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GI > anatomy of jaundice > Flashcards

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

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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

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3
Q

biliary tree

A

a set of tubes connecting the liver to the second part of the duodenum

bile travels through it

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4
Q

liver surface anatomy

A

largest organ in the body
located in RUG
protected by ribs 7-11
location changes in breathing

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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
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6
Q

role of the liver

A 
receives nutrients absorbed in the GI tract
functions involve
-glucagon storage
-bile secretion
-other metabolic functions
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7
Q

role of pancreas

A

excretes digestive enzymes into the second part of the duodenum which is necessary for the digestion of food

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8
Q

clinically important areas of the peritoneal cavity

A 
hepatorenal access (morrisons pouch)
hepationeal recess
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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

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10
Q

4 anatomical lobes

A

right lobe
left lobe
caudate lobe
quadrate lobe

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11
Q

porta hepatis

A

site of the portal triad entering the liver

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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
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13
Q

portal triad

A

hepatic portal vein
hepatic portal artery
bile duct
contains main structures that enter or leave the liver parenchyma

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14
Q

part of the lesser omentum

A

heptaduodenal and

hepatogastric

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15
Q

portal triad

A

vein-brings heptatic portal blood to liver

artery- blod from liver to duodenum

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16
Q

coeliac trunk

A

first of three midline branches of the aorta

retroperitineal

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17
Q

where does the coeliac trunk leave the aorta

A

at T12 vertebral level

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18
Q

function of coeliac trunk

A

supplies the organs of the foregut

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19
Q

what the coeliac trunk trifurcates to become

A

3 branches
splenic artery
left gastric artery
common hepatic artery

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20
Q

what does the common hepatic artery become

A

hepatic artery proper

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21
Q

spleen

A

superior border of the pancreas

splenic artery has very torturous course

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22
Q

spleen- type of organ

A

intraperitoneal organ within the left hypochondrium

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23
Q

clincical spleen

A

rib fracture could pierce the soft delicate spleen leading to substantial internal bleeding

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24
Q

anatomically spleen

A 
Anatomically related to:
Posteriorly - Diaphragm 
Anteriorly - Stomach 
Inferiorly - Splenic flexure 
Medially - Left kidney

Protected by ribs 9-11

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25
Q

functions of the spleen

A

functions within the haematological system

breaks down red blood cells to produce bilirubin

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26
Q

palpating the spleen

A

anatomically related to the diaphragm so moves with respiration

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27
Q

blood supply to the stomach

A

right and left gastric arteries

right and left gastro-omental arteries

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28
Q

right and left gastric arteries

A

along junction of lesser curvature and lesser omentum

anatamose together

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29
Q

right and left gastric omental arteries

A

Along junction of greater curvature and greater omentum

Anastomose together

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30
Q

minor blood supply to the stomach

A

posterior gastric arteries

short gastric arteries

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31
Q

blood supply to the liver

A

dual blood supply
comes from the right and left hepatic artery

or from branches of the hepatic artery proper

most from hepatic portal vein

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32
Q

hepatic portal vein drainage

A

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

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33
Q

what forms the hepatic portal vein

A 
splenic vein (drains forgut)
superior mesenteric vein (midgut)
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34
Q

inferior mesenteric vein

A

drains the blood from the hindgut to the splenic vein

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35
Q

inferior vena cava

A

retroperitoneal

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

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36
Q

anatomy of the gall bladder

A

fundus
body
neck

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37
Q

where gallbladder found

A

lies on the posterior aspect of the liver- often firmly attatched
lies anteriour to the duodenum

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38
Q

function of the gall bladder

A

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

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39
Q

blood supply for the gall bladder

A

via the cystic artery

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40
Q

how cystic artery located

A

branch of right hepatic artery in 75% if people

located in the cystohepatic triangle OF CALOT

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41
Q

where the cyctohepatic triangle located

A

cystic artery
common hepatic duct
cyctid duct

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42
Q

why gallbladder pain occurs

A

inflammation of the gallbladder or cyctic duct following impaction of a gallstone

