Clinical anatomy of jaundice 2 Flashcards

1
Q

Explain the anatomy of the Biliary Tree

A

Made up of a number of ducts which transport bile

  • Right + left hepatic duct = Common hepatic duct
  • Common hepatic duct + common bile duct = Common bile duct
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2
Q

How many parts does the doudenum have and where does bil drain into

A

4 parts

Bile drains into 2nd part

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3
Q

Where is the cystic artery found

A

triangle for callot - between the common heptatic duct and the cystic duct

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4
Q

Where does the doudenum begin and end

A

Begins - pyloric sphincter

Ends - Doudenojejunal fleture

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5
Q

Which parts of the doudenum are retroperitoneal and intraperitoneal

A
  • Superior doudenal cap = Intraperitoneal
  • Descending = retroperitoneal
  • Horizontal = retroperitoneal
  • Asceding = Retroperitoneal
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6
Q

What are the secretions of the doudenum

A
  • Gastrin
  • CCK
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7
Q

Where does pain form doudenum present

A

Epigastric region

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8
Q

Describe the anatomy of the pacreas

A
  • Locations = right side - lies transversly across poterior abdomen
  • Retroperitoneal organ

​Parts

  • Head - has an uncinate process
  • Neck
  • Body
  • Tail - lies closely to the hilum of the spleen
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9
Q

What are the anatomical relations of the pancreas

A

Posterioly lies

  • Abdominal aorta
  • Right and left kidney and adrenal glands
  • IVC
  • Bile duct
  • Superior Mesenteric vessesl
  • Part of the portal system

Anteirorly - lies Stomach

Doudenum - surrounds heads

Superior-posterioly - splenic vessels

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10
Q

what do these structure look like on a CT

A
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11
Q

What are the functions of the pancrea

A
  • Excorine function: Acinar cells - release pancratic digestive enzymes into main pancreatic duct
  • Endocrine functions: Islets of langerhands - Releases insulin and glucagon into the blood stream
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12
Q

What is the autonomic supply to the pancreas

A

Vagus nerve (all glands are supplied by parasympathetics

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13
Q

How does drainage from the biliary system occur

A
  • Bile duct descends posteriorly to the 1st part of doudenum
  • Then travels into a groove on the posterior aspect of the pancreas
  • Bile duct joins with the main prancreatic duct to form the ampulla of vater- wider duct
  • both drain Into the major doudenal papilla in 2nd part of doudenum
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14
Q

there are 2 papillas in the 2nd part of the doudenum what are they and what do they drain

A
  • Major papilla - drains ampulla of vater
  • Minor papilla - drains accessory pancreatic duct
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15
Q

What are anatomical sphicter

A

areas of lumen where smooth muscle encircles the lumen of the tract

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16
Q

What are the sphincters related to secretion into the doudenum

A
  • Dile duct sphincter
  • Sphincter of oddi
  • pancreatic sphincter
17
Q

What do the ducts look like on ERCP

A

procedure to looks at the different ducts - Biliary tree and pancreas to treat pathologies within it

  1. Endocope intersted into oral cavity into doudenum
  2. Cannula placed into major doudenal papilla and radio-opaque due is injected back into biliary tree
  3. Radiographic images are then taken
18
Q

What are the causes post-heptic jaundice

A
  • Gallstones
  • Carcinoma of head of pancreas
  • causes flow of bile and bilirubin back into liver
19
Q

What is the blood supply to the doudenum and pancreas

A
  • Superior peancreatic doudenal artery - branch of gastrodoudenal artery
  • and inferior panctreatic doudenal artery - branch of superior mesenteric artery
  • Anastomosis at head of pancreas
20
Q

At what level does the superior mesenteric artery branch come off the aorta

A

L1

21
Q

What is pancreatic pain and where is it felt

A
  • Pancreatitis due to Gallstone blockage of ampulla- Bile diverted to pancrea - irritation and inflammation
  • Midgut and foregut structure
  • Epigastric region
  • Umbillicul region
  • Back radiation
22
Q

What us acute pancreatitis

A
23
Q

is the small intestine a foregut or mid-gut structures

A
  • 1st and second part of doudenum - foregut
  • Rest of small intestine - midgut
24
Q

Describe the anatomy of the jejunum and ileum

A
  • Most of the small intestines
  • Found in all 4 quadrants
25
Q

Where does jejunum begin and ileum end

A
  • jejunum begins - Doudenaljejunal flexure - Intraperitoneal
  • Illeum ends at - Ileocaecal junction
26
Q

What is the difference in jejunum and ileum

A
27
Q

What is the blood supply to the jejunum and ileum

A

Aterial blood supply

  • Suprior mesenteric artery branches
  • Jejunal and ileal arteries

Venous drainage

  • Jejunal and ileal veins
  • to supeiror mesenteric veins
  • To hepatic veins
28
Q

Describe the anatomy of the superior mesenteric vessels

A
  • leave aorta at L1
  • Posterior to the neck of pancreas
  • Travels inferior, anerior to the uncinate process of the pancrease to enster the mesentery proper
29
Q

How is absorption of fat carried out

A
  • Bile help to absorb fat from GI lumen into the intestinal cells
  • Fat with chylomicrons are then absorbed from the intestinal cell into specialised lymphatic vessels of the small intestine called lacteals
  • They travels via the lymphatic system to eventually drain into the venous system at left venous angle
30
Q

Describe the lympahtics of the abdomen

A
  • Lie along side arteries

Main groups drianing abdominal organs:

  • Celiac nodes - foregut
  • Superior mesenteric nodes - Midgut
  • Inferior mesenteric nodes - hindgut
  • Lumbar nodes - kidney, posterior abdominal wall, pelvis and lower limbs
31
Q

What is the venous angle

A

junction between Sub-clavian and internal jugular veins

  • Left venous angle - thoracic duct drainage
  • Right venous angle - right lymphatic duct drainage