Jaundice 2 Flashcards
how is common hepatic duct formed
right and left hepatic ducts unite
how is bile duct formed
common hepatic duct unties with cystic duct
where does bile duct drain into
2nd part of duodenum
describe the course of the bile duct
descends posteriorly to the 1st part of duodenum
travels into a groove on the posterior aspect of pancreas
joins with main pancreatic duct
they both then drain into 2nd part of duodenum
what is formed as bile duct joins with main pancreatic duct
ampulla of Vater/hepatopancreatic ampulla
how does the bile duct drain into duodenum
via major duodenal papilla
what are anatomical sphincters
discrete areas where muscle completely encircles the lumen of the tract
smooth muscle sphincters in the biliary tract
bile duct sphincter
pancreatic duct sphincter
sphincter of Oddi
function of anatomical sphincters
prevent reflux of digestive secretions and duodenal content
specific function of bile duct sphincter
controls flow of bile into duodenum
investigation to study biliary tree and pancreas
endoscopic retrograde cholangiopancreatography (ERCP)
also treats pathologies!!!
extra hepatic obstructive causes of jaundice
obstruction of biliary tree
flow of bile back up to the liver
overspill into blood
how may the biliary tree be obstructed
gallstones
carcinoma at head of pancreas
describe the structure of the pancreas
head (with uncinate process)
neck
body
tail
describe the uncinate process
small projection from inferior part of the head of the pancreas and lies posterior to the superior mesenteric artery
describe the pancreas and its location
retroperitoneal organ
lies transversely across posterior abdomen
what lies posterior to the pancreas
the right kidney and adrenal gland IVC bile duct abdominal aorta superior mesenteric vessels left kidney and adrenal gland part of the portal venous system
what lies anterior to pancrwas
stomach
what surrounds the head of the pancreas
duodenum
what lies superoposteriorly to pancreas
splenic vessels
parasympathetic nerves of pancreas
vagus
sympathetic nerves of pancreas
abdominopelvic splanchnic nerves
blood supply of pancreas
mainly branches from splenic artery - pancreatic branches
close relationship to duodenum and so similar blood supply;
gastroduodenal artery
superior mesenteric artery
describe the gastroduodenal artery
superior pancreaticoduodenal
describe the superior mesenteric artery
inferior pancreaticoduodenal
inflammation of the pancreas
pancreatitis
causes of pancreatitis
blockage of the ampulla by a gallstone - bile diverted into pancreas leading to irritation and inflammation
radiation of pain in the pancreas
felt in epigastric and/or umbilical region
may radiate to patient’s back
4 parts of duodenum
25cm in length; superior (intraperitoneal) - duodenal cap descending (retroperitoneal) horizontal (retroperitoneal) ascending (retroperitoneal)
where does duodenum begin
at pyloric sphincter
describe the pylroic sphincter
anatomical sphincter controlling the flow of chyme from stomach to duodenum
what does duodenum secrete
peptide hormones into the blood;
gastrin
CCK
where is pain from a duodenal ulcer felt
epigastric region
sympathetic innervation of pyloric sphincter
promotes contraction
parasympathetic innervation of pyloric sphincter
promotes relaxation
blood supply of duodenum
gastroduodenal artery
superior mesenteric artery
which abdominal quadrant are jejunum and ileum found
all quadrants
jejunum - mainly upper left
ileum - mainly lower right
where does jejunum begin
duodenaljejunal flexure
where does ileum end
ileocaecal junction
what is the duodenal-jejunal flexure
the junction between duodenum and jejunum
mucosa in jejunum
highly folded - plicae circularis
wider
thick walled
less fat
mucosa in distal ileum
smooth
narrow
thin walled
more fatty
arterial blood supply of jejunum and ileum
superior mesenteric artery via jejunal and ileal arteries
venous drainage of jejunum and ileum
from jejunal and ileal veins to superior mesenteric vein and hepatic portal vein
protein and carbohydrate absorption in small intestine
aborbed from small intestine into portal venous system to be taken into liver
how do vessels travel in jejunum and ileum
within mesentery
how is fat absorbed from the GI tractl lumen
bile helps absorption into intestinal cells
where are fats absorbed from intestinal cells
absorbed into specialised lymphatic vessels of small intestine - lacteals
course of lacteals
travel via lymphatic system to drain into venous system at left venous angle
where are lymph vessels located in the abdomen
lie alongside arteries
main groups of lymph nodes draining abdominal organs
celiac - foregut organs
superior mesenteric - midgut organs
inferior mesenteric - hingut organs
lumbar - kidneys, posterior abdo wall, pelvis and lower limbs
where do superficial lymph vessels drain into
deep lymph vessels dependent on where they originate from;
thoracic duct or right lymphathtic duct
and then into venous system
venous angles
junction between subclavian and internal jugular veins
what drains into left venous angle
thoracic duct
what drains into right venous angle
right lymphatic duct drainage
