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Anatomy- Jaundice Flashcards

1
Q

jaundice definition

A

yellowing of the sclera (white of eyes) and skin

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2
Q

what causes jaundice?

A

an increase in the blood levels of bilirubin

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3
Q

bilirubin definition

A

normal by-product of the breakdown of red blood cells

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4
Q

where does breakdown of red blood cells (generating bilirubin) usually occur?

A

in the spleen

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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

liver

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7
Q

what happens once bile is formed?

A

it travels through the ‘biliary tree’

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8
Q

biliary tree

A

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

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9
Q

role of gall bladder

A

storage and concentration of bile

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10
Q

role of bile

A

important for the normal absorption of fats from the small intestine

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11
Q

what does the pancreas excrete?

A

digestive enzymes into the 2nd part of the duodenum

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12
Q

what does the liver receive?

A

nutrients absorbed from GI tract

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13
Q

functions of the liver

A

glycogen storage
bile secretion
other metabolic functions

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14
Q

surface anatomy of the liver

A

located mainly in the RUQ
protected by ribs 7-11
location changes in breathing

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15
Q

what are the 4 anatomical lobes of the liver?

A

right lobe
left lobe
caudate lobe
quadrate lobe

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16
Q

porta hepatis

A

site of entrance for portal triad structures

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17
Q

functional segments of the liver

A

I-VIII

allow for segmentectomy

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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)

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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

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20
Q

hepatic veins

A

direct deoxygenated blood from the liver and come together as 3 veins before entering IVC

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21
Q

what structure does the portal triad run within?

A

hepatoduodenal ligament

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22
Q

which ligaments does the lesser omentum contain?

A

hepatoduodenal lig.

hepatogastric lig.

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23
Q

portal triad

A

hepatic portal vein
hepatic artery proper
bile duct

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24
Q

coeliac trunk

A

first of 3 midline branches of the aorta
retroperitoneal
leaves aorta at T12 vertebral level

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25
Q

role of the coeliac trunk

A

supplies the organs of the foregut

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26
Q

3 branches of the coeliac trunk

A

splenic artery
left gastric artery
common hepatic artery

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27
Q

course of splenic artery

A

very tortuous

superior border of pancreas

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28
Q

location of spleen

A

intraperitoneal organ within left hypochondrium

moves with respiration

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29
Q

protection of spleen

A

ribs 9-11

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30
Q

spleen functions

A

within the haematological system

breaks down red blood cells to produce bilirubin

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31
Q

major blood supply of the stomach

A

right and left gastric arteries

right and left gastro-omental arteries

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32
Q

right and left gastric arteries

A

along junction of lesser curvature and lesser omentum

anastomose together

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33
Q

right and left gastro-omental arteries

A

along junction of greater curvature and greater omentum

anastomose together

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34
Q

minor blood supply to the stomach

A

posterior gastric arteries

short gastric arteries

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35
Q

blood supply to the liver

A

right and left hepatic arteries
branches of the hepatic artery proper
mostly hepatic portal vein
dual blood supply

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36
Q

recesses of the liver

A

hepatorenal recess
sub-phrenic recess
(both within the greater sac)

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37
Q

hepatorenal recess

A

between liver and right kidney

one of the lowest parts of the peritoneal cavity when the patient is supine

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38
Q

sub-phrenic recess

A

above the liver and below the lung

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39
Q

peritonitis

A

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

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40
Q

hepatic portal vein

A

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

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41
Q

what forms the hepatic portal vein?

A 
splenic vein (drains foregut)
superior mesenteric vein (midgut)
42
Q

inferior mesenteric vein

A

drains blood from the hindgut to the splenic vein

43
Q

inferior vena cava

A

retropritoneal

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

44
Q

portal triad structures (from anterior to posterior)

A

bile duct
hepatic artery proper
hepatic portal vein

45
Q

gall bladder location

A

foregut organ
on the posterior aspect of the liver (often firmly attached)
anterior to the duodenum

46
Q

function of the gall bladder

A

stores and concentrates bile in between meals

47
Q

how does bile flow in and out of the gall bladder?

A

via the cystic duct

48
Q

blood supply of the gall bladder

A

via the cystic artery
branch of right hepatic artery
located in the cystohepatic triangle (of calot)

49
Q

gall bladder pain cause

A

inflammation of the gall bladder or cystic duct from irritation or impaction of a gallstone

50
Q

gall bladder pain origin

A

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
Q

cholecystectomy

A

removal of the gall bladder

52
Q

biliary tree

A

made up of a number of ‘ducts’ which transport bile

53
Q

right and left hepatic ducts unite to form…

A

common hepatic duct

54
Q

common hepatic duct unites with cystic duct to form…

A

bile duct (common bile duct)

55
Q

where does the bile duct drain?

