Why might my patient be jaundice? Flashcards
What is jaundice?
Yellowing of the sclera (white of the eye) and skin
What causes jaundice?
Increase in the blood levels of bilirubin
What is bilirubin?
Normal by-product of the breakdown of red blood cells
Where does the breakdown of red blood cels mainly occur?
Spleen
What is bilirubin used to form in the liver?
Bile
Where does bile travel when leaving the liver?
Through the biliary tree
What is the biliary tree?
A set of tubes connecting the liver to the second part of the duodenum
What is the role of the gallbladder?
Important role in the storage and concentration of bile
What is the function of bile in the body?
Important for the normal absorption of fats from the small intestine
What other organ secretes digestive enzymes into the second part of the duodenum for food digestion?
Pancreas
Where is the portal triad found?
Free edge of the lesser omentum
What does the portal triad consist of?
Hepatic artery
Hepatic portal vein
Common bile duct
Nerves and lymphatics
What is the celiac trunk?
First branch of the abdominal aorta
At what level does the celiac trunk arise?
T12
Is the celiac trunk intra- or retroperitoneal?
Retroperitoneal
What organs does the celiac trunk supply?
The organs of the foregut
What are the three divisions of the celiac trunk?
Left gastric artery
Hepatic artery
Splenic artery
Name two further branches of the divisions of the celiac trunk
Gastroduodenal
Superior pancreatico-duodenal
Describe the course of the splenic artery
Very tortuous
What is the relationship between the spleen and the peritoneum?
Intraperitoneal
What abdominal region is the spleen in?
Hypochonridum
What is the spleen anatomically related to?
Diaphragm posteriorly
Stomach anteriorly
Splenic flexture inferiorly
Left kidney medially
What ribs protect the spleen?
9-11
Why do the spleen and liver move with respiration?
They are anatomically linked to the diaphragm
What is the main blood supply to the stomach?
Right and left gastric arteries
Right and left gastro-omental arteries
Where do the right and left gastric arteries run?
The lesser curvature of the stomach, then anastomose
Where do the right and left gastro-omental arteries run?
The greater curvature of the stomach, then anastomose
What is the blood supply to the liver?
Hepatic artery, branches into the right and left hepatic arteries
The liver has a dual blood supply. What percentage of the liver’s blood supply comes from the hepatic arteries?
20-25%
Where does the remaining 75-80% of blood come from?
Hepatic portal vein
Which quadrant does the liver mainly lie in?
In upper right
What ribs protect the liver?
7-11
How the liver be described in terms of segments?
4 anatomical segments
8 functional segments
What are the anatomical segments of the liver?
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
Each of the liver’s functional segments has its own blood supply. What does this include?
Hepatic artery
Hepatic portal vein
Hepatic vein
Bile drainage
What is the name of the removal of a liver segment?
Liver segmentectomy
What is the difference between hepatic veins and hepatic portal veins?
Hepatic veins carry cleaned blood, from the liver to the IVC
Hepatic portal veins, carry nutrient rich blood that in uncleaned, to the liver from the small intestine
Why does a rise in central venous pressure directly transmit to the liver?
The hepatic veins and IVC lack valves
What is the term for an enlarged liver due to being engorged with blood?
Hepatomegaly
What is the cellular structure of the liver?
It is made up liver lobules that have a central vein and interlobular portal triads at each corner
What makes up the interlobular portal triad?
Branch of HPV
Branch of HA
Biliary duct
What is the name for small, irregularly shaped blood vessels that lead from the portal triad to the central vein in a liver lobule?
Sinusoid
What are liver cells called?
Hepatocytes
What are the two clinically important areas of the peritoneal cavity related to the liver?
Hepatorenal recess (Morison's pouch) Subphrenic recess
What can peritonitis result in in the recesses of the peritoneal cavity?
Collection of pus in the recesses leading to abscess formation
When the patient is supine what such is one of the lowest parts of the peritoneal cavity?
Hepatorenal recess
What does the hepatic portal vein drain?
Drains blood from the foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
Where does the splenic vein drain blood from?
Drains blood from the foregut to the hepatic portal vein
Where does the inferior mesenteric vein drain blood from?
Drains blood from the hindgut to the splenic vein
Where does the superior mesenteric vein drain blood from?
Drains blood from the midgut to the hepatic portal vein
Where does the IVC drain blood from?
Drains cleaned blood from the hepatic veins to the right atrium
What ligaments attach hold the liver in place?
Coronary ligaments (attach to diaphragm) Falciform ligament (attaches to anterior abdominal wall) Ligamentum terers/round ligament (remnant of the embryological umbilical vein)
Where does the gallbladder lie?
Posterior aspect of the liver
Anterior to the duodenum
What is the structure of the gallbladder?
It has a head and neck that narrows to become the cystic duct
What does bile flow into and out of the gallbladder via?
Cystic duct
What is the blood supply to the gallbladder?
Cystic artery (branch of the right hepatic artery in 75% of people)
What causes gallbladder pain?
Inflammation of the gallbladder or cystic duct following irritation from/impaction of a gallstone
What part of the gut is the gallbladder in?
Foregut
At what level do the visceral afferents enter the spinal cord?
T6 and T9
Where would early gallbladder pain be felt?
Epigastric region
Hypochondrium
Referral to the right shoulder
Why can gallbladder pain be felt in the hypochondriac?
Anterior diaphragmatic irritation
What is the term for the surgical removal of the gallbladder?
Cholecystectomy
