01-29: Blood Supply to Abdominal Viscera Flashcards
(86 cards)
1
Q
At which vertebra does the abdominal aorta begin?
A
T12
2
Q
What does the abdominal aorta enter through to get to the abdomen?
A
aortic hiatus
3
Q
Is the abdominal aorta intraperitoneal or retroperitoneal?
A
retroperitoneal
4
Q
Is the abdominal aorta anterior or posterior to ventral bodies?
A
anterior
5
Q
At which vertebra does the abdominal aorta terminate?
A
L4
6
Q
What does the abdominal aorta divide into at L4?
A
Left and Right common iliac arteries
7
Q
Where is the IVC relative to the abdominal aorta?
A
just right to the abdominal aorta
8
Q
Which major vein crosses anterior to the aorta?
A
Left renal vein
9
Q
What forms the aortic hiatus?
A
Left and Right crus of the diaphragm
10
Q
What major structures are posterior to the abdominal aorta?
A
- Anterior longitudinal ligament
- Vertebral bodies
11
Q
Which nerves/plexuses are located on the anterior and lateral surfaces of the abdominal aorta?
A
- celiac plexus
- superior mesenteric plexus
- inferior mesenteric plexus
- renal plexus
- autonomic nerves
12
Q
Where is the thoracic duct with the cisterna chyli relative to the abdominal aorta?
A
to the right
13
Q
What are the relations of these structures to the abdominal aorta?
- IVC
- Pancreas
- Duodenum
- Root of THE mesentery
A
- IVC»_space; RIGHT
- Pancreas»_space; ANTERIOR
- Duodenum»_space; ANTERIOR
- Root of THE mesentery»_space; ANTERIOR
14
Q
What are the 6 paired branches of the abdominal aorta?
A
- inferior phrenic aa.
- subcostal aa.
- lumbar aa.
- (middle) suprarenal aa.
- renal aa.
- gonadal aa.
**terminates into common iliacs
15
Q
At which vertebra is the renal aa. located?
A
L2
16
Q
What are the 4 un-paired branches of the abdominal aorta and their vertebral levels?
A
- Celiac a./trunk (T12 & L1)
- Superior mesenteric a. (L1)
- Inferior mesenteric a. (L3)
- Median sacral a. (L4)
17
Q
The celiac trunk branches immediately below the ____________
A
aoritc hiatus
18
Q
What is the celiac trunk surrounded by?
A
celiac plexus and ganglia
19
Q
What are the 3 main branches of the celiac trunk?
A
- Left gastric a. (superior)
- Common hepatic a. (Right)
- Splenic a. (Left)
20
Q
What are the 2 branches of the Left gastric artery?
A
- Esophageal branches
- Branches to Lesser Curvature of stomach (anastamose with branches of the right gastric artery along the lesser curvature)
21
Q
What are the 2 branches of the common hepatic artery?
A
- Proper Hepatic artery (up)
- Gastroduodenal artery (down)
22
Q
What artery is usually a branch of the Right hepatic artery?
A
cystic artery
23
Q
What may the Gastroduodenal artery give off?
A
supraduodenal artery
24
Q
Where does most of the gastroduodenal artery run relative to the duodenum?
A
POSTERIOR
25
What are the terminal branches of the gastroduodenal artery?
- Right gastro-omental a
| - Superior pancreaticoduodenal branches
26
Where does the splenic artery run relative to the stomach and the pancreas?
POSTERIOR to stomach
| SUPERIOR to pancreas
27
What does the splenic artery terminate as?
several splenic arteries that do NOT anastomose
28
What are the 2 main branches of the splenic artery?
- Short gastric artery
| - Left gastro-omental artery
29
What are the 3 contents of the Hepatoduodenal ligament (portal triad)?
- Proper Hepatic artery [LEFT]
- Portal vein [POSTERIOR]
- Bile duct [RIGHT]
30
What kind of blood does the portal vein bring from the GI tract to the liver?
- deoxygenated
| - nutrient rich
31
What kind of blood does the Proper Hepatic artery supply?
-oxygenated blood
**because it is a branch of the common hepatic artery
32
What does the Proper hepatic artery further divide into?
Right and Left hepatic arteries
33
Where do the Right and Left hepatic arteries drain into?
IVC (right and left sides)
34
Do hepatic veins follow the branching patterns of portal veins, hepatic ducts, and hepatic arteries?
NO!!
35
Where is the superior mesenteric artery located?
1cm INFERIOR to the celiac trunk
36
Where does the superior mesenteric artery emerge from the aorta, relative to the neck of the pancreas?
POSTERIOR to the neck of the pancreas
37
Where does the pancreas receive blood supply from?
- Celiac a.
| - Superior mesenteric a.
38
What is the superior pancreaticoduodenal artery?
branch of the gastroduodenal artery coming off of the celiac trunk
39
What are the 2 branches of the superior pancreaticoduodenal artery?
Anterior & Posterior superior pancreaticoduodenal a.
40
What is usually the first branch of the superior mesenteric a.?
inferior pancreaticoduodenal a. (branches into ANT/POST)
41
What do the gastroduodenal a. and the inferior pancreaticoduodenal a. come together to form?
anastomosing arcades on the head of the pancreas
42
What are the 3 branches of the superior mesenteric a. that enter the small intestine?
- inferior pancreaticoduodenal a.
- jejunal arteries (LONG VR, SIMPLE arcades)
- ileal arteries (SHORT VR, COMPLEX arcades)
43
What are the 3 branches of the superior mesenteric a. that enter the large intestine?