A

into the 2nd part of duodenum along with main pancreatic duct

56
Q

4 parts of duodenum

A
  1. superior (part intraperitoneal)- duodenal cap
  2. descending (retroperitoneal)
  3. horizontal (retroperitoneal)
  4. ascending (retroperitoneal)
57
Q

where does the duodenum begin?

A

pyloric sphincter

58
Q

where does the duodenum end?

A

duodenojejunal flexure

59
Q

role of duodenum

A

secretes a number of peptide hormones into the blood eg gastrin, CCK

60
Q

location of pain of the duodenum

A

epigastric

61
Q

location of pancreas

A

retroperitoneal organ

lies transversely across the posterior abdomen

62
Q

4 parts of pancreas

A

head (with uncinate process)
neck
body
tail

63
Q

association of pancreas with duodenum

A

the head of the pancreas is described as being surrounded by the ‘C shape’ of the duodenum

64
Q

function of exocrine pancreas

A

acinar cells release pancreatic digestive enzymes into the main pancreatic duct

65
Q

endocrine pancreas function

A

islets of langerhands release insulin and glucagon into the bloodstream

66
Q

location of bile duct

A

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
Q

joining of the bile duct with the main pancreatic duct

A

forms the ampulla of vater/ hepatopancreatic ampulla
widened part
both then drain into the 2nd part of the duodenum

68
Q

drainage of the biliary system sphincters

A

bile duct sphincter
pancreatic duct sphincter
sphincter of oddi

69
Q

ERCP

A

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
Q

what can cause obstruction of the biliary tree?

A

gallstones

carcinoma at head of pancreas

71
Q

what does an obstruction of the biliary tree result in?

A

flow of bile back up to the liver

overspill into the blood, of its constituents including bilirubin

72
Q

blood supply of the duodenum and pancreas

A

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
Q

where does the superior mesenteric artery come from?

A

from aorta at L1

74
Q

causes of pancreatic pain

secondary to inflammation-

A

pancreatitis

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

75
Q

cause of acute pancreatitis

A

gallstone obstruction leading to reflux of bile and pancreatic juice into the main pancreatic duct

76
Q

advanced case of acute pancreatitis

A

vascular haemorrhage can occur leading to blood/fluid accumulation in the retroperitoneal space

77
Q

grey-turner’s sign

A

right or left flanks

78
Q

cullen’s sign

A

around umbilicus via falciform

79
Q

location of small intestines in abdomen

A

1st and 2nd parts of the duodenum are foregut organs

the rest of the small intestines are midgut organs

80
Q

where does the jejunum begin?

A

duodenaljejunal flexure

81
Q

where does the ileum end?

A

ileocaecal junction

82
Q

differences in colour of jejunum and ileum

A 
jejunum= deep red
ileum= light pink
83
Q

differences in wall of jejunum and ileum

A 
jejunum= thicker and heavier
ileum= thinner and lighter
84
Q

differences in vascularity of jejunum and ileum

A 
jejunum = more vascular
ileum = less vascular
85
Q

differences in mesenteric fat of jejunum and ileum

A 
jejunum = less
ileum = more
86
Q

differences in circular folds of jejunum and ileum

A 
jejunum = large, tall and closely packed fold
ileum = low and sparse folds
87
Q

differences in lymphoid tissue of jejunum and ileum

A

ileum has peyer’s patches

88
Q

arterial blood supply of jejunum and ileum

A

superior mesenteric artery

via jejunul and ileal arteries

89
Q

venous drainage of jejunum and ileum

A

jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein

90
Q

absorption of proteins and carbs in the small intestine

A

absorbed into the portal venous system to be taken to the liver

91
Q

how do vessels travel to the small intestine?

A

within the mesentery

92
Q

superior mesenteric vessels

A

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
Q

absorption of fat

A

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
Q

lymphatics of the abdomen

A

Lymph vessels tend to lie alongside arteries

95
Q

drainage of lymph from the abdomen

A

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
Q

left venous angle

A

thoracic duct drainage

97
Q

right venous angle

A

right lymphatic duct drainage

98
Q

lymph nodes for foregut organs

A

coeliac

99
Q

lymph nodes for midgut organs

A

superior mesenteric

100
Q

lymph nodes for hindgut organs

A

inferior mesenteric

101
Q

lymph nodes for kidneys, posterior abdo wall, pelvis and lower limbs

A

lumbar

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