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1st Year - Gastroenterology > Anatomy 3 and 4 - Patient with Jaundice > Flashcards

Anatomy 3 and 4 - Patient with Jaundice Flashcards

1
Q

Medical name for jaundice

A

Icterus

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2
Q

what is jaundicewhat is it caused by

A

Yellowing of sclera/ skinAn increase in the blood levels of bilirubin

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3
Q

What is bilirubin a normal by-product of?

A

The break down of red blood cells

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4
Q

Where does the breakdown of red blood cells normally occur (where is bilirubin produced)?

A

Spleen (and then passes to the liver where it is used to form bile)

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5
Q

what is bilirubin used to form

A

Bile

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6
Q

Where is bile formed

A

The liver

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7
Q

Where is bile stored and concentrated?

A

The gallbladder

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8
Q

what does bile pass through to get to the gallbladder from the liverWhat is this

A

Biliary treeA set f tubes connecting the liver to the 2nd part of the duodenum

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9
Q

What is bile important for

A

The normal absorption of fats from the small intestines

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10
Q

What other organ, apart from the gallbladder, excretes digestive enzymes into the 2nd part of the duodenum?

A

The pancreas

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11
Q

Where is the portal triad found

A

in the free edge of the lesser omentum

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12
Q

What are the 3 important “tubes” in the portal triad?

A

Hepatic arteryHepatic portal veinCommon bile duct

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13
Q

What part of the portal triad is part of the biliary tree?

A

The common bile duct (part of biliary tree)

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14
Q

What does the portal triad also contain (apart from the 3 tubes)

A

Nerve and lymphatics

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15
Q

Where does the celiac trunk branch from

A

First of 3 midline branches from the abdominal aorta (retroperitoneal)

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16
Q

At what level does the celiac trunk arise

A

From around T12

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17
Q

What organs does the celiac trunk supply

A

The organs of the foregut

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18
Q

What are the 3 branches of the celiac trunk

A

Splenic arteryHepatic artery Left gastric artery (each of these arteries then give rise to further arteries)

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19
Q

What kind of course does the splenic artery take

A

A very tortuous course along the superior border of the pancreas

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20
Q

In relation to the peritoneum, what type of organ is the spleenWhich region of the abdomen is it in

A

Intraperitoenal left hypochondrium

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21
Q

What is the function of the spleen within the haematological system

A

To break down red blood cells to produce bilirubin

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22
Q

Which ribs protect the spleen

A

Ribs 9-11 (rib fractures can therefore pierce the soft delicate spleen and cause substantial internal bleeding)

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23
Q

Where does the blood supply to the stomach mainly come from (2)

A

Right and left gastric arteries which run along the lesser curvature of the stomach and anastomose together Also the right and left gastro-mental arteries which run along the greater curvature and anastomose together

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24
Q

Where does the blood supply to the liver come from?

A

Hepatic artery which branches into the right and left hepatic arteries (this only accounts for about 20-25% of blood received by the liver - the rest comes from the hepatic portal vein)The liver has a dual blood supply

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25
Q

What is the liver anatomically related to?

A

The diaphragm, stomach, gallbladder, hepatic flexture, right kidney and right adrenal gland, IVC and abdominal aorta

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26
Q

Where does the gallbladder sit on the liver

A

Not the posterior and inferior surfaces

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27
Q

What type of organ is the liver

A

A major metabolic organ and converts bilirubin to bile

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28
Q

Which ribs protect the liver

A

7-11

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29
Q

4 anatomical segments of the liver

A

Right lobeleft lobecaudate lobe (more posterior and superior)Quadrate lobe (more anterior and inferior)

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30
Q

What does each of the 8 functional segments of the liver have?

A

Its own blood supply (hepatic artery and hepatic portal vein), venous drainage and bile drainage

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31
Q

What is hepatic drainage from the liver into

A

3 main hepatic veins that drain into the IVC

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32
Q

What does the fact that the IVC and hepatic veins lack valves mean

A

A rise in central venous pressure is directly transmitted to the liver and therefore can cause liver enlargement as it engorges it with blood (hepatomegaly)

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33
Q

What is segment I of the liver

A

The caudate lobe (rarely seen on images)

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34
Q

What does each liver lobule have in the middle and at each corner

A

Middle = central veinEach corner = interlobular portal triad

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35
Q

What is the interlobular portal triad made up of

A

Branch of HPV, branch of HA, biliary duct (bile formed in hepatocytes drains here)

