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Obstructive _jaundice___Anatomy and Physiology

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Publicado el

Malavika T R
Calicut Medical College

Publicado en: Salud y medicina
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Obstructive _jaundice___Anatomy and Physiology

  1. 1. LIVER  Right hypochondrium extent into Epigastrium & Left hypochondrium  1.5 kg
  2. 2. Ligaments  Right triangular ligament Fixes right lobe to under surface of right dome of diaphragm
  3. 3.  Left triangular ligament Fixes left lobe to to the diaphragm in a similar fashion
  4. 4.  Falciform Ligament Remnant of Umbilical vein From umbilicus to liver Divide to Rt & Lt lobes passing into interlobar fissure
  5. 5. Blood supply  80 % Portal vein  20 % Hepatic artery  Hepatc Artery Rt branch Lt branch Rt lobe Lt lobe
  6. 6. Venous drainage  3 Hepatic veins Right , Middle , & Left IVC
  7. 7. Hilum of liver – PORTA HEPATIS  Hepatic artery  Bile duct - anterior  Portal vein - posteriorly
  8. 8. Gall bladder  Pear shape  7.5 – 12 cm  Capacity = 5 ml
  9. 9. ANATOMICAL DIVISION HARTMANN’S POUCH Narrow angulated distal portion of neck m/c site where stones occur
  10. 10. CRYPTS OF LUSCHKA
  11. 11.  Cystic duct = 3 cm (variable )  Lumen = 1-3 mm  Valves of Heister = spiral folds  Sphincter of Lutkens = surrounding the wall
  12. 12. CHD = < 2.5 cm CBD = 7.5 cm
  13. 13. Supraduodenal portion Retroduodenal portion Infraduodenal portion Intraduodenal portion PARTS OF COMMON BILE DUCT
  14. 14. 2nd part Ampulla of vater
  15. 15. CALOT’S TRIANGLE  Left = CHD  Below = Cystic duct  Above = Inf. Surface of liver  Content = LN of Lund
  16. 16. ARTERIAL SUPPLY  Cystic artery = br .of right hepatic artery  Accessory cystic artery = gastroduodenal artery ( occasionally )
  17. 17. LYMPHATICS  Subserosal & Submucosal lymphatic vessels  Cystic LN of Lund ( sentinal LN ) (Junction of Cystic & CHD)  Efferent vessels  Hilum of liver   Coeliac LN
  18. 18. LIVER FUNCTIONS  Removal of endotoxins & foreign antigens  Synthesis of all proteins except globulins  Glucose metabolism ,Glycolysis ,Gluconeogenesis  Drug & hormone metabolism  Synthesis of clotting factors  Urea formation  Bilirubin formation
  19. 19. GALL BLADDER FUNCTIONS  Reservoir  Concentration  Mucus secretion
  20. 20. BILE FORMATION Hepatocytes Bile into canaliculi R & L Hepatic ducts CHD
  21. 21. Cystic duct Gall bladder Concentration of bile
  22. 22. BILE  250 – 1000 ml / day  98% water  Capacity of GB = 40 – 50 ml  Absorption of water concentration Fatty food CCK  GB contract Sphincter of Oddi relax
  23. 23. COMPOSITION OF BILE  Bile salts = cholate , chenodeoxy cholate , deoxy cholate  Cholesterol & Phospholipids  Bilirubin  Protein & Inorganic ions  Water
  24. 24. BILIRUBIN METABOLISM RETICULO ENDOTHELIAL SYSTEM
  25. 25. Hb HEME GLOBIN
  26. 26. HEME OXIDATION OXYGENASE BILI VER DIN REDUCTION BILIRU BIN BV REDUC TASE
  27. 27. BILI RUBI N BILIARY TREE
  28. 28. BILI RUBI N BILIARY TREE PREHEPATIC JAUNDICE
  29. 29. BILI RUBI N BILIARY TREE HEPATO CELLULAR JAUNDICE
  30. 30. BILI RUBI N BILIARY TREE OBSTRUCTIVE JAUNDICE

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