Abdomen 3 - blood supply, venous drainage, innervation

Question 1

Branches of Ab Aorta

Answer 1

Celiac a -> superior mesenteric a -> inferior mesenteric a -> bifurcation @ L4 into R/L common iliac a

Question 2

Celiac Trunk

Answer 2

• Left Gastric a
• Splenic a
• Common Hepatic a
• branches @ L1 superior border, below aortic hiatus of diaphragm, btwn R/L crura

Question 3

Splenic A

Answer 3

• posterior to stomach, superior border of pancreas
• dorsal pancreatic a
• short gastric a -> go to fundus of stomach
• greater pancreatic a
• L gastroepiploic (gastro-omental) a -> along greater curve, supplies stomach + greater omentum

Question 4

Left Gastric A

Answer 4

• up to L of cardia
• supplies esophagus + lesser curve of stomach
• runs along lesser curve in lesser omentum to anastamose w/R gastric a.

Question 5

Common Hepatic A

Answer 5

• upper border of pancreas

- proper hepatic, R gastric, gastroduodenal arteries

Question 6

Proper Hepatic A

Answer 6

• divides near porta hepatis
• R/L hepatic arteries (liver)
• Cystic a (from R hepatic, gall bladder)
• R gastric a

Question 7

R Gastric A

Answer 7

from proper/common hepatic -> pylorus -> lesser curve of stomach -> anastamoses w/L gastric

Question 8

Gastroduodenal A

Answer 8

• behind 1st part of duodenum
• right gastro-omental (gastroepiploic) a. -> along greater curve, supplies stomach + greater omentum
• supraduodenal a.
• posterior + anterior superior pancreaticoduodenal a.
• if cut, still get blood to stomach via inf panc duodenal a.

Question 9

Superior Mesenteric A

Answer 9

• behind neck of pancreas, jejunal and ileal
• Inferior pancreaticoduodenal a
• middle + right colic
• ileocolic a.

Question 10

Inferior pancreaticoduodenal a

Answer 10

• passes to right, divides into anterior-inferior + posterior-inferior pancreaticoduodenal a
• posterior surrounds pancreas
• anastamose w/ superior pancreaticoduodenal a.

Question 11

Middle Colic A

Answer 11

• supplies transverse colon
• divides into R branch - anastomoses w/R colic A
• and L branch - anastomoses w/L colic A

Question 12

Right Colic A

Answer 12

• right of and behind peritoneum
• divides into ascending + descending branches
• supplies ascending colon

Question 13

Ileocolic A.

Answer 13

• divides into ascending colic a (anastamoses w/R colic)
• and ileal artery (ileum) which divides into
• anterior + posterior cecal a (cecum)
• appendicular a. (supplies appendix)

Question 14

Inferior Mesenteric A

Answer 14

• to left behind peritoneum, supplies descending + sigmoid colon, upper rectum
• L colic A
• Sigmoid A
• Superior Rectal A

Question 15

L Colic A

Answer 15

• supplies descending colon, comes of at L3

- Ascending + descending branch of L colic a.

Question 16

Sigmoid A

Answer 16

• several, supply sigmoid colon

- ascending + descending branches

Question 17

Superior Rectal A

Answer 17

• termination of inferior mesenteric A.

- descends into pelvis + rectum

Question 18

Portal Vein (3)

Answer 18

• drains ab part of gut, spleen, pancreas, gall bladder
• tributaries from splenic vein and superior mesenteric vein (and inferior mesenteric)
• cap bed #1 (intestine) -> portal vein -> cap bed #2 (liver) -> IVC

Question 19

Splenic Vein tributaries (3)

Answer 19

1. Inferior mesenteric vein -> splenic
2. Short gastric veins -> left gastro-omental vein -> splenic vein
3. Pancreatic vein -> splenic vein

Question 20

Superior Mesenteric Vein (5)

Answer 20

• runs with sup mes a
  1. Colic veins
  2. Jejunal and ileal veins
  3. Right gastro-omental vein
  4. Anterior + posterior inferior pancreaticoduodenal veins

Question 21

Inferior Mesenteric Veins

Answer 21

• Superior rectal vein

- L colic vein

Question 22

Lymphatics

Answer 22

Pre-aortic lymph nodes:

1. Celiac nodes→ Cisterna chyli
2. Superior mesenteric nodes → Celiac nodes
3. Inferior mesenteric nodes → Superior mesenteric nodes

Inferior -> superior -> celiac -> cisterna chyli -> thoracic duct

These are JUST digestive nodes

Question 23

Thoracic Splanchnic Nerve Symp Innervation

Answer 23

• GVE, GVA fibers
• Greater splanchnic (T5-9) → celiac ganglion by celiac trunk, synapses to go from pre to post gang
• Lesser splanchnic (T10-11) → aorticorenal ganglion
• Least splanchnic (T12) → renal plexus; no ganglia that it goes to

Question 24

Lumbar + Sacral Splanchnic Nerve Symp Innervation

Answer 24

• Lumbar splanchnic (L1-2or 4) → pre vertebral plexus (no specific ganglia assoc. with)
• Sacral splanchnic → inferior hypograstric plexus; for pelvis

Question 25

Parasymp Innervation

Answer 25

1. Pelvic splanchnics (S2-4) → inferior hypogastric plexus

2. Anterior and posterior vagal trunks → abdominal pre vertebral plexus

Question 26

Sup Mes A Branches

Answer 26

All of branches go to edge that runs all the way around = marginal artery that runs entire length

Marginal A anastamoses inferior + superior mesenteric A

Question 27

Pre-Vertebral Plexus

Answer 27

1. Celiac plexus - btwn celiac trunk + renal arteries
2. Aortic plexus: intermesenteric plexus; on aorta
3. Superior hypogastric plexus: hypogastric nerve + inferior hypogastric plexus

Bifurcation of R/L common iliacs into external and internal iliac, form two cord like structures= superior hypogastric nerves leading into superior hypogastric plexus

Question 28

Received Vagus Nerve

Answer 28

• enters abdomen, assoc w/ esophagus to provide parasymp innervation to foregut + midgut
• ant + post vagal trunks -> pre-vert plexus -> has pre-gang parasymp fibers (GVA)

Question 29

Received Thoracic, Lumbar, Sacral Splanchnic Nerves

Answer 29

• carry pre-gang symp fibers from symp trunk/chain to pre-vert plexus and GVAs

Question 30

Received Pelvic Splanchnic Nerves

Answer 30

• carry pre-gang parasymp fibers from S2-4, enter inferior hypogastric plexus in pelvis
• some fibers move up into inferior mesenteric part of pre-vertebral plexus to innervate hindgut

Question 31

Innervation: Enteric System (5)

Answer 31

• Motor + sensory neurons in GI tract wall
• Brain of gut
• Controls: GI blood flow, contractions (peristalsis), and gastric secretion
• Input from symp and parasymp to control (only for mod of activity)
• if cut, enteric system will work w/o them aka independent of CNS

Question 32

Hepatic Portal Vein Tributaries

Answer 32

1. R/L gastric veins
2. Cystic vein
3. Paraumbilical veins