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Gastrointestinal > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is jaundice?

A

An increase in levels of bilirubin in the blood

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2
Q

Where does RBC breakdown take place?

A

in the spleen but also thought to occur in the liver

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3
Q

Where is bile produced?

A

the liver

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4
Q

What happens to bile in the bile duct?

A

It is concentrated and stored here

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5
Q

Where is the portal triad found?

A

in the free edge of the lesser omentum

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6
Q

What are the 3 tubes which make up the portal triad?

A

Hepatic artery (blood supply to)
Hepatic portal vein (drainage to the liver)
Common bile duct (Part of biliary tree linking liver to duodenum)
also contains nerves and lymphatics

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7
Q

Where does the splenic artery travel?

A

it has a tortuous course along the pancreas’s superior border

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8
Q

What is the spleen anatomically related to?

A

The diaphragm posteriorly
The stomach anteriorly
The splenic flexure inferiorly
The left kidney medially

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9
Q

What is the function of the spleen?

A

works as a giant lymph node within the immunological system
Store of blood - will release in an emergency
Breaks down old blood cells - breaks down RBCs to produce bilirubin
In the embryo makes RBC

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10
Q

How enlarged does the spleen need to be to be palpable?

A

when 3 times the initial size

would be palpable at the end of inspiration

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11
Q

What does the hepatic artery branch into?

A

Right and Left hepatic arteries

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12
Q

How much of the liver’s blood supply is from the hepatic portal vein?

A

75-80%

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13
Q

What is the liver anatomically related to?

A

The diaphragm superiorly, anteriorly, posteriorly
The anterior aspect of the stomach medially
The gallbladder posterior & inferiorly
The hepatic flexure inferiorly
The right kidney, right adrenal gland, IVC and abdominal aorta posteriorly

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14
Q

How many segments does the liver have?

A

4 anatomical segments and 8 functional segments

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15
Q

What ribs protect the liver?

A

Right ribs 7-11

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16
Q

What does the liver do in relation to the biliary system?

A

Converts bilirubin to bile

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17
Q

What are the 4 anatomical lobes of the liver?

A 
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
(these are visible to the naked eye)
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18
Q

How many main hepatic veins drain into the IVC?

A

3

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19
Q

What are the 2 clinically important areas of the peritoneal cavity related to the liver?

A

Hepatorenal recess (Morison’s pouch)
Sub-phrenic recess
(both within the grater sac)

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20
Q

What is the particular clinical relevance of the hepatorenal recess?

A

it is the lowest part of the peritoneal cavity when the patient is supine

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21
Q

Where does the gallbladder lie?

A

on the posterior aspect of the liver (often firmly attached)

anterior to the duodenum

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22
Q

What is a cholecystectomy?

A

surgical removal of gallbladder

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23
Q

What is bilirubin?

A

A breakdown product of RBC which is used to form bile in the liver

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24
Q

What happens to bile once it is ready to be used?

A

it travels down the biliary tree to the 2nd part of the duodenum where it has an important role in the absorption of fats from the small intestine

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25
Q

Where does the pancreas secrete digestive enzymes which are necessary for digestion?

A

Into the 2nd part of the duodenum

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26
Q

What is the celiac trunk?

A

the 1st of the 3 midline branches of the abdominal aorta (it is retroperitoneal)
arises around T12 level
supplies the organs of the foregut

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27
Q

What are the 3 branches the celiac trunk trifurcates into?

A

Splenic artery
Hepatic artery
Left gastric artery

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28
Q

Where is the spleen located?

A

It is an intraperitoneal organ within the hypochondrium

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29
Q

Why would the spleen be removed?

A

If it has been damaged it is often removed because it is a non-essential organ and carries a high risk of bleeding

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30
Q

What protects the spleen?

A

left ribs 9-11 - their fracture could potentially pierce the spleen

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31
Q

What arteries supply blood to the stomach?

A

the right and left gastric arteries - run along the lesser curvature and anastomose together

the right and left gastro-omental arteries - run along the greater curvature and anastomose together

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32
Q

Where is the liver located?

A

Mainly in the upper right quadrant

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33
Q

What is the significance of the IVC and hepatic veins lacking valves?

A

a rise in central venous pressure is directly transmitted to the liver which can enlarge it as it engorges with blood (hepatomegaly)

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34
Q

What does each of the functional lobes of the liver have (I-VIII)?

A

its own blood supply (hepatic artery and hepatic portal vein)
venous drainage
bile drainage

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35
Q

What is the surgical significance of the functional segements of the liver?

