1- why might patient be jaundiced?

Question 1

how are liver, spleen, gallbladder, pancreas and small intestine linked?

Answer 1

linked together by formation of bilirubin, bile and clinical condition of jaundice

Question 2

what is bilirubin?

Answer 2

= normal by-product of break down of red blood cells. used to form bile in liver

Question 3

what happens in spleen?

Answer 3

breakdown of red blood cell

Question 4

where does bile travel?

Answer 4

bile formed from bilirubin in spleen and then it travels through biliary tree which is set of tubes connecting the liver to the 2nd part of duodenum

bile = bile salts, bile acids, cholesterol, phospholipids, bilirubin, water & electrolytes

Question 5

what is gallbladders role?

Answer 5

plays an important role in storage + concentration of bile

Question 6

why is bile important?

Answer 6

important for normal absorption of fats from small intestine

Question 7

what does pancreas secrete?

Answer 7

digestive enzymes into 2nd part of duodenum

Question 8

how is liver anatomically related to
a) diaphragm
b) stomach
c) gallbladder
d) hepatic flexure
e) right kidney, right adrenal gland, IVC, abdominal aorta

Answer 8

a) diaphragm = superior, anteriorly, posteriorly

b) stomach = liver covers superior and anterior surface of stomach

c) gallbladder = posterior + inferiorly

d) hepatic flexure = inferiorly

e) right kidney, right adrenal gland, IVC, abdominal aorta = posterior to liver

Question 9

what is function of liver?

Answer 9

major metabolic organ that converts bilirubin to bile

Question 10

what is liver protected by?

Answer 10

ribs 7-11

Question 11

how many anatomical and functional segments are there in liver?

Answer 11

4 anatomical segments
8 functional segments

Question 12

what are the 4 anatomical segments of liver?

Answer 12

• left lobe
• right lobe
• caudate lobe (top)
• quadrate lobe (bottom)

Question 13

what are functional segments of liver?

Answer 13

I-VIII
= each have own blood supply (hepatic artery+hepatic portal vein), venous drainage and bile drainage

Question 14

what is venous drainage of liver?

Answer 14

from liver via 3 main hepatic veins into IVC - the central vein collects “cleaned” blood and drains into hepatic veins

Question 15

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

Answer 15

• hepatorenal recess (Morison’s pouch)
• subphrenic recess
  →both recesses are within greater sac

Question 16

what is peritonitis?

Answer 16

result in collection of pus in the liver recesses (hepatorenal recess, subphrenic recess) leading to an abscess formation

Question 17

what is one of the lowest parts of peritoneal cavity when patient is supine?

Answer 17

hepatorenal recess

Question 18

what is function of hepatic portal vein?

Answer 18

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

Question 19

what is function of inferior vena cava?

Answer 19

drains the cleaned blood from hepatic veins into right atrium

• it’s retroperitoneal (outside or behind peritoneum)

Question 20

what must be cut to remove the liver?

Answer 20

• at the superior end the coronary ligaments attach to the diaphragm
• the falciform ligament runs between the r+l lobe and attaches to anterior abdominal wall

Question 21

what is round ligament on liver?

Answer 21

• the ligamentum teres/round ligament (remnant of embryological umbilical vein)
  = it hangs off inferior end of falciform ligament that runs in between right + left lobe

Question 22

where is portal triad found?

Answer 22

= found in free edge of lesser omentum

Question 23

what are the 3 important tubes in portal triad?

Answer 23

• hepatic artery
• hepatic portal vein
• common bile duct

Question 24

where is common bile duct?

Answer 24

part of biliary tree linking liver to duodenum

Question 25

where is gallbladder?

Answer 25

lies on posterior aspect of liver (often firmly attached)

Question 26

what is purpose of gallbladder?

Answer 26

gallbladder stores + concentrates bile in between meals

Question 27

what is structure of gallbladder?

Answer 27

it has a body + a neck - the neck narrows to become the cystic duct - bile flows in + out of the gallbladder via the cystic duct which goes into common bile duct then duodenum = R&L hepatic ducts form common hepatic duct - cystic duct drains gall bladder and joins CHD to form common bile duct and drains into duodenum via ampulla of vater

Question 28

what is blood supply for gallbladder?

