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LC Gastroenterology Week 3 > Clinical Anatomy of Jaundice (Part 2) > Flashcards

Clinical Anatomy of Jaundice (Part 2) Flashcards

1
Q

What is bilirubin?

A

Normal by product of the break down of red blood cells

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2
Q

Where does the breakdown of RBC occur?

A

Spleen

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3
Q

What is contained within the interlobular portal triad?

A

Biliary duct
Branch of the hepatic artery
Branch of the hepatic portal vein

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4
Q

Describe the biliary tree?

A

Starts with right and left hepatic ducts
Join together to form common hepatic duct
Cystic duct joins common hepatic duct
Joins to form bile duct/common bile duct
Main pancreatic duct joins and then hat drains into the 2nd part of the duodenum

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5
Q

Describe the parts of the duodenum?

A 
1st - Superior (part intraperitoneal)
- Duodenal cap – relatively mobile
2nd - Descending (retroperitoneal)
3rd - Horizontal (retroperitoneal)
4th - Ascending (retroperitoneal)
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6
Q

What parts of the duodenum are intra and retro peritoneal?

A

1st part intraperitoneal

2-4 = retroperitoneal

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7
Q

Where does the duodenum start?

A

at the pyloric sphincter

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8
Q

What is the pyloric sphincter made of?

Describe the sympathetic and parasympathetics of it?

A

Smooth muscle - controlled by autonomic nerves

sympathetic - contraction
parasympathetic - relaxation

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9
Q

Where does the duodenum end?

A

At the duodenojejunal flexure

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10
Q

What does the duodenum secrete?

A

Peptide hormones

- Gastrin, CCK

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11
Q

Where would pain from a duodenal ulcer present?

A

In the epigastric region

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12
Q

Is the pancreas intra or retroperitoneal?

A

Retroperitoneal

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13
Q

What are the different parts of the pancreas?

A

Head (with a uncinate process)
Neck
Body
Tail

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14
Q

How would the head of the pancreas be describe?

A

A C shape which is formed by the duodenum

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15
Q

What lies supero-posteriorly to the pancreas?

A

The splenic vessels

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16
Q

What are the functions of the exocrine pancreas?

A

Acinar cells - pancreatic digestive enzymes into the main pancreatic duct

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17
Q

What cells release pancreatic digestive enzymes into the main pancreatic duct?

A

Acinar cells - EXOCRINE

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18
Q

What are the functions of the endocrine pancreas?

A

Islets of Langerhans - secrete insulin and glucagon into the blood stream

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19
Q

What cells release insulin and glucagon into the bloodstream?

A

Islets of langerhans - Endocrine

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20
Q

What does the joining of the main pancreatic duct and the bile duct form?

A

The ampulla of Vater/hepatopancreatic ampulla

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21
Q

What is the eminence called in which the united bile duct and pancreatic enter into the duodenum?

A

Major duodenal papilla

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22
Q

What goes into the duodenum through the minor duodenal papilla?

A

The accessory pancreatic duct

23
Q

What are anatomical sphincters?

A

Discrete areas where the muscle completely encircles the lumen of the tract

24
Q

What is the sphincter of Oddi? (smooth muscle sphincter)

A

The sphincter at which the bile duct and pancreatic duct join and then go into the 2nd part of the duodenum

25
Q

What are the other ducts in the biliary tree? (smooth muscle sphincters)

A

Bile duct sphincter

Pancreatic duct sphincter

26
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangiopancreatography

27
Q

What is ERCP?

A

Investigation used to study the biliary tree and pancreas and treat some pathologies associated with it

28
Q

What might cause obstruction of the biliary tree?

A

Gallstones

Carcinoma at the head of the pancreas

29
Q

What would happen if there was an obstruction the biliary tree?

A

The flow of bile would back up into the liver, this would overspill into the blood - including bilirubin

30
Q

What is the blood supply to the duodenum and pancreas?

A 
Gastroduodenal artery (off the common hepatic)
Superior pancreasticoduodenal artery (off the gastroduodenal)

Superior mesenteric artery (from Aorta at L1)
Inferior pancreasticoduodenal artery (from superior mesenteric artery)

Superior and inferior pancreaticoduodenal artery anastomosis

31
Q

What is the blood supply specfic to the pancreas?

A 
Splenic artery (from coeliac trunk)
Doral pancreas arteries (from splenic)
32
Q

What might be a cause of pancreatitis?

A

Blockage of the ampulla by a gallstone

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

33
Q

What type of organ is the pancreas? Fore, Mid or Hindgut?

A

Foregut and midgut

34
Q

Where would pain present from the pancreas?

A

In the epigastric and/or umbilical region

Can also radiate through to the back

35
Q

What is grey-turner’s sign and cullen’s sign?

A

Grey-turners = right or left flank bruising

Cullen’s sign - bruising around umbilicus via the falciform lig.

36
Q

Which parts of the duodenum are foregut organs?

A

1st and 2nd parts - the rest of the small intestines are midgut organs

37
Q

How long is the jejunum and ileum?

A

Jejunum - 3m

Ileum - 4m

38
Q

Where does the jejunum begin?

A

The duodenaljejunal flexure

39
Q

Where does the ileum end?

A

At the ileocaecal junction

40
Q

Describe the differences between the jejunum and the ileum?

A

Colour - J = deep red, I = Light pink

Wall - J = Thicket + darker, I = Thinner + lighter

Vascularity - J = more vascular

Mesenteric fat - J = more

Circular folds (L. plicae circulars) - J = has large tall and closely packed fold, I = low and sparse folds (absent distally)

Lymphoid tissue - I - has Peyer’s patches present

41
Q

Describe the blood supply to the jejunum and ileum, arterial?

A

From the SMA - via jejunal and ileal arteries

42
Q

Describe the blood supply to the jejunum and ileum, venous?

A

From jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein

43
Q

Where do the vessels travel within?

A

Within the mesentery

44
Q

Where do the superior mesenteric vessels leave the aorta?

A

L1 posterior to the ne k of the pancreas

45
Q

Where do the superior mesenteric vessels travel?

A

inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper

46
Q

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

A

Bile

47
Q

How are fats (within chylomicrons) asorbed?

A

From the intestinal cells into specialised lymphatic vessels of the small intestine called lacteals - they travel via the lymphatic system to eventually drain into the venous system

48
Q

Where does the lymph from the intestine eventually drain into the venous system?

A

At the left venous angle

49
Q

Where do lymph vessels tend to lie in the abdomen?

A

Alongside the arteries?

50
Q

What are the main groups of lymph nodes draining the abdominal organs?

A

Celiac (foregut organs)

Superior mesenteric (midgut organs)

Inferior mesenteric (hindgut organs)

Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)

51
Q

Where will lymph from either the thoracic duct or the right lymphatic duct eventually drain into?

A

the venous system for ‘recycling’ at venous angles

52
Q

What are the venous angles?

A

Junction between subclavian and internal jugular veins

53
Q

What is the left and right venous angle for drainage of?

A

Left = lymph from the thoracic duct

Right - lymph from the right lymphatic duct

LC Gastroenterology Week 3 (15 decks)

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