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Why might a patient be jaundiced? Flashcards

1
Q

What is jaundice and what causes it?

A

Yellowing of the skin and sclera

Caused by an increased level of bilirubin

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2
Q

What is bilirubin?

A

breakdown product of red blood cells used to form bile in the liver

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3
Q

what is the function of bile?

A

travels to the 2nd part of the duodenum via the biliary tree, important in the breakdown and absorption of fats

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4
Q

what are the 4 functions of the liver?

A

received nutrients absorbed from GI tract
glycogen storage
bile secretion
other metabolic functions

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5
Q

describe the surface anatomy of the liver

A

right upper quadrant
protected by ribs 7-11
location changes in breathing as adhered to diaphragm

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6
Q

what are the 7 anatomical relations of the liver?

A 
Gall bladder
hepatic flexure
right kidney
right adrenal gland
IVC
abdominal aorta
Stomach
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7
Q

what is the significance of the liver’s anatomical relations?

A

disease of the liver can affect all the related structures

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8
Q

where would pain from the liver/gall bladder refer to?

A

right shoulder

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9
Q

what are the 4 anatomical lobes of the liver?

A

right lobe
left lobe
caudate lobe (looks like a tail, flicks under IVC)
quadrate lobe

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10
Q

what separates the right and left lobe of the liver?

A

falciform ligament

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11
Q

what is the round ligament?

A

thickened part at inferior end of fusiform ligament

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12
Q

what does the individual blood supply/bile drainage of the 8 functional lobe of the liver allow for?

A

segmentectomy

a lobe can be removed without affecting the others

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13
Q

what are the 4 component parts of each functional lobe?

A

branch of hepatic artery
branch of hepatic portal vein
bile drainage to bile duct
venous drainage to IVC

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14
Q

the bile drainage to the functional lobes follows the same path as the arterial supply but in opposite direction, true or false?

A

true

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15
Q

why does hypertension cause pressure to back up into the liver?

A

IVC and hepatic portal vein lack valves

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16
Q

what ligament does the portal triad lie within?

A

hepatoduodenal ligament

in lesser omentum

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17
Q

what is the first branch that comes off the anterior surface of the abdominal aorta and what does it supply?

A

coeliac trunk

supplies foregut

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18
Q

what 3 branches does the coeliac trunk split into?

A

splenic artery (wavy path behind stomach)
left gastric artery (curves round lesser curvature of stomach)
common hepatic artery (becomes hepatic proper once gastroduodenal branches off)

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19
Q

what ribs protect the spleen?

A

9-11

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20
Q

how could a rib fracture lead to severe bleeding

A

could puncture the spleen

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21
Q

how is the spleen palpated?

A

lift up from the back, push inwards and upwards from the front

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22
Q

what arteries make up the major blood supply to the stomach?

A

right/left gastric arteries (anastamose at lesser curvature/lesser omentum)
right/left gastro-omental arteries (anastamose at greater curvature/greater omentum)

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23
Q

what is the dual blood supply to the liver?

A

hepatic artery proper/right and left hepatic arteries (25%)

hepatic portal vein (75%)

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24
Q

what are the 2 recesses in peritoneal cavity related to the liver?

