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GI > 1- why might patient be jaundiced? > Flashcards

1- why might patient be jaundiced? Flashcards

1
Q

how are liver, spleen, gallbladder, pancreas and small intestine linked?

A

linked together by formation of bilirubin, bile and clinical condition of jaundice

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2
Q

what is bilirubin?

A

= normal by-product of break down of red blood cells. used to form bile in liver

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3
Q

what happens in spleen?

A

breakdown of red blood cell

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4
Q

where does bile travel?

A

bile formed from bilirubin in spleen and then it travels through biliary tree which is set of tubes connecting the liver to the 2nd part of duodenum

bile = bile salts, bile acids, cholesterol, phospholipids, bilirubin, water & electrolytes

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5
Q

what is gallbladders role?

A

plays an important role in storage + concentration of bile

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6
Q

why is bile important?

A

important for normal absorption of fats from small intestine

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7
Q

what does pancreas secrete?

A

digestive enzymes into 2nd part of duodenum

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8
Q

how is liver anatomically related to
a) diaphragm
b) stomach
c) gallbladder
d) hepatic flexure
e) right kidney, right adrenal gland, IVC, abdominal aorta

A

a) diaphragm = superior, anteriorly, posteriorly

b) stomach = liver covers superior and anterior surface of stomach

c) gallbladder = posterior + inferiorly

d) hepatic flexure = inferiorly

e) right kidney, right adrenal gland, IVC, abdominal aorta = posterior to liver

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9
Q

what is function of liver?

A

major metabolic organ that converts bilirubin to bile

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10
Q

what is liver protected by?

A

ribs 7-11

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11
Q

how many anatomical and functional segments are there in liver?

A

4 anatomical segments
8 functional segments

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12
Q

what are the 4 anatomical segments of liver?

A
  • left lobe
  • right lobe
  • caudate lobe (top)
  • quadrate lobe (bottom)
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13
Q

what are functional segments of liver?

A

I-VIII
= each have own blood supply (hepatic artery+hepatic portal vein), venous drainage and bile drainage

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14
Q

what is venous drainage of liver?

A

from liver via 3 main hepatic veins into IVC - the central vein collects “cleaned” blood and drains into hepatic veins

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15
Q

what are the 2 clinically important areas of peritoneal cavity related to liver?

A
  • hepatorenal recess (Morison’s pouch)
  • subphrenic recess
    →both recesses are within greater sac
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16
Q

what is peritonitis?

A

result in collection of pus in the liver recesses (hepatorenal recess, subphrenic recess) leading to an abscess formation

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17
Q

what is one of the lowest parts of peritoneal cavity when patient is supine?

A

hepatorenal recess

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18
Q

what is function of hepatic portal vein?

A

drains blood from foregut, midgut & hindgut to the liver for first pass metabolism (cleaning)

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19
Q

what is function of inferior vena cava?

A

drains the cleaned blood from hepatic veins into right atrium

  • it’s retroperitoneal (outside or behind peritoneum)
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20
Q

what must be cut to remove the liver?

A
  • at the superior end the coronary ligaments attach to the diaphragm
  • the falciform ligament runs between the r+l lobe and attaches to anterior abdominal wall
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21
Q

what is round ligament on liver?

A
  • the ligamentum teres/round ligament (remnant of embryological umbilical vein)
    = it hangs off inferior end of falciform ligament that runs in between right + left lobe
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22
Q

where is portal triad found?

A

= found in free edge of lesser omentum

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23
Q

what are the 3 important tubes in portal triad?

A
  • hepatic artery
  • hepatic portal vein
  • common bile duct
24
Q

where is common bile duct?

A

part of biliary tree linking liver to duodenum

25
Q

where is gallbladder?

A

lies on posterior aspect of liver (often firmly attached)

26
Q

what is purpose of gallbladder?

A

gallbladder stores + concentrates bile in between meals

27
Q

what is structure of gallbladder?

A

it has a body + a neck

  • the neck narrows to become the cystic duct
  • bile flows in + out of the gallbladder via the cystic duct which goes into common bile duct then duodenum

= R&L hepatic ducts form common hepatic duct - cystic duct drains gall bladder and joins CHD to form common bile duct and drains into duodenum via ampulla of vater

28
Q

what is blood supply for gallbladder?

