1: Anatomy - Jaundice 1 Flashcards
What is jaundice?
Yellowing of the sclera and skin
What causes jaundice?
Increase in blood concentration of bilirubin
What is a byproduct of red blood cell breakdown in the spleen?
Bilirubin
Where does red blood cell breakdown occur?
Spleen
What is bilirubin used to form in the liver?
Bile
Bilirubin is a major component of ___.
bile
What is the biliary tree?
Liver, gall bladder and the ducts connecting them to the duodenum
What does the gall bladder do?
Stores and concentrates bile
(This question comes up in the anatomy spot and you need to quote it verbatim to get the mark)
Bile is important in the absorption of (carbohydrate / protein / fat).
fat
Which organ excretes digestive enzymes into the duodenum?
Pancreas
The pancreas excretes digestive ___ into the duodenum.
enzymes
Which organ is the largest in the body?
Liver
The liver receives nutrients absorbed from the __ tract.
GI
Which energy storage molecule is held in the liver?
Glycogen
The liver is involved in the secretion of ___ into the duodenum.
bile
The ___ secretes ___ into the duodenum.
The ___ secretes ___ ___ into the duodenum.
(digestive enzymes , liver , pancreas , bile)
liver, bile
pancreas, digestive enzymes
In which quadrant is the liver found?
Right upper quadrant
Which ribs protect the liver?
Ribs 7-11
1 true rib, 3 false ribs and 1 floating rib
The liver moves inferiorly during ___.
inspiration
The liver moves superiorly during ___.
expiration
Where is the liver in relation to the gall bladder?
Anterior and superior
What is the hepatic flexure?
Sharp bend between:
ascending colon
transverse colon
Where is the liver in relation to the hepatic flexure?
Superior
Where is the liver in relation to the right kidney, right adrenal gland, inferior vena cava and abdominal aorta?
Anterior
How many anatomical lobes (i.e those visible to the naked eye) does the liver have?
4
What are the four anatomical lobes of the liver?
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
Why is the caudate lobe named like that?
Looks like a tail
NOT inferior (caudal) as name suggests
The caudate lobe is found at the (superior / inferior) aspect of the (anterior / posterior) surface of the liver.
superior
posterior
The quadrate lobe is found at the (superior / inferior) aspect of the (anterior / posterior) surface of the liver.
inferior
posterior
Which ligament joins the right and left lobes of the liver?
Falciform ligament
Which ligament is found at the inferior aspect of the anterior surface of the liver?
Round ligament / Ligamentum teres
The round ligament of the liver is a remnant of which embryological structure?
Umbilical vein
What is found in the porta hepatis?
Everything except the hepatic veins draining deoxygenated blood from the liver, so the portal triad structures:
right and left hepatic ducts (for bile)
right and left hepatic arteries (oxygenated blood supply)
hepatic portal vein (from the portal system of the intestines, bringing absorbed stuff)
The porta hepatis carries the structures found within the omental foramen - the ___ ___ structures.
portal triad
What is the bare area of the liver?
Area with no peritoneal covering
What covers the bare area of the liver?
Right hemi-diaphragm
NOT peritoneum
How many functional lobes does the liver have?
8
The functional lobes of the liver are named in a (clockwise / anticlockwise) fashion.
clockwise
What name is given to the procedure which removes a functional lobe of the liver?
Segmentectomy
or lobectomy, doesn’t really matter
What vessels are found in each segment of liver?
Branch of hepatic artery
Branch of hepatic portal vein
Bile drainage to bile duct
Venous drainage to IVC
Why does an increase in central venous pressure damage the liver?
IVC and hepatic veins have NO VALVES
The hepatic veins draining deoxygenated blood from the functional lobes come together to form ___ veins which then enter the __ __ __.
three
inferior vena cava
What imaging method can be used to visualise the three hepatic veins entering the inferior vena cava?
Ultrasound
What three vessels are found in the portal triad?
Hepatic artery PROPER
Hepatic PORTAL vein
Bile duct
Which ligament does the portal triad run within?
