Abdominal Aorta

Question 0

L1, supplies the midgut (i.e. lower part of duodenum, jejunum, ileum, cecum, appendix, ascending colon & proximal 2/3 of transverse colon)

Answer 0

Superior mesenteric artery (SMA)

Question 1

T12, supplies the foregut (i.e. Intraabdominal esophagus, stomach, upper part of duodenum, liver, GB, & pancreas)

Branches:

• left gastric artery
• splenic artery
• common hepatic artery

Answer 1

Celiac trunk

Question 2

Kidneys

Answer 2

Renal artery

Question 3

Testes or ovaries

Answer 3

Gonadal artery

Question 4

L3, supplies the hindgut (i.e. distal 1/3 of transverse colon to upper portion of rectum)

Answer 4

Inferior mesenteric artery (IMA)

Question 5

As terminal branches

Answer 5

Common iliac artery

Question 6

Usually below L1 (below renal artery & SMA), elderly men

MC site of ruptured AAA: left posterolateral wall (retroperitoneal)

IMA usually lies in the middle of an AAA

SSX: sudden onset severe, central abdominal pain, radiate to the back, pulsatile tender abdominal mass, hypotension if ruptured

Surgical complications: ischemic colitis (ligation of IMA), spinal cord ischemia (ligation of great redicular artery or artery of Adamkiewicz)

Answer 6

Abdominal aortic aneurysm (AAA)

Question 7

MC cause: embolism within SMA

Severe abdominal pain, out of proportion to P.E. findings

Patient profile: elderly, +heart disease, taking digoxin (splanchnic vasoconstrictor)

Answer 7

Acute mesenteric ischemia

Question 8

MC: bifurcation of abdominal aorta

May result to claudication (i.e. leg pains when walking) & impotence (lack of blood in internal iliac artery)

Answer 8

Gradual occlusion

Question 9

Union of R & L common iliac vein at level L5

Drains all blood from below diaphragm to the R atrium

IVC below kidneys may be ligated (50% mortality)

L gonadal vein –> L renal vein

R gonadal vein –> IVC

• R sided hydronephrosis in a woman may indicate thrombosis of R ovarian vein –> ureter constrict because the R ovarian vein crosses the ureter to drain into IVC
• L sided testicular varicocele may indicate occlusion of L testicular vein or L renal vein by malignant renal tumor

If IVC is blocked by a retroperitoneal tumor or large thrombus, 2 routes of collateral venous return are followed:

1. Azygous vein ➡️ R atrium
2. Lumbar vein ➡️ external & internal vertebral venous plexus ➡️ cranial dural sinuses ➡️ internal jugular vein ➡️ R atrium

Answer 9

Inferior vena cava

Question 10

Hepatic portal system

Answer 10

Portal vein

• formed posterior to the neck of pancreas
• Union of splenic vein & SMV

Inferior mesenteric vein
- ends by joining splenic vein

Question 11

Portal-IVC anastomosis

Answer 11

Site of anastomosis
ESOPHAGUS

Clinical sign
ESOPHAGEAL VARICES

Veins involved (PortalCaval)
L GASTRIC VEIN  ESOPHAGEAL VEIN

Question 12

Portal-IVC anastomosis

Answer 12

Site of anastomosis
UMBILICUS

Clinical sign
CAPUT MEDUSA

Veins involved (PortalCaval)
PARAUMBILICAL VEIN  SUPERFICIAL & INFERIOR EPIGASTRIC VEIN

Question 13

Portal-IVC anastomosis

Answer 13

Site of anastomosis
RECTUM

Clinical sign
HEMORRHOIDS

Veins involved (PortalCaval)
SUPERIOR RECTAL VEIN  MIDDLE & INFERIOR RECTAL VEIN

Question 14

Portal-IVC anastomosis

Answer 14

Site of anastomosis
RETROPERITONEAL ORGANS

Clinical sign
NOT CLINICALLY RELEVANT

Veins involved (PortalCaval)
TRIBUTARIES OF SMV & IMV  VEINS OF POSTERIOR ABDOMINAL WALL