Anatomy- Jaundice Flashcards
(177 cards)
1
Q
what is jaundice
A
yellowing of the sclera (white of the eyes) and the skin
2
Q
what causes jaundice
A
an increase in bilirubin in the blood
3
Q
what is bilirubin
A
is a normal bi product of the breakdown of red blood cells
4
Q
where does the break down of red blood cells mainly occur
A
in the spleen
5
Q
what is bilirubin used to form and where does this hapen
A
bile, in the liver
6
Q
how does bile leave the liver
A
travels through a set of tubes connecting the liver to the 2nd part of the duodenum
THE BILIARY TREE
7
Q
what is the role of the gallbladder
A
the storage and concentration of bile
8
Q
why is bile important
A
for the normal absorption of fats from the small intestine
9
Q
what does the pancreas do
A
excretes digestive enzymes into the 2nd part of the duodenum- necessary for digestion
10
Q
what is the largest organ in the body
A
the liver
11
Q
what are the functions of the liver
A
glycogen storage,
bile secretion,
other metabolic functions
12
Q
what quadrant is the liver in
A
right upper
13
Q
what ribs protect the liver
A
7-11
14
Q
why does the location of the liver change
A
during breathing as it is attached to the diaphragm
15
Q
anatomical relations: the liver is… to the right hemi-diaphragm
A
inferior
16
Q
anatomical relations: gallbladder to the liver
A
posterior and inferior
17
Q
anatomical relations: hepatic flexure to thr liver
A
inferior
18
Q
anatomical relations: right kidney, right adrenal gland, IVC and abdominal aorta to the liver
A
posterior
19
Q
anatomical relations: stomach to the liver
A
posterior at mid/left side
20
Q
why do pathologies of spread from the liver to the IVC
A
as very connected
21
Q
how many anatomical lobes does the kidney have and what are they called
A
4 right left caudate quadrate
22
Q
why is the caudate lobe called that
A
as it looks like a tail, isn’t caudal
23
Q
what is the porta hepatis
A
site of entry for portal triad structures
24
Q
how many functional lobes does the liver have and what are they related to
A
8
vasculature and drainage
25
what divides the right and left lobes of the liver
the falciform ligament
26
what is the round ligament of the liver
at end of falciform ligament
| is a remnant of the umbilical vein
27
where does the falciform ligament attach to
the abdominal wall
28
what do the functional lobes allow for and how
segmentectomy
29
what does each functional segment have
branch of hepatic artery, branch of a hepatic portal vein, bile drainage, venous drainage
30
where does the venous drainage of the liver drain into
the IVC
31
where does bile drain from the liver into
the bile duct
32
what do the IVC and hepatic veins lack
valves
33
why can an increase in central venous pressure cause liver disease
as no valves, can lead to an back pressure directed at the liver
34
how do you remeber the segments of the liver
thumb in fist, knuckles divinding line
thumb 1, 1st upper 2 lower 2, 2nd whole 4, 3rd lower 5, pinky lower 6 upper 7, 3rd upper 8
35
what happens to the hepatic veins carrying blood from the liver before they enter the IVC
the 3 come together
36
what structures are within the portal triad
hepatic portal vein, hepatic artery proper, bile duct
37
what do the structures in the portal triad run within
the hepatoduodenal ligament
38
what is the coeliac trunk
the first three midline branches of the aorta
39
where is the coeliac trunk found
retroperitoneal, leaves aorta at T12
40
what does the coeliac trunk supply
organs of the foregut
41
what does the coeliac trunk split into
3 branches
- splenic artery
- left gastric artery
- common hepatic artery
42
what artery supply the lesser curvature of the stomach
the left gastric
43
describe the splenic artery
wiggly and big, goes posteriorly to stomach to spleen
44
where does the hepatic artery proper originate from
common hepatic artery (commener gives of gas and becomes proper) (gas= gastroduodenal artery)
45
what is the course of the splenic artery
tortuous course along the superior border of the pancreas to the spleen
46
where is the spleen found
intraperitoneal organ
| in left hypochondrium
47
what ribs protect the spleen
9-11
48
anatomical relations: diaphragm to the spleen
posterior
49
anatomical relations: stomach to the spleen
anterior
50
anatomical relations: splenic flexure to the spleen
