Clinical Antomy of Jaundice - 2

Question 1

what is jaundice

Answer 1

yellowing of the sclera (white of the eyes)/ skin

caused by an increase in the blood levels of bilirubin

Question 2

what is bilirubin

Answer 2

normal by product of break down of red blood cells

breakdown of red blood cells mainly occurs in the spleen

used to form bile in the liver

bile then travels through the ‘biliary tree’ (set of tubes connecting liver to 2nd part of the duodenum)

Question 3

what makes up the interlobular portal triad

Answer 3

branch of the HPV
branch of the HA
bilary duct (bile formed in hepatocytes drain here)

Question 4

what does the central vein in the liver do?

Answer 4

collects ‘cleaned’ blood and drains into hepatic vein

Question 5

what is a hepatocyte

Answer 5

liver cell

Question 6

describe the path of the ducts of the biliary tree

Answer 6

right and left hepatic ducts
unite to form COMMOM hepatic duct
unites with CYSTIC duct to form
BILE DUCT

Question 7

4 parts of the duodenum

Answer 7

superior
descending
horizontal
ascending

Question 8

where does the duodenum begin

Answer 8

at pyloric sphincter

–Anatomical sphincter controlling the flow of chyme from stomach to duodenum
Smooth muscle – autonomic nerves, (Symp) contraction, (ParaSymp) relaxation

Question 9

where does the duodenum end

Answer 9

duodenojejunal flexure

Question 10

what does Retroperitoneal mean

Answer 10

situated or occurring behind the peritoneum

Question 11

where does the pancreas lie

Answer 11

transversely across the posterior abdomen

The head of the pancreas is described as being surrounded by the “C-shape” formed by the duodenum

Question 12

what are the parts of the pancreas

Answer 12

head (with uncinate process)
neck
body
tail

Question 13

anatomical relations of the pancreas

Answer 13

anteriorly lies the stomach

duodenum surrounds the head
superoposteriorly - the splenic vessels

Question 14

functions of the pancreas

Answer 14

exocrine - pancreatic digestive enzymes into main pancreatic duct

endocrine - insulin and glucagon into bloodstream

Question 15

drainage of the biliary system

Answer 15

The Bile Duct descends posteriorly to the 1st (superior) part of the duodenum

Then travels into a groove on the posterior aspect of the pancreas

It then joins with the main pancreatic duct

• Forms the ampulla of Vater / hepatopancreatic ampulla
• Widened part

Both then drain into the 2nd part of the duodenum

Question 16

what are anatomical sphincters

Answer 16

discrete areas where muscle completely encircles the lumen of the tract

Question 17

what is used to investigate the biliary tree and pancreas

and how does it work

Answer 17

ERCP - endoscopre retrograde cholangiopancreatogrephy

endoscope inserted through oral cavity, oesophagus, stomach and into duodem

cannula placed into major duodenal papilla and radio-opaque dye injected back into the bilary tree

Radiographic images are taken of the dye-filled biliary tree

Question 18

obstructive causes and process of jaundice

Answer 18

obstruction of the biliary tree by: gall stones, carcinoma at head of pancreas

flow of bile back up to the liver

overspill into the blood, of its constituents (including bilirubin)

These are extra hepatic (outside the liver) obstructive causes of jaundice
Post-hepatic jaundice

Question 19

what makes up the small intestine

Answer 19

duodenum
jejunum
ileum

Question 20

where does the jejunmun begin and where does the ileum end

Answer 20

duodenaljejunal flaxure

ilecaecal junction

Question 21

differences in the jejunum and the ileum

Answer 21

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
Ileum is less vascular

Mesenteric Fat
Jejunum has less
Ileum has more

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

Question 22

Blood Supply of Jejunum and Ileum: arterial blood from

Answer 22

superior mesenteric artery

via jejunal and ileal arteries

Question 23

Blood Supply of Jejunum and Ileum: venous drainage from

Answer 23

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

Question 24

Blood Supply of Jejunum and Ileum: where do the vessels all travel

Answer 24

within the mesentery

Question 25

superior mesenteric vessels path

Answer 25

leaves aorta at L1 vertebral level

posterior to the neck of the pancreas

travels inferiorly, anterior to the uncinate process of pancreas to entre the mesentery proper

Question 26

what helps the absorbtion of fats from the GI tract into the intestinal cells

Answer 26

bile

Question 27

main groups of lymph groups of the abdominal

Answer 27

Celiac (foregut organs)

Superior mesenteric (midgut organs)

Inferior mesenteric (hindgut organs)

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

Question 28

where are venous angles

Answer 28

Junction between subclavian and internal jugular veins

Question 29

Lymphatics of the Abdomen:where will lymph drain into

Answer 29

thoracic duct

right lymphatic duct