Clinical Anatomy of Jaundice I Flashcards
What organs are involved in the formation of bile and bilirubin?
Liver Spleen Pancreas Gallbladder Small intestines
What is bilirubin and what does it do?
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
Where is bile stored and what is it important in?
Bile is stored in the gallbladder. It is important for the normal absorption of fats from the small intestine
What are the functions of the liver?
Receiving nutrients from the GI tract
Storing glycogen
Secreting bile
What is the surface anatomy of the liver?
Lies mainly in the RUQ
Protected by ribs 7-11
What are the anatomical relations of the liver?
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
What are the four anatomical liver lobes?
Caudate lobe
Quadrate lobe
Right lobe
Left lobe
Describe the functional anatomy of the liver
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
How may ascites be caused by hepatic circulation?
As both the IVC and hepatic vein lack valves, an increase in central pressure will cause increased hepatic pressure causing ascites
Describe the portal triad and name the structures within it
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
What is the coeliac trunk and what does it supply?
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
Give the surface anatomy of the splenic artery
Passes over superior border of the pancreas
Give the anatomical relations of the splenic artery
Diaphragm posteriorly
Stomach anteriorly
Splenic flexure inferiorly
Left kidney medially
What is the major blood supply to the stomach?
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
What is the minor blood supply to the stomach?
Posterior gastric arteries
Short gastric arteries
What is the blood supply to the liver?
Right and left hepatic arteries
Branches of hepatic artery proper
Hepatic portal vein
Explain the anatomy of an interlobular portal triad
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
Explain the clinical importance of the recesses of the peritoneal cavity of the liver
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
Explain the function of the hepatic portal system and describe its anatomy
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
Describe the anatomy of the gallbladder
The gallbladder lies on the posterior aspect of the liver and is anterior to the duodenum
It stores and concentrates bile between meals
Describe the blood supply to the gallbladder
The gallbladder is supplied by the cystic artery, located in the cystohepatic triangle
Explain the cause and presentation of gallbladder pain
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
What term is used for the surgical removal of a gallbladder?
Cholecystectomy