inferior
51
anatomical relations: left kidney to the spleen
medially
52
what could a rib fracture do to the spleen
pierce it as its soft, delicate and this can lead to substantial internal bleeding
53
where is the spleen in relation to the mid axillary line
posterior, ruptured by trauma to the back
54
what organs in the abdomen move with respiration
spleen and liver
55
when is the spleen usually felt in a clinical exam
under pathological conditions
56
where are the right and left gastric arteries
anastomose together, travel along the junction of lesser curvature and lesser omentum
57
what are the major blood supplies to the stomach
right and left gastric, right and left gastro-omental arteries
58
where are the right and left gastro-omental arteries
along junction of greater curvature and greater omentum, anastomose together
59
what are the minor blood supplies to the heart
posterior gastric arteries, short gastric arteries
60
where does the blood supply to the liver come from
right and left hepatic arteries (branches of the hepatic artery proper)
61
describe the dual blood supply of the liver
20-25% of the blood received by the liver is from the hepatic artery proper branches, rest is from hepatic portal vein
62
describe the structure of a liver lobule
central vein in middle,
| interlobular portal triad at each corner (hexagon)
63
what is the interlobular portal triad
branch of hepatic portal vein, branch of hepatic artery, biliary duct
64
where does bile formed in the hepatocytes drain into
drains into biliary duct
65
what is a hepatocyte
liver cell
66
what does the central vein collect and where does it take it
'cleaned' blood,
| drains into the hepatic veins
67
what is the role of hepatocytes
remove toxins and produce bile
68
what are the two clinically important recesses relating to the liver
```
hepatorenal recess (morison's pouch),
sub-phrenic recess
```
69
what are both recesses associated with the liver in
the greater sac
70
how can the recess be associated with peritonitis
peritonitis can result in a collection of pus in these recesses leading to an abscess formation
71
what is the role of the hepatic portal vein
drains blood from the foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
72
what forms the hepatic portal vein
splenic vein and superior mesenteric vein
73
what vein drains the foregut
the splenic vein
74
what vein drains the midgut
superior mesenteric vein
75
what does the inferior mesenteric vein do
drains the blood from the hindgut to the splenic vein
76
where is the IVC in relation to the peritoneum
retroperitoneal
77
what is the role of the IVC in relation to the liver
drains the cleaned blood from the hepatic veins into the right atrium
78
where is the gall bladder
lies of the posterior aspect of the liver (often firmly attached), anterior to the duodenum
79
what risk does the narrowing of gall bladder create
gallstone impaction
80
via what structure does the bile flow in and out of the gall bladder
via the cystic duct
81
what is the blood supply of the gall bladder
cystic artery
82
what is the triangle of calot
'cystohepatic' triangle made by cystic duct and common hepatic duct, in which the cystic artery is found
83
what is the cystic artery a branch of in 75% of people
right hepatic artery
84
what causes gall bladder pain
inflammation of the gallbladder or cystic duct following irritation/impaction from a gallstone
85
where do the visceral afferent for the gallbladder enter the spinal chord
t6-9 as gallbladder a foregut organ
86
where will early gallbladder pain present
in the epigastric region
87
where is a secondary site if gallbladder pain
can present in the hypochondrium, with/without pain referral to the right shoulder as a result of anterior diaphragmatic irritation
88
what is a cholecystectomy
surgical removal of gallbladder
89
what is bilirubin used to form and where
bile in the liver
90
what is jaundice a symptom of
liver disease
91
what do the right and left hepatic ducts combine to form
the common hepatic duct
92
what does the common hepatic duct unite with to form what
unites with the cystic duct to form the bile duct
93
what is the bile duct also known as
the common bile duct
94
where does the bile duct drain into
the 2nd part of the duodenum
95
