103 - Vessels, Nerves, Lymphatics of the Abdomen

Question 1

Where does the abdominal aorta start?

Answer 1

~T12/L1

Question 2

Where does the AA divide into the common iliac arteries?

Answer 2

L4

Question 3

Branches of the AA 1 2 3

Answer 3

1) 3x unpaired anterior branches 2) 3x paired lateral branches 3) Series of paired posterior branches

Question 4

What do the posterior branches of the AA supply?

Answer 4

The walls of the aorta (including the diaphragm). The phrenic artery (for diaphragm) and lumbar arteries for abdominal walls.

Question 5

What do the three paired branches of the AA supply? 1 2 3

Answer 5

1) Kidneys (left and right renal) 2) Adrenals (left and right suprarenal) 3) Gonads (left and right gonadal, testicular/ovarian)

Question 6

What do the three unpaired anterior branches of the AA supply?

Answer 6

Abdominal viscera

Question 7

Three unpaired branches of the AA

Answer 7

1) Coeliac 2) Superior mesenteric 3) Inferior mesenteric

Question 8

Artery supplying derivatives of the primitive foregut

Answer 8

Coeliac artery

Question 9

Artery supplying derivatives of the primitive midgut

Answer 9

Superior mesenteric artery

Question 10

Artery supplying derivatives of the primitive hindgut

Answer 10

Inferior mesenteric artery

Question 11

Structures supplied by the coeliac artery

Answer 11

Liver, gallbladder, pancreas, spleen, abdominal oesophagus, stomach, duodenum up to the major duodenal papilla

Question 12

Structures supplied by the superior mesenteric artery

Answer 12

Duodenum from the major duodenal papilla until the transverse colon, proximal to the splenic flexure

Question 13

Structures supplied by the inferior mesenteric artery

Answer 13

Last part of the transverse colon until the anal canal

Question 14

Where does the coeliac trunk branch from the AA?

Answer 14

~T12

Question 15

Branches from the coeliac trunk 1 2 3

Answer 15

1) Left gastric artery 2) Splenic artery 3) Common hepatic artery

Question 16

Path of the left gastric artery 1 2 3 4

Answer 16

1) First unpaired anterior artery to branch form the AA. 2) Travels upwards, to the left. 3) Gives branches to abdominal oesophagus. 4) Runs along lesser curvature of stomach

Question 17

Path of the splenic artery 1 2 3

Answer 17

1) Runs along superior border of the pancreas towards the hilum of the spleen. 2) Sends short gastric arteries to fundus of the stomach. 3) Sends left gastroepiploic arteries that line greater curvature

Question 18

Structures supplied by splenic artery 1 2 3 4

Answer 18

1) Body, tail of the pancreas 2) Spleen 3) Fundus of stomach 4) Left gastroepiploic branches line greater curvature of stomach.

Question 19

Path of the common hepatic artery 1 2 3 4 5 6 7

Answer 19

1) Travels to the right, to the free edge of the lesser omentum. 2) Splits into proper hepatic artery and gastroduodenal artery. Right gastric artery branches from common hepatic artery. 3) Proper hepatic artery ascends free edge of lesser omentum, then splits into right and left hepatic arteries. 4) Cystic artery often branches from right hepatic artery (variable) 5) Gastroduodenal artery descends, travels under 1st part of duodenum. 6) Right gastroepiploic artery branches to greater curvature under 1st part of duodenum. 7) Anterior superior pancreaticoduodenal artery branches.

Question 20

* Coeliac trunk

Answer 20

COELIACARTERY

Question 21

Branches of the superior mesenteric artery 1 2 3 4

Answer 21

1) Inferior pancreaticojejunal artery 2) Jejunal arteries 3) Ileac arteries 4) Colic arteries

Question 22

Where does the superior mesenteric artery branch from the AA?

Answer 22

L1

Question 23

Path of the superior mesenteric artery 1 2 3 4 5

Answer 23

1) Branches at L1 2) gives off inferior pancreaticoduodenal branch 3) Travels over the duodenum, aorta, right psoas 4) Branches to the left supply the small intestine (jejunal, ileac arteries) 5) Branches to the right supply the large intestine (colic arteries)

Question 24

Path of colic arteries 1 2 3

Answer 24

1) Branch to the right from the superior mesenteric artery 2) Ileocolic, right colic, middle colic arteries 3) Colic arteries feed marginal artery that runs alongside the large intestine, branches from which supply large intestine.

Question 25

Where does the inferior mesenteric artery branch?

Answer 25

L3

Question 26

How does the inferior mesenteric leave the aorta?

Answer 26

Travels inferolateral from L3 into the lower left quadrant

Question 27

Path of the inferior mesenteric artery

Answer 27

Gives off a series of colic branches, before becoming superior rectal artery

Question 28

Venous drainage of viscera

Answer 28

All visceral veins drain into a single portal vein, which enters the liver at the porta hepatica

Question 29

Where does the portal vein originate?

Answer 29

Behind the neck of the pancreas at T12. Where the splenic vein joins the superior mesenteric vein

Question 30

Where does the portal vein drain after travelling through the liver?

Answer 30

Into the IVC, just before it penetrates the diaphragm

Question 31

Where do the hepatic veins drain?

Answer 31

Into the IVC

Question 32

Danger of liver fibrosis

Answer 32

Because portal system is low pressure, fibrosis can occlude blood flow into the liver if it results in an elevation of pressure within the hepatic portal system

Question 33

Effect of portal hypertension 1 2 3 4

Answer 33

1) Portal veins don’t have valves, so blood backs up. 2) Direction of flow is reversed. 3) Anastamoses are formed so that blood can return to the heart via the systemic venous circulation (porto-systemic anastamoses) 4) This can occur in five places

Question 34

Five places where porto-systemic anastamoses can occur 1 2 3 4 5

Answer 34

1) Distal end of oesophagus 2) Anal canal (superior rectal vein fuses with portal system) 3) Anterior abdominal wall veins (opens ligamentum teres into the umbilical vein) 4) Retroperitoneal space behind colon 5) Trop of the liver, where it presses against the diaphragm

Question 35

Danger of porto-systemic anastamoses forming at the distal oesophagus

Answer 35

Oesophageal varices can form, which bleed profusely

Question 36

Which nervous system innervates abdominal viscera?

Answer 36

Autonomic

Question 37

Spinal segments from which preganglionic sympathetic fibres innervating GIT originate

Answer 37

T6 - L2

Question 38

Where do the sympathetic ganglia cluster in the abdomen?

Answer 38

Unpaired branches of aorta, renal arteries

Question 39

Parasympathetic innervation of midgut and foregut

Answer 39

Vagus

Question 40

Parasympathetic innervation of the hindgut

Answer 40

Pelvic splanchnic nerves

Question 41

How do post-ganglionic fibres innervate targets?

Answer 41

Pass to targets with blood vessels

Question 42

Segments supplying autonomic innervation to foregut

Answer 42

T6 - T9

Question 43

Segments supplying autonomic innervation to midgut

Answer 43

T8 - T12

Question 44

Segments supplying autonomic innervation to hindgut

Answer 44

T12 - L2

Question 45

Afferents from viscera until the mid-sigmoid colon

Answer 45

Run with sympathetic innervaiton

Question 46

Referred pain from unpaired viscera until mid-sigmoid colon

Answer 46

Refer pain to anterior abdominal wall (dermatones T6 - L2)

Question 47

Referred pain from unpaired viscera after mid-sigmoid colon

Answer 47

Refer pain to perineal region (dermatomes S2 - S4)