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GI > Anatomy- Jaundice > Flashcards

Anatomy- Jaundice Flashcards

1
Q

what is jaundice

A

yellowing of the sclera (white of the eyes) and the skin

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2
Q

what causes jaundice

A

an increase in bilirubin in the blood

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3
Q

what is bilirubin

A

is a normal bi product of the breakdown of red blood cells

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4
Q

where does the break down of red blood cells mainly occur

A

in the spleen

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5
Q

what is bilirubin used to form and where does this hapen

A

bile, in the liver

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6
Q

how does bile leave the liver

A

travels through a set of tubes connecting the liver to the 2nd part of the duodenum

THE BILIARY TREE

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7
Q

what is the role of the gallbladder

A

the storage and concentration of bile

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8
Q

why is bile important

A

for the normal absorption of fats from the small intestine

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9
Q

what does the pancreas do

A

excretes digestive enzymes into the 2nd part of the duodenum- necessary for digestion

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10
Q

what is the largest organ in the body

A

the liver

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11
Q

what are the functions of the liver

A

glycogen storage,
bile secretion,
other metabolic functions

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12
Q

what quadrant is the liver in

A

right upper

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13
Q

what ribs protect the liver

A

7-11

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14
Q

why does the location of the liver change

A

during breathing as it is attached to the diaphragm

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15
Q

anatomical relations: the liver is… to the right hemi-diaphragm

A

inferior

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16
Q

anatomical relations: gallbladder to the liver

A

posterior and inferior

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17
Q

anatomical relations: hepatic flexure to thr liver

A

inferior

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18
Q

anatomical relations: right kidney, right adrenal gland, IVC and abdominal aorta to the liver

A

posterior

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19
Q

anatomical relations: stomach to the liver

A

posterior at mid/left side

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20
Q

why do pathologies of spread from the liver to the IVC

A

as very connected

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21
Q

how many anatomical lobes does the kidney have and what are they called

A 
4
right
left 
caudate 
quadrate
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22
Q

why is the caudate lobe called that

A

as it looks like a tail, isn’t caudal

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23
Q

what is the porta hepatis

A

site of entry for portal triad structures

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24
Q

how many functional lobes does the liver have and what are they related to

A

8

vasculature and drainage

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25
Q

what divides the right and left lobes of the liver

A

the falciform ligament

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26
Q

what is the round ligament of the liver

A

at end of falciform ligament

is a remnant of the umbilical vein

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27
Q

where does the falciform ligament attach to

A

the abdominal wall

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28
Q

what do the functional lobes allow for and how

A

segmentectomy

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29
Q

what does each functional segment have

A

branch of hepatic artery, branch of a hepatic portal vein, bile drainage, venous drainage

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30
Q

where does the venous drainage of the liver drain into

A

the IVC

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31
Q

where does bile drain from the liver into

A

the bile duct

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32
Q

what do the IVC and hepatic veins lack

A

valves

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33
Q

why can an increase in central venous pressure cause liver disease

A

as no valves, can lead to an back pressure directed at the liver

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34
Q

how do you remeber the segments of the liver

A

thumb in fist, knuckles divinding line

thumb 1, 1st upper 2 lower 2, 2nd whole 4, 3rd lower 5, pinky lower 6 upper 7, 3rd upper 8

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35
Q

what happens to the hepatic veins carrying blood from the liver before they enter the IVC

A

the 3 come together

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36
Q

what structures are within the portal triad

A

hepatic portal vein, hepatic artery proper, bile duct

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37
Q

what do the structures in the portal triad run within

A

the hepatoduodenal ligament

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38
Q

what is the coeliac trunk

A

the first three midline branches of the aorta

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39
Q

where is the coeliac trunk found

A

retroperitoneal, leaves aorta at T12

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40
Q

what does the coeliac trunk supply

A

organs of the foregut

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41
Q

what does the coeliac trunk split into

A

3 branches

  • splenic artery
  • left gastric artery
  • common hepatic artery
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42
Q

what artery supply the lesser curvature of the stomach

A

the left gastric

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43
Q

describe the splenic artery

A

wiggly and big, goes posteriorly to stomach to spleen

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44
Q

where does the hepatic artery proper originate from

A

common hepatic artery (commener gives of gas and becomes proper) (gas= gastroduodenal artery)

