The Right Upper Quadrant
To best see in the RUQ, the patient should lie in the reverse Trendelenburg position with the body tilted with the right side up. First, the liver should be assessed overall for its shape, size, and surface texture (Figure 7.1). Also demonstrable is the under surface of the right diaphragm (Figure 7.2). Generally, the umbilical port is best for doing this, with instruments in the other ports used for lifting up the edge of the liver and looking underneath at the porta hepatis, and the gallbladder (Figure 7.3, see color plate). Also visible is the hepatic flexure of the
- Figure 7.1. At the start of a laparoscopy, the liver to the right of the falciform ligament may be viewed broadly over its surface (hepatic segments of Couinaud and the hepatic veins are depicted in the drawing).
- Figure 7.2. Peering above the right portion of the liver, the posterior portions of segments VIII and IVa and the undersurface of the right diaphragm may be seen.
- Figure 7.3. By lifting up the lower edge of the liver, the porta hepatic and the gallbladder may be seen. CA, cystic artery; CBD, common bile duct; D, duodenum; PV, portal vein; HA, hepatic artery. (See color plate.)
- Figure 7.4. Just below the liver in a thin patient, the hepatic flexure, duodenum, and pancreatic head may be seen. HF, hepatic flexure; Gb, gallbladder; D, duodenum; P, pancreas; GEV, gastroepiploic vessels. (See color plate.)
right colon with the duodenum, in thinner patients the pancreatic head, gallbladder, and the inferior aspect of the right lobe of the liver (Figure 7.4, see color plate).
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