Anatomy Week 4

Hiatus Hernias - sliding vs. shifting

(paraesophageal)

Characteristic

Jejenum

Ileum

Color

Deep red

Paler pink

Caliber

2-4cm

2-3cm

wall

Thick and
heavy

Thin and light

vascularity

greater

less

Vasa recta

long

short

arcades

A few large
loops

Many short
loops

Fat in
mesentery

less

more

Circular folds

Large, tall
closely packed

Low and
sparse, absent
in distal part

few

many

Lymphoid
nodules
Moores
p244

X- Ray Interpretation
Radiopaedia.org awesome reference

Small bowel obstruction

Central
Plicae circulares (mucosal folds of the
small intestine)

X- Ray #2

 Sigmoid volvulus- twisting of the

sigmoid colon in its mesentery
Common cause of large bowel
obstruction
Large bowel dilatation
Colon is often collapsed distally

Kidney bean sign (sigmoid

volvulus)

Signs of bowel perforation- free air

under the diaphragm

Liver Enzymes
Cholestatic blockage of the bile
duct at any point
Hepatitic conditions that damage
the cells of the liver
Mixed

Transaminases originate from the hepatocyte cytoplasm

Phosphatases originate from the bile cannaliculi

What does a cholestatic picture look like??

- ALP>200IU/L
- ALP more than 3x ALT
Common causes:
bile stones
Tumours
Pregnancy

 What does a hepatitic picture look like?

ALT>200IU/L
ALT 3x more than ALP
Common causes:
Infection (Hepatitis; EBV; CMV;)
Alcohol
NASH
Drugs (paracetamol)
Hereditary (Wilsons; Haemachromatosis)
Autoimmune

 What does an isolated raise in GGT

suggest?

Racgp case studies:

35 y/o woman complains of abdo pain +
dark urine. Clinically mildly jaundiced;
LFTs:

What does this picture look like?

 Raised ALP compared to ALT

suggests cholestatic pattern
Biliary disease is highly likely
What are the ddxs?
Stones
Tumour

What is the appropriate ivx?

Abdo ultrasound- dilatation of the bile
duct

 39 y/o male has the following LFTs

after a work check-up:

 Mildly elevated transaminases suggest

hepatitic picture:
DDx??
Chronic hepatitis
NASH
Cirrhosis
Hereditary haemachromatosis

Next step?
Liver ultrasound; hep serology; serum iron
concentrations

 66y/o male presents with weight loss

and fatigue. Has normocytic
anaemia..

 Raised ALP compared to ALT suggest

cholestasis
low albumin and anaemic picture
suggest intrahepatic cholestasis
metastases are the most likely dx

Conjugated/Unconjugated
Bilirubin
Bilirubin is partly made of the breakdown
products of RBCs in the spleen
Bilirubin is conjugated by the liver
Excreted in bile and urine
Able to measure the level of conjugated vs.
unconjugated bile in the blood in jaundiced
patients:
Unconjugated hypersplenism; haemolytic anaemia
Conjugated obstruction of the bile duct (painless
jaundice is pancreatic cancer until proven otherwise)

Arterial Supply of the small

intestines?

Arterial Supply of the small

intestines?
SupplyProximal to the ampulla of vater: gastroduodenal
artery; superior pancreaticoduodenal artery
Distal to the ampulla of vater: superior mesenteric
artery; inferior pancreaticoduodenal artery
Jejunal arteries which arise from the superior
mesenteric artery
Ileal arteries which arise from the superior
mesenteric artery

Revision