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GI > Clinical Anatomy of jaundice > Flashcards

Clinical Anatomy of jaundice Flashcards

1
Q

what is jaundice?

A

= yellowing the sclera (white of eyes) and skin

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2
Q

what causes jaundice?

A

= an increase in blood levels of bilirubin

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3
Q

what is bilirubin?

A

= normal by-product of break down of red blood cells mainly occurring in spleen

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4
Q

what is bilirubin used to form?

A

= bile in the liver

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5
Q

what does Bille travel through?

A

= the biliary tree

- a set of tubes connective the liver to the 2nd part of the duodenum

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6
Q

what role does the gallbladder ave?

A

= plays an important role in storage and concentration of bile

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7
Q

what is bile important for?

A

= normal absorption of fats from small intestine

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8
Q

what does the pancreas?

A

= excretes digestive enzymes into 2nd part of duodenum

- necessary for digestion of food

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9
Q

Yes or No.

Is liver the largest organ in the body?

A

= Yes.

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10
Q

what 3 functions does the liver have?

A

= glycogen storage
= bile secretions
= other metabolic functions

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11
Q

where is the liver located in terms of quadrants and ribs?

A
  • Right upper quadrant

- protected by ribs 7-11

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12
Q

when does the location of liver change?

A

in breathing

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13
Q

where is the liver in terms of hemi-diaphragm, gall bladder, hepatic flexure, stomach and right kidney, right adrenal gland, ICC and abdominal aorta?

A

= inferior to right hemi-diaphragm

Gallbladder
- posterior and inferior

Hepatic flexure
= inferior

Right kidney, right adrenal gland, IVC, adominal aorta
= posterior

Stomach
= posterior at mid/left side

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14
Q

what are the 4 anatomical lobes to the liver?

A

1) right lobe
2) left lobe
3) quadrate lobe
4) caudate lobe

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15
Q

how many functional lobes are there?

A

8

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16
Q

wha is the portal hepatis?

A

= site of entrance for portal triad structure

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17
Q

what are the right and left lobes separated by?

A

= falciform ligament

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18
Q

what is the thicker part of the falciform ligament called?

A

= round ligament of liver

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19
Q

what do the 8 functional segments allow?

A

= vasculature and bile drainage

= segmentectomy

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20
Q

what 4 things do each segment have?

A

1) branch of hepatic artery
2) branch of hepatic portal vein
3) bile orange (to bile duct)
4) venous drainage (to IVC)

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21
Q

what do the inferior vena cava and hepatic veins lack?

A

= valves

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22
Q

where is the increased central venous pressure directed to?

A

= liver

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23
Q

what sort of blood is there in bile drainage and blood supply?

A

= oxygenated and nutrient rich

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24
Q

what do the hepatic veins direct?

A

= deoxygenated blood from liver which comes together as 3 veins before entering IVC

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25
Q

what does the portal triad contain?

A

= contains structures that enter or leave the liver parenchyma

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26
Q

what do the structures that enter or leave the liver parenchyma run within?

A

= the hepattoduodenal ligaments

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27
Q

what 2 thins are contained within the lesser omentum?

A
  • hepatoduodenal ligament

- hepatogastric ligament

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28
Q

what is the coeliac trunk?

A

= first 3 midline branches of aorta

- retroperitoneal

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29
Q

where does the coeliac trunk leave the aorta?

A

at T12 vertebral level

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30
Q

what does the coeliac trunk supply?

A
  • organs of foregut
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31
Q

what does the coeliac trunk trifurcate into?

A

1) splenic artery
2) left gastric artery
3) common hepatic artery

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32
Q

what is the course of the splenic artery?

A

= superior border of pancreas

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33
Q

Is the spleen an intra- or retroperiitotneal organ?

A

= intra-peritoneal organ within left hypochondria

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34
Q

what 4 things is the spleen related to?

what what does the spleen do?