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45
Q

what is the course of the splenic artery

A

tortuous course along the superior border of the pancreas to the spleen

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46
Q

where is the spleen found

A

intraperitoneal organ

in left hypochondrium

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47
Q

what ribs protect the spleen

A

9-11

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48
Q

anatomical relations: diaphragm to the spleen

A

posterior

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49
Q

anatomical relations: stomach to the spleen

A

anterior

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50
Q

anatomical relations: splenic flexure to the spleen

A

inferior

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51
Q

anatomical relations: left kidney to the spleen

A

medially

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52
Q

what could a rib fracture do to the spleen

A

pierce it as its soft, delicate and this can lead to substantial internal bleeding

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53
Q

where is the spleen in relation to the mid axillary line

A

posterior, ruptured by trauma to the back

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54
Q

what organs in the abdomen move with respiration

A

spleen and liver

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55
Q

when is the spleen usually felt in a clinical exam

A

under pathological conditions

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56
Q

where are the right and left gastric arteries

A

anastomose together, travel along the junction of lesser curvature and lesser omentum

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57
Q

what are the major blood supplies to the stomach

A

right and left gastric, right and left gastro-omental arteries

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58
Q

where are the right and left gastro-omental arteries

A

along junction of greater curvature and greater omentum, anastomose together

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59
Q

what are the minor blood supplies to the heart

A

posterior gastric arteries, short gastric arteries

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60
Q

where does the blood supply to the liver come from

A

right and left hepatic arteries (branches of the hepatic artery proper)

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61
Q

describe the dual blood supply of the liver

A

20-25% of the blood received by the liver is from the hepatic artery proper branches, rest is from hepatic portal vein

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62
Q

describe the structure of a liver lobule

A

central vein in middle,

interlobular portal triad at each corner (hexagon)

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63
Q

what is the interlobular portal triad

A

branch of hepatic portal vein, branch of hepatic artery, biliary duct

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64
Q

where does bile formed in the hepatocytes drain into

A

drains into biliary duct

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65
Q

what is a hepatocyte

A

liver cell

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66
Q

what does the central vein collect and where does it take it

A

‘cleaned’ blood,

drains into the hepatic veins

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67
Q

what is the role of hepatocytes

A

remove toxins and produce bile

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68
Q

what are the two clinically important recesses relating to the liver

A 
hepatorenal recess (morison's pouch),
sub-phrenic recess
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69
Q

what are both recesses associated with the liver in

A

the greater sac

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70
Q

how can the recess be associated with peritonitis

A

peritonitis can result in a collection of pus in these recesses leading to an abscess formation

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71
Q

what is the role of the hepatic portal vein

A

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

72
Q

what forms the hepatic portal vein

A

splenic vein and superior mesenteric vein

73
Q

what vein drains the foregut

A

the splenic vein

74
Q

what vein drains the midgut

A

superior mesenteric vein

75
Q

what does the inferior mesenteric vein do

A

drains the blood from the hindgut to the splenic vein

76
Q

where is the IVC in relation to the peritoneum

A

retroperitoneal

77
Q

what is the role of the IVC in relation to the liver

A

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

78
Q

where is the gall bladder

A

lies of the posterior aspect of the liver (often firmly attached), anterior to the duodenum

79
Q

what risk does the narrowing of gall bladder create

A

gallstone impaction

80
Q

via what structure does the bile flow in and out of the gall bladder

A

via the cystic duct

81
Q

what is the blood supply of the gall bladder

A

cystic artery

82
Q

what is the triangle of calot

A

‘cystohepatic’ triangle made by cystic duct and common hepatic duct, in which the cystic artery is found

83
Q

what is the cystic artery a branch of in 75% of people

A

right hepatic artery

84
Q

what causes gall bladder pain

A

inflammation of the gallbladder or cystic duct following irritation/impaction from a gallstone

85
Q

where do the visceral afferent for the gallbladder enter the spinal chord

A

t6-9 as gallbladder a foregut organ

86
Q

where will early gallbladder pain present

A

in the epigastric region

87
Q

where is a secondary site if gallbladder pain

A

can present in the hypochondrium, with/without pain referral to the right shoulder as a result of anterior diaphragmatic irritation

88
Q

what is a cholecystectomy

A

surgical removal of gallbladder

89
Q

what is bilirubin used to form and where

A

bile in the liver

90
Q

what is jaundice a symptom of

A

liver disease

91
Q

what do the right and left hepatic ducts combine to form

A

the common hepatic duct

92
Q

what does the common hepatic duct unite with to form what

A

unites with the cystic duct to form the bile duct

93
Q

what is the bile duct also known as

A

the common bile duct

94
Q

where does the bile duct drain into

A

the 2nd part of the duodenum

95
Q

what drains with the bile duct into the duodenum

A

the pancreatic duct

96
Q

what are the four parts of the duodenum

A

superior (+ duodenal cap), descending, horizontal, ascending

97
Q

what parts of the duodenum are retro-peritoneal

A

descending, horizontal, ascending

98
Q

how mobile is the duodenal cap

A

relatively

99
Q

where does the duodenum begin

A

at the pyloric sphincter

100
Q

what is the pyloric sphincter made of and what innervates it

A

smooth muscle- autonomic nerves (symp contraction, para relaxation)

