Anatomy of jaundice

Question 1

Which ribs protect the spleen?

Answer 1

Ribs 9-11

Question 2

What is the blood supply to the stomach?

Answer 2

The right and left gastric arteries running along the lesser curvature
The right and left gastro-omental arteries which run along the greater curvature

Question 3

Where does the left gastro-omental artery arise from?

Answer 3

The splenic artery

Question 4

Where does the right gastric artery arise from?

Answer 4

The hepatic artery

Question 5

What connects the right and left gastro-omental arteries?

Answer 5

An anastamoses

Question 6

What does the hepatic artery bifurcate into?

Answer 6

The right and left hepatic arteries

Question 7

Why does a rise in central venous pressure cause hepatomegaly?

Answer 7

Because the IVC and the hepatic veins lack valves

Question 8

What are the four lobes of the liver?

Answer 8

Right lobe
Left lobe
Caudate lobe
Quadrate lobe

Question 9

What is the name of the space between the liver and the right kidney?

Answer 9

The hepatorenal recess

Question 10

What is the name of the recess between the liver and the diaphragm

Answer 10

The subphrenic recess

Question 11

What ligaments attach the liver to the diaphragm?

Answer 11

The coronary ligaments

Question 12

What ligament attaches the liver to the abdominal wall?

Answer 12

The falciform ligament

Question 13

What ligament is the remnant of the embryological umbilical vein?

Answer 13

The round ligament/ligamentum teres

Question 14

What is the cystic artery a branch of in 75% of people?

Answer 14

The right hepatic artery

Question 15

Where does the gallbladder lie in relation to the liver?

Answer 15

On the posterior aspect

Question 16

Where do visceral afferents from the gallbladder enter the spinal cord?

Answer 16

Between T6 and T9

Question 17

Where can early pain from the gallbladder present?

Answer 17

In the epigastric region
It can also present in the right hyperchondrial region with or without referral to the right shoulder as a result of anterior diagphragmatic irritation

Question 18

What is the first branch to come off the hepatic artery? (inferiorly)

Answer 18

The gastroduodenal artery

Question 19

Which branch of the gastro-duodenal artery descends over the anterior aspect of the head of the pancreas?

Answer 19

The superior pancreatico-duodenal

Question 20

What forms the bile duct/common bile duct?

Answer 20

The union of the cystic duct with the common hepatic duct

Question 21

What forms the common hepatic duct?

Answer 21

The union of the right and left hepatic ducts

Question 22

What is ERCP?

Answer 22

endoscopic retrograde cholangiopancreatography

Question 23

What is ERCP used for?

How does it work?

Answer 23

investigation used to study the biliary tree and pancreas (and treat certain pathologies associated)
• 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 taken of the dye-filled biliary tree

Question 24

How does the bile duct get to the duodenum?

Answer 24

The bile duct descends posterior to the 1st (superior) part of the duodenum and into a groove in the posterior aspect of the pancreas.
It then joins with the main pancreatic duct and both drain into the 2nd part of the duodenum through the major duodenal papilla

Question 25

What is formed by the union of the bile duct and the main pancreatic duct?

Answer 25

The ampulla of vater/

the hepatopancreatic ampulla

Question 26

Name 3 sphincters in the biliary tree

Answer 26

Sphincter of oddi
Bile duct sphincter
Pancreatic duct sphincter

Question 27

What are the different parts of the pancreas?

Answer 27

The head with an uncinate process
The neck
The body
The tail

Question 28

Which cavity is the pancreas found in?

Answer 28

The retroperitoneum

Question 29

Is the pancreas a foregut, midgut or hindgut organ?

Answer 29

It is a foregut and a midgut organ

Question 30

Where can pain from the pancreas present?

Answer 30

In the epigastric and/or the umbilical region

Question 31

Which parts of the duodenum are foregut organs?

Answer 31

The first and second parts

Question 32

How many parts does the duodenum have?

What are they?

Answer 32

It has four parts.

1. Superior (part intraperitoneal)
2. Descending (retroperitoneal)
3. Horizontal (retroperitoneal)
4. Ascending (retroperitoneal)

Question 33

What is the inital section of the first part of the duodenum called?

Answer 33

The duodenal cap

It is intraperitoneal and relatively mobile

Question 34

Which arteries supply the duodenum?

Answer 34

The gastro-duodenal artery

The superior mesenteric artery

Question 35

What are the main groups of lymph node draining the abdominal organs?

Answer 35

Coeliac - draining the foregut organs
Superior mesenteric- draining the midgut organs
Inferior mesenteric- draining the hindgut organs
Lumbar- draining kidneys, posterior abdominal wall, pelvis and lower limbs

Question 36

Where does the right lymphatic duct drain into?

Answer 36

The right venous angle:

The angle between the right subclavian and right internal jugular veins

Question 37

Where does the thoracic duct drain into?

Answer 37

The left venous angle:

The angle between the left subclavian and left internal jugular veins