1: Anatomy - Jaundice 2 Flashcards
The yellowing of the sclera and skin associated with jaundice is caused by an increase in the blood levels of ___.
bilirubin
Bilirubin is formed by the breakdown of ___ ___ ___.
red blood cells
Where does bilirubin release mainly occur?
Spleen
where RBC breakdown occurs
Bilirubin is a major constituent of ___.
bile
Where do the right and left hepatic ducts come from?
Liver
The right and left hepatic ducts unite to form the ___ hepatic duct.
common hepatic duct
Which duct travels from the gallbladder to connect to the common hepatic duct?
Cystic duct
The cystic duct and common hepatic duct unite to form the ___ duct.
bile duct
What connects to the bile duct just before it empties its contents into the duodenum?
Main pancreatic duct
Which part of the duodenum does the bile duct empty into?
2nd part of the duodenum
Where does the duodenum start?
Pyloric sphincter of the stomach
What are the parts of the duodenum?
1 - superior
2 - descending
3 - horizontal
4 - ascending
The 1st part of the duodenum is (intraperitoneal / retroperitoneal).
intraperitoneal
The 2nd, 3rd, 4th parts of the duodenum are (intraperitoneal / retroperitoneal).
retroperitoneal
Where does the duodenum end?
Duodenojejunal flexure
Name two hormones secreted from the duodenum.
What is their function?
Gastrin - stimulates HCl release
CCK - satiation signal, tells you that you’re full
If a patient has duodenal ulcers, where will they experience pain?
Epigastric region
Which mobile structure is found on the 1st part of the duodenum?
Duodenal cap
The pancreas is (intraperitoneal / retroperitoneal).
retroperitoneal
What are the four parts of the pancreas, from left to right?
Head
Neck
Body
Tail
What hook-like structure is found at the inferior aspect of the head of the pancreas?
Uncinate process
What is anterior to the pancreas?
Stomach
What is posterior to the pancreas?
Pretty much everything you’ll ever be asked about
except the stomach
Which type of cells secrete digestive enzymes into the main pancreatic duct?
Are they endocrine or exocrine?
Acinar cells (also found in the exocrine salivary glands)
Exocrine
Which endocrine cells, found in the pancreas, secrete insulin and glucagon into the bloodstream?
Islets of Langerhans
What is the widened duct formed by the union of the bile duct and main pancreatic duct?
Hepatopancreatic ampulla
or
Ampulla of Vater
Where does the Ampulla of Vater drain?
Major duodenal papilla
found in the 2nd part of the duodenum
Accessory pancreatic ducts can sometimes drain into the duodenum via a ___ ___ ___.
minor duodenal papilla
Each duct connecting to the Ampulla of Vater has its own ___ to prevent backflow of bile / digestive enzymes.
sphincter
Which sphincter is found at the terminal end of the Ampulla of Vater, where the duct drains into the major duodenal papilla?
Sphincter of Oddi
Which type of muscle makes up the biliary sphincters?
Smooth muscle
Which type of endoscope can be used to view a dye-filled biliary tree?
ERCP
endoscopic retrograde cholangiopancreatography
What causes jaundice?
Increase in blood levels of bilirubin
What are two causes of biliary tree obstruction?
Gallstones
Carcinoma at head of pancreas (compressing ducts posterior to it)
Why does biliary tree obstruction cause jaundice?
Backflow of bile into the liver ⇒ blood
Bile contains bilirubin
Which two abdominal branches of the aorta anastomose to supply the duodenum and pancreas?
Coeliac trunk
Superior mesenteric artery
Which branch of the coeliac trunk gives off the gastroduodenal artery?
Common hepatic artery
one of the the three initial trifurcations, not to be confused with hepatic artery proper ⇒ right and left hepatics
The superior pancreaticoduodenal artery’s aortic origin is the ___ ___, found at vertebral level ___.
The inferior pancreaticoduodenal artery’s aortic origin is the __ __ __, found at vertebral level ___.
coeliac trunk , T12
superior mesenteric artery , L1
The superior and inferior pancreaticoduodenal arteries ___ to supply the pancreas and duodenum.
anastomose
What is the name given to inflammation of the pancreas?
Pancreatitis
If the bile duct is blocked by a gallstone, where can bile be redirected to?
Pancreas via main pancreatic duct
Where is pancreatic pain (e.g resulting from pancreatitis) felt?
Epigastric region (because it’s half foregut)
Umbilical region (because it’s half midgut)
Where can pancreatic pain radiate?
Back
In advanced pancreatitis, ___ can occur resulting in characteristic bruise-like skin discolouration.
Where are these discolourations typically found?
haemorrhage
flanks and umbilicus
Which branch of the aorta supplies the jejunum and ileum?
Superior mesenteric artery
Which two types of artery supply the jejunum and ileum specifically?
Jejunal arteries
Ileal arteries
Which two types of vein drain the jejunum and ileum specifically?
Jejunal veins
Ileal veins
Which vein do the jejunal and ileal arteries drain into?
Which vein then delivers this nutrient-rich blood to the liver?
Superior mesenteric vein
Hepatic portal vein
Which “organ” do the small intestinal arteries and veins travel within?
Mesentery
At which vertebral level do the superior mesenteric vessels branch off?
L1
The superior mesenteric vessels travel ___ to the neck of the pancreas and ___ to the uncinate process.
(anterior / posterior)
posterior to the neck
anterior to the uncinate process
Which dietary component does bile aid the digestion of?
Fats
Which lymphatic vessels do fats travel in after absorption in the small intestine?
Lacteals
Where do lymphatic vessels from the abdomen drain into the venous system?
Via which lymphatic duct?
Left venous angle
Thoracic duct
Which lymph nodes drain foregut organs?
Coeliac nodes
Which lymph nodes drain midgut organs?
Superior mesenteric nodes
remember the lacteals which drain fats from intestinal cells
Which lymph nodes drain hindgut organs?
Inferior mesenteric nodes
Which lymph nodes drain the kidneys, posterior abdominal wall, pelvis and lower limbs?
Lumbar nodes
Through which duct do the abdominal and lumbar lymphatics drain to empty their contents at the left venous angle?
Thoracic duct
Which lymphatic duct supplies the right arm and right thorax?
Right lymphatic duct
Where does the right lymphatic duct drain?
Right venous angle