(Superior >> Inferior)
- Middle colic a.
- Right colic a.
- Ileocolic a.
44
What are the 4 branches of the ileocolic a.?
- posterior cecal branch
- anterior cecal branch
- ileal branches
- appendicular branch
45
What part of the gut does the inferior mesenteric artery supply?
hindgut
46
What are the 3 branches of the inferior mesenteric artery?
- Left colic a.
- Sigmoid arteries
- Superior rectal a.
47
What are the 2 branches of the left colic a.?
ascending and descending branch
48
With which 3 veins off the inferior mesenteric vein is there overlap within the portal system?
- superior rectal vein
- middle rectal vein
- inferior rectal vein
49
What does the superior rectal vein drain into?
inferior mesenteric vein
50
What does the middle rectal vein drain into?
internal iliac veins
51
What does the inferior rectal vein drain into?
external pudendal veins
52
What does the hepatic portal system begin and end as?
```
Begin = capillaries in the DIGESTIVE SYSTEM
End = capillaries in the LIVER
```
53
What kind of blood is in the hepatic portal system?
- deoxygenated
| - nutrient rich
54
Where does the hepatic portal system drain blood to and from?
```
FROM = Esophagus
TO = Upper anal canal
```
55
How long is the portal vein?
2 inches
56
Does the portal vein have valves?
NO
57
Which veins form the portal vein?
- Splenic vein
- Superior mesenteric vein
- Inferior mesenteric vein
58
Which 2 veins does the inferior mesenteric vein enter?
Either:
- Superior mesenteric v.
- Splenic v.
59
Where does the hepatic portal system form, relative to the pancreas?
POSTERIOR to the neck of the pancreas
60
What does the portal system run through to enter the liver?
Hepatoduodenal ligament
61
Where does the portal system enter the liver?
at the Porta Hepatis
62
What are the 4 direct tributaries of the portal vein?
- (paraumbilical vv. [anterior wall])
- cystic v.
- Left gastric v.
- Right gastric v.
63
What are the 4 direct tributaries of the splenic vein?
- splenic vv. (proper)
- short gastric vv.
- Left gastro-omental v.
- Pancreatic vv.
64
What are the 2 direct tributaries of the superior mesenteric vein?
- Right gastro-omental v.
| - Pancreaticoduodenal vv.
65
What are the 4 branches of the superior mesenteric vein?
- intestinal vv. (jejunal and ileal vv.)
- ileocolic v. (cecal and appendicular vv.)
- Right colic v.
- Middle colic v.
66
What is the overlap between the veins of the esophagus clinically important?
-blood can drain superiorly or inferiorly into the azygos system
**NOTE- Submucous venous plexus in the esophagus
67
What are the 2 veins that drain the liver through the IVC?
- Right hepatic vein
| - Left hepatic vein
68
The hepatic veins are __________
intersegmental
69
Where do the common iliac veins join to form the IVC?
- L5
| - Posterior and inferior to aortic bifurcation
70
Does the IVC pass through the anterior or posterior aspect of the liver?
posterior
71
At which vertebra does the IVC pierce the central tendon of the diaphragm?
T8
72
What does the IVC drain?
- posterior body wall muscles
- GU system (internal iliac veins)
- LE (external iliac veins)
73
What are the tributaries of the IVC?
- Right and left common iliac veins
- Median sacral v.
- Lumbar veins (paired, segmented)
- Right and Left renal vv.
- Right gonadal v.
- Right suprarenal v.
- Hepatic vv.
- Inferior phrenic vv.
74
Which veins are NOT tributaries of the IVC and instead enter the Left Renal vein?
- Left gonadal v.
| - Left suprarenal v.
75
Where do the veins from the GI tract normally drain?
into the portal vein (either directly or indirectly)
76
Where do the veins from posterior structures (kidneys) normally drain?
into the IVC
77
What are the portal-caval anastomoses?
connections between the portal venous system and the IVC system
78
When does the portal-caval anastomoses become important?
when the liver is blocked
**varicosities = backup of blood >> hemorrhage
79
What happens when the liver is blocked due to disease?
blood flows back through the portal system >> through interconnections with the IVC >> heart
80
Why is the portal-caval anastomoses possible?
portal system does NOT have valves
81
What are the 4 main ways for blood to bypass the liver?
- Esophageal branches
- Periumbilical veins
- Colic veins
- Superior, Middle, Inferior rectal veins
82
How do the esophageal branches of the Left Gastric vein help blood bypass the liver?
They connect with veins on the lower thoracic esophagus
* *Causes esophageal varicosities
* *Result of portal HTN (cirrhosis)
83
Where do paraumbilical veins run?
in the base of the falciform ligament
**drain the umbilical area
84
How do the paraumbilical veins in the falciform ligament with the subcutaneous veins around the umbilicus in the anterior abdominal wall help blood bypass the liver?
Liver blocked >> paraumbilical veins dilate >> blood flows towards caval system
* *Causes Inferior/Superior epigastric veins empty into external iliac and femoral veins
* *Result: Caput Medusae
85
How do the colic veins to the retroperitoneal veins help blood bypass the liver?
veins draining ascending (sup. mes) and descending (inf. mes.) colon >> connect with retroperitoneal veins (Veins of Retzius) >> drain the posterior body wall >> into lumbar veins >> IVC
86
How do the Superior, Middle, and Inferior rectal veins help blood bypass the liver?
middle and inferior rectal veins >> empty into internal iliac veins >> common iliac veins
**Rectal varicosities/internal hemorrhoids
