Clinical Anatomy of Jaundice (Part 2) Flashcards
What is bilirubin?
Normal by product of the break down of red blood cells
Where does the breakdown of RBC occur?
Spleen
What is contained within the interlobular portal triad?
Biliary duct
Branch of the hepatic artery
Branch of the hepatic portal vein
Describe the biliary tree?
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
Describe the parts of the duodenum?
1st - Superior (part intraperitoneal) - Duodenal cap – relatively mobile 2nd - Descending (retroperitoneal) 3rd - Horizontal (retroperitoneal) 4th - Ascending (retroperitoneal)
What parts of the duodenum are intra and retro peritoneal?
1st part intraperitoneal
2-4 = retroperitoneal
Where does the duodenum start?
at the pyloric sphincter
What is the pyloric sphincter made of?
Describe the sympathetic and parasympathetics of it?
Smooth muscle - controlled by autonomic nerves
sympathetic - contraction
parasympathetic - relaxation
Where does the duodenum end?
At the duodenojejunal flexure
What does the duodenum secrete?
Peptide hormones
- Gastrin, CCK
Where would pain from a duodenal ulcer present?
In the epigastric region
Is the pancreas intra or retroperitoneal?
Retroperitoneal
What are the different parts of the pancreas?
Head (with a uncinate process)
Neck
Body
Tail
How would the head of the pancreas be describe?
A C shape which is formed by the duodenum
What lies supero-posteriorly to the pancreas?
The splenic vessels
What are the functions of the exocrine pancreas?
Acinar cells - pancreatic digestive enzymes into the main pancreatic duct
What cells release pancreatic digestive enzymes into the main pancreatic duct?
Acinar cells - EXOCRINE
What are the functions of the endocrine pancreas?
Islets of Langerhans - secrete insulin and glucagon into the blood stream
What cells release insulin and glucagon into the bloodstream?
Islets of langerhans - Endocrine
What does the joining of the main pancreatic duct and the bile duct form?
The ampulla of Vater/hepatopancreatic ampulla
What is the eminence called in which the united bile duct and pancreatic enter into the duodenum?
Major duodenal papilla
What goes into the duodenum through the minor duodenal papilla?
The accessory pancreatic duct
What are anatomical sphincters?
Discrete areas where the muscle completely encircles the lumen of the tract
What is the sphincter of Oddi? (smooth muscle sphincter)
The sphincter at which the bile duct and pancreatic duct join and then go into the 2nd part of the duodenum
What are the other ducts in the biliary tree? (smooth muscle sphincters)
Bile duct sphincter
Pancreatic duct sphincter
What does ERCP stand for?
Endoscopic Retrograde Cholangiopancreatography
What is ERCP?
Investigation used to study the biliary tree and pancreas and treat some pathologies associated with it
What might cause obstruction of the biliary tree?
Gallstones
Carcinoma at the head of the pancreas
What would happen if there was an obstruction the biliary tree?
The flow of bile would back up into the liver, this would overspill into the blood - including bilirubin
What is the blood supply to the duodenum and pancreas?
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
What is the blood supply specfic to the pancreas?
Splenic artery (from coeliac trunk) Doral pancreas arteries (from splenic)
What might be a cause of pancreatitis?
Blockage of the ampulla by a gallstone
- bile is then diverted into the pancreas leading to irritation and inflammation
What type of organ is the pancreas? Fore, Mid or Hindgut?
Foregut and midgut
Where would pain present from the pancreas?
In the epigastric and/or umbilical region
Can also radiate through to the back
What is grey-turner’s sign and cullen’s sign?
Grey-turners = right or left flank bruising
Cullen’s sign - bruising around umbilicus via the falciform lig.
Which parts of the duodenum are foregut organs?
1st and 2nd parts - the rest of the small intestines are midgut organs
How long is the jejunum and ileum?
Jejunum - 3m
Ileum - 4m
Where does the jejunum begin?
The duodenaljejunal flexure
Where does the ileum end?
At the ileocaecal junction
Describe the differences between the jejunum and the ileum?
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
Describe the blood supply to the jejunum and ileum, arterial?
From the SMA - via jejunal and ileal arteries
Describe the blood supply to the jejunum and ileum, venous?
From jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein
Where do the vessels travel within?
Within the mesentery
Where do the superior mesenteric vessels leave the aorta?
L1 posterior to the ne k of the pancreas
Where do the superior mesenteric vessels travel?
inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper
What helps in the absorption of fats from the GI tract lumen into the intestinal cells?
Bile
How are fats (within chylomicrons) asorbed?
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
Where does the lymph from the intestine eventually drain into the venous system?
At the left venous angle
Where do lymph vessels tend to lie in the abdomen?
Alongside the arteries?
What are the main groups of lymph nodes draining the abdominal organs?
Celiac (foregut organs)
Superior mesenteric (midgut organs)
Inferior mesenteric (hindgut organs)
Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)
Where will lymph from either the thoracic duct or the right lymphatic duct eventually drain into?
the venous system for ‘recycling’ at venous angles
What are the venous angles?
Junction between subclavian and internal jugular veins
What is the left and right venous angle for drainage of?
Left = lymph from the thoracic duct
Right - lymph from the right lymphatic duct