A

Posteriorly - diaphragm
Anteriorly - Stomach
Inferiorly - Splenic Flexure
Medially - Left kidney

= breaks down red blood cells to produce billirubin

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35
Q

what is the spleen protected by?

A

= rings 9-11

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36
Q

what could the rib fractures do?

A

= pierce the soft, delicate spleen leading to substantial internal bleeding

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37
Q

why do the spleen and liver move with respiration?

A

= as they are anatomically related to the diaphragm

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38
Q

what are the 2 major blood supply’s of the stomach and describe their location?

A

1) right and left gastric arteries
= along junction of lesser curvature and lesser momentum
= anastomose together

2) right and left gastro-mental arteries
- along junction of greater curvature & greater omentum
= anastomose together

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39
Q

what are the 2 minor blood supplies to the stomach?

A
  • posterior gastric arteries

- short gastric arteries

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40
Q

what sort of blood supply does the liver have?

where does then blood supply from the liver come from?

A

= dual blood supply

  • Right and left hepatic arteries
  • branches of hepatic artery proper

= only accounts for 20-25% if blood received by liver, rest is from hepatic portal vein

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41
Q

describe the blood supply in each liver lobule?

A

= central vein in middle

= inter-lobular portal triad at each corner

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42
Q

what 3 things does the inter-lobular portal triad contain?

A

1) branch of HPV
2) branch HA
3) bile duct

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43
Q

what are 2 important areas of the peritoneal cavity related to liiver?

A

1) hepatorenal recess

2) sub-phrenic recess

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44
Q

where are the 2 recesses located?

A

= within the greater sac

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45
Q

what can peritonitis result in?

A

= collection of pus in these recesses leading to an abscess formation

46
Q

why does pus from an abscess in sub-phrenic recess drain into hepatorenal recess when a patient is bedridden?

A

= as hepatorenal recess is one of lowest parts of peritoneal cavity when patient is supine

47
Q

where does the hepatic portal vein drain blood from?

A
  • foregut, midgut and hindgut to liver for first pass metabolism (cleaning)
48
Q

what 2 things forms the HPV?

A

1) splenic vein (drains foregut)

2) superior mesenteric vein (midgut)

49
Q

what does the infioeiir mesenteric vein drain?

A

= blood from handgun to splenic vein

50
Q

describe the inferior vena cava?

A

= retro-peritoneal

- drains cleaned blood from hepatic veins into right atrium

51
Q

where does the gallbladder lie?

A

on posterior aspect of liver (often firmly attached)

- lies anterior to duodenum

52
Q

what is the function of the gallbladder?

A

= stores and concentrates bile in between means

53
Q

what does narrowing of gallbladder a potential site for?

A

= gallstone impaction

54
Q

how does bile flow in and out of gallbladder?

A

via cystic ducts

55
Q

how is blood supplied in the gall bladder?

A

= via the cystic artery

  • branch of right hepatic artery
  • located in cysto-hepatic triangle (of Clalot)
56
Q

what can inflammation of gallbladder or cystic duct follow?

A

= irritation or impaction of a gallstone

57
Q

what kind of organ is the gallbladder?

A

= a foregut organ

58
Q

where do the visceral afferents of the foregut enter spinal cord?

A

= between T6-T9

59
Q

where will early pain of gallbladder present in?

A

= epigastric region

and

60
Q

where else can pain present in?

A

= hypochondria
(with or without pain referral to right shoulder)
(a result of anterior diaphragmatic irritation)

61
Q

what is cholecystectomy?

A

= surgical removal of gallbladder

62
Q

PART 2

A

PART 2

63
Q

what is the biliary tree made up of?

A

= ducts which transport bile

64
Q

what do right and left hepatic ducts unite to form?

A

= common hepatic ducts

65
Q

what do common hepatic ducts unity with to form bile ducts?

A

= unity with cystic ducts

66
Q

what does the bile ducts drain into?

