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
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
