1: Anatomy - Jaundice 2

Question 1

The yellowing of the sclera and skin associated with jaundice is caused by an increase in the blood levels of ___.

Answer 1

bilirubin

Question 2

Bilirubin is formed by the breakdown of ___ ___ ___.

Answer 2

red blood cells

Question 3

Where does bilirubin release mainly occur?

Answer 3

Spleen

where RBC breakdown occurs

Question 4

Bilirubin is a major constituent of ___.

Answer 4

bile

Question 5

Where do the right and left hepatic ducts come from?

Answer 5

Liver

Question 6

The right and left hepatic ducts unite to form the ___ hepatic duct.

Answer 6

common hepatic duct

Question 7

Which duct travels from the gallbladder to connect to the common hepatic duct?

Answer 7

Cystic duct

Question 8

The cystic duct and common hepatic duct unite to form the ___ duct.

Answer 8

bile duct

Question 9

What connects to the bile duct just before it empties its contents into the duodenum?

Answer 9

Main pancreatic duct

Question 10

Which part of the duodenum does the bile duct empty into?

Answer 10

2nd part of the duodenum

Question 11

Where does the duodenum start?

Answer 11

Pyloric sphincter of the stomach

Question 12

What are the parts of the duodenum?

Answer 12

1 - superior

2 - descending

3 - horizontal

4 - ascending

Question 13

The 1st part of the duodenum is (intraperitoneal / retroperitoneal).

Answer 13

intraperitoneal

Question 14

The 2nd, 3rd, 4th parts of the duodenum are (intraperitoneal / retroperitoneal).

Answer 14

retroperitoneal

Question 15

Where does the duodenum end?

Answer 15

Duodenojejunal flexure

Question 16

Name two hormones secreted from the duodenum.

What is their function?

Answer 16

Gastrin - stimulates HCl release

CCK - satiation signal, tells you that you’re full

Question 17

If a patient has duodenal ulcers, where will they experience pain?

Answer 17

Epigastric region

Question 18

Which mobile structure is found on the 1st part of the duodenum?

Answer 18

Duodenal cap

Question 19

The pancreas is (intraperitoneal / retroperitoneal).

Answer 19

retroperitoneal

Question 20

What are the four parts of the pancreas, from left to right?

Answer 20

Head

Neck

Body

Tail

Question 21

What hook-like structure is found at the inferior aspect of the head of the pancreas?

Answer 21

Uncinate process

Question 22

What is anterior to the pancreas?

Answer 22

Stomach

Question 23

What is posterior to the pancreas?

Answer 23

Pretty much everything you’ll ever be asked about

except the stomach

Question 24

Which type of cells secrete digestive enzymes into the main pancreatic duct?

Are they endocrine or exocrine?

Answer 24

Acinar cells (also found in the exocrine salivary glands)

Exocrine

Question 25

Which **endocrine** cells, found in the pancreas, secrete **insulin** and **glucagon** into the bloodstream?

Answer 25

**Islets of Langerhans**

Question 26

What is the **widened duct** formed by the union of the bile duct and main pancreatic duct?

Answer 26

**Hepatopancreatic ampulla** or **Ampulla of Vater**

Question 27

Where does the **Ampulla of Vater** drain?

Answer 27

**Major duodenal papilla** found in the **2nd part** of the duodenum

Question 28

Accessory pancreatic ducts can sometimes drain into the duodenum via a ___ \_\_\_ \_\_\_.

Answer 28

**minor duodenal papilla**

Question 29

Each duct connecting to the **Ampulla of Vater** has its own ___ to prevent backflow of bile / digestive enzymes.

Answer 29

**sphincter**

Question 30

Which sphincter is found at the terminal end of the **Ampulla of Vater**, where the duct drains into the major duodenal papilla?

Answer 30

**Sphincter of Oddi**

Question 31

Which type of muscle makes up the **biliary sphincters**?

Answer 31

Smooth muscle

Question 32

Which type of endoscope can be used to view a dye-filled biliary tree?

Answer 32

**ERCP** endoscopic retrograde cholangiopancreatography

Question 33

What causes **jaundice**?