Hepatoduodenal ligament
The coeliac trunk is the first midline branch of the ___.
abdominal aorta
Is the coeliac trunk intraperitoneal or retroperitoneal?
retroperitoneal
At which vertebral level does the coeliac trunk leave the aorta?
T12
The coeliac trunk supplies the (foregut / midgut / hindgut).
foregut
What are the three branches of the trifurcation of the coeliac trunk?
Left gastric artery
Splenic artery
Common hepatic artery
Which artery, part of the portal triad, branches from the common hepatic artery?
Hepatic artery proper
Which two arteries anastomose to supply the lesser curvature of the stomach?
Right gastric artery
Left gastric artery
The course of the splenic artery is (straight / torturous).
torturous
The splenic artery runs along the superior border of which organ?
Pancreas
The splenic artery runs along the superior aspect of the ___.
pancreas
In which abdominal region is the spleen found?
Left hypochondrium
Is the spleen intraperitoneal or retroperitoneal?
Intraperitoneal
Which bend in the large intestine is the spleen superior to?
Which aspects of the large intestine are connected by this bend?
Splenic flexure
Transverse colon to descending colon
Which ribs protect the spleen?
Ribs 9-11
2 false ribs, 1 floating rib
The spleen breaks down red blood cells to produce ___.
bilirubin
Why may a rib fracture in the left hypochondrium cause massive internal bleeding?
Punctured spleen
Apart from the liver, which other organ moves with the diaphragm during inspiration and expiration?
Spleen
Which arteries supply the liver?
Which artery do these arteries originally branch from?
Right and left hepatic arteries
Hepatic artery proper
The right and left hepatic arteries account for the (majority / minority) of hepatic blood supply.
minority
Which structure accounts for most of the liver’s blood supply?
Hepatic portal vein
The liver has a dual blood supply - which structures are responsible?
Hepatic portal vein (from the portal system carrying nutrients from the intestines)
Right and left hepatic arteries - branches of the hepatic artery proper, which carries blood from the coeliac trunk, which is a branch of the aorta
What are the two recesses you stuck your hand in during the first dissections?
Subphrenic recess
Hepatorenal recess - behind the liver, towards the kidneys
What can collect in the recesses of the abdominal cavity if a patient has peritonitis?
Pus
What is an abscess?
A painful build-up of pus in the tissue
Which abdominal recess will fluid drain into if a patient lies supine?
Hepatorenal recess
The hepatic portal vein drains blood from which collections of abdominal organs?
Foregut
Midgut
Hindgut
i.e all of them
What happens to blood in the liver?
First pass metabolism
“cleaned”
Which vein drains the foregut?
Splenic vein
Which vein drains the midgut?
Superior mesenteric vein
Which vein drains the hindgut?
Which vein does it then merge with?
INFERIOR mesenteric vein
Drains into the splenic vein
Which two veins form the hepatic portal vein?
Splenic vein (which the inferior mesenteric vein has already drained into)
Superior mesenteric vein
Which vein drains blood from the hepatic veins into the right atrium?
Inferior vena cava
The gall bladder lies on the (anterior / posterior) aspect of the liver.
posterior
The gall bladder lies (anterior / posterior) to the duodenum.
anterior
What can become stuck in the gall bladder?
Gallstones
How does bile flow in and out of the gall bladder?
Cystic duct
Which artery supplies the gall bladder?
In most people, this artery is a branch of the right ___ artery.
cystic artery
right hepatic artery
In which “triangle” can the cystic artery and cystic duct be found?
Triangle of Calot
What can cause inflammation of the gall bladder?
Gallstones
Given that the gall bladder is a foregut organ, in which region of the abdomen does gall bladder pain present?
Epigastric region
also the hypochondrium
Where is pain associated with gallbladder inflammation referred?
Right shoulder / neck
Why does gall bladder pain sometimes refer to the right shoulder and neck?
If the diaphragm is irritated by the gall bladder, refers to the diaphraghm spinal nerves C345, dermatomes for C345 are found in the right shoulder / neck
What is a cholecystectomy?
Removal of the gallbladder
