Jaundice Flashcards
(95 cards)
1
Q
What is jaundice?
A
An increase in levels of bilirubin in the blood
2
Q
Where does RBC breakdown take place?
A
in the spleen but also thought to occur in the liver
3
Q
Where is bile produced?
A
the liver
4
Q
What happens to bile in the bile duct?
A
It is concentrated and stored here
5
Q
Where is the portal triad found?
A
in the free edge of the lesser omentum
6
Q
What are the 3 tubes which make up the portal triad?
A
Hepatic artery (blood supply to)
Hepatic portal vein (drainage to the liver)
Common bile duct (Part of biliary tree linking liver to duodenum)
also contains nerves and lymphatics
7
Q
Where does the splenic artery travel?
A
it has a tortuous course along the pancreas’s superior border
8
Q
What is the spleen anatomically related to?
A
The diaphragm posteriorly
The stomach anteriorly
The splenic flexure inferiorly
The left kidney medially
9
Q
What is the function of the spleen?
A
works as a giant lymph node within the immunological system
Store of blood - will release in an emergency
Breaks down old blood cells - breaks down RBCs to produce bilirubin
In the embryo makes RBC
10
Q
How enlarged does the spleen need to be to be palpable?
A
when 3 times the initial size
would be palpable at the end of inspiration
11
Q
What does the hepatic artery branch into?
A
Right and Left hepatic arteries
12
Q
How much of the liver’s blood supply is from the hepatic portal vein?
A
75-80%
13
Q
What is the liver anatomically related to?
A
The diaphragm superiorly, anteriorly, posteriorly
The anterior aspect of the stomach medially
The gallbladder posterior & inferiorly
The hepatic flexure inferiorly
The right kidney, right adrenal gland, IVC and abdominal aorta posteriorly
14
Q
How many segments does the liver have?
A
4 anatomical segments and 8 functional segments
15
Q
What ribs protect the liver?
A
Right ribs 7-11
16
Q
What does the liver do in relation to the biliary system?
A
Converts bilirubin to bile
17
Q
What are the 4 anatomical lobes of the liver?
A
Right lobe Left lobe Caudate lobe Quadrate lobe (these are visible to the naked eye)
18
Q
How many main hepatic veins drain into the IVC?
A
3
19
Q
What are the 2 clinically important areas of the peritoneal cavity related to the liver?
A
Hepatorenal recess (Morison’s pouch)
Sub-phrenic recess
(both within the grater sac)
20
Q
What is the particular clinical relevance of the hepatorenal recess?
A
it is the lowest part of the peritoneal cavity when the patient is supine
21
Q
Where does the gallbladder lie?
A
on the posterior aspect of the liver (often firmly attached)
anterior to the duodenum
22
Q
What is a cholecystectomy?
A
surgical removal of gallbladder
23
Q
What is bilirubin?
A
A breakdown product of RBC which is used to form bile in the liver
24
Q
What happens to bile once it is ready to be used?
A
it travels down the biliary tree to the 2nd part of the duodenum where it has an important role in the absorption of fats from the small intestine
25
Where does the pancreas secrete digestive enzymes which are necessary for digestion?
Into the 2nd part of the duodenum
26
What is the celiac trunk?
the 1st of the 3 midline branches of the abdominal aorta (it is retroperitoneal)
arises around T12 level
supplies the organs of the foregut
27
What are the 3 branches the celiac trunk trifurcates into?
Splenic artery
Hepatic artery
Left gastric artery
28
Where is the spleen located?
It is an intraperitoneal organ within the hypochondrium
29
Why would the spleen be removed?
If it has been damaged it is often removed because it is a non-essential organ and carries a high risk of bleeding
30
What protects the spleen?
left ribs 9-11 - their fracture could potentially pierce the spleen
31
What arteries supply blood to the stomach?
the right and left gastric arteries - run along the lesser curvature and anastomose together
the right and left gastro-omental arteries - run along the greater curvature and anastomose together
32
Where is the liver located?
Mainly in the upper right quadrant
33
What is the significance of the IVC and hepatic veins lacking valves?
a rise in central venous pressure is directly transmitted to the liver which can enlarge it as it engorges with blood (hepatomegaly)
34
What does each of the functional lobes of the liver have (I-VIII)?
its own blood supply (hepatic artery and hepatic portal vein)
venous drainage
bile drainage
35
What is the surgical significance of the functional segements of the liver?
