Clinical Antatomy of Jaudice Flashcards by Alison Gourlay

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

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What is bilirubin?

Normal by-product of the break down of red blood cells (mainly occurs in the spleen)

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What produces bile?

the liver

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What stores and concentrates bile?

the gall bladder

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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

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What is bile important for?

normal absorption of fats from the small intestine

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What are the functions of the liver?

Glycogen storage

Bile secretion

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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

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What are the names of the anatomical lobes of the liver?

Caudate lobe
Left lobe
Right lobe
Quadrate lobe

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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)

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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

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Where does the hepatic veins come from?

Inferior Vena Cava

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What does the portal triad run inside?

the hepatoduodenal ligament

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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

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What does the Coeliac Trunk split into?

Splenic artery
Left gastric artery
Common Hepatic artery

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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

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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

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What are the minor blood supplies to the stomach?

Posterior gastric arteries

Short gastric arteries

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What is the liver blood supply?

DUAL BLOOD SUPPLY
Right and Left hepatic arteries
Branches of the Hepatic artery proper

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What are liver cells called?

hepatocytes

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What are the two recesses that are related to the liver?

Hepatorenal recess (Morison’s pouch)
Sub-phrenic recess

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What does the hepatic portal vein do?

drains blood from foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)

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What is the hepatic portal vein made up of?

Splenic vein (drains foregut)
Superior mesenteric vein (midgut)

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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