Abdominal Angiology Flashcards
Arteries of the Abdominal Wall:
(1) Subcostal A
(2) Lumbar A
(3) Deep Circumflex Iliac A
(4) Superficial Circumflex Iliac A
(5) Superficial Epigastric A
(6) Inferior Epigastric A
(7) Superior Epigastric A
Subcostal Artery
- Branch off the thoracic aorta
- Follows the 12th rib under the diaphragm, in front of the quadratus lumborum muscle near the lateral arcuate ligament and behind the kidneys
- Passes into the anterior abdominal wall between the internal oblique and transversus abdominis muscle
- Subcostal N accompanies this vessel
Lumbar Artery
- 4 paired branches of the abdominal aorta in the lumbar region (L1-L4)
- Pass posterolateral across the abdominal wall, over the quadratus lumborum before entering the space between the internal oblique and transversus abdominis muscles
- Supply the abdominal wall structures they pass by via branches
Deep Circumflex Iliac Artery
- Branch off the R and L External Iliac A
- Runs parallel to the Inguinal Ligament, moving towards the Iliac Crest
- Supplies the Iliacus muscle and Inferior Anterolateral Abdominal Wall
Superficial Circumflex Iliac Artery
- Branch off the R and L Femoral A
- Runs above the Inguinal Ligament
- Supplies the Subcutaneous Tissue near the inguinal ligament
Superficial Epigastric Artery
- Branch of the R and L Femoral A
- Follows a medial direction towards the Umbilicus, supplying the subcutaneous tissue in the area (tissue above inferior portion of rectus abdominis)
Inferior Epigastric Artery
- Paired vessel
- Branch off the External Iliac Artery, superior to the Inguinal Ligament
- Runs medially, anterior to the Transversalis Fascia within the Lateral Umbilical Fold, to enter the Rectus Sheath near the Arcuate Line
- Runs behind the Rectus Abdominis muscle
- Anastamoses with the Superior Epigastric A
- Supplies the anterior abdominal wall
Superior Epigastric Artery
- Branches the L and R Internal Thoracic Artery
- Runs inferiorly on the back of the Rectus Abdominis muscle, enters the rectus sheath then anastomoses with the Inferior Epigastric A
- Supplies the Rectus Abdominis muscle
Arteries of the Superior Surface of the Diaphragm (3):
- Superior Phrenic A
- Musculophrenic A
- Pericardiacophrenic A
Arteries of the Inferior Surface of the Diaphragm:
Inferior Phrenic A which has the Superior Suprarenal A branching off of it
Superior Phrenic Artery
- Paired branch off the Thoracic Aorta
- Branches and supplies the superior surface of the diaphragm
- Anastomoses with the Musculophrenic and Pericardiacophrenic arteries
Musculophrenic Artery
- Paired branch off the Internal Thoracic A
- Travels along the costal margin of ribs 7-9, supplying that area before reaching superior surface of diaphram
Pericardiacophrenic Artery
- Paired branch off the Internal Thoracic A
- Runs down the pericardium, supplying it before reaching the superior surface of the diaphragm
Inferior Phrenic Artery
- First paired branch off the abdominal aorta
- Provides vascularization to the inferior surface of the diaphragm
- Sends branches to the esophagus and suprarenal glands
What Artery Branches off the Inferior Phrenic Artery?
Superior Suprarenal Artery
Superior Suprarenal Artery
- Branches of the Inferior Phrenic Arteries
- Run inferiorly to supply the right and left suprarenal glands
Abdominal Aorta
- Runs from T12 to L4
- At L4 it bifurcates into the Common Iliac Arteries
- Retroperitoneal
- Branches use ligaments and mesentery to reach organs they supply
Branches off of the Abdominal Aorta (9):
(1) Inferior Phrenic A (paired)
(2) Celiac Trunk (unpaired)
(3) Middle Suprarenal A (paired)
(4) Lumbar As (paired)
(5) Renal A (paired)
(6) Superior Mesenteric A (unpaired)
(7) Gonadal A (paired)
(8) Inferior Mesenteric A (unpaired)
(9) Medial Sacral A (unpaired)
What are the 3 main branches off the Celiac Trunk?