It is possible to perform a hepatic segmentectomy
36
Describe what happens in a lobule
Blood flows to the lobule via the hepatic portal triad, it then flows to the central vein through the sinusoids
The sinusoids are like specialised capillaries, they have leaky walls and allow blood to interact with the hepatocytes allowing the hepatocytes to make bile
Bile flows from the hepatocytes in the lobule to the bile duct within the triad to be carried away
37
What can happen in the pouches when there is peritonitis?
a collection pus leading to an abcess
38
Where does the hepatic portal vein drain blood to?
Drains blood from foregut, midgut and hindgut to the liver for first pass metabolism (cleaning)
39
Where does the splenic vein drain blood to?
Drains the blood from the foregut to the hepatic portal vein
40
Where does the inferior mesenteric vein drain blood to?
Drains the blood from the hindgut to the splenic vein
41
Where does the superior mesenteric vein drain blood to?
Drains the blood from the midgut to the hepatic portal vein
42
Where does the inferior vena cava drain blood to from the liver?
The retroperitonum it drains the cleaned blood from the hepatic veins and into the right atrium
43
What attaches the liver to the diaphragm?
the coronary ligaments
44
What is the ligamentum teres/round ligament?
It is a remnant of the embryological umbilical vein
45
What attaches the liver to the anterior abdominal wall?
the falciform ligament
46
What is the role of the gall bladder?
it stores and concentrates bile in between meals
47
What are the different parts of the gall bladder?
The body and the neck
| - the neck narrows to become the cystic duct (the narrowing provides a potential site of gallstone impaction)
48
How does bile flow in and out of the gallbladder?
Through the cystic duct
49
What is the blood supply of the gallbladder?
via the cystic artery in 75% of people this is a branch of right hepatic artery
50
What region of the gut s the gallbladder in?
It is a foregut organ
51
Where is gallbladder pain felt?
the visceral afferents enter the spinal cord between T6 & T9
- early pain - the epigastric region
- can also be in the hypochondrium with/without pain referral to the right shoulder due to anterior diaphragmatic irritation
52
What is the biliary tree?
It is made up of the series of ducts which transport bile
53
What forms the common hepatic duct?
When the right and left hepatic ducts unite
54
What forms the bile duct?
When the common hepatic duct unites with the cystic duct
55
Where does the bile duct drain into what other duct drains here?
the 2nd part of the duodenum (along with the main pancreatic duct)
56
What is the path of the bile duct in relation to the duodenum?
descends posteriorly to the 1st part of the duodenum then int a groove on the posterior aspect of the pancreas
57
Where does the bile duct join with the main pancreatic duct?
within the groove on the pancreas the bile duct joins with the main pancreatic duct to form the ampulla of Vater/ hepatopancreatic ampulla at the widened part
58
How do the bile duct and main pancreatic duct drain into the duodenum?
only 25% drain separately
| drain through the major duodenal papilla (looks like a small nipple)
59
What are the 3 sphincters which are involved in the flow of bile into the duodenum?
bile duct sphincter
pancreatic duct sphincter
sphincter of Oddi
60
What is the purpose of the sphincters in the biliary tree?
prevent reflux of digestive secretions and duodenal content
| bile duct sphincter plays a significant role in controlling the flow of bile into the duodenum
61
What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?
investigation used to study the biliary tree and pancreas and treat selected pathologies
62
How is ERCP carried out?
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
63
What is the technical term for jaundice?
icterus
64
What happens if something is compressing the biliary tree?
the bile cannot flow down it and into the duodenum as it should so it is pushed back up to the liver and overspills into the blood (including bilirubin)
65
What are the extra hepatic causes of jaundice?
Gallstones
| Carcinoma at the head of the pancreas
66
What are the 4 parts of the pancreas?
head
neck
body
tail
67
What is the uncinate process?
a small projection from the inferior part of the head of the pancreas and lies posterior to the superior mesenteric artery.
68
What structures does the body of the pancreas overlie?
aorta
| L2 vertebra
69
What structure does the tail of the pancreas overlie?
the left kidney
70
Where is the head of the pancreas in relation to the duodenum?
It lies within the C shape formed by the duodenum
71
Where is the pancreas located?