101
Q

where does the duodenum end

A

at the duodenojejunal flexure

102
Q

what does the duodenum secrete into the blood

A

peptide hormones (gastrin, CCK)

103
Q

where does the duodenum go retroperitoneal

A

at the head of the pancrease

104
Q

when is CCK released in to the blood and what does it do

A

released as fat enters the duodenum and stimulates the digestion of fat and protein- increases bile production

105
Q

where does pain from duodenal ulcers tend to present

A

in the epigastric region

106
Q

where is the pancreas

A

retroperitoneal, lies transversely across the abdomen

107
Q

what are the part of the pancreas

A

head (with uncinate- hook- process), neck, body, tail

108
Q

how is the duodenum associated with the pancreas

A

the head of the pancreas is surrounded by the duodenum

109
Q

where does the tail of the pancreas lie

A

close to the hilum of the spleen

110
Q

why is the pancreas secondarily retroperitoneal

A

as in embryo is it peritoneal (e.g. kidneys primary peritoneal)

111
Q

what is posterior to the pancreas

A
  • right KIDNEY and adrenal glad
  • IVC
  • bile duct
  • abdominal aorta
  • superior mesenteric vessels
  • left kidney and adrenal gland
  • part of the portal venous system
112
Q

what is anterior to the pancreas

A

the stomach

113
Q

what surrounds the head of the pancread

A

the duodenum

114
Q

what is superoposterior to the pancreas

A

the splenic vessels

115
Q

where does the aorta lie

A

anterior to the body of vertebrae

116
Q

what are the two functions of the pmacreas

A

exocrine (acinar cells release digestive enzymes into main pancreatic duct)

endocrine (islets of langerhans release hormones (insulin and glucagon) into the blood stream)

117
Q

what stimulates acinar cells

A

sympathetic stimulation

118
Q

what part of the duodenum does the bile duct drain posterior to

A

the 1st (superior) part

119
Q

where does the bile duct pass via the pancreas

A

in a groove on the posterior aspect of the pancreas

120
Q

what duct does the bile duct join with

A

the main pancreatic duct

121
Q

what is the lepatopancreatic ampulla of vater

A

formed when bile and main pancreatic ducts combine

122
Q

where does the ampulla of vater drain

A

into the second part of the duodenum

123
Q

how does the ampulla of vater drain into the duodenum

A

via the major duodenal papilla, found on the major duodenal papilla

124
Q

what are the sphincters of the biliary system

A

bile duct sphincter, pancreatic duct sphincter, sphincter of oddi

125
Q

what is the role of the sphincter of oddi

A

controls amount of bile and pancreatic juices that get into duodenum

126
Q

what controls the spincters

A

hormonal and neurological control

127
Q

what is an ERCP

A

an investigation used to study the biliary tree and pancreas

128
Q

how does an ERCP work

A

Endoscope inserted through oral cavity, oesophagus, stomach and into duodenum

Cannula placed into major duodenal papilla and radio-opaque dye injected back into biliary tree

Radiographic images are taken of the dye-filled biliary tree

129
Q

why does the cystic duct look wispy on an ERCP

A

as a spiral duct- acts as storage mechanism due to slow drainage

130
Q

what would happen to the levels of bilirubin in the blood if there was an obstruction somewhere in the biliary tree

A

there would be a flow of bile back up to the liver an it would overspill into the blood (including bilirubin)

131
Q

what would cause an onbstruction of the biliary tree

A

gallstones or carcinoma at the head of the pancreas (enlarges it)

132
Q

what is post hepatic jaundice caused by

A

extra- hepatic (outside the liver) obstructions

133
Q

where does the gastroduodenal artery come from

A

common hepatic

134
Q

where does the splenic artery come from

A

the celiac trunk

135
Q

where does the pancreaticoduodenal artery come from

A

gastroduodenal

136
Q

what does the superior pancreaticoduodenal artery anastosmose with

A

the inferior pancreaticoduodenal artery

137
Q

where does the inferior pancreacticoduodenal artery come from

A

the superior mesenteric

138
Q

where does the superior mesenteric artery come from

A

aorta at L1

139
Q

where do the dorsal pancreatic arteries come from

A

splenic arteries

140
Q

why does the pancreas have high vasculature

A

due to its endocrine function

141
Q

where do the vasculature of the fore gut and mid gut combine

A

at the superior and inferior pancreaticoduodenal artery anastomoses

142
Q

what is a common cause of pain arising from the pancreas

A

secondary to pancreatitis

143
Q

what is a common cause of pancreatitis

A

blockage of the ampulla by a gallstone- bile is diverted into the pancreas leading to irritation and inflammation

