Clinical Antomy of Jaundice (Part 1)

Question 1

What is bilirubin?

Answer 1

Normal by-product of the break down of red blood cells

Question 2

Where does breakdown of red blood cells mainly occur?

Answer 2

In the spleen

Question 3

What is bilirubin used to form?

Answer 3

Bile - which is formed in the liver

Question 4

Where does bile travel through?

Answer 4

The biliary tree - A set of tubes connecting the liver to the 2nd part of the duodenum

Question 5

What does the gallbladder do in terms of bile?

Answer 5

It stores and concentrates bile

Question 6

What does bile aid in the small intestine?

Answer 6

The normal absorption of fats

Question 7

What does the pancreas do?

Answer 7

Excretes digestive enzymes into the 2nd part of the duodenum

Question 8

Describe the surface anatomy of the liver?

Answer 8

Located mainline the RUQ

Protected by ribs 7-11

Question 9

What are some of the functions of the liver?

Answer 9

Glycogen storage
Bile secretion
Other metabolic functions

Question 10

Where is the gall bladder in relation to the liver?

Answer 10

Posterior and inferior

Question 11

What are the 4 lobes of the liver?

Answer 11

Right and Left
Caudate lobe - superior
Quadrate lobe - lower

Question 12

What is the round ligament of the liver?

Answer 12

The remnant of the umbilical vein

Question 13

What is the ligament that ‘runs between’ the left and right lobe?

Answer 13

Falciform ligament

Question 14

What is the ports hepatis?

Answer 14

Site of entrance for portal triad structures

Question 15

Describe the functional segments of the liver?

Answer 15

There are 8 different segments - allowing for segmentectomy

Question 16

What does each segment of the liver have?

Answer 16

Branch of a hepatic artery
Branch of a hepatic portal vein
Bile drainage (to bile duct)
Venous drainage (to IVC)

Question 17

What does the IVC and hepatic veins lack?

Answer 17

They lack valves - so if they have a high amount of pressure it will be directed back and cause an enlarged liver, leading to ascites - CHECK

Question 18

What happens if there is an increase in central venous pressure? (CHECK WORDING)

Answer 18

It is directed to the liver

Question 19

What do the hepatic veins do before entering the IVC?

Answer 19

The hepatic veins directing deoxygenated blood from the liver come together as 3 veins before entering IVC

Question 20

What is the portal triad?

Answer 20

Hepatic portal vein
Hepatic artery proper
Bile duct

Question 21

What does the portal triad run with?

Answer 21

The hepatoduodenal ligament - free edge of the lesser omentum

Question 22

What is the coeliac trunk?

Answer 22

It is the first of the 3 main midline branches of the aorta which supplies the foregut
IT is retroperitoneal

Question 23

Where does the coeliac trunk leave the aorta?

Answer 23

T12

Question 24

What does the coeliac trunk trifurcate into?

Answer 24

Splenic artery
Left gastric artery
Common Hepatic artery

Question 25

What does the common hepatic artery eventually become? (CHECK)

Answer 25

Gastroduodenal artery to then the hepatic artery proper | man gives off gas, and then becomes proper

Question 26

Describe the position of the spleen?

Answer 26

``` It runs along the superior border of the pancreas Its intraperitoneal (attached to body wall) Within the left hypochondrium ```

Question 27

What is the spleen protected by?

Answer 27

Ribs 9-11

Question 28

What is the main function of the spleen?

Answer 28

Functions with the haematological system | Breaks down red blood cells to produce bilirubin

Question 29

What can trauma of the spleen cause? (stabbing, rib fracture)

Answer 29

Major internal bleeding

Question 30

What are the major blood supplies of the stomach, along the junction of the lesser curvature and lesser omentum?

Answer 30

Right and left gastric arteries (from the hepatic artery proper and coeliac trunk) Anastomose together

Question 31

What are the major blood supplies of the stomach, along junction of greater curvature and greater omentum?

Answer 31

Right and left gastro-omental arteries (from the gastro-duodenal artery and splenic proper) Anastomose together

Question 32

Where does the blood supply to the liver come from? (20-25%)

Answer 32

Right and left hepatic arteries - branches of the hepatic artery proper

Question 33

Where does the rest of the blood reaching the liver come from?

Answer 33

The hepatic portal vein

Question 34

Describe the liver lobules

Answer 34

They have a central vein in the middle and an interlobular portal triad at each corner

Question 35

What does the central vein collect?

Answer 35

The cleaned blood and drains it into the hepatic veins

Question 36

What are the 2 recesses linked with the liver?

Answer 36

Hepatorenal recess - lowest part of the peritoneal cavity when patient is supine Sub-phrenic recess

Question 37

Where are both the recesses located?

Answer 37

Within the greater sac

Question 38

What does the hepatic portal vein do?

Answer 38

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

Question 39

What is the hepatic portal vein formed by?

Answer 39

``` Splenic vein (inferior mesenteric vein joins splenic vein too) - foregut Superior mesenteric vein - midgut ```

Question 40

What does the inferior mesenteric vein do?

Answer 40

Drains blood from the hindgut to the splenic vein

Question 41

What does the IVC do from the liver?

Answer 41

drains the cleaned blood from the hepatic veins into the right atrium

Question 42

Describe the portal triad structures from anterior to posterior?

Answer 42

Bile duct Hepatic artery proper Hepatic portal vein

Question 43

What are the different parts of the gallbladder?

Answer 43

Fundus Body Neck Cystic duct - narrowing

Question 44

What is the function of the gallbladder?

Answer 44

Stores and concentrates bile in between meals

Question 45

How does bile flow in and out of the gallbladder?

Answer 45

Via the cystic duct

Question 46

What does the rustic duct have?

Answer 46

A spiral valve, pushes bile up and round into the gallbladder for storage

Question 47

How is blood supplied to the gallbladder?

Answer 47

Via the cystic artery (branch of the hepatic artery)

Question 48

What is the cystic artery?

Answer 48

It is a brach of the right hepatic artery, it is located in the cystohepatic triangle (of calot)

Question 49

Describe where pain of the gallbladder will be found?

Answer 49

It will present in the epigastric region as it is a foregut organ

Question 50

Describe the visceral afferents of the gallbladder?

Answer 50

visceral afferents enter spinal cord between T6-T9 as it is a foregut organ

Question 51

How can pain also present with the gallbladder?

Answer 51

Can also present in the hypochondriac with or without pain referral to the right shoulder/neck as a result of anterior diapragatic irritation

Question 52

Where can variation occur in terms of the gallbladder

Answer 52

Variation can occur in both the cystic duct and cystic artery... but they do usually lie in the triangle of calot

Question 53

what is jaundice caused by?

Answer 53

Increase of bilirubin in the blood

Question 54

What are the 2 minor blood supplies to the stomach?

Answer 54

Posterior gastric arteries (from splenic) | Short gastric arteries (from splenic)

Question 55

Is the IVC retroperitoneal or intraperitoneal?

Answer 55

Retroperitoneal