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36
Q

What does the central vein in a hepatocyte do

A

Collects “cleaned” blood and drains into the hepatic veins

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37
Q

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

A

Hepatorenal recess (Morrison’s Pouch)Subphrenic recess(both within the greater sac)

38
Q

What can peritonitis result in (in relation to the clinically important areas of the peritoneal cavity related to the liver)

A

A collection of pus in the hepatorenal recess and subphrenic recess leading to an abscess formation (the hepatorenal recess is one of the lowest parts of the peritoneal cavity when a patient is supine meaning that pus from an access in the subphrenic recess can drain into the hepatorenal recess when a patient is bedridden)

39
Q

Hepatic portal vein

A

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

40
Q

Splenic vein

A

Drains the blood from the foregut to the hepatic portal vein

41
Q

Inferior mesenteric vein

A

Drains the blood from the handgun to the splenic vein (there can be variations in where this joins)

42
Q

Superior mesenteric vein

A

Drains the blood from the midgut to the hepatic portal vein

43
Q

inferior vena cava

A

RetroperitonealDrains the cleaned blood from the hepatic veins into the right atrium

44
Q

Ligaments of the liver and where they attach to?

A

Coronary ligaments (attachment to the diaphragm)Falciform ligament (attachment to the anterior abdominal wall)Ligamentum teres/ round ligament (remnant of the embrylogical umbilical vein)

45
Q

Where does the gallbladder lie

A

The posterior aspect of the liver (often firmly attached) - anterior to the duodenum

46
Q

What is the purpose of the gallbladder

A

To store and concentrate bile in between meals

47
Q

Parts of the gallbladder

A

BodyNeckNeck narrows to form cystic duct (potential site for gallstone impaction)

48
Q

How does bile flow into and out of the gallbladder

A

Through the cystic duct

49
Q

What provides a blood supply to the gallbladder

A

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

50
Q

What causes gallbladder pain

A

Inflammation of the gallbladder or cystic duct following irriation from or impaction of a gallstone

51
Q

Is the gallbladder a foregut/ midgut or hindgut organwhere does the visceral afferents for it enter the spinal cord

A

Foregut organT6-T9

52
Q

where will early pain from the gallbladder be presentWhere might pain also be presentWhere can you get referred pain from the gallbladder and why

A

In the epigastric regionHypochondriumRight shoulder due to anterior diaphragmatic irritation

53
Q

Name for surgical removal of the gallbladder

A

Cholecystectomy (must be able to correctly identify the cystic duct and cystic artery)

54
Q

What do the right and left hepatic ducts unite to form

A

The common hepatic duct

55
Q

What does the common hepatic duct unite with and what does this form

A

Common hepatic duct and cystic duct unite to form the (common) bile duct

56
Q

What does the bile duct drain intoWhat else drains into here at this point

A

The 2nd part of the duodenum The pancreatic duct

57
Q

Where does the bile duct travel in relation to the duodenum and pancreas

A

It travels posteriorly to the 1st part of the duodenum and then travels in a groove on the posterior aspect of the pancreas before joining with the main pancreatic duct

58
Q

What does bile duct join with to form

A

It joins with the main pancreatic duct to form the ampulla (of Vater)/ hepatopancreatic ampulla

59
Q

What does the ampulla drain into

A

The 2nd part of the duodenum through the major duodenal papilla

60
Q

What is the small bump where the ampulla joins the duodenum called

A

The major duodenal papilla

61
Q

What are the 4 (5ish) parts of the pancreas

A

The head (with uncinate process), neck, body and tail

62
Q

What are the names of the 3 smooth muscle sphincters in the areas around the biliary tree joining to the duodenum?

A

bile duct sphincterpancreatic duct sphincterSphincter of Oddi (at papilla)

63
Q

What is endoscopic retrograde cholangiopancreatography?What happens during this?

A

Investigation used to study the biliary tree and pancreas (also used to treat some pathologies associated with it)An enoscope is inserted through the oral cavity and into the duodenum A cannula is placed into the major duodenal papilla and radio-opaque dye injected back into the biliary tree

64
Q

What can obstruct the biliary tree?How does this cause jaundice?

