Anatomy- Jaundice Flashcards
1
Q
jaundice definition
A
yellowing of the sclera (white of eyes) and skin
2
Q
what causes jaundice?
A
an increase in the blood levels of bilirubin
3
Q
bilirubin definition
A
normal by-product of the breakdown of red blood cells
4
Q
where does breakdown of red blood cells (generating bilirubin) usually occur?
A
in the spleen
5
Q
what is bilirubin used to form?
A
bile
6
Q
where is bile formed?
A
liver
7
Q
what happens once bile is formed?
A
it travels through the ‘biliary tree’
8
Q
biliary tree
A
a set of tubes connecting the liver to the 2nd part of the duodenum
9
Q
role of gall bladder
A
storage and concentration of bile
10
Q
role of bile
A
important for the normal absorption of fats from the small intestine
11
Q
what does the pancreas excrete?
A
digestive enzymes into the 2nd part of the duodenum
12
Q
what does the liver receive?
A
nutrients absorbed from GI tract
13
Q
functions of the liver
A
glycogen storage
bile secretion
other metabolic functions
14
Q
surface anatomy of the liver
A
located mainly in the RUQ
protected by ribs 7-11
location changes in breathing
15
Q
what are the 4 anatomical lobes of the liver?
A
right lobe
left lobe
caudate lobe
quadrate lobe
16
Q
porta hepatis
A
site of entrance for portal triad structures
17
Q
functional segments of the liver
A
I-VIII
allow for segmentectomy
18
Q
what does each functional segment have?
A
branch of hepatic artery
branch of hepatic portal vein
bile drainage (to bile duct)
venous drainage (to IVC)
19
Q
what is special about IVC and hepatic veins?
A
they lack valves so increase in central venous pressure is directed to the liver
20
Q
hepatic veins
A
direct deoxygenated blood from the liver and come together as 3 veins before entering IVC
21
Q
what structure does the portal triad run within?
A
hepatoduodenal ligament
22
Q
which ligaments does the lesser omentum contain?
A
hepatoduodenal lig.
hepatogastric lig.
23
Q
portal triad
A
hepatic portal vein
hepatic artery proper
bile duct
24
Q
coeliac trunk
A
first of 3 midline branches of the aorta
retroperitoneal
leaves aorta at T12 vertebral level
25
role of the coeliac trunk
supplies the organs of the foregut
26
3 branches of the coeliac trunk
splenic artery
left gastric artery
common hepatic artery
27
course of splenic artery
very tortuous
| superior border of pancreas
28
location of spleen
intraperitoneal organ within left hypochondrium
| moves with respiration
29
protection of spleen
ribs 9-11
30
spleen functions
within the haematological system
| breaks down red blood cells to produce bilirubin
31
major blood supply of the stomach
right and left gastric arteries
| right and left gastro-omental arteries
32
right and left gastric arteries
along junction of lesser curvature and lesser omentum
| anastomose together
33
right and left gastro-omental arteries
along junction of greater curvature and greater omentum
| anastomose together
34
minor blood supply to the stomach
posterior gastric arteries
| short gastric arteries
35
blood supply to the liver
right and left hepatic arteries
branches of the hepatic artery proper
mostly hepatic portal vein
dual blood supply
36
recesses of the liver
hepatorenal recess
sub-phrenic recess
(both within the greater sac)
37
hepatorenal recess
between liver and right kidney
| one of the lowest parts of the peritoneal cavity when the patient is supine
38
sub-phrenic recess
above the liver and below the lung
39
peritonitis
can result in a collection of pus in these recesses leading to an abscess formation
40
hepatic portal vein
drains blood from foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
41
what forms the hepatic portal vein?
```
splenic vein (drains foregut)
superior mesenteric vein (midgut)
```
42
inferior mesenteric vein
drains blood from the hindgut to the splenic vein
43
inferior vena cava
retropritoneal
| drains the cleaned blood from the hepatic veins into the right atrium
44
portal triad structures (from anterior to posterior)
bile duct
hepatic artery proper
hepatic portal vein
45
gall bladder location
foregut organ
on the posterior aspect of the liver (often firmly attached)
anterior to the duodenum
46
function of the gall bladder
stores and concentrates bile in between meals
47
how does bile flow in and out of the gall bladder?
via the cystic duct
48
blood supply of the gall bladder
via the cystic artery
branch of right hepatic artery
located in the cystohepatic triangle (of calot)
49
gall bladder pain cause
inflammation of the gall bladder or cystic duct from irritation or impaction of a gallstone
50
gall bladder pain origin
visceral afferents enter spinal cord between T6-T9
epigastric region pain
hypocondrium pain sometimes with or without pain referral to the right shoulder as a result of anterior diaphragmatic irritation
51
cholecystectomy
removal of the gall bladder
52
biliary tree
made up of a number of 'ducts' which transport bile
53
right and left hepatic ducts unite to form...
common hepatic duct
54
common hepatic duct unites with cystic duct to form...
bile duct (common bile duct)
55
where does the bile duct drain?
