4- jaundice part 2 Flashcards
what is jaundice?
increase in blood levels of bilirubin
what is process of bilirubin (basic)?
breakdown of red blood cells →occurs in spleen, then Bilirubin is used to form bile – in the liver →Bile then travels through the ‘biliary tree’
what is biliary tree?
A set of tubes connecting the liver to the 2nd part of the duodenum
what is jaundice presentation?
- Yellowing of the sclera (white of eyes) / skin
- Caused by an increase in the blood levels of bilirubin
what is movement of blood & bile in hepatic lobules?
- for blood →between these vessels are lines of hepatocytes come up through portal triad and then along funnels called sinusoids and cleaned along the way so cleaned blood to enter central vein
- while that is happening, bile is being formed from breakdown of bilirubin in hepatocyte and passed back in opposite direction towards bile duct of portal triad
what re 2 main causes of obstruction of bilirubin?
carcinoma of head of pancreas or gallstone = these are extrahepatic & post-hepatic obstructive jaundice
- causes bile to flow back up towards liver instead of being secreted into duodenum and when reaches liver, overspill into blood
is gallbladder foregut, midgut or hindgut?
foregut
where is pain of gallbladder felt?
foregut organ →early pain in epigastric region but pain can also present in hypochondrium and pain referred to right shoulder (because irritating anterior diaphragm which is somatic sensory innervation from c3,4,5 which same nerves carrying to shoulder so referred to shoulder)
what is calot’s triangle?
= anatomical landmark that must be dissected in cholecystectomy surgery
- small triangle area at area of entry or exit for vessels at liver
what are boundaries for calot’s triangle?
- cystic duct laterally
- common hepatic duct medially
- inferior border of liver superiorly
why must cystic artery be identified?
must be correctly identified to be tied off before removal of gallbladder to avoid iatrogenic injury
how does gallstone cause pancreatitis?
blockage of the ampulla by a gallstone which means bile directed to pancreas not duodenum = irritation of pancreas
where is pain of pancreas felt?
- pain in the epigastric region and/or umbilical region.
- It can also radiate through to the patients back
what imaging technique can be done to see biliary tree?
seen in clinical imaging technique ERCP (endoscope and then dye into biliary tree then take pics)
how is bile involved in absorption of fats?
- bile required for absorption of fats from lumen of GI tract into intestinal cells
- occurs by specialised lymphatic vessels of small intestine called lacteals →these drain into lymphatic plexuses in walls of small intestine and drain into lymphatic vessels within mesentery
- fat in intestine picked up by lacteals and passed into walls of intestine then into lymphatic vessels in mesentery then head to superior mesenteric lymph nodes then to left venous angle
