Why might a patient be jaundiced? Flashcards
What is jaundice and what causes it?
Yellowing of the skin and sclera
Caused by an increased level of bilirubin
What is bilirubin?
breakdown product of red blood cells used to form bile in the liver
what is the function of bile?
travels to the 2nd part of the duodenum via the biliary tree, important in the breakdown and absorption of fats
what are the 4 functions of the liver?
received nutrients absorbed from GI tract
glycogen storage
bile secretion
other metabolic functions
describe the surface anatomy of the liver
right upper quadrant
protected by ribs 7-11
location changes in breathing as adhered to diaphragm
what are the 7 anatomical relations of the liver?
Gall bladder hepatic flexure right kidney right adrenal gland IVC abdominal aorta Stomach
what is the significance of the liver’s anatomical relations?
disease of the liver can affect all the related structures
where would pain from the liver/gall bladder refer to?
right shoulder
what are the 4 anatomical lobes of the liver?
right lobe
left lobe
caudate lobe (looks like a tail, flicks under IVC)
quadrate lobe
what separates the right and left lobe of the liver?
falciform ligament
what is the round ligament?
thickened part at inferior end of fusiform ligament
what does the individual blood supply/bile drainage of the 8 functional lobe of the liver allow for?
segmentectomy
a lobe can be removed without affecting the others
what are the 4 component parts of each functional lobe?
branch of hepatic artery
branch of hepatic portal vein
bile drainage to bile duct
venous drainage to IVC
the bile drainage to the functional lobes follows the same path as the arterial supply but in opposite direction, true or false?
true
why does hypertension cause pressure to back up into the liver?
IVC and hepatic portal vein lack valves
what ligament does the portal triad lie within?
hepatoduodenal ligament
in lesser omentum
what is the first branch that comes off the anterior surface of the abdominal aorta and what does it supply?
coeliac trunk
supplies foregut
what 3 branches does the coeliac trunk split into?
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)
what ribs protect the spleen?
9-11
how could a rib fracture lead to severe bleeding
could puncture the spleen
how is the spleen palpated?
lift up from the back, push inwards and upwards from the front
what arteries make up the major blood supply to the stomach?
right/left gastric arteries (anastamose at lesser curvature/lesser omentum)
right/left gastro-omental arteries (anastamose at greater curvature/greater omentum)
what is the dual blood supply to the liver?
hepatic artery proper/right and left hepatic arteries (25%)
hepatic portal vein (75%)
what are the 2 recesses in peritoneal cavity related to the liver?
hepatorenal recess
sub-phrenic recess
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)
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
what is the function of the IVC in relation to the liver?
drains clean blood from hepatic veins to the right atrium
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)
where in the gall bladder are gall stones most likely to form?
at the narrowing at the neck
where does the gall bladder sit and what is its function?
posterior to liver, anterior to duodenum
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
what is a cholecystectomy?
gall bladder removal
where does the breakdown of red blood cells mainly take place
in the spleen
bile is produced in the interlobular segments, true or false?
true
what are the 3 components of the interlobular portal triad?
branch of hepatic portal vein
branch of hepatic artery
biliary duct
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
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
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)
what does the duodenum secrete into the blood?
peptide hormones
eg. gastrin, CCK(stimulates release of bile into duodenum)
where would pain from the pancreas present?
epigastric/umbilical region
may radiate to back
the pancreas is a retroperitoneal organ lying transversely across the posterior abdominal wall, true or false?
true
what are the 4 parts of the pancreas?
head (with uncinated pancreas)
neck
body
tail
what surrounds the head of the pancreas?
C-shaped curve of the duodenum
why might the pancreas be describes as “secondary retroperitoneal”?
as it doesn’t begin retroperitoneal but moves there during development
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
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
what is the nervous supply to the pancreas?
autonomic periarterial plexus (parasympathetic - vagus and sympathetic - coeliac and superior mesenteric plexus)
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
what sphincters are involved in the drainage of the bilary tree?
bile duct sphincter
pancreatic duct sphincter
sphincter of oddi (at entrance to duodenum)
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
what does the stic duct look like on ERCP?
wispy spiral
cystic duct = spiral valve which slows entry/exit of bile from gall bladder
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)
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
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
what can cause pancreatitis?
blockage of the ampulla by a gallstone (bile is redirected to the pancreas causing irritation and inflammation)
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
where is the division between the fore and mid gut in the small intestine?
between 2nd and 3rd part of duodenum
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
describe arterial supply to jejunum and ileum
superior mesenteric artery (via jejunal and ileal arteries)
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
how do the vessels travel to and from the jejunum and ileum?
in the mesentery
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
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
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)
superficial lymph vessels drain into deep lymph vessels, true or false?
true
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)
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