into the 2nd part of duodenum along with main pancreatic duct
56
4 parts of duodenum
1. superior (part intraperitoneal)- duodenal cap
2. descending (retroperitoneal)
3. horizontal (retroperitoneal)
4. ascending (retroperitoneal)
57
where does the duodenum begin?
pyloric sphincter
58
where does the duodenum end?
duodenojejunal flexure
59
role of duodenum
secretes a number of peptide hormones into the blood eg gastrin, CCK
60
location of pain of the duodenum
epigastric
61
location of pancreas
retroperitoneal organ
| lies transversely across the posterior abdomen
62
4 parts of pancreas
head (with uncinate process)
neck
body
tail
63
association of pancreas with duodenum
the head of the pancreas is described as being surrounded by the 'C shape' of the duodenum
64
function of exocrine pancreas
acinar cells release pancreatic digestive enzymes into the main pancreatic duct
65
endocrine pancreas function
islets of langerhands release insulin and glucagon into the bloodstream
66
location of bile duct
descends posteriorly to the 1st part of the duodenum
then travels into a groove on the posterior part of the pancreas
it then joins with the main pancreatic duct
67
joining of the bile duct with the main pancreatic duct
forms the ampulla of vater/ hepatopancreatic ampulla
widened part
both then drain into the 2nd part of the duodenum
68
drainage of the biliary system sphincters
bile duct sphincter
pancreatic duct sphincter
sphincter of oddi
69
ERCP
Investigation used to study the biliary tree and pancreas and treat some pathologies associated with it
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
70
what can cause obstruction of the biliary tree?
gallstones
| carcinoma at head of pancreas
71
what does an obstruction of the biliary tree result in?
flow of bile back up to the liver
| overspill into the blood, of its constituents including bilirubin
72
blood supply of the duodenum and pancreas
gastroduodenal artery (from common hepatic)
splenic artery (from celiac trunk)
dorsal pancreatic arteries
superior pancretaicoduodenal artery (from gastroduodenal)
inferior pancreaticoduodenal artery (from superior mesenteric)
superior mesenteric artery
73
where does the superior mesenteric artery come from?
from aorta at L1
74
causes of pancreatic pain
| secondary to inflammation-
pancreatitis
| blockage of the ampulla by a gallstone as bile is then diverted into the pancreas leading to irritation and inflammation
75
cause of acute pancreatitis
gallstone obstruction leading to reflux of bile and pancreatic juice into the main pancreatic duct
76
advanced case of acute pancreatitis
vascular haemorrhage can occur leading to blood/fluid accumulation in the retroperitoneal space
77
grey-turner's sign
right or left flanks
78
cullen's sign
around umbilicus via falciform
79
location of small intestines in abdomen
1st and 2nd parts of the duodenum are foregut organs
| the rest of the small intestines are midgut organs
80
where does the jejunum begin?
duodenaljejunal flexure
81
where does the ileum end?
ileocaecal junction
82
differences in colour of jejunum and ileum
```
jejunum= deep red
ileum= light pink
```
83
differences in wall of jejunum and ileum
```
jejunum= thicker and heavier
ileum= thinner and lighter
```
84
differences in vascularity of jejunum and ileum
```
jejunum = more vascular
ileum = less vascular
```
85
differences in mesenteric fat of jejunum and ileum
```
jejunum = less
ileum = more
```
86
differences in circular folds of jejunum and ileum
```
jejunum = large, tall and closely packed fold
ileum = low and sparse folds
```
87
differences in lymphoid tissue of jejunum and ileum
ileum has peyer's patches
88
arterial blood supply of jejunum and ileum
superior mesenteric artery
| via jejunul and ileal arteries
89
venous drainage of jejunum and ileum
jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein
90
absorption of proteins and carbs in the small intestine
absorbed into the portal venous system to be taken to the liver
91
how do vessels travel to the small intestine?
within the mesentery
92
superior mesenteric vessels
leaves the aorta at L1 vertebral level
posterior to the neck of the pancreas
travels inferiorly, anterior to the uncinate process of pancreas to enter the mesentery proper
93
absorption of fat
Bile helps in the absorption of fats from the GI tract lumen into the intestinal cells
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
At the left venous angle
94
lymphatics of the abdomen
Lymph vessels tend to lie alongside arteries
95
drainage of lymph from the abdomen
Superficial lymph vessels drains into deep lymph vessels
Depending on where it originated from, lymph will either drain into:
Thoracic duct (from ¾ of body)
or
Right lymphatic duct (from ¼ of body)
It will eventually drain into venous system for ‘recycling’ at venous angles:
Junction between subclavian and internal jugular veins
96
left venous angle
thoracic duct drainage
97
right venous angle
right lymphatic duct drainage
98
lymph nodes for foregut organs
coeliac
99
lymph nodes for midgut organs
superior mesenteric
100
lymph nodes for hindgut organs
inferior mesenteric
101
lymph nodes for kidneys, posterior abdo wall, pelvis and lower limbs
lumbar
