1- why might patient be jaundiced? Flashcards
how are liver, spleen, gallbladder, pancreas and small intestine linked?
linked together by formation of bilirubin, bile and clinical condition of jaundice
what is bilirubin?
= normal by-product of break down of red blood cells. used to form bile in liver
what happens in spleen?
breakdown of red blood cell
where does bile travel?
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
what is gallbladders role?
plays an important role in storage + concentration of bile
why is bile important?
important for normal absorption of fats from small intestine
what does pancreas secrete?
digestive enzymes into 2nd part of duodenum
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) 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
what is function of liver?
major metabolic organ that converts bilirubin to bile
what is liver protected by?
ribs 7-11
how many anatomical and functional segments are there in liver?
4 anatomical segments
8 functional segments
what are the 4 anatomical segments of liver?
- left lobe
- right lobe
- caudate lobe (top)
- quadrate lobe (bottom)
what are functional segments of liver?
I-VIII
= each have own blood supply (hepatic artery+hepatic portal vein), venous drainage and bile drainage
what is venous drainage of liver?
from liver via 3 main hepatic veins into IVC - the central vein collects “cleaned” blood and drains into hepatic veins
what are the 2 clinically important areas of peritoneal cavity related to liver?
- hepatorenal recess (Morison’s pouch)
- subphrenic recess
→both recesses are within greater sac
what is peritonitis?
result in collection of pus in the liver recesses (hepatorenal recess, subphrenic recess) leading to an abscess formation
what is one of the lowest parts of peritoneal cavity when patient is supine?
hepatorenal recess
what is function of hepatic portal vein?
drains blood from foregut, midgut & hindgut to the liver for first pass metabolism (cleaning)
what is function of inferior vena cava?
drains the cleaned blood from hepatic veins into right atrium
- it’s retroperitoneal (outside or behind peritoneum)
what must be cut to remove the liver?
- 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
what is round ligament on liver?
- 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
where is portal triad found?
= found in free edge of lesser omentum
what are the 3 important tubes in portal triad?
- hepatic artery
- hepatic portal vein
- common bile duct
where is common bile duct?
part of biliary tree linking liver to duodenum
where is gallbladder?
lies on posterior aspect of liver (often firmly attached)
what is purpose of gallbladder?
gallbladder stores + concentrates bile in between meals
what is structure of gallbladder?
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
what is blood supply for gallbladder?
via the cystic artery (branch of right hepatic artery in 75% of people)
what makes up the biliary tree?
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
what is route of bile duct?
= 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
what are the anatomical sphincters in bile duct (pancreas duodenal area)?
- bile duct sphincter
- pancreatic duct sphincter
- sphincter of Oddi (where it enters duodenum)
what are anatomical sphincters?
= discrete areas where muscle completely encircles the lumen of the tract
what is structure of pancreas?
- head (with uncinate process)
- neck
- body
- tail
= closely associated with duodenum
where is pancreas located in body?
it’s a retroperitoneal organ that lies transversely across posterior abdomen
what organs/structures are posterior to pancreas? (lots)
right kidney + adrenal gland, IVC, bile duct, abdominal aorta, superior mesenteric vessels, left kidney + adrenal gland, part of portal venous system
what organ is anterior to pancreas?
stomach
where is duodenum in relation to pancreas?
closely related = it surround sthe head
what structures are superoposterior to pancreas?
splenic vessels
what are exocrine cells of pancreas?
acinar cells = secretes pancreatic digestive enzymes into main pancreatic duct
what are endocrine cells of pancreas?
islets of langerhans (secretes insulin + glucagon into blood stream)
what is blood supply to pancreas?
- 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
what makes up the small intestine?
duodenum, jejunum, ileum
what parts of small intestine are
a) foregut
b) midgut
a) 1st +2nd part of duodenum
b) rest of small intestine
what are 4 parts of duodenum?
- superior (intraperitoneal) = duodenal cap, relatively mobile
- descending (retroperitoneal)
- horizontal (retroperitoneal)
- ascending (retroperitoneal)
where does duodenum begin?
at pyloric sphincter = smooth muscle supplied by autonomic nerves (sympathetic = contraction, parasympathetic = relaxation)
what does duodenum secrete?
a number of peptide hormones into blood
where is pain from duodenal ulcer felt?
in epigastric region (middle upper 9th region)
what is blood supply to duodenum?
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)
what quadrants is the jejunum + ileum found in?
all 4 quadrants - jejunum 3m and ileum 4m
where does jejunum begin?
duodenal jejunal flexure
where does ileum end?
ileocaecal junction
what is the mucosa like in jejunum and ileum?
their mucosa differs
→jejunum mucosa is highly folded, the folds called plicae circularis
→ileum mucosa is much smoother (especially distally)
what is the arterial blood supply to jejunum + ileum?
superior mesenteric artery via jejunal and ileal arteries
what is the venous blood supply from jejunum + ileum?
jejunal + ileal veins to superior mesenteric veins to hepatic portal vein
what do vessels of jejunum and ileum travel within?
mesentery
