anatomy of jaundice Flashcards
1
Q
bilrubin
A
normal by-product of the break-down of red blood cells mainly occurs in the spleen
used to form bile in the liver
2
Q
bile
A
bile is important for the normal absorption of fats from the small intestine
it travels through the biliary tree
it is stored and concentrated in the gall bladder
3
Q
biliary tree
A
a set of tubes connecting the liver to the second part of the duodenum
bile travels through it
4
Q
liver surface anatomy
A
largest organ in the body
located in RUG
protected by ribs 7-11
location changes in breathing
5
Q
anatomical relations of the liver
A
Inferior to the right hemi-diaphragm Gallbladder – Posterior and inferior Hepatic flexure – Inferior Right kidney, Right adrenal gland, IVC, Abdominal aorta – Posterior Stomach – Posterior at mid/left side
6
Q
role of the liver
A
receives nutrients absorbed in the GI tract functions involve -glucagon storage -bile secretion -other metabolic functions
7
Q
role of pancreas
A
excretes digestive enzymes into the second part of the duodenum which is necessary for the digestion of food
8
Q
clinically important areas of the peritoneal cavity
A
hepatorenal access (morrisons pouch) hepationeal recess
9
Q
anatomy of the liver lobes and regions
A
4 anatomical lobes- visible with the naked eye
8 functional lobes- related to vasculatures and bile drainage
10
Q
4 anatomical lobes
A
right lobe
left lobe
caudate lobe
quadrate lobe
11
Q
porta hepatis
A
site of the portal triad entering the liver
12
Q
functional segments of the liver
A
each segment has a branch of a hepatic artery branch of a hepatic portal vein bile drainage to bile duct venous drainage to inferior vena cave
13
Q
portal triad
A
hepatic portal vein
hepatic portal artery
bile duct
contains main structures that enter or leave the liver parenchyma
14
Q
part of the lesser omentum
A
heptaduodenal and
hepatogastric
15
Q
portal triad
A
vein-brings heptatic portal blood to liver
artery- blod from liver to duodenum
16
Q
coeliac trunk
A
first of three midline branches of the aorta
retroperitineal
17
Q
where does the coeliac trunk leave the aorta
A
at T12 vertebral level
18
Q
function of coeliac trunk
A
supplies the organs of the foregut
19
Q
what the coeliac trunk trifurcates to become
A
3 branches
splenic artery
left gastric artery
common hepatic artery
20
Q
what does the common hepatic artery become
A
hepatic artery proper
21
Q
spleen
A
superior border of the pancreas
splenic artery has very torturous course
22
Q
spleen- type of organ
A
intraperitoneal organ within the left hypochondrium
23
Q
clincical spleen
A
rib fracture could pierce the soft delicate spleen leading to substantial internal bleeding
24
Q
anatomically spleen
A
Anatomically related to: Posteriorly - Diaphragm Anteriorly - Stomach Inferiorly - Splenic flexure Medially - Left kidney
Protected by ribs 9-11
25
functions of the spleen
functions within the haematological system
| breaks down red blood cells to produce bilirubin
26
palpating the spleen
anatomically related to the diaphragm so moves with respiration
27
blood supply to the stomach
right and left gastric arteries
right and left gastro-omental arteries
28
right and left gastric arteries
along junction of lesser curvature and lesser omentum
| anatamose together
29
right and left gastric omental arteries
Along junction of greater curvature and greater omentum
| Anastomose together
30
minor blood supply to the stomach
posterior gastric arteries
| short gastric arteries
31
blood supply to the liver
dual blood supply
comes from the right and left hepatic artery
or from branches of the hepatic artery proper
most from hepatic portal vein
32
hepatic portal vein drainage
drains blood from forgeu midgut and hindgut to the liver for first pass metabolism (cleaning)
33
what forms the hepatic portal vein
```
splenic vein (drains forgut)
superior mesenteric vein (midgut)
```
34
inferior mesenteric vein
drains the blood from the hindgut to the splenic vein
35
inferior vena cava
retroperitoneal
| drains the cleaned blood from the hepatic veins into the right atrium
36
anatomy of the gall bladder
fundus
body
neck
37
where gallbladder found
lies on the posterior aspect of the liver- often firmly attatched
lies anteriour to the duodenum
38
function of the gall bladder
stores and concentrates bile inbetween meals
narrowing is potential site for gallstone impactions
bile flows in and out of the gallbladder via the cystic duct
39
blood supply for the gall bladder
via the cystic artery
40
how cystic artery located
branch of right hepatic artery in 75% if people
| located in the cystohepatic triangle OF CALOT
41
where the cyctohepatic triangle located
cystic artery
common hepatic duct
cyctid duct
42
why gallbladder pain occurs
