Anatomy of Jaundice Pt 1 Flashcards
How is bilirubin made?
By-product of RBC break down
This usually occurs in the spleen
What does bilirubin do??
Used to form bile in liver which travels through biliary tree
What is the biliary tree?
Set of tubes connecting liver to 2nd part of duodenum
Why is bile important?
Important for normal absorption of fats from small intestine
What does a pancreas do that is necessary for digestion?
Excrete digestive enzymes into 2nd part of duodenum
What is portal triad and where is it?
- Consists of 3 tubes- hepatic artery, hepatic portal vein and common bile duct
- Part of the biliary tree linking liver to duodenum
- Free edge of lesser omentum
What does portal triad do?
Blood supply and drainage TO the liver
3 tubes in portal triad?
Hepatic Artery
Hepatic Portal Vein
Common Bile duct
What is the celiac trunk?
1st of 3 midline branches of abdominal aorta
Where does celiac trunk arise from?
Retroperitoneal and arises from around T12 vertebral level
What does the celiac trunk supply?
Organs of the foregut
What happens to celiac trunk?
Trifurcates into 3 branches
1) Splenic artery
2) Hepatic artery
3)Left gastric artery
Each of these give rise to further branches such as
Gastroduodenal and superior pancreatico-duodenal
Where is the splenic artery route?
Above pancreas
Where is the spleen?
Intraperitoneal
Within left hypochondrium
What is the spleen anatomically related to?
Posterior to dipahragm
Anterior to stomach
Inferior to splenic flexure
Medial to Left Kidney
What does spleen do?
Breaks down RBCs to produce bilirubin
What protects the spleen?
Ribs 9-11
When the spleen is palpable it is..
3 times the size it’s meant to be
Why does spleen move in respiration?
It and the liver are anatomically related to spleen
2 main supplies of blood to the stomach?
R/L gastric arteries
R/L gastro-omental arteries
Where do gastric arteries run?
Along lesser curvature
Anastamose together
Where do R/L gastro-omental arteries run?
Along greater curvature
Anastamose together
Blood supply to liver?
Heaptic artery (20-25%) (poor nutrient, well oxygenated) Rest comes from HPV (75%)= rich nutrients/poor O2
Where does liver lie?
Mainly upper right quadrant `
What is the liver anatomically related to?
- Superior, anterior and posterior to diaphragm
- Anterior aspect of stomach medially
- Posterior & Inferior to Gall bladder
- Inferior to hepatic fixture
What does the liver do?
Converts bilirubin to bile
What is the liver protected by?
Rib 7-11
4 anatomical segments of liver?
Right lobe
(seen anteriorly)
Left lobe
Caudate lobe
Quadrate lobe
(all 4 seen posteriorly, caudate lobe above quadrate)IVC and hepatic veins have valves. True or false?
False
Venous drainage from liver?
Via 3 main hepatic veins into IVC
What is special about caudate venous drains?
Has own hepatic veins which drains straight to IVC
How many functional segments in liver?
8 functional segments
Functional segment of liver blood supply?
HA and HPV
Each have their own venous drainage and bile drainage
What lies in centre of lobule?
Central vein
2 clinically important areas of the peritoneal cavity related to liver?
Hepatorenal recess (Morrison's pouch) Sub-phrenic recess
What is peritonitis?
Collection of pus in recesses leading to abscess formation
What does the HPV drain?
Drains blood from foregut, midgut and hindgut to liver for first pass metabolism
Where does the splenic vein drain to?
Drains blood from foregut to HPV
Where does inferior mesenteric vein drain to?
Drains blood from hindgut to splenic vein
Where does superior mesenteric vein drain to?
Drains blood from midgut to HPV
What veins are in the portal venous system?
HPV
Splenic vein
IMV
SMV
Where does the IVC drain to?
Drains cleaned blood from hepatic veins into the RA
What is in the systemic venous system?
IVC
Where does GB lie?
Posterior aspect of liver, anterior to duodenum
What is role of Gall Bladder?
Stores and concentrates bile in between meals
Structure of GB?
Head body and neck which narrows to become cystic duct
What does the cystic duct potentially house?
Potential site of Gall stone
Where will early pain present if GB is involved?
Epigastric region or in hypochondrium
Sometimes with pain in right shoulder
Because visceral afferents enter spinal cord between T6-T9
What is a cholecystectomy?
Removal of GB, cystic duct and artery