- Left Gastric A
- Splenic A
- Common Hepatic A
Celiac Trunk
- Unpaired trunk
- Emerges off the Aorta around T12
- Retroperitoneal
- Supplies structures of the foregut
Left Gastric Artery
- Branch of Celiac Trunk
- Branches once it reaches the cardiac part of the stomach
- Part of the artery follows the lesser curvature of the stomach (within the lesser omentum) and anastomoses with the R Gastric A (from common hepatic)
What artery branches off the Left Gastric Artery?
Esophageal Branch
Esophageal Branch
- Branch of the Left Gastric A
- Runs superiorly to supply the the thoracic and abdominal aspects of the esophagus
Splenic Artery
- Branch off the Celiac Trunk
- Travels towards the L side of the abdomen, running along the superior border of the pancreas
- Enters the Splenorenal Ligament to reach the hilum of the spleen
What are the 3 branches off the Splenic Artery?
- Left Gastroepiploic A
- Short Gastric As
- Pancreatic As
Left Gastroepiploic (Gastro-omental) Artery
- Branch of Splenic A
- Runs through the Gastrosplenic Ligament to the greater curvature of the stomach
- Anastomoses with the R Gastroepiploic A in the Greater Omentum (Gastrocolic L)
Short Gastric Arteries
- Branch off near the terminal end of the Splenic A
- Travels towards the stomach within the Gastrosplenic L
- Supplies the fundus of the stomach
Pancreatic Arteries
- Branch of Splenic A
- Located superior to the pancreas
- Supply the body and tail of the pancreas
What are the branches of the Common Hepatic Artery?
- Right Gastric A
- Gastroduodenal A
- Proper Hepatic A
Common Hepatic Artery
- Branch off the Celiac Trunk
- Has 3 branches that run towards the R side of the body
- Its branches supply the liver, gallbladder, biliary system, stomach, duodenum, and pancreas
Proper Hepatic Artery (Hepatic Artery Proper)
- Branch off the Common Hepatic A
- Runs through the Hepatoduodenal Ligament to reach the Porta Hepatis
- Divides into two branches to supply the Non-Parenchymal Cells of the Liver
What are the two branches of the Proper Hepatic Artery?
- Left Hepatic A
- Right Hepatic A
Left Hepatic Artery
- Branch off the Proper Hepatic A
- Travels towards the left lobe of the liver to supply the non-parenchymal liver cells
Right Hepatic Artery
- Branch off the Proper Hepatic A
- Travels towards the right lobe of the liver to supply the non-parenchymal liver cells
- Cystic A branches off of this
What branches off of the Right Hepatic Artery?
Cystic Artery
Cystic Artery
- Branch of Right Hepatic A
- Located in the cystohepatic triangle (Triangle of Calot)
- Supplies the Gallbladder and Cystic Duct
Right Gastric Artery
- Branch of the Common Hepatic A
- Travels towards the L abdominal wall and the lesser curvature of the stomach (lesser omentum)
- Anastomoses with the Left Gastric A
Gastroduodenal Artery
- Branch off of the Common Hepatic A
- Sends branches inferiorly to supply the stomach, pancreas, and first part of the duodenum
What are the branches off of the Gastroduodenal Artery?
- Right Gastroepiploic (Gastro-omental) A
- Superior Pancreaticoduodenal A
Right Gastroepiploic (Gastro-omental) Artery
- Branch of the Gastroduodenal A
- Travels along the greater curvature of the stomach within the greater omentum (gastrocolic ligament)
- Anastomoses with the left gastroepiploic A
Superior Pancreaticoduodenal Artery
- Branch of the Gastroduodenal A
- Has posterior and anterior branches that go around the head of the pancreas and provide vascular supply
- Anastomose with Inferior Pancreaticoduodenal branches off of the Superior Mesenteric A
- Supplies the proximal duodenum and head of the pancreas
Middle Suprarenal Artery
- Paired branches of the abdominal aorta
- Branch around/below T12
- Travel across the posterior abdominal wall to reach the suprarenal gland
- Joined by the Superior Suprarenal A and Inferior Suprarenal A to supply the Suprarenal Gland
What are the branches off of the Superior Mesenteric Artery?