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43
Q

if gall bladder bigger

A

touches the diaphragm

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44
Q

where gall bladder pain located

A

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

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45
Q

linking together the liver spleen gallbladder pancreas and small intestines

A

linked by the formaton of bilirubin then bile and the clinical condition of jaundice

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46
Q

jaundice (icterus)

A

yellowing of the sclera (white of eyes) and skin

caused by an increase in the blood levels of bilirubin

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47
Q

simple location of the spleen

A

posterior to the stomach

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48
Q

clinical note on IVC and hepatic veins

A

the lack valves

increase in central venous pressure is directed to the liver

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49
Q

what functional lobes allow for

A

segmentectomy

50
Q

falfciform ligament

A

peritoneal thickening forming border between right and left liver lobe

51
Q

liver lobule

A

portal triad on each corner and a central vein

52
Q

triad of Glisson

portal triad

A

portal vein runs alongside the bile duct and hepatic artery surrounded by connective tissue

53
Q

each segment

A

all functional as have their own individual vessels

54
Q

what happens to the hepatic veins

A

they direct deoxygenated blood from the liver and come together as 3 veins before entering the inferior vena cave

55
Q

what does the common hepatic artery branch into

A

hepatic artery proper

gastroduodenal artery

56
Q

what does the gastroduodenal artery branch to become

A

supraduodenal artery

superior pancreatic duodenal

57
Q

where right gastric artery comes from

A

heaptic artery proper

58
Q

where left gastric artery comes from

A

hepatic artery proper

59
Q

where right gastro-omental comes from

A

gastro-duodenal artery

60
Q

where posterior gastric artery comes from

A

splenic artery

61
Q

where short gastric artery comes from

A

from splenic artery

62
Q

where left gastro-omental artery comes from

A

splenic proper

63
Q

central vein

A

in centre of each liver lobule

collects cleaned blood and drains into the hepatic veins

64
Q

role of bilary duct

A

bile formed in hepatocytes drains here

65
Q

hepatocytesl

A

liver cells found in each portal triad

join sinusoids together

66
Q

where hepatorenal recess and sub-phrenic recess located

A

within the greater sac

67
Q

peritonitis

A

results in a collection of pus in the recesses of the liver leading to abscess formation

68
Q

located the hepatorenal recess

A

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

69
Q

abscesses in the recesses of the liver

A

pus from an absess in the sub-phrenic recess can drain into the hepatorenal recess when a patient is bedridden

70
Q

where gallbladder located

A

it is a foregut organ

visceral afferents enter spinal cord between T6-T9

71
Q

cholecystectomy

A

surgical removal of gallbladder

must correctly identify the cystic duct and cystic artery
variation can occur in both these strucutres

72
Q

formation of the hepatic portal vein

A

formed by the
splenic vein (drains foregut)
superior mesenteric vein (midgut)

73
Q

inferior mesenteric vein

A

drains blood from the hindgut to the splenic vein

74
Q

inferior vena cave

A

retroperitineal

drains the clean blood from the hepatic vein into the right atrium

75
Q

what causes jaundice

A

increase in the blood levels of bilirubin

76
Q

what forms the common hepatic duct`

A

the union of the left hepatic duct and the right hepatic duct, joinging of the left and right side of the lung`

77
Q

as cyctic duct joins the common hepatic duct

A

forms the bile duct

78
Q

parts of the duodenum

A

gut tube starts off intraperitoneal

superior -part intraperitoneal
(duodenal cap relatively mobile)

descending (retroperitoneal)

horizontal (retroperitoneal)

ascending (retroperitoneal)