A

Gallstones and carcinoma at the head of the pancreasFlow of bile back up into the liver causing bilirubin to overspill into the blood (there are also many other intra-hepatic causes of jaundice)

65
Q

What is the head of the pancreas surrounded by

A

The duodenum

66
Q

Where does the splenic artery and vein lie in relation to the pancreas

A

Splenic vein = directly posterior to the pancreasSplenic artery = supra-posterior border of the pancreas

67
Q

Exocrine and endocrine cells of the pancreas?

A

Exocrine = acinar cell (pancreatic and digestive into the main pancreatic duct)Endocrine = islets of Langerhans (insulin and glucagon into the bloodstream)

68
Q

Sympathetic nerve supply to the pancreasParasympathetic supply

A

Abdomino pelvic splanchnic Vagus (these form celiac ganglia and sup. mesentery ganglia as well as periarterial plexus)

69
Q

Blood supply to the pancreas (3)

A

Mainly pancreatic branches of the splenic arteryAlso superior pancreaticoduodenal (continuation of gasproduodenal artery that branches from the hepatic artery)Also inferior pancreaticoduodenal (branch of the superior mesenteric artery)

70
Q

How does blockage of the ampulla by a gallstone cause pancreatitis?

A

Bile is diverted up into the pancreas leading to irritation and inflammation

71
Q

Where can pain from the pancreas be felt

A

In the epigastric and/or umbilical region (it is a foregut and midgut organ)It can radiate to the back

72
Q

What parts of the small intestines are foregut organs

A

The 1st and 2nd part of the duodenum (the rest of the small intestines are midgut organs)

73
Q

4 parts of the duodenum

A

1st part = superior (duodenal cap)2nd = descending3rd = horizontal4th = ascending

74
Q

Is the duodenum retroperitoneal or intraperitoneal

A

Retroperitoneal except the duodenal cap which is part intraperitoneal and therefore relatively mobile

75
Q

What does the pyloric sphincter do?Type of muscle forming itNerve supply type

A

Controls flow of chyme from stomach to duodenum Smooth muscleAutonomic nerves (S = contraction, P=relaxation)

76
Q

What hormones are secreted by the duodenum

A

Gastrin?CCK (cholecystokinin)

77
Q

where does pain from a duodenal ulcer tend to be present

A

In the epigastric region

78
Q

Blood supply to the duodenum (2)

A

superior pancreaticoduodenal (continuation of gastroduodenal artery that branches from the hepatic artery)inferior pancreaticoduodenal (branch of the superior mesenteric artery)

79
Q

At what flexure does the jejunum begin

A

The duodenaljejunanal flexure

80
Q

At what junction does the ileum end

A

Ileocaecal junction

81
Q

How can you tell the difference between the jejunum and ileum

A

The mucosa differs between the jejunum and ileum (jejunum = highly folded with plicae circularis whilst the mucosae of the distal ileum is much smoother)

82
Q

Where is most of the ileum and most of the jejunum found

A

Jejunum = LUQIleum = RLQ

83
Q

What are the folds in the jejunum called

A

Plicae circularis

84
Q

What provides arterial blood supply to the jejunum and ileum

A

Superior messenteric artery via jejunal and ileal arteries

85
Q

What provides venous drainage from the jejunum and ileum

A

Jejunal and ileal veins which drain into the superior mesenteric vein which drains into the hepatic portal vein

86
Q

What does bile do

A

Helps the absorption of fats from the GI tract lumen into the intestinal cells

87
Q

What happens to fats within chylomicrons in intestinal cells

A

They are absorbed into specialised lymphatic vessels of the small intestines called lacteals They then travel via the lymphatic system to eventually drain into the venous system

88
Q

What do lymph vessels tend to run alongside

A

Arteries

89
Q

What are the 4 main groups of lymph nodes draining abdominal organs

A

Celiac (foregut organs)Superior mesenteric (midgut organs)Inferior mesenteric (hindgut organs)Lumbar (kidneys, posterior abdo. wall, pelvis and lower limbs)

90
Q

Where does lymph drain into? (2)

A

Thoracic duct (from 3/4 of body)Right lymphatic duct (from upper right quarter of body)

91
Q

Where does the thoracic duct and right lymphatic duct drain into

A

They both drain into the junction between the subclavian and internal jugular vein on the correct side (left venous angle and right venous angle)

1st Year - Gastroenterology (37 decks)

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