144
Q

is the pancreas a fore or mid gut organ

A

both

145
Q

where can pain from the pancreas present

A

in the epigastric and/ or umbilical region- can also radiate through to patients back

146
Q

what can happen when acute pancreatitis causes vascular haemorrhage

A

blood/fluid accumulation in the retroperitoneal space

147
Q

how can pancreatitis cause vascular haemorrhage

A

digestive enzymes in blood stream from overfill of pancreatic juice in pancreatic duct

148
Q

what is an anatomical clinical sign of vascular haemorrhage due to acute pancreatitis

A

grey-turners sign (righto or left flanks)

cullens sign (around umbillicus)

149
Q

why is the umbillicus affected by acute pancreatitis

A

due to embryological remnant of round ligament- leads to falciform ligament

150
Q

what are the three parts of the small intestine

A

duodenum, jejunum, ilieum (DJ ileum)

151
Q

what parts of the small intestine are in the foregut

A

the 1st and second parts of the duodenum- rest mid gut organs

152
Q

where does the jejunum begin

A

at the duodenaljejunal flexure

153
Q

where does the ileum end

A

ileocaecal junction

154
Q

what are the difference between the jejunum and ileum

A

Colour
Jejunum is deep red
Ileum is lighter pink

Wall
Jejunum is thicker and heavy
Ileum is thinner and lighter

Vascularity
Jejunum is more vascular
Ileum is less vascular

Mesenteric Fat
Jejunum has less
Ileum has more

Circular Folds (L. plicae circularis)
Jejunum has large, tall and closely packed fold
Ileum has low and sparse folds (absent distally)

Lymphoid Tissue (Peyer’s Patches)
- Present in ileum
155
Q

why is the jejunum a darker colour than the ileum

A

as it is more vascularised

156
Q

what is a plicae

A

fold

157
Q

why is the jejunum more absorptive

A

as it has more folds

158
Q

what is the arterial supply to the jejunum and ileum

A

superior mesenteric arteries via jejunal and ileal arteries

159
Q

what is the venous drainage of the jejunum and ileum

A

jejunal and ileal veins to superior mesenteric vein

and to hepatic portal vein

160
Q

where do proteins and carbs go after they have been absorbed

A

from small intestine into the portal venous system to be taken to the liver

161
Q

where do vessels travel within to get to the small intestine

A

within the mesentery

162
Q

where does the SMA leave the aorta

A

L1

163
Q

what is the path of the SMA in relation to the pancreas

A

Posterior to the neck of the pancreas

Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper

164
Q

what helps in the absorption of fats from the GI tract lumen into the intestinal cells

A

bile

165
Q

where does fat go from the intestinal cells

A

Fats (within chylomicrons) are then absorbed from intestinal cells into specialised lymphatic vessels of the small intestine called lacteals

They travel via the lymphatic system to eventually drain into the venous system

166
Q

where does fat drain into the venous system

A

at the left venous angle

167
Q

alongside what do lymph vessels tend to lie alongside

A

arteries

168
Q

what is the group of lymph nodes for the foregut called

A

celiac

169
Q

what is the group of lymph nodes for the midgut called

A

superior mesenteric

170
Q

what is the group of lymph nodes for the hindgut called

A

inferior mesenteric

171
Q

what is the group of lymph nodes for the kidneys, posterior abdo wall, pelvis and lower limbs called

A

lumbar

172
Q

where do superficial lymph vessels drain into

A

deep lymph vessels

173
Q

Depending on where it originated from, lymph will either drain into where

A

Thoracic duct (from ¾ of body)
or
Right lymphatic duct (from ¼ of body)

174
Q

why and where does lymph drain into the venous system

A

It will eventually drain into venous system for ‘recycling’ at venous angles:

175
Q

where are the venous angles

A

junction between subclavian and internal jugular veins

176
Q

what does the left venous angle collect

A

thoracic duct drainage

177
Q

what does the right venous angle collect

A

right lymphatic duct drainage

GI (64 decks)

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