- Inferior Pancreaticoduodenal A
- Jejunal Branches
- Right Colic A
- Middle Colic A
- Ileal Branches
- Ileocolic A
Superior Mesenteric Artery
- Unpaired Trunk off of the Abdominal Aorta
- Branches around L1
- Located behind the neck of the pancreas; travels anterior to the Horizontal Duodenum
- Supplies the Midgut Organs (distal duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal aspect of the transverse colon)
Inferior Pancreaticoduodenal Artery
- First branch off of the Superior Mesenteric A
- Branches into anterior and posterior branches that travel to the head of the pancreas where they anastomose with the Superior Pancreaticoduodenal Arteries
- Supply the Head of the Pancreas and distal Duodenum – marks the transition between the foregut and midgut
Where is the transition between the Foregut and Midgut?
- Foregut: Duodenum proximal to the opening of the Bile Duct
- Midgut: Duodenum distal to the opening of the Bile Duct
Jejunal Branches
- Branches of the Superior Mesenteric A
- Typically 7-8 branches
- Supplies the Jejunum
Jejunal Branches: Arcades & Vasa Recta
- Arcades: Few large loops
- Vasa Recta: Very long
Ileal Branches
- Branches of the Superior Mesenteric A
- Typically 8-9 branches
- Supplies the Ileum
Ileal Branches: Arcades & Vasa Recta
- Arcades: Many short loops
- Vasa Recta: Short
Ileocolic Artery
- Terminal branch of the Superior Mesenteric A
- Runs obliquely towards the LLQ within the mesentery
- Supplies the distal Ileum, cecum, appendix and some of the ascending colon
What branches off of the Ileocolic Artery?
Appendicular Artery
Appendicular Artery
- Branch of the Ileocolic A
- Supplies the Vermiform Appendix (reaches it via the Mesoappendix)
Right Colic Artery
- Branch off of the Superior Mesenteric A
- Travels through the Mesocolon
- Supplies the Ascending Colon
Middle Colic Artery
- Branch off of the Superior Mesenteric A (in lab will see this branching off of Right Colic A)
- Travels through the transverse mesocolon
- Supplies the Right 1/2 to 2/3 of the Transverse Colon
Cannon’s Point
- Junction of the midgut and hindgut
(Midgut: Right 1/2 to 2/3 of Transverse Colon; Foregut: Left 1/3 to 1/2 of Transverse Colon)
Supplies the Foregut:
Celiac Trunk
Supplies the Midgut:
Superior Mesenteric Artery
Supplies the Hindgut:
Inferior Mesenteric Artery
Renal Artery
- Paired branches of the Abdominal Aorta that come off around L1-L2
- Right is longer than Left because it has to cross under the IVC
- Supply the kidneys, suprarenal glands, and ureters
- Branches into Segmental Arteries once it reaches the Hilum of the Kidney
Arteries that supply the Ureters:
- Gonadal As
- Common Iliac A
- Branches of Internal Iliac A
- Renal A
What branches off of the Renal Artery?