A

= 2nd part of duodenum, along with main pancreatic duct

67
Q

what are the 4 parts to the duodenum?

A

1) superior (part intra-peritoneal)
2) descending (retroperitoneal)
3) horizontal (retroperitoneal)
4) ascending (retroperitoneal)

68
Q

what does the superior part of the duodenum contain?

A

= duodenal cap (monile)

69
Q

where does the duodenum begin and end?

A

BEGINS
= at pyloric sphincter
(controls flow of chyme from stomach to duodenum)
(smooth muscle, autonomic nerves, contractions, relaxations)

ENDS
= at duodenojejunal flexure

70
Q

what does the duodenum secrete and were into?

A

Secretes peptide hormones (Gastrin,CCK) into blood

71
Q

where does pain from peptic ulcer tend to be?

A

= in epigastric region

72
Q

what type of organ is the pancreas and where does it lie in relation to the abdomen?

A

= retro-peritoneal organ

- lying transversely across posterior abdomen

73
Q

what is the pancreas describe as having?

A
  • head(with uncinate process)
  • neck
  • body
  • tail
74
Q

what is the pancreas ultimately associated with?

A

duodenum

- head of pancreas is described as being surrounded by C shape from by duodenum

75
Q

describe the pancreas’ anatomical relationships with the kidney/adrenal gland, IVC, bile duct, abdominal aorta, superior mesenteric vessels, left kidney/adrenal gland and part of portal venous system?

A

POSTERIOIRLY to all of them

76
Q

describe the anatomical relationship between the pancreas and stomach, duodenum and splenic vessels?

A

Anteriorly lies stomach

Duodenum surrounds head of pancreas

Supero-posterioirly = splenic vessel

77
Q

what are the functions of the pancreas?

A

1) exocrine
- acinar cells (pancreatic digestive enzymes which are secreted into main pancreatic duct)

2) endocrine
- islets of langerhans (insulin and glucagon into bloodstream)

78
Q

where does the bile ducts descend posteriorly to and then how does it travel? SEE DIAGRAM on slide 10

A

= to 1st (superior) part of duodenum.

  • then travels into a groove on the posterior aspect of he pancreas

= then joins with main pancreatic duct, forming ampulla of Vater/hepatopancreatic ampulla (widened part)

= both hen drain into 2nd part of duodenum

79
Q

what are anatomical sphincters?

A

= discrete areas where muscle completely encircles the lumen of the tract

80
Q

name 3 of the smooth muscle sphincters of this area?

A

1) bile duct sphincter
2) pancreatic duct sphincter
3) sphincter of Oddi

81
Q

what is ERCP?

A

= endoscopic retrograde Cholangiopancreatography

  • an investigations which studies the biliary tree and pancreas and treats pathologies with it
  • endoscope is 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 dye-filled biliary tree
82
Q

what are 2 possible mechanisms of obstructive the biliary tree?

A

1) gall stones

2) carcinoma at head of pancreas

83
Q

what happens if there is an obstruction of the biliary tree?

A

= flow of bile back up to liver
= overspills into blood, one of its constituents being bilirubin

= this is an extra hepatic (outside liver) obstructive cause of jaundice
- post-hepatic jaundice

84
Q

what are 6 of the suppliers of blood to the duodenum and pancreas?

A

1) splenic arteries (cell trunk)
2) gastro-duodenal artery (common hepatic a)
3) superior pancreaticoduuodenal artery (from gastro-duodenal a)
4) inferior pancreatic-duodenal arteries (from superior mesenteric a)
5) superior mesenteric artery (from aorta at L1)
6) dorsal pancreatic arteries (from splenic a)

85
Q

what do the superior pancreaticoduuodenal artery

and inferior pancreatic-duodenal arteries form?

A

anastomosis

86
Q

what is one of the reasons for pancreatic pain?

A

= pancreatitis

87
Q

what is one cause of pancreatitis?