A

via the cystic artery (branch of right hepatic artery in 75% of people)

29
Q

what makes up the biliary tree?

A

right + left hepatic duct unites to form common hepatic duct that joins with cystic duct (from gallbladder) & pancreatic duct to form common bile duct that then drains into 2nd part of duodenum via ampulla of vater

30
Q

what is route of bile duct?

A

= descends posteriorly to 1st part of duodenum and travels in a groove on the posterior aspect of the pancreas and then joins with main pancreatic duct to make ampulla of Vater/hepatopancreatic ampulla = then drains into 2nd part of duodenum through the major duodenal papilla

31
Q

what are the anatomical sphincters in bile duct (pancreas duodenal area)?

A
  • bile duct sphincter
  • pancreatic duct sphincter
  • sphincter of Oddi (where it enters duodenum)
32
Q

what are anatomical sphincters?

A

= discrete areas where muscle completely encircles the lumen of the tract

33
Q

what is structure of pancreas?

A
  • head (with uncinate process)
  • neck
  • body
  • tail
    = closely associated with duodenum
34
Q

where is pancreas located in body?

A

it’s a retroperitoneal organ that lies transversely across posterior abdomen

35
Q

what organs/structures are posterior to pancreas? (lots)

A

right kidney + adrenal gland, IVC, bile duct, abdominal aorta, superior mesenteric vessels, left kidney + adrenal gland, part of portal venous system

36
Q

what organ is anterior to pancreas?

A

stomach

37
Q

where is duodenum in relation to pancreas?

A

closely related = it surround sthe head

38
Q

what structures are superoposterior to pancreas?

A

splenic vessels

39
Q

what are exocrine cells of pancreas?

A

acinar cells = secretes pancreatic digestive enzymes into main pancreatic duct

40
Q

what are endocrine cells of pancreas?

A

islets of langerhans (secretes insulin + glucagon into blood stream)

41
Q

what is blood supply to pancreas?

A
  • mainly pancreatic branches from splenic artery and it’s close to duodenum so similar in blood supply
  • superior pancreaticoduodenal branches off gastroduodenal artery
  • inferior pancreaticoduodenal branches off superior mesenteric artery
42
Q

what makes up the small intestine?

A

duodenum, jejunum, ileum

43
Q

what parts of small intestine are
a) foregut
b) midgut

A

a) 1st +2nd part of duodenum
b) rest of small intestine

44
Q

what are 4 parts of duodenum?

A
  1. superior (intraperitoneal) = duodenal cap, relatively mobile
  2. descending (retroperitoneal)
  3. horizontal (retroperitoneal)
  4. ascending (retroperitoneal)
45
Q

where does duodenum begin?

A

at pyloric sphincter = smooth muscle supplied by autonomic nerves (sympathetic = contraction, parasympathetic = relaxation)

46
Q

what does duodenum secrete?

A

a number of peptide hormones into blood

47
Q

where is pain from duodenal ulcer felt?

A

in epigastric region (middle upper 9th region)

48
Q

what is blood supply to duodenum?

A

close relationship to pancreas so similarities in blood supply:

  • gastroduodenal artery (that then branches to pancreaticoduodenal)
  • superior mesenteric artery (that then branches to inferior pancreaticoduodenal)
49
Q

what quadrants is the jejunum + ileum found in?

A

all 4 quadrants - jejunum 3m and ileum 4m

50
Q

where does jejunum begin?

A

duodenal jejunal flexure

51
Q

where does ileum end?

A

ileocaecal junction

52
Q

what is the mucosa like in jejunum and ileum?

A

their mucosa differs

→jejunum mucosa is highly folded, the folds called plicae circularis

→ileum mucosa is much smoother (especially distally)

53
Q

what is the arterial blood supply to jejunum + ileum?

A

superior mesenteric artery via jejunal and ileal arteries

54
Q

what is the venous blood supply from jejunum + ileum?

A

jejunal + ileal veins to superior mesenteric veins to hepatic portal vein

55
Q

what do vessels of jejunum and ileum travel within?

A

mesentery

GI (56 decks)

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