what drains with the bile duct into the duodenum
the pancreatic duct
96
what are the four parts of the duodenum
superior (+ duodenal cap), descending, horizontal, ascending
97
what parts of the duodenum are retro-peritoneal
descending, horizontal, ascending
98
how mobile is the duodenal cap
relatively
99
where does the duodenum begin
at the pyloric sphincter
100
what is the pyloric sphincter made of and what innervates it
smooth muscle- autonomic nerves (symp contraction, para relaxation)
101
where does the duodenum end
at the duodenojejunal flexure
102
what does the duodenum secrete into the blood
peptide hormones (gastrin, CCK)
103
where does the duodenum go retroperitoneal
at the head of the pancrease
104
when is CCK released in to the blood and what does it do
released as fat enters the duodenum and stimulates the digestion of fat and protein- increases bile production
105
where does pain from duodenal ulcers tend to present
in the epigastric region
106
where is the pancreas
retroperitoneal, lies transversely across the abdomen
107
what are the part of the pancreas
head (with uncinate- hook- process), neck, body, tail
108
how is the duodenum associated with the pancreas
the head of the pancreas is surrounded by the duodenum
109
where does the tail of the pancreas lie
close to the hilum of the spleen
110
why is the pancreas secondarily retroperitoneal
as in embryo is it peritoneal (e.g. kidneys primary peritoneal)
111
what is posterior to the pancreas
- right KIDNEY and adrenal glad
- IVC
- bile duct
- abdominal aorta
- superior mesenteric vessels
- left kidney and adrenal gland
- part of the portal venous system
112
what is anterior to the pancreas
the stomach
113
what surrounds the head of the pancread
the duodenum
114
what is superoposterior to the pancreas
the splenic vessels
115
where does the aorta lie
anterior to the body of vertebrae
116
what are the two functions of the pmacreas
exocrine (acinar cells release digestive enzymes into main pancreatic duct)
endocrine (islets of langerhans release hormones (insulin and glucagon) into the blood stream)
117
what stimulates acinar cells
sympathetic stimulation
118
what part of the duodenum does the bile duct drain posterior to
the 1st (superior) part
119
where does the bile duct pass via the pancreas
in a groove on the posterior aspect of the pancreas
120
what duct does the bile duct join with
the main pancreatic duct
121
what is the lepatopancreatic ampulla of vater
formed when bile and main pancreatic ducts combine
122
where does the ampulla of vater drain
into the second part of the duodenum
123
how does the ampulla of vater drain into the duodenum
via the major duodenal papilla, found on the major duodenal papilla
124
what are the sphincters of the biliary system
bile duct sphincter, pancreatic duct sphincter, sphincter of oddi
125
what is the role of the sphincter of oddi
controls amount of bile and pancreatic juices that get into duodenum
126
what controls the spincters
hormonal and neurological control
127
what is an ERCP
an investigation used to study the biliary tree and pancreas
128
how does an ERCP work
Endoscope inserted through oral cavity, oesophagus, stomach and into duodenum
Cannula placed into major duodenal papilla and radio-opaque dye injected back into biliary tree
Radiographic images are taken of the dye-filled biliary tree
129
why does the cystic duct look wispy on an ERCP
as a spiral duct- acts as storage mechanism due to slow drainage
130
what would happen to the levels of bilirubin in the blood if there was an obstruction somewhere in the biliary tree
there would be a flow of bile back up to the liver an it would overspill into the blood (including bilirubin)
131
what would cause an onbstruction of the biliary tree
gallstones or carcinoma at the head of the pancreas (enlarges it)
132
what is post hepatic jaundice caused by
extra- hepatic (outside the liver) obstructions
133
where does the gastroduodenal artery come from
common hepatic
134
where does the splenic artery come from
the celiac trunk
135
where does the pancreaticoduodenal artery come from
gastroduodenal
136
what does the superior pancreaticoduodenal artery anastosmose with
the inferior pancreaticoduodenal artery
137
where does the inferior pancreacticoduodenal artery come from
the superior mesenteric
