anatomy of jaundice Flashcards
bilrubin
normal by-product of the break-down of red blood cells mainly occurs in the spleen
used to form bile in the liver
bile
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
biliary tree
a set of tubes connecting the liver to the second part of the duodenum
bile travels through it
liver surface anatomy
largest organ in the body
located in RUG
protected by ribs 7-11
location changes in breathing
anatomical relations of the liver
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
role of the liver
receives nutrients absorbed in the GI tract functions involve -glucagon storage -bile secretion -other metabolic functions
role of pancreas
excretes digestive enzymes into the second part of the duodenum which is necessary for the digestion of food
clinically important areas of the peritoneal cavity
hepatorenal access (morrisons pouch) hepationeal recess
anatomy of the liver lobes and regions
4 anatomical lobes- visible with the naked eye
8 functional lobes- related to vasculatures and bile drainage
4 anatomical lobes
right lobe
left lobe
caudate lobe
quadrate lobe
porta hepatis
site of the portal triad entering the liver
functional segments of the liver
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
portal triad
hepatic portal vein
hepatic portal artery
bile duct
contains main structures that enter or leave the liver parenchyma
part of the lesser omentum
heptaduodenal and
hepatogastric
portal triad
vein-brings heptatic portal blood to liver
artery- blod from liver to duodenum
coeliac trunk
first of three midline branches of the aorta
retroperitineal
where does the coeliac trunk leave the aorta
at T12 vertebral level
function of coeliac trunk
supplies the organs of the foregut
what the coeliac trunk trifurcates to become
3 branches
splenic artery
left gastric artery
common hepatic artery
what does the common hepatic artery become
hepatic artery proper
spleen
superior border of the pancreas
splenic artery has very torturous course
spleen- type of organ
intraperitoneal organ within the left hypochondrium
clincical spleen
rib fracture could pierce the soft delicate spleen leading to substantial internal bleeding
anatomically spleen
Anatomically related to: Posteriorly - Diaphragm Anteriorly - Stomach Inferiorly - Splenic flexure Medially - Left kidney
Protected by ribs 9-11
functions of the spleen
functions within the haematological system
breaks down red blood cells to produce bilirubin
palpating the spleen
anatomically related to the diaphragm so moves with respiration
blood supply to 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
anatamose together
right and left gastric 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
dual blood supply
comes from the right and left hepatic artery
or from branches of the hepatic artery proper
most from hepatic portal vein
hepatic portal vein drainage
drains blood from forgeu midgut and hindgut to the liver for first pass metabolism (cleaning)
what forms the hepatic portal vein
splenic vein (drains forgut) superior mesenteric vein (midgut)
inferior mesenteric vein
drains the blood from the hindgut to the splenic vein
inferior vena cava
retroperitoneal
drains the cleaned blood from the hepatic veins into the right atrium
anatomy of the gall bladder
fundus
body
neck
where gallbladder found
lies on the posterior aspect of the liver- often firmly attatched
lies anteriour to the duodenum
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
blood supply for the gall bladder
via the cystic artery
how cystic artery located
branch of right hepatic artery in 75% if people
located in the cystohepatic triangle OF CALOT
where the cyctohepatic triangle located
cystic artery
common hepatic duct
cyctid duct
why gallbladder pain occurs
inflammation of the gallbladder or cyctic duct following impaction of a gallstone
if gall bladder bigger
touches the diaphragm
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
linking together the liver spleen gallbladder pancreas and small intestines
linked by the formaton of bilirubin then bile and the clinical condition of jaundice
jaundice (icterus)
yellowing of the sclera (white of eyes) and skin
caused by an increase in the blood levels of bilirubin
simple location of the spleen
posterior to the stomach
clinical note on IVC and hepatic veins
the lack valves
increase in central venous pressure is directed to the liver
what functional lobes allow for
segmentectomy
falfciform ligament
peritoneal thickening forming border between right and left liver lobe
liver lobule
portal triad on each corner and a central vein
triad of Glisson
portal triad
portal vein runs alongside the bile duct and hepatic artery surrounded by connective tissue
each segment
all functional as have their own individual vessels
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
what does the common hepatic artery branch into
hepatic artery proper
gastroduodenal artery
what does the gastroduodenal artery branch to become
supraduodenal artery
superior pancreatic duodenal
where right gastric artery comes from
heaptic artery proper
where left gastric artery comes from
hepatic artery proper
where right gastro-omental comes from