It is a reteroperitoneal organ
lies transversely across the posterior abdomen
posteriorly lie the right kidney & adrenal gland, IVC, the bile duct, abdominal aorta, superior mesenteric vessels, left kidney & adrenal gland, part of the portal venous system
anteriorly lies the stomach
the duodenum surrounds the head
superoposteriorly – the splenic vessels
72
What are the functions of the pancreas?
exocrine- acinar cells make pancreatic digestive enzymes - delivered via the main pancreatic duct
endocrine - islets of Langerhans produce insulin and glucagon which go into the bloodstream
73
What is the nerve supply to the pancreas?
Sympathetic - abominopelvic splanchnic nerves
Parasympathetic - vagus nerves
these pass through the diaphragm, then follow arteries from the celiac and superior mesenteric plexus to reach the pancreas.
Plexus fibres are distributed to acinar cells and islets
74
What controls secretion from the pancreas?
parasympathetic fibres are secretomoteo in function but actual secretion is contolled by hormones in the duodenum and intestinal mucosa as a response to acid.
75
Arterial supply to the pancreas
Mainly the pancreatic branches from the splenic artery
Branches to the gastroduodenal artery which branches to the pancreaticduodenal artery
The superior mesenteric arty also branches to the inferior mesenteric artey
76
Give an example of what can cause pancreatic pain?
Pancreatitis e.g due to a blockage of the ampulla by a gallstone so bile is diverted into the pancreas irritating and inflaming it
77
Where is pancreatic pain felt?
It is a foregut and midgut organ and so can be felt in the epigastric and/ or the umbilical region
can radiate though the patients bac
78
What type of organ is the small intestine?
1st and 2nd part of the duodenum are foregut organs
| rest of small intestine is midgut
79
what are the 4 parts of the duodenum?
```
Superior (part intraperitoneal)
- Duodenal cap – relatively mobile
Descending (retroperitoneal)
Horizontal (retroperitoneal)
Ascending (retroperitoneal)
```
80
Where does the duodenum begin?
At the pyloric sphincter which controls the flow of chyme from the stomach into the duodenum
sympathetic innervation promotes pyloric sphincter contraction and parasympathetic innervation promotes relaxation
81
What is the arterial blood supply of the duodenum?
Gastroduodenal artery - branches to Superior pancreaticoduodenal
artery
Superior mesenteric artery branches to Inferior pancreaticoduodenal
82
How long are each of the sections of the small intestine?
Duodenum - 25cm
Jejunum - 3m
Ileum - 4m
83
Where does the jejunum begin?
at the duodenaljejunal flexure - L2 vertebral level few cm left of midline
84
What quadrant do the ileum and jejunum lie in?
jejunum mainly in the left upper quadrant
| ileum mainly in the right lower quadrant
85
Where does the jejunum become the ileum?
Hard to find the point of transition but there are clinically and surgically significant differences - differences in mucosa
86
Where does the ileum end?
At the ileocaceal junction
87
What is the mucosa like in the jejunum?
highly folded - Folds are called plicae circularis
it also has thicker walls than the ileum
the jejunum has a wider diameter than the ileum
88
What is the mucosa and mesentery like in the ileum?
It is smoother than the jejunum mucosa and the mesentery has a higher fat content than the mesentery of the jejunum
89
What is the arterial supply to the jejunum and ileum?
Arterial blood from:
superior mesenteric artery via jejunal and ileal arteries
The jejunum has a greater vascularity with long vasa recta and few large loops of arterial arcades
The ileum has less vascularity with short vasa recta and many shorted looped arcades
vessels travel in the mesentery
90
What is the venous drainage of the jejunum and ileum?
jejunal and ileal veins drain to the superior mesenteric vein to hepatic portal vein
proteins and carbohydrates are absorbed from the small intestines into the portal venous system to be taken to the liver
Vessels travel in the mesentery
91
How are absorbed fats transported to the venous system?
After the action of bile helping to absorb fats into 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
At the left venous angle
92
What are the main groups of lymph nodes draining abdominal organs?
```
Celiac (foregut organs)
Superior mesenteric (midgut organs)
Inferior mesenteric (hindgut organs)
Lumbar (kidneys, posterior abdo wall, pelvis and lower limbs)
```
93
How do the abdominal lymph vessels travel?
tend to lie alongside arteries
| superficial lymph vessels drain into deep
94
Where does lymph drain to eventually?
```
Depending on origin will drain into
Thoracic duct (from ¾ of body)
Right lymphatic duct (from ¼ of body)
```
95
Where does the lymph drain into the venous system?
At venous angles - the junction between the subclavian and internal jugular veins
left venous angle = thoracic duct drainage
right venous angle = right lymphatic duct drainage
