Anatomy- Jaundice Flashcards
jaundice definition
yellowing of the sclera (white of eyes) and skin
what causes jaundice?
an increase in the blood levels of bilirubin
bilirubin definition
normal by-product of the breakdown of red blood cells
where does breakdown of red blood cells (generating bilirubin) usually occur?
in the spleen
what is bilirubin used to form?
bile
where is bile formed?
liver
what happens once bile is formed?
it travels through the ‘biliary tree’
biliary tree
a set of tubes connecting the liver to the 2nd part of the duodenum
role of gall bladder
storage and concentration of bile
role of bile
important for the normal absorption of fats from the small intestine
what does the pancreas excrete?
digestive enzymes into the 2nd part of the duodenum
what does the liver receive?
nutrients absorbed from GI tract
functions of the liver
glycogen storage
bile secretion
other metabolic functions
surface anatomy of the liver
located mainly in the RUQ
protected by ribs 7-11
location changes in breathing
what are the 4 anatomical lobes of the liver?
right lobe
left lobe
caudate lobe
quadrate lobe
porta hepatis
site of entrance for portal triad structures
functional segments of the liver
I-VIII
allow for segmentectomy
what does each functional segment have?
branch of hepatic artery
branch of hepatic portal vein
bile drainage (to bile duct)
venous drainage (to IVC)
what is special about IVC and hepatic veins?
they lack valves so increase in central venous pressure is directed to the liver
hepatic veins
direct deoxygenated blood from the liver and come together as 3 veins before entering IVC
what structure does the portal triad run within?
hepatoduodenal ligament
which ligaments does the lesser omentum contain?
hepatoduodenal lig.
hepatogastric lig.
portal triad
hepatic portal vein
hepatic artery proper
bile duct
coeliac trunk
first of 3 midline branches of the aorta
retroperitoneal
leaves aorta at T12 vertebral level
role of the coeliac trunk
supplies the organs of the foregut
3 branches of the coeliac trunk
splenic artery
left gastric artery
common hepatic artery
course of splenic artery
very tortuous
superior border of pancreas
location of spleen
intraperitoneal organ within left hypochondrium
moves with respiration
protection of spleen
ribs 9-11
spleen functions
within the haematological system
breaks down red blood cells to produce bilirubin
major blood supply of the stomach
right and left gastric arteries
right and left gastro-omental arteries
right and left gastric arteries
along junction of lesser curvature and lesser omentum
anastomose together
right and left gastro-omental arteries
along junction of greater curvature and greater omentum
anastomose together
minor blood supply to the stomach
posterior gastric arteries
short gastric arteries
blood supply to the liver
right and left hepatic arteries
branches of the hepatic artery proper
mostly hepatic portal vein
dual blood supply
recesses of the liver
hepatorenal recess
sub-phrenic recess
(both within the greater sac)
hepatorenal recess
between liver and right kidney
one of the lowest parts of the peritoneal cavity when the patient is supine
sub-phrenic recess
above the liver and below the lung
peritonitis
can result in a collection of pus in these recesses leading to an abscess formation
hepatic portal vein
drains blood from foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
what forms the hepatic portal vein?
splenic vein (drains foregut) superior mesenteric vein (midgut)
inferior mesenteric vein
drains blood from the hindgut to the splenic vein
inferior vena cava
retropritoneal
drains the cleaned blood from the hepatic veins into the right atrium
portal triad structures (from anterior to posterior)
bile duct
hepatic artery proper
hepatic portal vein
gall bladder location
foregut organ
on the posterior aspect of the liver (often firmly attached)
anterior to the duodenum
function of the gall bladder
stores and concentrates bile in between meals
how does bile flow in and out of the gall bladder?
via the cystic duct
blood supply of the gall bladder
via the cystic artery
branch of right hepatic artery
located in the cystohepatic triangle (of calot)
gall bladder pain cause
inflammation of the gall bladder or cystic duct from irritation or impaction of a gallstone
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
cholecystectomy
removal of the gall bladder
biliary tree
made up of a number of ‘ducts’ which transport bile
right and left hepatic ducts unite to form…
common hepatic duct
common hepatic duct unites with cystic duct to form…
bile duct (common bile duct)
where does the bile duct drain?
into the 2nd part of duodenum along with main pancreatic duct
4 parts of duodenum
- superior (part intraperitoneal)- duodenal cap
- descending (retroperitoneal)
- horizontal (retroperitoneal)
- ascending (retroperitoneal)
where does the duodenum begin?
pyloric sphincter
where does the duodenum end?
duodenojejunal flexure
role of duodenum
secretes a number of peptide hormones into the blood eg gastrin, CCK
location of pain of the duodenum
epigastric
location of pancreas
retroperitoneal organ
lies transversely across the posterior abdomen
4 parts of pancreas
head (with uncinate process)
neck
body
tail
association of pancreas with duodenum
the head of the pancreas is described as being surrounded by the ‘C shape’ of the duodenum
function of exocrine pancreas
acinar cells release pancreatic digestive enzymes into the main pancreatic duct
endocrine pancreas function
islets of langerhands release insulin and glucagon into the bloodstream
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
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
drainage of the biliary system sphincters
bile duct sphincter
pancreatic duct sphincter
sphincter of oddi
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
what can cause obstruction of the biliary tree?
gallstones
carcinoma at head of pancreas
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
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
where does the superior mesenteric artery come from?
from aorta at L1
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
cause of acute pancreatitis
gallstone obstruction leading to reflux of bile and pancreatic juice into the main pancreatic duct
advanced case of acute pancreatitis
vascular haemorrhage can occur leading to blood/fluid accumulation in the retroperitoneal space
grey-turner’s sign
right or left flanks
cullen’s sign
around umbilicus via falciform
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
where does the jejunum begin?
duodenaljejunal flexure
where does the ileum end?
ileocaecal junction
differences in colour of jejunum and ileum
jejunum= deep red ileum= light pink
differences in wall of jejunum and ileum
jejunum= thicker and heavier ileum= thinner and lighter
differences in vascularity of jejunum and ileum
jejunum = more vascular ileum = less vascular
differences in mesenteric fat of jejunum and ileum
jejunum = less ileum = more
differences in circular folds of jejunum and ileum
jejunum = large, tall and closely packed fold ileum = low and sparse folds
differences in lymphoid tissue of jejunum and ileum
ileum has peyer’s patches
arterial blood supply of jejunum and ileum
superior mesenteric artery
via jejunul and ileal arteries
venous drainage of jejunum and ileum
jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein
absorption of proteins and carbs in the small intestine
absorbed into the portal venous system to be taken to the liver
how do vessels travel to the small intestine?
within the mesentery
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
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
lymphatics of the abdomen
Lymph vessels tend to lie alongside arteries
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
left venous angle
thoracic duct drainage
right venous angle
right lymphatic duct drainage
lymph nodes for foregut organs
coeliac
lymph nodes for midgut organs
superior mesenteric
lymph nodes for hindgut organs
inferior mesenteric
lymph nodes for kidneys, posterior abdo wall, pelvis and lower limbs
lumbar
