why might my patient be jaundiced

Question 1

what is an ERCP

Answer 1

endoscopic retrograde cholangiopancreatography

> used to study the biliary tree and pancreas
biliary tree is filled with dye

Question 2

what causes jaundice

Answer 2

increased levels of bilirubin in the blood

Question 3

what are the two main extra-hepatic causes of obstruction in the biliary tree

Answer 3

> gallstones

>carcinoma at head of pancreas

Question 4

how do extra-hepatic obstructions of the biliary tree cause jaundice

Answer 4

> there is a flow of bile back up to the liver

>overspills into the blood of its constituents

Question 5

where can the pancreas be found

Answer 5

• posteriorly to stomach
• duodenum surrounds the head of the pancreas
• the splenic nerves can be found superoposteriorly to the pancreas

Question 6

what is the exocrine secretion of the pancreas

Answer 6

acinar cells secrete digestive enzymes into the main pancreatic duct

-‘pancreatic juice’

Question 7

what does the endocrine pancreas secrete

Answer 7

islets of langerhans secrete insulin and glucagon into the bloodstream

Question 8

what is a cause of pancreatitis

Answer 8

blockage of the ampulla by a gallstone

Question 9

where might patients find pancreatic pain

Answer 9

**pancreas is a foregut and midgut organ - so there may be pain found

> in the epigastric region and/or the umbilical region
can also radiate through to the patient’s back

Question 10

what is the duodenum

Answer 10

the first part of the small intestine

> split into 4 parts; superior descending horizontal ascending

> begins at the pyloric sphincter

Question 11

what does the duodenum secrete

Answer 11

peptide hormones (into blood)

Question 12

how might an ulcer in the duodenum present

Answer 12

pain in the epigastric region

Question 13

characteristics of the jejunum and ileum

Answer 13

> makes up most of the intestines
found in all 4 quadrant
jejunum begins at the duodenaljejunal flexure and ileum ends at the ileocaecal valve

Question 14

is the mucosa different between the jejunum and the ileum

Answer 14

yes !

> jejunum lumen is quite wide - end of ileum quite narrow

> mucosa of jejunum has place circulares
mucosa of distal ileum is much smoother

Question 15

where does the jejunum and ileum gets its blood from

Answer 15

arterial :
SMA - superior mesenteric artery

venous drainage from : -jejunal and ileal veins
-superior mesenteric vein
-hepatic portal vein
>vessels travel within the mesentery

Question 16

the role of bile in absorption of fat

Answer 16

bile helps absorption of fats from the GI tract lumen into the intestinal cells

Question 17

what are lacteals

Answer 17

specialised lymphatic vessels of the small intestine that drain fatty fluid into the lymphatic plexus which then drain into lymphatic vessels found within the mesentery (travel via the lymphatic system to eventually drain into the venous system)

Question 18

what are the main groups of lymph nodes draining abdominal organs

Answer 18

> coeliac - foregut organs
superior mesenteric - midgut organs
inferior mesenteric - hindgut organs
lumbar - kidneys, posterior abdominal wall, pelvis, lower limbs

Question 19

______lymph vessels drains into ______ lymph vessels

Answer 19

superficial

deep

Question 20

what will lymph (in the abdomen) either drain into

Answer 20

thoracic duct
or
right lymphatic duct

(depends where it originated in the body)

Question 21

what happens at venous angles

Answer 21

lymph will drain into venous system for recycling

> is the junction between subclavian and internal jugular veins