Inferior Suprarenal Artery
Inferior Suprarenal Artery
- Branch off of Renal A
- Supplies the Suprarenal Gland
Gonadal Artery
- Paired branches off of the Abdominal Aorta that come off around L2
- Different locations between the sexes – pathway and end location are different
Ovarian Artery
- Paired artery from abdominal aorta
- Travels inferolateral to supply the ovaries, uterine tube and ureter
- Runs through the Suspensory Ligament of the Ovary
Testicular Artery (Internal Spermatic Artery)
- Paired vessels from abdominal aorta
- Run inferiorly to the anterior abdominal wall to enter the Deep Inguinal Ring (Inguinal Canal); run in the Spermatic Cord to reach the testes within the scrotum
- Supplies the testes, epididymis, and ureters
Inferior Mesenteric Artery
- Unpaired branch of the abdominal aorta that come off around L3
- Retroperitoneal
- Supplies the hindgut structures (Distal transverse colon, descending colon, sigmoid colon, proximal rectum)
Marginal Artery (Marginal Artery of Drummond)
- Anastomosis arcade between the superior and inferior mesenteric arteries (middle colic and left colic) around the left colic flexure
- Provides collateral flow to the intestines
- Marks the transition between the midgut and hindgut
Branches off of the Inferior Mesenteric Artery:
- Left Colic A
- Sigmoid A
- Superior Rectal A
Left Colic Artery
- Branch of the Inferior Mesenteric A
- Travels towards the L side of the abdominal cavity to reach the Descending Colon
- Supplies the Descending Colon
Sigmoid Artery
- Branch of the Inferior Mesenteric A
- Travels towards the inferior portion of the abdomen within the sigmoid mesocolon
- Supplies the descending colon, sigmoid colon and superior rectum
Superior Rectal Artery
- Terminal branch of the Inferior Mesenteric A
- Supplies the proximal part of the rectum
Median Sacral Artery
- Unpaired branch off the abdominal aorta just superior to the bifurcation of the common iliac arteries
- Travels along the midline inferiorly
- Supplies the sacrum and its surrounding structures
Common Iliac Artery
- Abdominal Aorta bifurcates around the level of L4 and creates the R and L Common Iliac As
- Travel inferolateral into the pelvis, running along with the psoas muscles and subdivide around the pelvic brim into an internal and external iliac A
Internal Iliac Artery
- Paired arteries off of the Common Iliac Arteries
- Travel medially into the pelvic cavity
- Supplies pelvic organs, gluteal muscles, and perineum
External Iliac Artery
- Paired arteries off of the Common Iliac Arteries
- Two branches: Inferior Epigastric A, Deep Circumflex Iliac A
- Transitions into Femoral A after exiting Inguinal Ligament
Middle Rectal Artery
- Paired vessel off of the anterior division of the internal iliac artery
- Supplies the inferior rectum and anal canal
Inferior Rectal Artery
- Branch of the internal pudendal artery
- Supplies the distal anal canal
Inferior Vena Cava
- Receives nutrient-poor blood from the lower limbs, back, abdominal wall, abdominal viscera (via portal venous system), and pelvic viscera
- Located to the right of the abdominal aorta
- Does not contain any valves until it reaches its end at the heart
Gonadal Vein
- Drain nutrient-poor blood from the gonads and their associated structures
- Have a non-common path for venous return – Right path different from Left path
Right Gonadal Vein: Females (Ovarian)
- Drains the ovary and associated structures
- Runs from within the pelvic cavity to the IVC (around level of L2-L3)
Left Gonadal Vein: Males & Females
- Drains into the Left Renal Vein after leaving the hilum of the kidney
- Passes under the superior mesenteric artery to drain into the IVC
Right Gonadal Vein: Males (Testicular)
- Drains the testes and associated structures
- Combines with the pampiniform plexus (from spermatic cord) when it reaches the abdominal wall within the inguinal canal, and forms the Testicular Vein Proper
- Drains into the IVC (around level of L2-L3)
Portal Venous System
- Network of veins that take the venous blood from the GI tract’s capillaries and directs it to the liver capillaries
- Once this blood is processed by the liver it is returned to the IVC near the diaphragm
Portal-Systemic Anastomoses
- Connects the Portal System (liver) to the Systemic/Caval System (IVC)
- If something happens within the portal system or liver, this anastomosis allows the blood to return to systemic circulation without undergoing processing by the liver
- Alternative pathways for flow can create varices
Superior Mesenteric Vein
- Collects venous return from foregut and midgut areas (stomach, greater omentum, pancreas, duodenum, jejunum, ileum, cecum, vermiform appendix, ascending colon, transverse colon)
- Transfers blood into the venous portal system by merging with the splenic vein to form the hepatic portal vein
Right Gastroepiploic Vein
Drains the stomach and greater omentum
Inferior Pancreaticoduodenal Vein
Drains the pancreas and duodenum
Jejunal Veins
Drains Jejunum
Ileal Veins
Drains Ileum
Ileocolic Veins
Drains Cecum and Vermiform Appendix
Right Colic Vein
Drains Ascending Colon
Middle Colic Vein
Drains Transverse Colon
Splenic vein
- Part of the venous portal system
- Drains the spleen, inferior mesenteric vein, short gastric vein, left gastroepiploic vein, and pancreatic veins
- Starts within the Splenorenal Ligament and travels towards the liver
Inferior Mesenteric Vein
Drains Large Intestine (transverse colon, descending colon, sigmoid colon) and Rectum
Short Gastric Vein
Drains Stomach
Left Gastroepiploic Vein
Drains stomach
Pancreatic Veins
Drains Pancreas
The ___ ___ ___ drains into the Splenic Vein before it merges with the ___ ___ ___ to form the Hepatic Portal Vein around L1.
