clinical anatomy of jaundice Flashcards
What is jaundice
Yellowing of skin and eyes due to increased bilirubin in the blood
What is Billirubin
- By-product of the breakdown of RBC in the Spleen
- Travels to the liver where is it used to make Bile
- Bile is then stored in the Gallbladder
- The bile then makes its way down the billary Tree into the 2nd part of the doudenum
What is Bile used for
- Fat Reabsorption from the small intestine
- Pancreas also secretes Digestive enzymes into the 2nd part of the doudenum
- Important for food digestion
What are the functions of the liver
- Recieves all the nutrients absorbed form the GI tract
- Glycogen storage
- Bile secretion
- Other metabolic functions
What is the surface anatomy of the liver/where is it found
- Upper right quadrant
- protected by ribs 7-11
- Location changes with breathing- contraction of diaphragm
- more palpable with pathology
- Deep breath in - liver palpable
What are the anatomical relations of the Liver
- Inferior to right hemi-diaphragm
- Gall-bladder - is located posteriorly and inferiorly
- Hepatic flexure - located inferiorly
- Anterior to - right kidneys, right adrenal gland and IVC and abdominal aorta
- Stomach - located posteriorly at mid/left side
What issues can arise from these relations
- Right shoulder pain - liver is infeirorly to the right
- Hemi-diaphragm irritation- liver located inferiorly to it or due to gall-bladder disease
- IVC - any liver disease can cause inferior vena cava disease
- liver disease can affect the stomach
What types of lobes are in the liver
- Anatomical lobes = 4
- Functional lobes = 8
What are the 4 anatomical lobes of the liver
- Right lobe - larger and meateier - with tail poking out
- Left blode - smaller
- Caudate lobe- superiorly next to IVc
- Daudrate lobe - inferiorly next the gallbladder
Describe the anteiror anatomy of the liver
- left and right lobes
- Falciform ligaments - divided the two anteiror lobes - from a peritoneal fold which attacks liver to the anterior abdominal wall
- Round ligament - thick section just inferior to the falciform ligament - umbilical vein - embryological remnant
Describe the posterior anatomy of the liver
- Caudate lobe - most superior part of the posteiror side
- Qaudrate - looks square like - inferior oppsite to caudate - functional lobe gets its own blood supply
- Porta hepatis: structures going into the liver - where NVB enters
Whats the Porta Hepatis
- Deep fissue where the dual blood supply to liver enters
- Oxygen rich artery blood
- Nutrient rich portal blood
- Bile coming out with the Hepatic ducts
What is the functional anatomy of the liver
- 8 functional lobes - allows for segmentectomy - each lobes has its own blood supply
- Hepatic artery proper splits into left and right hepatic artery which spits twice more tof form terriary blood supply to the lobes
- Bile from the hepatocytes follows these branches back into the hepatic duct
- Hepatic veins- 3 veins right, left and middle
- drains deoxygenated nutrient blood into the IVC
Whats the major blood supply to the liver
What is the blood supply to each othe 8 functional segments
- Hepatice artery branch
- Heptatic portal vein branch
- Bile drainage - to bile duct
- Venous drainage - to IVC
the Hepatic veins and the IVC have no valves whats the significance of this
- Hypertention will affect the liver as it will cause portal hypertension
- Back pressure can cause liver disease
What is the portal triad and whats contained within it
- structures that leave or enter the lungs with the - Hepatodoudenal ligament
- Hepatic portal vein - nutrient rich blood - chunky thick
- Hepatic artery proper - anterior to heptaic portal vein
- Common Bile duct - laterally to right hand side
How does the lesser omentum connect to the liver
- Hepatodudenal ligament - contains portal triad
- Hetapogastric ligament
What is the coeliac Trunk
- Frist 3 midline branches of the Abdominal aorta
- Retroperitoneal
- Abdominal aorta gives off coelliac trunk at T12
- Supplies Foregut organs
What are the branches of the Coeliac Trunk
- Splenic artery
- Left gastric artery
- Common hepatic artery - becomes the hepatic artery proper after giving off the branch right gastric artery
- Common man gives off gas and becomes as proper man
Describe the anatomy of the Spleen
- Supplied by the Splenic artery - has a tortorous course - above pancreas
- Intra-peritoneal organ lies withtin the left hypochondrium
- located posteiror to the mid-axillary line
- Function: storage system for blood - break down RBC to make bilirubin
- Protected by ribs 9-11 - rib fracture can cause haemorrhage
What are the anatomical relations of the Spleen
- Posterior to diaphragm
- Anterior to stomach
- Splenich flexture = inferior
- Medial to left kidney
Describe the surface anatomy of the Spleen
- hard to palpate unless splemomegaly
- move with inspiration -
- to palpate ask pateint to take a deep breath in
What is the blood supply to the Stomach
- Right and left gastric arteries - Anastomose together along the lesser curvature
- right and left gastro-omental arteries - anastomose together along the greater curvature
Whats the dual blood supply to the liver
- right and left hepatic arteries from hepatic artery proper - 20% blood revieced
- Hepatic portal vein - rest of the blood
Describe the anatomy of the liver lobules
- Make up form lots of hepatocytes
- 6 sided ring - 6 portal triads surronding each corner
- Central vein in the the middle where clean blood drains to
Whats the function of the liver lobule
- Mixed deoxygenated nutrient rich blood and the oxygen rich hepatic artery blood will go through the Sinusiod lined by hepatocytes and drian into the central vein
- Hepatocytes clean blood
- Blood is the drained into the central vein -> Hepatic vein to the IVC
- Bile formed in the hepatocytes drain into bile duct away from central vein
What are the two cavities related to the liver
- Hepatorenal recess - Morisons pouch - deepest part of abdomine when lying flat
- Sub-phrenic recess-
What is the clinical importance of the hepatic recesses
- Liver dieseae = fluid produciton in the peritoneal cavity
- blood, pus and normal fluid can lead to abcess formation
- pus form an abcess in the sub-phrenic recess can drain into the hepto-renal recess when patient is flat
Describe the hepatic portal system
- Haptic portal vein - drains blood form the foregut, midgut, and hindgut to the liver for first pass metabolism
- HPV is formed from the splenic vein (foregut) and superior mesenteric vein (Midgut)
- Inferior mesenteric vein- drains from the hind gut into the splenic vein
- Inferior vena cava - Retroperitoneal - drains the cleaned blood from the liver into the right atrium
Describe the anatomy of the Gallbladder
- Located on the posterior side of the liver inferiorly firmely attached - foregut structure
- Structure - contains a fundus, body neck and a cystic duct
- Function: Stores and concentrates bile
- Bile is essential for Fat absorption
How does bile get stored in the gall-bladder
As bile is produced it goes down the billary system but the sphincter is closed so it cannot drain therefore back pressure allows it track back up into the gall-bladder where it is stored and concetrated by removing water and released when sphincter relaxes
What is the Triangle of callot
The triangle between the cystic duct and the common hepatic duct - this is where the cystic artery is found
What is the blood supply to the gallbladder
- Cystic artery - branch of the right hepatic artery
- Location: Cystohepatic Triangle of Calot
- Venous drainage - Mini veins posterior to gall-bladder entering the liver then IVC
Describe the anatomy of Gallbladder pain
- inflammaiton of gladd-bladder or cystic duct due to gallstones
- Visceral afferents will enter spinal cord between T6-T9
- Epigastric pain + right hypochondrium
- Irritation of hemi-diaphragm = right shoulder pain
What is cholecystectomy
- Surgical removal of gall-bladder
- Important to identify gall-bladder and cystic artery