A

hepatorenal recess

sub-phrenic recess

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25
where is fluid most likely to collect when lying flat?
hepatorenal recess some in retrovesicle/uterine pouch (can cause abscess to form if puss collects)
26
what veins form the hepatic portal vein and what does it do?
``` splenic vein (receives from inferior mesenteric) and superior mesenteric vein Drains blood from fore, mid and hind gut to the liver for cleaning ```
27
what is the function of the IVC in relation to the liver?
drains clean blood from hepatic veins to the right atrium
28
what is the triangle of calot?
tringle formed by inferior border of liver, cystic duct and common hepatic duct (site of cystic artery which supplies the gall bladder)
29
where in the gall bladder are gall stones most likely to form?
at the narrowing at the neck
30
where does the gall bladder sit and what is its function?
posterior to liver, anterior to duodenum
31
where might pain from the gall bladder be felt?
epigastric region early on | Hypocondrium/right shoulder if gall bladder gets inflamed and irritates the diaphragm
32
what is a cholecystectomy?
gall bladder removal
33
where does the breakdown of red blood cells mainly take place
in the spleen
34
bile is produced in the interlobular segments, true or false?
true
35
what are the 3 components of the interlobular portal triad?
branch of hepatic portal vein branch of hepatic artery biliary duct
36
what are the component parts of the biliary tree?
right and left hepatic ducts unite to form common hepatic duct common hepatic duct unites with cystic duct to form bile duct/common bile duct main pancreatic duct joins common bile duct drains into the 2nd part of duodenum
37
describe the 4 parts of the duodenum
``` 1st = superior, horizontal, partly intraperitoneal, contains duodenal cap (mesentery-like flap) 2nd = descending, retroperitoneal 3rd = horizontal, retroperitoneal 4th = ascending, retroperitoneal ```
38
where does the duodenum start and end?
begins as pyloric sphincter (smooth muscle under autonomic control) ends at duodenojejunal flexure (between duodenum and jejunum, under pancreas)
39
what does the duodenum secrete into the blood?
peptide hormones | eg. gastrin, CCK(stimulates release of bile into duodenum)
40
where would pain from the pancreas present?
epigastric/umbilical region | may radiate to back
41
the pancreas is a retroperitoneal organ lying transversely across the posterior abdominal wall, true or false?
true
42
what are the 4 parts of the pancreas?
head (with uncinated pancreas) neck body tail
43
what surrounds the head of the pancreas?
C-shaped curve of the duodenum
44
why might the pancreas be describes as "secondary retroperitoneal"?
as it doesn't begin retroperitoneal but moves there during development
45
name some anatomical relationships of the pancreas, what is the significance of this?
posteriorly: right and left kidney/adrenal gland, VC, bile duct, abdominal aorta, superior mesenteric vessels, part of portal venous system Anteriorly: stomach superoposteriorly: splenic vessels Duodenum surrounds the head disease of pancreas can affect the others and vice versa
46
describe the endocrine and exocrine functions of the pancreas
exocrine: acinar cells secrete digestive enzymes into main pancreatic duct endocrine: islets of Langerhans secrete insulin and glucagon into bloodstream
47
what is the nervous supply to the pancreas?
``` autonomic periarterial plexus (parasympathetic - vagus and sympathetic - coeliac and superior mesenteric plexus) ```
48
how does the biliary tree drain into the 2nd part of the duodenum?
Bile Duct descends posteriorly towards 1st part of the duodenum Then travels into a groove behind the pancreas It then joins with the main pancreatic duct (and accessory pancreatic duct if present) Forms the ampulla of Vater / hepatopancreatic ampulla Widened part Both then drain into the 2nd part of the duodenum via major duodenal papilla
49
what sphincters are involved in the drainage of the bilary tree?
bile duct sphincter pancreatic duct sphincter sphincter of oddi (at entrance to duodenum)
50
what is endoscopic retrograde cholangiopancreatography (ERCP)?
investigation to study/treat the pancreas and biliary system endoscope inserted via oral cavity down into duodenum cannula inserted into major duodenal papilla and dye injected into biliary tree radiographic images taken of dye-filled biliary tree
51
what does the stic duct look like on ERCP?
wispy spiral | cystic duct = spiral valve which slows entry/exit of bile from gall bladder
52
name 2 extra hepatic obstructive causes of jaundice and how they cause jaundice
gallstones carcinoma at head of pancreas obstruction causes back up of bile into liver contents of liver overspill into blood (including bilirubin)
53
why could the pancreas be considered the dividing point between the foregut and midgut?
its the site of anastomoses between superior and inferior pancreaticoduodenal arteries which supply the foregut and midgut respectivey
54
which vessels supply the pancreas?
gastroduodenal (from common hepatic, from coeliac trunk) dorsal pancreatic artery (from splenic artery, from coeliac trunk) superior/inferior pancreaticoduodenal arteries
55
what can cause pancreatitis?
blockage of the ampulla by a gallstone (bile is redirected to the pancreas causing irritation and inflammation)
56
what are grey-turner's and Cullen's signs?
blood/fluid accumulation in the retroperitoneal space due to vascular haemorrhage as a result of advanced pancreatitis Grey-Turners = right/left flank or both Cullens = around belly button
57
where is the division between the fore and mid gut in the small intestine?
between 2nd and 3rd part of duodenum
58
name 6 differences between the jejunum and ileum
jejunum = dark red, ileum = pink jejunum wall = thick and heavy, ileum = thin and light jejunum = more vascular than ileum jejunum = less fat than ileum jejunum = large densely packed circular folds, ileum = few sparse folds Peyers patches mainly present in ileum
59
describe arterial supply to jejunum and ileum
superior mesenteric artery (via jejunal and ileal arteries)
60
describe venous drainage of the jejunum and ileum
jejunal and ileal veins > superior mesenteric vein > hepatic portal vein carries absorbed proteins and carbohydrates to the liver
61
how do the vessels travel to and from the jejunum and ileum?
in the mesentery
62
what is the course of the superior mesenteric vessels?
Leaves the Aorta at L1 vertebral level Posterior to the neck of the pancreas Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper
63
how is fat absorbed?
Bile helps absorption of fats from the GI tract lumen into intestinal cells Fats (within chylomicrons) 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
64
what are the 4 main groups of lymph nodes that drain the abdominal organs ?
``` coelic (foregut organs) superior mesenteric (midgut organs) Inferior mesenteric (hindgut organs) Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs) ```
65
superficial lymph vessels drain into deep lymph vessels, true or false?
true
66
what 2 ducts might lymph drain into, depending on where it originated from?
``` thoracic duct (from 3/4 of body) right lymphatic duct (from 1/4 of body) ```
67
what are venous angles?
junction between subclavian and internal jugular veins where lymphfrom ducts drain to be recycled left venous angle = thoracic duct right venous angle = right lymphatic duct

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