- Inferior Mesenteric Vein
- Superior Mesenteric Vein
Hepatic Portal Vein
- Formed by the joining of the Splenic Vein and Superior Mesenteric Vein around the neck of the pancreas
- Takes blood from GI Tract and brings it to the Liver (supplies parenchymal cells of the liver with nutrients)
Hepatic Portal Vein joins the ___ ___ and __ ___ ___ to enter the liver via the ___ ____
- Hepatic Duct and Proper Hepatic Artery
- Porta Hepatis
Porta Hepatis is contained within the:
Hepatoduodenal Ligament of the Lesser Omentum
Hepatic Vein
Drains Liver
Right Hepatic Vein
Drains Right lobe of Liver
Left Hepatic Vein
Drains Left Lobe of Liver
Middle Hepatic Vein
Drains middle portion of Liver
Lymphatic Vessels of the Abdominal Wall that are located above the Umbilicus go to the:
Axillary Lymph Nodes and some to the Parasternal Lymph Nodes
Lymphatic Vessels of the Abdominal Wall that are located below the Umbilicus go to the:
Superficial Inguinal Lymph Nodes (located near inguinal canal)
Deep Lymphatic Vessels of the Abdominal Wall follow the deeper veins to lymph nodes near the ___ ____ ___ and the ____
- Inferior Vena Cava
- Aorta
Lymphatics from the Testis use the ___ ___ to enter the abdomen and drain into the ___ and ___-____ lymph nodes
- Spermatic Cord
- Lumbar
- Pre-Aortic
Lymphatic drainage of the scrotum goes to the ___ ____ lymph nodes first before entering the abdominal cavity, and then draining into the ____ and ___ lymph nodes
- Superficial Inguinal
- Iliac
- Lumbar
Lymphatic Vessels of the Posterior Abdominal Wall lie along the:
- Aorta
- IVC
- Iliac Vessels (common, internal, external)
Posterior Abdominal Wall Lymphatics: Celiac Lymph Nodes
Receive lymph from Foregut organs
Posterior Abdominal Wall Lymphatics: Superior Mesenteric Lymph Nodes
Receive lymph from Midgut organs
Posterior Abdominal Wall Lymphatics: Inferior Mesenteric Lymph Nodes
Receive lymph from Hindgut organs
Posterior Abdominal Wall Lymphatics: Lumbar Lymph Nodes
Receive lymph from Posterior abdominal wall, kidneys, ureters and gonads
Cisterna Chyli
- Blunt sac-like structure around the level of L1 or L2
- Start of the thoracic duct
- Collects lymph from lower limbs, pelvis and abdomen
Spleen
- Largest lymphatic organ
- Located in LUQ between the stomach and diaphragm, around the left 9-11th ribs
- Intraperitoneal
- Attachments to the Gastrosplenic Ligament and Splenorenal Ligaments
Gastrosplenic Ligament
- Connects the greater curvature of the stomach to the spleen
- Contains the Short Gastric Arteries
Splenorenal Ligaments (Lienorenal Ligament)
- Connects left kidney to the spleen
- Contains the splenic vessels and tail of the Pancreas
Hilum of the Spleen
- Notch-like structure on the medial surface of the spleen
- Splenic artery and vein enter and exit here