Answer 33

Increase in blood levels of bilirubin

Question 34

What are **two causes** of **biliary tree obstruction**?

Answer 34

**Gallstones** **Carcinoma at head of pancreas** (compressing ducts posterior to it)

Question 35

Why does **biliary tree obstruction** cause **jaundice**?

Answer 35

**Backflow** of **bile into the liver ⇒ blood** **Bile contains bilirubin**

Question 36

Which two **abdominal branches** of the aorta **anastomose** to supply the **duodenum** and **pancreas**?

Answer 36

**Coeliac trunk** **Superior mesenteric artery**

Question 37

Which branch of the coeliac trunk gives off the **gastroduodenal artery**?

Answer 37

**Common hepatic artery** one of the the three initial trifurcations, not to be confused with hepatic artery proper ⇒ right and left hepatics

Question 38

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 \_\_\_.

Answer 38

**coeliac trunk , T12** **superior mesenteric artery , L1**

Question 39

The **superior** and **inferior** **pancreaticoduodenal arteries** ___ to supply the pancreas and duodenum.

Answer 39

**anastomose**

Question 40

What is the name given to **inflammation** of the **pancreas**?

Answer 40

**Pancreatitis**

Question 41

If the bile duct is **blocked** by a gallstone, where can bile be redirected to?

Answer 41

**Pancreas** via main pancreatic duct

Question 42

Where is **pancreatic pain** (e.g resulting from pancreatitis) felt?

Answer 42

**Epigastric region** (because it's half foregut) **Umbilical region** (because it's half midgut)

Question 43

Where can **pancreatic pain** radiate?

Answer 43

**Back**

Question 44

In advanced pancreatitis, ___ can occur resulting in characteristic bruise-like skin discolouration. Where are these discolourations typically found?

Answer 44

**haemorrhage** **flanks** and **umbilicus**

Question 45

Which branch of the aorta supplies the jejunum and ileum?

Answer 45

**Superior mesenteric artery**

Question 46

Which two types of artery supply the **jejunum** and **ileum** specifically?

Answer 46

**Jejunal arteries** **Ileal arteries**

Question 47

Which two types of vein drain the jejunum and ileum specifically?

Answer 47

**Jejunal veins** **Ileal veins**

Question 48

Which vein do the **jejunal** and **ileal arteries** drain into? Which vein then delivers this nutrient-rich blood to the liver?

Answer 48

**Superior mesenteric vein** **Hepatic portal vein**

Question 49

Which "organ" do the small intestinal arteries and veins travel within?

Answer 49

**Mesentery**

Question 50

At which vertebral level do the **superior mesenteric vessels** branch off?

Answer 50

**L1**

Question 51

The superior mesenteric vessels travel ___ to the **neck** of the pancreas and ___ to the **uncinate process.** (anterior / posterior)

Answer 51

**posterior** to the **neck** **anterior** to the **uncinate process**

Question 52

Which dietary component does **bile** aid the digestion of?

Answer 52

**Fats**

Question 53

Which lymphatic vessels do **fats** travel in after absorption in the small intestine?

Answer 53

**Lacteals**

Question 54

Where do lymphatic vessels from the abdomen **drain** into the venous system? Via which lymphatic duct?

Answer 54

**Left venous angle** **Thoracic duct**

Question 55

Which lymph nodes drain **foregut** organs?

Answer 55

**Coeliac nodes**

Question 56

Which lymph nodes drain **midgut** organs?

Answer 56

**Superior mesenteric nodes** remember the **lacteals** which drain fats from intestinal cells

Question 57

Which lymph nodes drain **hindgut** organs?

Answer 57

**Inferior mesenteric nodes**

Question 58

Which lymph nodes drain the **kidneys**, **posterior abdominal wall**, **pelvis** and **lower limbs**?

Answer 58

**Lumbar nodes**

Question 59

Through which duct do the abdominal and lumbar lymphatics drain to empty their contents at the **left venous angle**?

Answer 59

**Thoracic duct**

Question 60

Which **lymphatic duct** supplies the right arm and right thorax?

Answer 60

**Right lymphatic duct**

Question 61

Where does the **right lymphatic duct** drain?

Answer 61

**Right venous angle**