effusion, inferior vena cava variability, lung sliding and B-lines, and Morison’s pouch. Hennepin EMS has the same probe/equipment setup as LifeLink III as described above. Ultrasound interpretation is documented in real time in the patient care report. There is currently no real-time streaming of images to a remote client (i.e. medical oversight).
The effect of e-learning on point-of-care ultrasound education in novices
Published in Medical Education Online, 2023
Wan-Ching Lien, Phone Lin, Chih-Heng Chang, Meng-Che Wu, Cheng-Yi Wu
The instructors reviewed the electronic medical records and made the ‘final diagnosis’ (the existence of fluid at the Morison’s pouch, splenorenal recess, the pelvis, pericardial cavity, pleural cavity, or pneumothorax or not). In case of disagreement, a third expert physician reviewed the medical records and adjudicated the case. Diagnostic accuracy was defined as the agreement between the sonographic diagnosis and the final diagnosis.