inflammation of the gallbladder or cyctic duct following impaction of a gallstone
43
if gall bladder bigger
touches the diaphragm
44
where gall bladder pain located
early pain in epigastric region
pain can also present in the hypochondrium
with/without pain referral to the right shoulder- result of anterior diaphragmatic irritation
45
linking together the liver spleen gallbladder pancreas and small intestines
linked by the formaton of bilirubin then bile and the clinical condition of jaundice
46
jaundice (icterus)
yellowing of the sclera (white of eyes) and skin
| caused by an increase in the blood levels of bilirubin
47
simple location of the spleen
posterior to the stomach
48
clinical note on IVC and hepatic veins
the lack valves
| increase in central venous pressure is directed to the liver
49
what functional lobes allow for
segmentectomy
50
falfciform ligament
peritoneal thickening forming border between right and left liver lobe
51
liver lobule
portal triad on each corner and a central vein
52
triad of Glisson
| portal triad
portal vein runs alongside the bile duct and hepatic artery surrounded by connective tissue
53
each segment
all functional as have their own individual vessels
54
what happens to the hepatic veins
they direct deoxygenated blood from the liver and come together as 3 veins before entering the inferior vena cave
55
what does the common hepatic artery branch into
hepatic artery proper
| gastroduodenal artery
56
what does the gastroduodenal artery branch to become
supraduodenal artery
| superior pancreatic duodenal
57
where right gastric artery comes from
heaptic artery proper
58
where left gastric artery comes from
hepatic artery proper
59
where right gastro-omental comes from
gastro-duodenal artery
60
where posterior gastric artery comes from
splenic artery
61
where short gastric artery comes from
from splenic artery
62
where left gastro-omental artery comes from
splenic proper
63
central vein
in centre of each liver lobule
collects cleaned blood and drains into the hepatic veins
64
role of bilary duct
bile formed in hepatocytes drains here
65
hepatocytesl
liver cells found in each portal triad
| join sinusoids together
66
where hepatorenal recess and sub-phrenic recess located
within the greater sac
67
peritonitis
results in a collection of pus in the recesses of the liver leading to abscess formation
68
located the hepatorenal recess
one of the lowest parts of the peritoneal cavity when the patient is supine
69
abscesses in the recesses of the liver
pus from an absess in the sub-phrenic recess can drain into the hepatorenal recess when a patient is bedridden
70
where gallbladder located
it is a foregut organ
| visceral afferents enter spinal cord between T6-T9
71
cholecystectomy
surgical removal of gallbladder
must correctly identify the cystic duct and cystic artery
variation can occur in both these strucutres
72
formation of the hepatic portal vein
formed by the
splenic vein (drains foregut)
superior mesenteric vein (midgut)
73
inferior mesenteric vein
drains blood from the hindgut to the splenic vein
74
inferior vena cave
retroperitineal
| drains the clean blood from the hepatic vein into the right atrium
75
what causes jaundice
increase in the blood levels of bilirubin
76
what forms the common hepatic duct`
the union of the left hepatic duct and the right hepatic duct, joinging of the left and right side of the lung`
77
as cyctic duct joins the common hepatic duct
forms the bile duct
78
parts of the duodenum
gut tube starts off intraperitoneal
superior -part intraperitoneal
(duodenal cap relatively mobile)
descending (retroperitoneal)
horizontal (retroperitoneal)
ascending (retroperitoneal)
79
after a big meal
secretes a number of peptide hormones
| gastrin CCK
80
what does CCK promote
gall bladder to contract
pushes bile through the biliary tree
81
how movement through duodenum occurs
begins at the pyloric sphincter
parasympathetic- smooth muscle relaxes, causes relaxation
sympathetic smooth muscle contracts, autonomic nerves
82
where duodenum ends ad begins
begins- pyloric sphincter
ends- duodenojejunal flexure
83
where pain from duodenal ulcer tends to present
epigastric region
84
what is the pyloric sphincter
anatomical sphincter controlling the flow of chime from stomach to duodenum
85
how pancreas and duodenum link
head of the pancreas is described as being surrounded by the C shape formed by the duodenum
86
what odes the pancreas contain
head (with uncinate process)
neck
body
tail
87
what is the pancreas
retroperitoneal organ that lies transversely across the posterior abdomen
88
what lies posteriorly to the pancreas
```
Right kidney & adrenal gland
IVC
Bile duct
Abdominal aorta
Superior mesenteric vessels
Left kidney & adrenal gland
Part of the portal venous system.