A

It is possible to perform a hepatic segmentectomy

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36
Q

Describe what happens in a lobule

A

Blood flows to the lobule via the hepatic portal triad, it then flows to the central vein through the sinusoids
The sinusoids are like specialised capillaries, they have leaky walls and allow blood to interact with the hepatocytes allowing the hepatocytes to make bile
Bile flows from the hepatocytes in the lobule to the bile duct within the triad to be carried away

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37
Q

What can happen in the pouches when there is peritonitis?

A

a collection pus leading to an abcess

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38
Q

Where does the hepatic portal vein drain blood to?

A

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

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39
Q

Where does the splenic vein drain blood to?

A

Drains the blood from the foregut to the hepatic portal vein

40
Q

Where does the inferior mesenteric vein drain blood to?

A

Drains the blood from the hindgut to the splenic vein

41
Q

Where does the superior mesenteric vein drain blood to?

A

Drains the blood from the midgut to the hepatic portal vein

42
Q

Where does the inferior vena cava drain blood to from the liver?

A

The retroperitonum it drains the cleaned blood from the hepatic veins and into the right atrium

43
Q

What attaches the liver to the diaphragm?

A

the coronary ligaments

44
Q

What is the ligamentum teres/round ligament?

A

It is a remnant of the embryological umbilical vein

45
Q

What attaches the liver to the anterior abdominal wall?

A

the falciform ligament

46
Q

What is the role of the gall bladder?

A

it stores and concentrates bile in between meals

47
Q

What are the different parts of the gall bladder?

A

The body and the neck

- the neck narrows to become the cystic duct (the narrowing provides a potential site of gallstone impaction)

48
Q

How does bile flow in and out of the gallbladder?

A

Through the cystic duct

49
Q

What is the blood supply of the gallbladder?

A

via the cystic artery in 75% of people this is a branch of right hepatic artery

50
Q

What region of the gut s the gallbladder in?

A

It is a foregut organ

51
Q

Where is gallbladder pain felt?

A

the visceral afferents enter the spinal cord between T6 & T9

  • early pain - the epigastric region
  • can also be in the hypochondrium with/without pain referral to the right shoulder due to anterior diaphragmatic irritation
52
Q

What is the biliary tree?

A

It is made up of the series of ducts which transport bile

53
Q

What forms the common hepatic duct?

A

When the right and left hepatic ducts unite

54
Q

What forms the bile duct?

A

When the common hepatic duct unites with the cystic duct

55
Q

Where does the bile duct drain into what other duct drains here?

A

the 2nd part of the duodenum (along with the main pancreatic duct)

56
Q

What is the path of the bile duct in relation to the duodenum?

A

descends posteriorly to the 1st part of the duodenum then int a groove on the posterior aspect of the pancreas

57
Q

Where does the bile duct join with the main pancreatic duct?

A

within the groove on the pancreas the bile duct joins with the main pancreatic duct to form the ampulla of Vater/ hepatopancreatic ampulla at the widened part

58
Q

How do the bile duct and main pancreatic duct drain into the duodenum?

A

only 25% drain separately

drain through the major duodenal papilla (looks like a small nipple)

59
Q

What are the 3 sphincters which are involved in the flow of bile into the duodenum?

A

bile duct sphincter
pancreatic duct sphincter
sphincter of Oddi

60
Q

What is the purpose of the sphincters in the biliary tree?

A

prevent reflux of digestive secretions and duodenal content

bile duct sphincter plays a significant role in controlling the flow of bile into the duodenum

61
Q

What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?

A

investigation used to study the biliary tree and pancreas and treat selected pathologies

62
Q

How is ERCP carried out?

A

Endoscope inserted through oral cavity, oesophagus, stomach and into duodenum
Cannula placed into major duodenal papilla and radio-opaque dye injected back into biliary tree
Radiographic images are taken of the dye-filled biliary tree

63
Q

What is the technical term for jaundice?

A

icterus

64
Q

What happens if something is compressing the biliary tree?

A

the bile cannot flow down it and into the duodenum as it should so it is pushed back up to the liver and overspills into the blood (including bilirubin)

65
Q

What are the extra hepatic causes of jaundice?

A

Gallstones

Carcinoma at the head of the pancreas

66
Q

What are the 4 parts of the pancreas?

A

head
neck
body
tail

67
Q

What is the uncinate process?

A

a small projection from the inferior part of the head of the pancreas and lies posterior to the superior mesenteric artery.

68
Q

What structures does the body of the pancreas overlie?

A

aorta

L2 vertebra

69
Q

What structure does the tail of the pancreas overlie?

A

the left kidney

70
Q

Where is the head of the pancreas in relation to the duodenum?

A

It lies within the C shape formed by the duodenum

71
Q

Where is the pancreas located?

A

It is a reteroperitoneal organ
lies transversely across the posterior abdomen
posteriorly lie the right kidney & adrenal gland, IVC, the bile duct, abdominal aorta, superior mesenteric vessels, left kidney & adrenal gland, part of the portal venous system
anteriorly lies the stomach
the duodenum surrounds the head
superoposteriorly – the splenic vessels

72
Q

What are the functions of the pancreas?