gastro-duodenal artery
where posterior gastric artery comes from
splenic artery
where short gastric artery comes from
from splenic artery
where left gastro-omental artery comes from
splenic proper
central vein
in centre of each liver lobule
collects cleaned blood and drains into the hepatic veins
role of bilary duct
bile formed in hepatocytes drains here
hepatocytesl
liver cells found in each portal triad
join sinusoids together
where hepatorenal recess and sub-phrenic recess located
within the greater sac
peritonitis
results in a collection of pus in the recesses of the liver leading to abscess formation
located the hepatorenal recess
one of the lowest parts of the peritoneal cavity when the patient is supine
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
where gallbladder located
it is a foregut organ
visceral afferents enter spinal cord between T6-T9
cholecystectomy
surgical removal of gallbladder
must correctly identify the cystic duct and cystic artery
variation can occur in both these strucutres
formation of the hepatic portal vein
formed by the
splenic vein (drains foregut)
superior mesenteric vein (midgut)
inferior mesenteric vein
drains blood from the hindgut to the splenic vein
inferior vena cave
retroperitineal
drains the clean blood from the hepatic vein into the right atrium
what causes jaundice
increase in the blood levels of bilirubin
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`
as cyctic duct joins the common hepatic duct
forms the bile duct
parts of the duodenum
gut tube starts off intraperitoneal
superior -part intraperitoneal
(duodenal cap relatively mobile)
descending (retroperitoneal)
horizontal (retroperitoneal)
ascending (retroperitoneal)
after a big meal
secretes a number of peptide hormones
gastrin CCK
what does CCK promote
gall bladder to contract
pushes bile through the biliary tree
how movement through duodenum occurs
begins at the pyloric sphincter
parasympathetic- smooth muscle relaxes, causes relaxation
sympathetic smooth muscle contracts, autonomic nerves
where duodenum ends ad begins
begins- pyloric sphincter
ends- duodenojejunal flexure
where pain from duodenal ulcer tends to present
epigastric region
what is the pyloric sphincter
anatomical sphincter controlling the flow of chime from stomach to duodenum
how pancreas and duodenum link
head of the pancreas is described as being surrounded by the C shape formed by the duodenum
what odes the pancreas contain
head (with uncinate process)
neck
body
tail
what is the pancreas
retroperitoneal organ that lies transversely across the posterior abdomen
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.
what lies anteriourly to the pancreas
stomach
what lies superopoateriourly to the pancreas
the splenic vessels- follow the tail you get to the spleen
what lies around the head of the pancreas
the duodenum
exocrine
ductal system
endocrine
a part of the vascular system
exocrine in pancreas
acinar cell Ipranceatic digestive enzymes into main pancreatic duct)
endocrine in pancreas
islets of Langerhans (insulin and glucagon into bloodstream)
main pancreatic duct
duct of wirsung
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
ERCP
investigation used to study the biliary tree and treat some pathologies associated with it
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
reasons for jaundice
obstruction of the biliary tree
posdt-hepatic jaundice- extra hepatic outer the liver obstructive cause of jaundice
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
anastamosis
dual blood supply
if one artery gets blocked, get blood from the other
where does anastomosis occur in duodenum and pancreas
superior pancreaticoduodenal artery
inferior pancreaticoduodenal artery
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
reasons for pancreatic pain
pancreatitis
cause of pancreatitis
blockage of the ampulla by a gallstone
bile then diverted into the pancreas leading to irritation and inflammation
acute pancreatitis
caused by gallstone obstruction leading to the reflux of bile and pancreatic juice in the main pancreatic duct
advanced acute pancreatitis
vascular haemorrhage can occur leading to blood/fluid accumulation in the retroperitineal space
grey-turners sign
right or left flanks
Cullen sign
around umbilicas via falciform ligament
beginning and end of different parts of small intestine
Jejunum begins at duodenaljejunal flexure
Ileum ends at ileocaecal junction
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)
arterial blood of jejenum and ileum
from the superior mesenteric artery
via jejunal and ileal arteries
venous drainage of jejenum and ileum
from the jejunal and ileal veins to superior mesentrin vein ‘
to hepatic portal vein
what happens to proteins and carbohydrates
absorbed from the small intestines into the portal venous system to be taken to the liver
where to vessels that supply jejunum and ileum travel
within the mesentry
where is superior mesenteric vessels
leaves the aorta at L1 vertebral level
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
absorption of fats
bile helps in absorbtion of fats from the GI lumen into the intestingal cells
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
