Examination of the gallbladder and liver

2009-01-08T02:11:12Z

70.83.81.118: /* GALLBLADDER */

==Positioning==
*expose from nipples to pubis
*have patient lying supine on bed with knees flexed

==INSPECTION==
(from foot of the bed)
*level of comfort, jaundice
*abdominal distension, bulging flanks, visible abdominal mass
*prominent veins (caput medusae)

==PALPATION==
*patient relaxed and breathing slowly
*LIGHT palpation over entire abdomen, save tender areas to last
*DEEP palpation with finger tips, feel with inspiration, relocate during expiration

===LIVER===
*start in RLQ with the examining hand parallel to the rectus muscles, advance hand superiorly with expirations and anticipate the liver edge striking the forefinger on inspiration
*attempt to feel the surface of the liver
*describe: '''consistency, tenderness, nodularity, pulsations'''

===GALLBLADDER===
*orient hand perpendicular to the costal margin feeling from medial to lateral below the right costal margin (feels bulbous, focally rounded mass that moves downward on inspiration)

*'''Murphy’s sign (cholecystitis)'''
*place left hand with forefinger parallel to and at the RLCM and with thumb pressing on the intersection of the costal margin and the lateral border of the abdominal rectus muscle
**+ → pain elicited around the area pressed during a deep inspiration

==PERCUSSION==
*measure at the same point in the respiratory cycle

*LOWER BORDER: start below the umbilicus and percuss upward at right MCL and mid sternal line to liver dullness
*UPPER BORDER (6th ICS in MCL): from lung resonance and percuss downward to liver dullness
*measure liver span (liver span is 10 at MCL, 6 at MSL)

==AUSCULTATION==
*hepatic friction rub (tumour, inflammation, infarct)
*venous hum (portal hypertension)
*bruit (HCC, acute ETOH hepatitis, AV malformation)

==Other OSCE modules==
{{OSCE2}}
[[Category: Clinical Skills]][[Category:Gastroenterology]]

Top 100 Global Universities

2008-07-19T00:05:25Z

70.83.240.216: /* Top 100 Global Universities 2007 */

The '''Top 100 Global Universities''' is a ranking of the best College and University programs in the world as indicated by a survey conducted by [[Newsweek]]. The schools were evaluated on some of the measures used in well-known rankings published by [[Shanghai Jiaotong University]] and [[Times Higher Education]]. Fifty percent of the score came from equal parts of three measures used by Shanghai Jiatong: the number of highly-cited researchers in various academic fields, the number of articles published in Nature and Science, and the number of articles listed in the ISI Social Sciences and Arts & Humanities indices. Another 40 percent of the score came from equal parts of four measures used by the Times: the percentage of international faculty, the percentage of international students, citations per faculty member (using ISI data), and the ratio of faculty to students. The final 10 percent came from library holdings (number of volumes).