A

exocrine- acinar cells make pancreatic digestive enzymes - delivered via the main pancreatic duct
endocrine - islets of Langerhans produce insulin and glucagon which go into the bloodstream

73
Q

What is the nerve supply to the pancreas?

A

Sympathetic - abominopelvic splanchnic nerves
Parasympathetic - vagus nerves
these pass through the diaphragm, then follow arteries from the celiac and superior mesenteric plexus to reach the pancreas.
Plexus fibres are distributed to acinar cells and islets

74
Q

What controls secretion from the pancreas?

A

parasympathetic fibres are secretomoteo in function but actual secretion is contolled by hormones in the duodenum and intestinal mucosa as a response to acid.

75
Q

Arterial supply to the pancreas

A

Mainly the pancreatic branches from the splenic artery
Branches to the gastroduodenal artery which branches to the pancreaticduodenal artery
The superior mesenteric arty also branches to the inferior mesenteric artey

76
Q

Give an example of what can cause pancreatic pain?

A

Pancreatitis e.g due to a blockage of the ampulla by a gallstone so bile is diverted into the pancreas irritating and inflaming it

77
Q

Where is pancreatic pain felt?

A

It is a foregut and midgut organ and so can be felt in the epigastric and/ or the umbilical region
can radiate though the patients bac

78
Q

What type of organ is the small intestine?

A

1st and 2nd part of the duodenum are foregut organs

rest of small intestine is midgut

79
Q

what are the 4 parts of the duodenum?

A 
Superior (part intraperitoneal)
- Duodenal cap – relatively mobile
Descending (retroperitoneal)
Horizontal (retroperitoneal)
Ascending (retroperitoneal)
80
Q

Where does the duodenum begin?

A

At the pyloric sphincter which controls the flow of chyme from the stomach into the duodenum
sympathetic innervation promotes pyloric sphincter contraction and parasympathetic innervation promotes relaxation

81
Q

What is the arterial blood supply of the duodenum?

A

Gastroduodenal artery - branches to Superior pancreaticoduodenal
artery
Superior mesenteric artery branches to Inferior pancreaticoduodenal

82
Q

How long are each of the sections of the small intestine?

A

Duodenum - 25cm
Jejunum - 3m
Ileum - 4m

83
Q

Where does the jejunum begin?

A

at the duodenaljejunal flexure - L2 vertebral level few cm left of midline

84
Q

What quadrant do the ileum and jejunum lie in?

A

jejunum mainly in the left upper quadrant

ileum mainly in the right lower quadrant

85
Q

Where does the jejunum become the ileum?

A

Hard to find the point of transition but there are clinically and surgically significant differences - differences in mucosa

86
Q

Where does the ileum end?

A

At the ileocaceal junction

87
Q

What is the mucosa like in the jejunum?

A

highly folded - Folds are called plicae circularis
it also has thicker walls than the ileum
the jejunum has a wider diameter than the ileum

88
Q

What is the mucosa and mesentery like in the ileum?

A

It is smoother than the jejunum mucosa and the mesentery has a higher fat content than the mesentery of the jejunum

89
Q

What is the arterial supply to the jejunum and ileum?

A

Arterial blood from:
superior mesenteric artery via jejunal and ileal arteries
The jejunum has a greater vascularity with long vasa recta and few large loops of arterial arcades
The ileum has less vascularity with short vasa recta and many shorted looped arcades
vessels travel in the mesentery

90
Q

What is the venous drainage of the jejunum and ileum?

A

jejunal and ileal veins drain to the superior mesenteric vein to hepatic portal vein
proteins and carbohydrates are absorbed from the small intestines into the portal venous system to be taken to the liver
Vessels travel in the mesentery

91
Q

How are absorbed fats transported to the venous system?

A

After the action of bile helping to absorb fats into the intestinal cells. Fats (within chylomicrons) are then 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

92
Q

What are the main groups of lymph nodes draining abdominal organs?

A 
Celiac (foregut organs)
Superior mesenteric (midgut organs)
Inferior mesenteric (hindgut organs)
Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)
93
Q

How do the abdominal lymph vessels travel?

A

tend to lie alongside arteries

superficial lymph vessels drain into deep

94
Q

Where does lymph drain to eventually?

A 
Depending on origin will drain into
Thoracic duct (from ¾ of body)
Right lymphatic duct (from ¼ of body)
95
Q

Where does the lymph drain into the venous system?

A

At venous angles - the junction between the subclavian and internal jugular veins
left venous angle = thoracic duct drainage
right venous angle = right lymphatic duct drainage

Gastrointestinal (12 decks)

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