Answer 28

via the cystic artery (branch of right hepatic artery in 75% of people)

Question 29

what makes up the biliary tree?

Answer 29

right + left hepatic duct unites to form common hepatic duct that joins with cystic duct (from gallbladder) & pancreatic duct to form common bile duct that then drains into 2nd part of duodenum via ampulla of vater

Question 30

what is route of bile duct?

Answer 30

= descends posteriorly to 1st part of duodenum and travels in a groove on the posterior aspect of the pancreas and then joins with main pancreatic duct to make ampulla of Vater/hepatopancreatic ampulla = then drains into 2nd part of duodenum through the major duodenal papilla

Question 31

what are the anatomical sphincters in bile duct (pancreas duodenal area)?

Answer 31

- bile duct sphincter - pancreatic duct sphincter - sphincter of Oddi (where it enters duodenum)

Question 32

what are anatomical sphincters?

Answer 32

= discrete areas where muscle completely encircles the lumen of the tract

Question 33

what is structure of pancreas?

Answer 33

- head (with uncinate process) - neck - body - tail = closely associated with duodenum

Question 34

where is pancreas located in body?

Answer 34

it’s a retroperitoneal organ that lies transversely across posterior abdomen

Question 35

what organs/structures are posterior to pancreas? (lots)

Answer 35

right kidney + adrenal gland, IVC, bile duct, abdominal aorta, superior mesenteric vessels, left kidney + adrenal gland, part of portal venous system

Question 36

what organ is anterior to pancreas?

Answer 36

stomach

Question 37

where is duodenum in relation to pancreas?

Answer 37

closely related = it surround sthe head

Question 38

what structures are superoposterior to pancreas?

Answer 38

splenic vessels

Question 39

what are exocrine cells of pancreas?

Answer 39

acinar cells = secretes pancreatic digestive enzymes into main pancreatic duct

Question 40

what are endocrine cells of pancreas?

Answer 40

islets of langerhans (secretes insulin + glucagon into blood stream)

Question 41

what is blood supply to pancreas?

Answer 41

- mainly pancreatic branches from splenic artery and it’s close to duodenum so similar in blood supply - superior pancreaticoduodenal branches off gastroduodenal artery - inferior pancreaticoduodenal branches off superior mesenteric artery

Question 42

what makes up the small intestine?

Answer 42

duodenum, jejunum, ileum

Question 43

what parts of small intestine are a) foregut b) midgut

Answer 43

a) 1st +2nd part of duodenum b) rest of small intestine

Question 44

what are 4 parts of duodenum?

Answer 44

1. superior (intraperitoneal) = duodenal cap, relatively mobile 2. descending (retroperitoneal) 3. horizontal (retroperitoneal) 4. ascending (retroperitoneal)

Question 45

where does duodenum begin?

Answer 45

at pyloric sphincter = smooth muscle supplied by autonomic nerves (sympathetic = contraction, parasympathetic = relaxation)

Question 46

what does duodenum secrete?

Answer 46

a number of peptide hormones into blood

Question 47

where is pain from duodenal ulcer felt?

Answer 47

in epigastric region (middle upper 9th region)

Question 48

what is blood supply to duodenum?

Answer 48

close relationship to pancreas so similarities in blood supply: - gastroduodenal artery (that then branches to pancreaticoduodenal) - superior mesenteric artery (that then branches to inferior pancreaticoduodenal)

Question 49

what quadrants is the jejunum + ileum found in?

Answer 49

all 4 quadrants - jejunum 3m and ileum 4m

Question 50

where does jejunum begin?

Answer 50

duodenal jejunal flexure

Question 51

where does ileum end?

Answer 51

ileocaecal junction

Question 52

what is the mucosa like in jejunum and ileum?

Answer 52

their mucosa differs →jejunum mucosa is highly folded, the folds called plicae circularis →ileum mucosa is much smoother (especially distally)

Question 53

what is the arterial blood supply to jejunum + ileum?

Answer 53

superior mesenteric artery via jejunal and ileal arteries

Question 54

what is the venous blood supply from jejunum + ileum?

Answer 54

jejunal + ileal veins to superior mesenteric veins to hepatic portal vein

Question 55

what do vessels of jejunum and ileum travel within?

Answer 55

mesentery