Clinical Antatomy of Jaudice Flashcards
Define jaundice? What is it cuased by?
Yellowing of the sclera (white of eyes) and skin
Caused by an increase in the blood levels of bilirubin
What is bilirubin?
Normal by-product of the break down of red blood cells (mainly occurs in the spleen)
What produces bile?
the liver
What stores and concentrates bile?
the gall bladder
How does bile travel from the liver to the gall bladder?
Bile then travels through the ‘biliary tree’
A set of tubes connecting the liver to the 2nd part of the duodenum
What is bile important for?
normal absorption of fats from the small intestine
What are the functions of the liver?
Glycogen storage
Bile secretion
Describe the surface anatomy of the liver? Position? Relations?
Located mainly in RUQ
Protected by Ribs 7-11
Location changes in breathing
Inferior to the right hemi-diaphragm
What are the names of the anatomical lobes of the liver?
Caudate lobe
Left lobe
Right lobe
Quadrate lobe
What does each functional lobe of the liver have?
Branch of a hepatic artery
Branch of a hepatic portal vein
Bile drainage (to bile duct)
Venous drainage (to IVC)
What are the names of the functional lobes and what do they allow for?
I, II, III, IV, V, VI, VII, VIII
allow for a segmentectomy = ie you can remove just one segment
Where does the hepatic veins come from?
Inferior Vena Cava
What does the portal triad run inside?
the hepatoduodenal ligament
Describe the Coeliac Trunk?
First of three midline branches of the aorta
Retroperitoneal
Leaves aorta at T12 vertebral level
Supplies the organs of the foregut
What does the Coeliac Trunk split into?
Splenic artery
Left gastric artery
Common Hepatic artery
Describe the anatomical postition and functions of the spleen?
Protected by ribs 9-11
Intraperitoneal organ within left hypochondrium
Functions within the haematological system
Breaks down red blood cells to produce bilirubin
What are the major blood supplies to the stomach?
Right and left gastric arteries
Anastomose together along junction of lesser curvature and lesser omentum
Right and left gastro-omental arteries
Anastomose together along junction of greater curvature and greater omentum
What are the minor blood supplies to the stomach?
Posterior gastric arteries
Short gastric arteries
What is the liver blood supply?
DUAL BLOOD SUPPLY
Right and Left hepatic arteries
Branches of the Hepatic artery proper
What are liver cells called?
hepatocytes
What are the two recesses that are related to the liver?
Hepatorenal recess (Morison’s pouch) Sub-phrenic recess
What does the hepatic portal vein do?
drains blood from foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
What is the hepatic portal vein made up of?
Splenic vein (drains foregut) Superior mesenteric vein (midgut)
What does the inferior mesentric vein do?
Drains the blood from the hindgut to the splenic vein
What does the inferior vena cava do?
Drains the cleaned blood from the hepatic veins into the right atrium
What is the blood supply of the gall bladder?
cystic artery
- Branch of right hepatic artery
- Located in the Cystohepatic triangle (of Calot)
How does bile flow in and out of the gall bladder?
cystic duct
What is a Cholecystectomy?
surgical removal of the gall bladder
What does each liver lobule contain?
central vein in the middle
intralobular portal triad at each corner
What is the intralobular portal triad?
biliary duct
branch of hepatic artery
branch of hepatic portal vein
What are the 1st, 2nd, 3rd and 4th parts of the duodenum called?
1 - superior
2 - decending
3 - horizontal
4 - ascending
Which part of the duodenum does the main pancreatic duct and bile duct drain into?
2nd part
What makes up the bile duct?
Common hepatic duct (left and right hepatic duct)
Cystic duct
Where does the duodenum begin and end?
Begins = Pyloric sphincter
Ends = the duodenojejunal flexure
What makes up the superior part of the duodenum?
duodenal cap
At what point does the duodenum change from being retroperitoneal to intraperitoneal?
the duodenojejunal flexure
What is the role of the duodenum?
Secretes a number of peptide hormones into blood:
Gastrin, CCK
CCK stimulates gall bladder contraction (i.e. increased bile production)
Describe the peritoneal position of the pancreas? What are the four parts?
Retroperitoneal
Head
Neck
Body
Tail
What are the two functions of the pancreas?
Exocrine = pancreatic digestive enzymes into the pancreatic duct Endocrine = insulin and glucagon into the blood stream
What does the main pancreatic duct join?
bile duct
What does the main pancreatic duct and bile duct form?
Ampulla of Vater
-> to then drain into the 2nd part of the duodenum
What are the names of the Spinchters around the bile duct and duodenum?
Bile duct sphincter
Pancreatic duct sphincter
Sphincter of Oddi
What is ERCP?
Endoscopic Retrograde Cholangiopancreatography
Investigation used to study the biliary tree and pancreas
Endoscope inserted through oral cavity, oesophagus, stomach and into duodenum
What are the possible causes of jaunice?
Obstruction of the biliary tree
- Gallstones
- Carcinoma at head of pancreas
Flow of bile back up to the liver
Overspill into the blood, of its constituents, including bilirubin
Name the blood supplies of the duodenum and pancreas?
Superior mesenteric artery Inferior pancreaticoduodenal artery and Superior pancreaticoduodenal artery (astamose together) Gastroduodenal artery Splenic artery Dorsal pancreatic arteries
Where is pain from a duodenal ulcer normally felt?
epigastric pain
Describe a cause of pancreatitis?
blockage of the ampulla by a gallstone
- bile is then diverted into the pancreas leading to irritation and inflammation
Where can pain from the pancreas present?
epigastric or umbillical
- also radiate to the back
Describe what can cause acute pancreatitis? and what can occur in very severe cases?
Can be caused by gallstone obstruction leading to reflux of bile and pancreatic juice in to the main pancreatic duct
In more advanced cases vascular haemorrhage can occur, leading to blood/fluid accumulation in the retroperitoneal space
Where does the ileum end?
ileocaecal junction
Describe the differences between the ileum and jejunum?
Colour
Jejunum is deep red
Ileum is lighter pink
Wall
Jejunum is thicker and heavy
Ileum is thinner and lighter
Vascularity
Jejunum is more vascular – more blood
Ileum is less vascular
Mesenteric Fat
Jejunum has less fat
Ileum has more fat
Circular Folds (L. plicae circularis)
Jejunum has large, tall and closely packed fold
Ileum has low and sparse folds (absent distally)
Lymphoid Tissue (Peyer’s Patches) - Present in ileum (maybe duodenum too)
What is the arterial blood supply of the ileum and jejunum?
superior mesenteric artery via jejunal and ileal arteries
What is the venous blood supply of the ileum and jejunum?
jejunal and ileal veins
to superior mesenteric vein
to hepatic portal vein
Describe the superior mesentric vessels?
Leaves the Aorta at L1 vertebral level
Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper
Describe the absoprtion of fat?
Bile helps in the absorption of fats from the GI tract lumen into the intestinal cells
Fats (within chylomicrons) are absorbed from 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 at the left venous angle
What are the main groups of lymph nodes draining abdominal organs called?
Celiac (foregut organs)
Superior mesenteric (midgut organs)
Inferior mesenteric (hindgut organs)
Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)
Describe the left venous angle?
left subclavian and internal jugular veins
thoracic duct drainage
Describe the right venous angle?
right subclavian and internal jugular veins
right lymphatic duct drainage