138
where does the superior mesenteric artery come from
aorta at L1
139
where do the dorsal pancreatic arteries come from
splenic arteries
140
why does the pancreas have high vasculature
due to its endocrine function
141
where do the vasculature of the fore gut and mid gut combine
at the superior and inferior pancreaticoduodenal artery anastomoses
142
what is a common cause of pain arising from the pancreas
secondary to pancreatitis
143
what is a common cause of pancreatitis
blockage of the ampulla by a gallstone- bile is diverted into the pancreas leading to irritation and inflammation
144
is the pancreas a fore or mid gut organ
both
145
where can pain from the pancreas present
in the epigastric and/ or umbilical region- can also radiate through to patients back
146
what can happen when acute pancreatitis causes vascular haemorrhage
blood/fluid accumulation in the retroperitoneal space
147
how can pancreatitis cause vascular haemorrhage
digestive enzymes in blood stream from overfill of pancreatic juice in pancreatic duct
148
what is an anatomical clinical sign of vascular haemorrhage due to acute pancreatitis
grey-turners sign (righto or left flanks)
cullens sign (around umbillicus)
149
why is the umbillicus affected by acute pancreatitis
due to embryological remnant of round ligament- leads to falciform ligament
150
what are the three parts of the small intestine
duodenum, jejunum, ilieum (DJ ileum)
151
what parts of the small intestine are in the foregut
the 1st and second parts of the duodenum- rest mid gut organs
152
where does the jejunum begin
at the duodenaljejunal flexure
153
where does the ileum end
ileocaecal junction
154
what are the difference between the jejunum and ileum
Colour
Jejunum is deep red
Ileum is lighter pink
Wall
Jejunum is thicker and heavy
Ileum is thinner and lighter
Vascularity
Jejunum is more vascular
Ileum is less vascular
Mesenteric Fat
Jejunum has less
Ileum has more
Circular Folds (L. plicae circularis)
Jejunum has large, tall and closely packed fold
Ileum has low and sparse folds (absent distally)
```
Lymphoid Tissue (Peyer’s Patches)
- Present in ileum
```
155
why is the jejunum a darker colour than the ileum
as it is more vascularised
156
what is a plicae
fold
157
why is the jejunum more absorptive
as it has more folds
158
what is the arterial supply to the jejunum and ileum
superior mesenteric arteries via jejunal and ileal arteries
159
what is the venous drainage of the jejunum and ileum
jejunal and ileal veins to superior mesenteric vein
| and to hepatic portal vein
160
where do proteins and carbs go after they have been absorbed
from small intestine into the portal venous system to be taken to the liver
161
where do vessels travel within to get to the small intestine
within the mesentery
162
where does the SMA leave the aorta
L1
163
what is the path of the SMA in relation to the pancreas
Posterior to the neck of the pancreas
| Travels inferiorly, Anterior to the Uncinate process of pancreas to enter the mesentery proper
164
what helps in the absorption of fats from the GI tract lumen into the intestinal cells
bile
165
where does fat go from the intestinal cells
Fats (within chylomicrons) are 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
166
where does fat drain into the venous system
at the left venous angle
167
alongside what do lymph vessels tend to lie alongside
arteries
168
what is the group of lymph nodes for the foregut called
celiac
169
what is the group of lymph nodes for the midgut called
superior mesenteric
170
what is the group of lymph nodes for the hindgut called
inferior mesenteric
171
what is the group of lymph nodes for the kidneys, posterior abdo wall, pelvis and lower limbs called
lumbar
172
where do superficial lymph vessels drain into
deep lymph vessels
173
Depending on where it originated from, lymph will either drain into where
Thoracic duct (from ¾ of body)
or
Right lymphatic duct (from ¼ of body)
174
why and where does lymph drain into the venous system
It will eventually drain into venous system for ‘recycling’ at venous angles:
175
where are the venous angles
junction between subclavian and internal jugular veins
176
what does the left venous angle collect
thoracic duct drainage
177
what does the right venous angle collect
right lymphatic duct drainage