==Top 100 Global Universities 2007 ==

{| class="wikitable"
|-
|1. [[QUEENS UNIVERSITY]]
|-
|2. [[Stanford University]]
|-
|3. [[Yale University]]
|-
|4. [[California Institute of Technology]]
|-
|5. [[University of California at Berkeley]]
|-
|6. [[University of Cambridge]]
|-
|7. [[Massachusetts Institute of Technology]]
|-
|8. [[Oxford University]]
|-
|9. [[University of California at San Francisco]]
|-
|10. [[Columbia University]]
|-
|11. [[University of Michigan at Ann Arbor]]
|-
|12. [[University of California at Los Angeles]]
|-
|13. [[University of Pennsylvania]]
|-
|14. [[Duke University]]
|-
|15. [[Princeton University]]
|-
|16. [[Tokyo University]]
|-
|17. [[Imperial College London]]
|-
|18. [[University of Toronto]]
|-
|19. [[Cornell University]]
|-
|20. [[University of Chicago]]
|-
|21. [[Swiss Federal Institute of Technology in Zurich]]
|-
|22. [[University of Washington at Seattle]]
|-
|23. [[University of California at San Diego]]
|-
|24. [[Johns Hopkins University]]
|-
|25. [[University College London]]
|-
|26. [[Swiss Federal Institute of Technology in Lausanne]]
|-
|27. [[University Texas at Austin]]
|-
|28. [[University of Wisconsin at Madison]]
|-
|29. [[Kyoto University]]
|-
|30. [[University of Minnesota Twin Cities]]
|-
|31. [[University of British Columbia]]
|-
|32. [[University of Geneva]]
|-
|33. [[Washington University in St. Louis]]
|-
|34. [[London School of Economics]]
|-
|35. [[Northwestern University]]
|-
|36. [[National University of Singapore]]
|-
|37. [[University of Pittsburgh]]
|-
|38. [[Australian National University]]
|-
|39. [[New York University]]
|-
|40. [[Pennsylvania State University]]
|-
|41. [[University of North Carolina at Chapel Hill]]
|-
|42. [[McGill University]]
|-
|43. [[Ecole Polytechnique]]
|-
|44. [[University of Basel]]
|-
|45. University of Maryland
|-
|46. [[University of Zurich]]
|-
|47. [[University of Edinburgh]]
|-
|48. [[University of Illinois at Urbana Champaign]]
|-
|49. [[University of Bristol]]
|-
|50. [[University of Sydney]]
|-
|51. [[University of Colorado at Boulder]]
|-
|52. [[Utrecht University]]
|-
|53. [[University of Melbourne]]
|-
|54. [[University of Southern California]]
|-
|55. [[University of Alberta]]
|-
|56. [[Brown University]]
|-
|57. [[Osaka University]]
|-
|58. [[University of Manchester]]
|-
|59. [[University of California at Santa Barbara]]
|-
|60. [[Hong Kong University of Science and Technology]]
|-
|61. [[Wageningen University]]
|-
|62. [[Michigan State University]]
|-
|63. [[University of Munich]]
|-
|64. [[University of New South Wales]]
|-
|65. [[Boston University]]
|-
|66. [[Vanderbilt University]]
|-
|67. [[University of Rochester]]
|-
|68. [[Tohoku University]]
|-
|69. [[University of Hong Kong]]
|-
|70. [[University of Sheffield]]
|-
|71. [[Nanyang Technological University]]
|-
|72. [[University of Vienna]]
|-
|73. [[Monash University]]
|-
|74. [[University of Nottingham]]
|-
|75. [[Carnegie Mellon University]]
|-
|76. [[Lund University]]
|-
|77. [[Texas A&M University]]
|-
|78. [[University of Western Australia]]
|-
|79. [[Ecole Normale Superieure Paris]]
|-
|80. [[University of Virginia]]
|-
|81. [[Technical University of Munich]]
|-
|82. [[Hebrew University of Jerusalem]]
|-
|83. [[Leiden University]]
|-
|84. [[University of Waterloo]]
|-
|85. [[King's College London]]
|-
|86. [[Purdue University]]
|-
|87. [[University of Birmingham]]
|-
|88. [[Uppsala University]]
|-
|89. [[University of Amsterdam]]
|-
|90. [[University of Heidelberg]]
|-
|91. [[University of Queensland]]
|-
|92. [[University of Leuven]]
|-
|93. [[Emory University]]
|-
|94. [[Nagoya University]]
|-
|95. [[Case Western Reserve University]]
|-
|96. [[Chinese University of Hong Kong]]
|-
|97. [[University of Newcastle]]
|-
|98. [[Innsbruck University]]
|-
|99. [[University of Massachusetts at Amherst]]
|-
|100. [[Sussex University]]
|}

==Criticism==

[[Criticism of college and university rankings (North America)]]

[[vi: Top 100 trường đại học trên thế giới‎]]
{{uncategorized|date=June 2008}}

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Examination of the gallbladder and liver

Top 100 Global Universities