```
89
what lies anteriourly to the pancreas
stomach
90
what lies superopoateriourly to the pancreas
the splenic vessels- follow the tail you get to the spleen
91
what lies around the head of the pancreas
the duodenum
92
exocrine
ductal system
93
endocrine
a part of the vascular system
94
exocrine in pancreas
acinar cell Ipranceatic digestive enzymes into main pancreatic duct)
95
endocrine in pancreas
islets of Langerhans (insulin and glucagon into bloodstream)
96
main pancreatic duct
duct of wirsung
97
drainage of the biliary duct
the bile duct descends posteriourly to the 1st superior part of the duodenum
then travels into a groove on the posterior aspect of the pancreas
then joins with the main pancreatic duct
wider part
both then drain into second part of duodenum
98
ERCP
investigation used to study the biliary tree and treat some pathologies associated with it
99
how ERCP carried out
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
100
reasons for jaundice
obstruction of the biliary tree
posdt-hepatic jaundice- extra hepatic outer the liver obstructive cause of jaundice
101
what causes obstruction of the biliary tree
gallstones
carcinoma at head of pancreas
causes flow of the bile back up to the liver
overspill into the blood of its constituents including bilirubiin
102
anastamosis
dual blood supply
if one artery gets blocked, get blood from the other
103
where does anastomosis occur in duodenum and pancreas
superior pancreaticoduodenal artery
inferior pancreaticoduodenal artery
104
where pain from pancreas felt
it is a forgut and midgut organ
pain presents in the epigastric and or umbilical region
can also radiate through patients back
105
reasons for pancreatic pain
pancreatitis
106
cause of pancreatitis
blockage of the ampulla by a gallstone
| bile then diverted into the pancreas leading to irritation and inflammation
107
acute pancreatitis
caused by gallstone obstruction leading to the reflux of bile and pancreatic juice in the main pancreatic duct
108
advanced acute pancreatitis
vascular haemorrhage can occur leading to blood/fluid accumulation in the retroperitineal space
109
grey-turners sign
right or left flanks
110
Cullen sign
around umbilicas via falciform ligament
111
beginning and end of different parts of small intestine
Jejunum begins at duodenaljejunal flexure
| Ileum ends at ileocaecal junction
112
differences in jejunum and ileum
colour (J=red, I= Lighter pink)
wall-(J=thicker and heavy, I- thinner and lighter)
vascularity (J more vascular than I
mesenteric fat (J= less, I=more)
circular folds (J=large tall and closely packed, I= low sparse folds
lymphoid tissues (present in ileum)
113
arterial blood of jejenum and ileum
from the superior mesenteric artery
| via jejunal and ileal arteries
114
venous drainage of jejenum and ileum
from the jejunal and ileal veins to superior mesentrin vein '
to hepatic portal vein
115
what happens to proteins and carbohydrates
absorbed from the small intestines into the portal venous system to be taken to the liver
116
where to vessels that supply jejunum and ileum travel
within the mesentry
117
where is superior mesenteric vessels
leaves the aorta at L1 vertebral level
118
where superior mesenteric vessel found
Posterior to the neck of the pancreas
| Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper
119
absorption of fats
bile helps in absorbtion of fats from the GI lumen into the intestingal cells
120
how fats actually absorbed
fats (within chylomicrons) are absorbed from intestinal cells into specialised lymphatic vessels of the small intestine called lacteals
they drain via the lymphatic system to eventually drain into the venous system at the left venous angle
