clinical anatomy of jaundice

Question 1

what organs are involved in jaundice and why

Answer 1

liver 
spleen 
gallbladder
pancreas
small intestines 

> linked by the formation of bilirubin and bile

Question 2

what is bilirubin

Answer 2

> is a normal by-product of the break down of red blood cells
bilirubin is used to form bile
bile then travels through the biliary tree
the gallbladder plays an important role in the storage and concentration of bile
bile is important for the normal absorption of fats from the small intestine
the pancreas also excretes digestive enzymes

Question 3

what composes the portal triad

Answer 3

> hepatic artery
hepatic portal vein
common bile duct

Question 4

features of portal triad

Answer 4

blood supply to and drainage to the liver

part of the biliary tree linking liver to duodenum

also contain nerves and lymphatics

Question 5

what is the spleen

Answer 5

> a lympahtic organ
also a haematological organ ie breaks down red blood cells to produce bilirubin
pretty soft squishy organ that is easily hurt - so cute !

> > is an intraperitoneal organ within the left hypochondrium

>>anatomically related to >the diaphragm - posteriorly 
>the stomach - anteriorly 
>the splenic flexure -inferiorly 
>the left kidney - medially 
>>protected by ribs 9-11

Question 6

how would you palpate the spleen

Answer 6

> moves with respiration as spleen , liver anatomically related to the diaphragm
would get the patient to breathe in

Question 7

the liver - relative anatomy

Answer 7

> tasked with cleaning the blood essentially
turns bilirubin into bile
is a metabolic organ

> > anatomically related to:
the diaphragm - superiorly anteriorly and posteriorly
the anterior aspect of the stomach medially
the gallbladder posteriorly and inferiorly
the hepatic flexure inferiorly
the right kidney, right adrenal gland, IVC and abdominal aorta posteriorly

> > is protected by ribs 7-11

Question 8

what are the 4 anatomical segments of the liver

Answer 8

right lobe
left lobe
caudate lobe ( has a tail/process - so cute !)
quadrate lobe

Question 9

features of the 8 different functional segments of the liver

Answer 9

> each has its own blood supply (hepatic artery and hepatic portal vein), venous drainage and bile drainage
it is possible to form a hepatic segmentectomy
venous drainage from the liver is via 3 main hepatic veins into the IVC
the IVC and hepatic veins lacks valves
- a rise in central venous pressure is directly transmitted to the liver
-can enlarge as it engorges with blood (hepatomegaly)

Question 10

what is the liver made up of

Answer 10

hepatic lobules with a central vein in the middle of it and an interlobular portal triad at each corner
>kind of hexagonally shaped

Question 11

what does the interlobular portal triad consist of

Answer 11

branch of HA
branch of HPV
biliary duct

**hepatocytes (kinda fill the space between the interlobular triad and the central vein

**blood comes up through the hepatic portal vein, comes down the rows of hepatocytes in a funnel called sinusoids to the central vein
>blood will be cleaned by the time it reaches the hepatocytes ready to go back into the heart

Question 12

what are the two clinically important areas of the peritoneal cavity related to the liver

Answer 12

hepatorenal recess

sub-phrenic recess

Question 13

hepatorenal recess fun fact !

Answer 13

one of the lowest parts of the peritoneal cavity when the patient is supine

‘morrisons’ pouch’

so any extra fluid is gonna go there ie blood pus water
»can get peritonitis

Question 14

the gallbladder

Answer 14

> stores and concentrates bile in-between meals
has a body and neck - the neck narrows to become the cystic duct
bile flows in and out of the gallbladder via the cystic duct
blood supply is via the cystic artery
-branch of right hepatic artery in 75% of people

!!doesn’t produce bile!!

Question 15

gallbladder pain characteristics

Answer 15

*the gallbladder is a foregut organ
>early pain will present in the epigastric region
>pain can also present in the hypochondrium with or without pain referral to the right shoulder (phrenic nerve)

ie this is the kind of pain a paint would get with gallstones in the cystic duct

Question 16

cholecystectomy

Answer 16

removal of the gallbladder

Question 17

what is the biliary tree

Answer 17

a number of ducts transporting bile

Question 18

ducts of the biliary tree

Answer 18

right and left hepatic ducts
>these unite to form the common hepatic duct

> the common hepatic duct unites with the cystic duct to form the bile duct

> > the bile duct then drains into the duodenum

Question 19

the abdominal aorta has three midline branches - what are they

Answer 19

splenic artery
hepatic artery
left gastric artery

> arises around T12 vertebral level

**each of these branches gives rise to further branches ie gastroduodenal, superior pancreatico-duodenal

Question 20

the splenic artery

largest branch of the celiac trunk

Answer 20

has a very torturous course ie twisty

> runs along superior border of the pancreas

Question 21

where does the blood supply to the stomach come from

Answer 21

> right and left gastric arteries

• run along the lesser curvature
• anastomose together
• left = celiac trunk - splenic artery branch
• right = hepatic artery branch

> right and left gastro-mental arteries

• run along the greater curvature
• anastomose together

Question 22

where does the bloody supply to the liver come from

Answer 22

the hepatic artery
(which branches into right and left hepatic arteries)

> the rest comes from the hepatic portal vein

Question 23

venous drainage of the liver can be classified into two systems

Answer 23

portal venous drainage system and systemic venous drainage system

Question 24

portal venous system consists of …

Answer 24

>HPV
-drains from foregut, midgut and hindgut
>splenic vein 
-drains from the foregut 
>inferior mesenteric vein 
-drains from hindgut
>superior mesenteric vein 
-drains from midgut
>the inferior vena cava 
-drains the cleaned blood from the hepatic veins into the right atrium