A

= blockage of ampulla by gallstones

- bile is then diverted into pancreas leading to irritation and inflammation

88
Q

what type of organ is the pancreas?

A

= foregut AND midgut

89
Q

where does pancreatic pain present?

A

= in epigastric region and/or umbilical region

- it can also radiate to patients back

90
Q

what happens in acute pancreatitis?

A

= gall obstruction
= cause reflux of bile and pancreatic juice into main pancreatic duct

  • in more advanced cases vascular haemorrhage can occur, leading to blood/fluid accumulation in retroperitoneal space
91
Q

what is Grey-Turners sign and Cullen’s sign?

A

Grey-turners
= right or left flanks

Cullen’s sign
= around umbilicus via falciform ligament

92
Q

what type of organs is the 1st and 2nd part of the duodenum and what type of organ is the rest of he small intestine?

A

1st and 2nd
= foregut organs

Rest of small intestine
= midgut

93
Q

what makes up most of the small intestines?

A

= jejunum and ileum

94
Q

where are the jejunum and ileum found?

A

= in all 4 quadrants

95
Q

where does jejunum begin and ileum end?

A

jejunum begins
= at duodenal-jejunal flexure

ileum ends
= at ileo-caecal junctions

96
Q

describe the differences between jejunum and ileum in terms of their colour?

A

Jejunum
= deep red

Ileum
= lighter pink

97
Q

describe the differences between jejunum and ileum in terms of their wall and vasculature?

A

Jejunum
= thicker and heavy
= more vascular

Ileum
= thinner and lighter
= less vascular

98
Q

describe the differences between jejunum and ileum in terms of their mesenteric fat?

A

Jejunum
= less fat

Ileum
= more fat

99
Q

describe the differences between jejunum and ileum in terms of their circular folds (L. place circulars)?

A

Jejunum
= large, tall and closely packed folds

Ileum
= low and parse folds (absent distally)

100
Q

describe the differences between jejunum and ileum in terms of their lymphoid tissue?

A

present in ileum

101
Q

where does the artery blood supply come from in jejunum and ileum?

A

= from superior mesenteric artery

- via jejunal and leal arteries

102
Q

describe the venous drainage of jejunum and ileum?

A

Venous drainage from;

  • jejunal and ileal veins
  • to superoir mesenteric veins
  • to hepatic portal veins
103
Q

describe where proteins and carbohydrates are absorbed from and into?

A

= from small intestine into portal venous system to be taken to liver

  • vessels travel within the mesentery
104
Q

describe the superior mesenteric vessels?

A

= leaves aorta at L1 vertebral level

  • posterior to neck of pancreas
  • travels inferiorly, anterior to uncinate process of pancreas to enter the mesentery proper
105
Q

what helps the absorption of fats from GI tract lumen into the intestinal cells?

A

= bile

106
Q

describe what happens to the fats (within chylomicrons) once absorbed from intestinal cells?

A

are absorbed from intestinal cells into specialised lymphatic vessels of small intestine called lacteals

  • drain via lymphatic system to eventually drain into venous system
    = at left venous angle
107
Q

where do lymph vessels tend to lie?

A

= alongside artereis

108
Q

what are the 4 main group of lymph nodes draining abdominal organs?

A

1) Celiac (foregut organs)
2) Superior mesenteric (midgut organs)
3) Inferior mesenteric (hindgut organs)
4) Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)

109
Q

what do superficial lymph vessels drain into?

A

= deep lymph vessels

110
Q

depending on where it is originated form, where will lymph drain into?

A

either;
1) thoracic duct (from 3/4 of body)
or
2) right lymphatic duct (from 1/4 of body)

111
Q

where will the lymph then eventually drain into?

A

= venous system for ‘recycling’ at venous angles;

112
Q

what are venous angels?

A
  • junctions between subclavian and internal jugular veins
  • left venous angle = thoracic duct drainage
  • right venous angel = right lymphatic duct drainage

GI (43 decks)

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