Clinical Anatomy of Jaundice I

Question 1

What organs are involved in the formation of bile and bilirubin?

Answer 1

Liver
Spleen
Pancreas
Gallbladder
Small intestines

Question 2

What is bilirubin and what does it do?

Answer 2

Bilirubin is the normal by-product of the breakdown of red blood cells (done in the spleen)
It is used to form bile in the liver

Question 3

Where is bile stored and what is it important in?

Answer 3

Bile is stored in the gallbladder. It is important for the normal absorption of fats from the small intestine

Question 4

What are the functions of the liver?

Answer 4

Receiving nutrients from the GI tract
Storing glycogen
Secreting bile

Question 5

What is the surface anatomy of the liver?

Answer 5

Lies mainly in the RUQ

Protected by ribs 7-11

Question 6

What are the anatomical relations of the liver?

Answer 6

Inferior to the right hemi-diaphragm
Gallbladder lies posterior and inferior
Hepatic flexure lies inferior
Right kidney, adrenal gland, IVC and abdominal aorta lie posterior
Stomach lies posterior at middle/left side

Question 7

What are the four anatomical liver lobes?

Answer 7

Caudate lobe
Quadrate lobe
Right lobe
Left lobe

Question 8

Describe the functional anatomy of the liver

Answer 8

The liver contains eight functional segments in a clockwise orientation. Each segment contains:
Branch of hepatic artery
Branch of hepatic portal vein
Bile drainage
Venous drainage

Question 9

How may ascites be caused by hepatic circulation?

Answer 9

As both the IVC and hepatic vein lack valves, an increase in central pressure will cause increased hepatic pressure causing ascites

Question 10

Describe the portal triad and name the structures within it

Answer 10

The portal triad contains the main structures that enter/leave the liver parenchyma within the hepatoduodenal ligament. They include:
Hepatic portal vein
Hepatic artery proper
Bile duct

Question 11

What is the coeliac trunk and what does it supply?

Answer 11

The coeliac trunk is the first of three midline aortic branches. It leaves at T12, and trifurcates to:
Splenic artery
Left gastric artery
Common hepatic artery
These arteries supply the foregut organs

Question 12

Give the surface anatomy of the splenic artery

Answer 12

Passes over superior border of the pancreas

Question 13

Give the anatomical relations of the splenic artery

Answer 13

Diaphragm posteriorly
Stomach anteriorly
Splenic flexure inferiorly
Left kidney medially

Question 14

What is the major blood supply to the stomach?

Answer 14

Right and left gastric arteries along the junction of the lesser curvature and lesser omentum
Right and left gastro-omental arteries along the junction of the greater curvature and greater omentum

Question 15

What is the minor blood supply to the stomach?

Answer 15

Posterior gastric arteries

Short gastric arteries

Question 16

What is the blood supply to the liver?

Answer 16

Right and left hepatic arteries
Branches of hepatic artery proper
Hepatic portal vein

Question 17

Explain the anatomy of an interlobular portal triad

Answer 17

Each interlobular portal triad contains
Branch of hepatic artery
Branch of hepatic portal vein - drains into central veins
Central vein - collects “cleaned” blood and drains into hepatic veins
Biliary duct - collects bile formed in hepatocytes

Question 18

Explain the clinical importance of the recesses of the peritoneal cavity of the liver

Answer 18

The two clinically important recesses are
Hepatorenal recess
Sub-phrenic recess

Both recessess are in the greater sac, meaning peritonitis can cause pus and abscess formation in the recesses
The hepatorenal recess is also a common site of fluid drainage in a supine patient

Question 19

Explain the function of the hepatic portal system and describe its anatomy

Answer 19

The hepatic portal vein drains blood from foregut, midgut and hindgut structures to the liver. It is formed by
Splenic vein - drains foregut
Superior mesenteric vein - drains midgut

The inferior mesenteric vein drains blood from the hindgut to the splenic vein, while the inferior vena cava drains clean blood from hepatic veins to right atrium

Question 20

Describe the anatomy of the gallbladder

Answer 20

The gallbladder lies on the posterior aspect of the liver and is anterior to the duodenum
It stores and concentrates bile between meals

Question 21

Describe the blood supply to the gallbladder

Answer 21

The gallbladder is supplied by the cystic artery, located in the cystohepatic triangle

Question 22

Explain the cause and presentation of gallbladder pain

Answer 22

Gallbladder pain is caused by inflammation of the gallbladder/cystic duct. It is a foregut organ meaning pain presents in the epigastrium and right hypochrondrium

Question 23

What term is used for the surgical removal of a gallbladder?

Answer 23

Cholecystectomy