79
Q

after a big meal

A

secretes a number of peptide hormones

gastrin CCK

80
Q

what does CCK promote

A

gall bladder to contract

pushes bile through the biliary tree

81
Q

how movement through duodenum occurs

A

begins at the pyloric sphincter
parasympathetic- smooth muscle relaxes, causes relaxation

sympathetic smooth muscle contracts, autonomic nerves

82
Q

where duodenum ends ad begins

A

begins- pyloric sphincter

ends- duodenojejunal flexure

83
Q

where pain from duodenal ulcer tends to present

A

epigastric region

84
Q

what is the pyloric sphincter

A

anatomical sphincter controlling the flow of chime from stomach to duodenum

85
Q

how pancreas and duodenum link

A

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

86
Q

what odes the pancreas contain

A

head (with uncinate process)
neck
body
tail

87
Q

what is the pancreas

A

retroperitoneal organ that lies transversely across the posterior abdomen

88
Q

what lies posteriorly to the pancreas

A 
Right kidney & adrenal gland
IVC
Bile duct
Abdominal aorta
Superior mesenteric vessels
Left kidney & adrenal gland
Part of the portal venous system.
89
Q

what lies anteriourly to the pancreas

A

stomach

90
Q

what lies superopoateriourly to the pancreas

A

the splenic vessels- follow the tail you get to the spleen

91
Q

what lies around the head of the pancreas

A

the duodenum

92
Q

exocrine

A

ductal system

93
Q

endocrine

A

a part of the vascular system

94
Q

exocrine in pancreas

A

acinar cell Ipranceatic digestive enzymes into main pancreatic duct)

95
Q

endocrine in pancreas

A

islets of Langerhans (insulin and glucagon into bloodstream)

96
Q

main pancreatic duct

A

duct of wirsung

97
Q

drainage of the biliary duct

A

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
Q

ERCP

A

investigation used to study the biliary tree and treat some pathologies associated with it

99
Q

how ERCP carried out

A

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
Q

reasons for jaundice

A

obstruction of the biliary tree

posdt-hepatic jaundice- extra hepatic outer the liver obstructive cause of jaundice

101
Q

what causes obstruction of the biliary tree

A

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
Q

anastamosis

A

dual blood supply

if one artery gets blocked, get blood from the other

103
Q

where does anastomosis occur in duodenum and pancreas

A

superior pancreaticoduodenal artery

inferior pancreaticoduodenal artery

104
Q

where pain from pancreas felt

A

it is a forgut and midgut organ

pain presents in the epigastric and or umbilical region

can also radiate through patients back

105
Q

reasons for pancreatic pain

A

pancreatitis

106
Q

cause of pancreatitis

A

blockage of the ampulla by a gallstone

bile then diverted into the pancreas leading to irritation and inflammation

107
Q

acute pancreatitis

A

caused by gallstone obstruction leading to the reflux of bile and pancreatic juice in the main pancreatic duct

108
Q

advanced acute pancreatitis

A

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

109
Q

grey-turners sign

A

right or left flanks

110
Q

Cullen sign

A

around umbilicas via falciform ligament

111
Q

beginning and end of different parts of small intestine

A

Jejunum begins at duodenaljejunal flexure

Ileum ends at ileocaecal junction

112
Q

differences in jejunum and ileum

A

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
Q

arterial blood of jejenum and ileum

A

from the superior mesenteric artery

via jejunal and ileal arteries

114
Q

venous drainage of jejenum and ileum

A

from the jejunal and ileal veins to superior mesentrin vein ‘
to hepatic portal vein

115
Q

what happens to proteins and carbohydrates

A

absorbed from the small intestines into the portal venous system to be taken to the liver

116
Q

where to vessels that supply jejunum and ileum travel

A

within the mesentry

117
Q

where is superior mesenteric vessels

A

leaves the aorta at L1 vertebral level

118
Q

where superior mesenteric vessel found

A

Posterior to the neck of the pancreas

Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper

119
Q

absorption of fats

A

bile helps in absorbtion of fats from the GI lumen into the intestingal cells

120
Q

how fats actually absorbed

A

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

GI (10 decks)

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