Abdominal Neurovasculature Flashcards
Where does abdominal aorta enter abdomen
Enters abd at t12 through thoracic aperture
Descends along vertebral column, left to midline
Where does abdominal aorta terminate
Terminates at l4
Bifurcates into 2 common iliac arteries
2-2.5 cm below umbilicus
Describe branches of abdominal aorta
Paired parietal posterior
Paired visceral lateral
Unpaired anterior
Describe paired parietal posterior branches abd aorta
Related to post abd wall
Branches = Inferior phrenic, Lumbar arteries
Describe inferior phrenic (paired parietal posterior)
1st branches from aorta, under thoracic aperture
Follows inf surface diaphragm (recall musclophrenic and phrenic = ant and lat surface)
What does inferior phrenic give (paired parietal posterior)
Superior suprarenal arteries- to suprarenal gland
Describe lumbar arteries (paired parietal posterior)
4 pairs, l1-l4
From post aspect abd aorta to along vertebral body
Also vascularizes spinal chord - segments, cns - and post abd wall
Describe paired visceral later branches abd aorta
Retro visceral
Branches = middle suprarenal, renal, gonadal
Describe middle suprarenal (paired visceral lateral)
Arise on each side aorta, superior to renal arteries
Vascularize suprarenal renal glands (superior pole kidneys)
Describe renal (paired visceral lateral)
Large vessels arise on each side aorta, almost lateral to SMA,
Left and right renal artery
Vascularize kidneys = 1.2l/min
Describe left renal artery vs right renal artery (paired visceral lateral)
Left renal = 1/2 shorter than right
Right renal = passes behind ivc
OPPOSITE FOR RENAL VEINs
What does renal give (paired visceral lateral)
Inferior suprarenal arteries
Describe gonadal (paired visceral lateral)
Testicular or ovarian
Urinary and reproductive blood supply comes from abd region bc embryology
Arise inferior to renal arteries on anterolateral surface aorta
Directed inferiorly, crosses over ureter and travels down psoas
Describe where gonadal goes for males and females (paired visceral lateral)
Male = in spermatic cord in inguinal canal
Female = to ovary in pelvic cavity
Describe unpaired visceral anterior branches abd aorta
Branches = celiac trunk, superior mesenteric, inferior mesenteric
What does celiac trunk supply
Foregut
Arises on ant surface aorta, right below aortic aperture - t12
Name the 3 branches of celiac trunk
Left gastric
Common hepatic artery
Splenic artery
Describe left gastric (celiac trunk)
Uppermost branch celiac trunk
Follows lesser curvature stomach
Vascularize lesser curvature stomach, inferior portion eso (abdominal) and lesser omentum
What does left gastric give (celiac trunk)
Gives oesophageal branches
Describe common hepatic artery
Large vessels
Directed to right - to liver
Name the 2 branches common hepatic gives (celiac trunk)
Proper hepatic artery
Gastroduodenal artery
Describe proper hepatic artery (celiac trunk)
Goes towards liver (also cystic)
What does proper hepatic artery give (celiac trunk)
Right gastric (for lesser curvature stomach) - anastomose with left gastric
Right and left hepatic arteries
Describe gastroduodenal artery (celiac trunk)
Goes down towards pancreas and duodenum
What does gastroduodenal artery give (celiac trunk)
Right gastro omental artery
Superior pancreaticoduodenal arteries
Describe splenic artery (celiac trunk)
Large curled vessel, directed to left, passing posterior to stomach
What does splenic artery give (celiac trunk)
Pancreatic arteries
Left gastro omental= anastomose with right gastro omental artery
Short gastric artery = Vascularize fundus of stomach
What does superior mesenteric supply (celiac trunk)
Anterior surface aorta
Behind neck of pancreas
Anterior to left renal vein
Vascularize midgut, transition d2 recall
What does superior mesenteric give (celiac trunk)
Inferior pancreaticoduodenal arteries - 1st branch, anastomose with superior pancreaticoduodenal
All other branches si = jejunal, ileal, iliocolic, right colic middle colic
What does inferior mesenteric supply (celiac trunk)
Anterior surface aorta, l3, inferior to duo
Vascularize hind gut
What does inferior mesenteric give (celiac trunk)
Left colic - anastomose with middle colic via marginal colic branch
Sigmoid arteries
Superior rectal artery
Describe inferior vena cava
Originates where 2 common iliac veins merge
Drains post abd wall and retro organs
Ascends on right side vertebral column, passes posterior to liver and enters thoracic cavity through canal aperture - t8
What can we use ivc for - clinical
To help repair rupture of abd aorta, can live w/o ivc
Describe what drains posterior abd wall
Inferior phrenic veins and lumbar veins (4)= drain post abd wall and diaphragm
Ascending lumbar veins
Describe ascending lumbar - drains post abd wall
Between lumbar veins, continuous with azygous system
Functions as collateral pathway between ivc and svc
Drains into ivc
Describe veins of Retroperitoneal organs
Renal, suprarenal and Gondal veins
Describe drainage of gonadal and suprarenal veins
Left gonadal and suprarenal veins drain into left renal vein
NOT ivc directly
NOT THE SAME AS RIGHt= drains directly into ivc
Describe veins of Intraperitoneal organs
Hepatic veins = drains liver to return blood to systemic circulation, immediately inferior to canal aperture
Does ivc has anterior unpaired vein branches from gi
Nahhhahahhah
What is hepatic portal vein
Drains All segments gi
Downstream vessel, before liver
Passes posterior to duo, enters hepatoduodenal ligament, most pos structure
Major anatomical variation, usually connection of splenic and superior mesenteric
Name the 3 main branches of portal vein
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
Describe splenic vein - branch of portal vein
Drains spleen and part of foregut - receives short gastrics, esophageal, left gastro omental and inferior pancreaticoduodenal veins
Describe superior mesenteric vein - branch of portal vein
Midgut, drains si and most of li, same as sma tributaries
Receives right gastro omental and inferior pancreaticoduodenal veins
Describe inferior mesenteric vein - branch of portal vein
Drawings hindgut, same as ima tributaries
Left colic, sigmoidal, superior renal (NOT middle and inf rectal)
Smaller than sma
Where does inferior mesenteric vein DRAIN - branch of portal vein
Drains into splenic vein but sometimes directly into hepatic portal vein
What is portosystemic anastomosis
Drains by 2 systems
Hepatic portal system drains abd viscera, organs to liver
If high portal vein pressure - like in cirrhosis = less blood flows to liver but wil reflux into systemic circulation through portosystemic anastomosis
Describe gastroesophageal junction - portosystemic anastomosis
Esophageal veins from left gastric vein to azygous system
Reflux into esophageal veins = esophageal varices
Describe anorectal junction - portosystemic anastomosis
Superior rectal veins to middle and inferior rectal veins
Reflux into veins from internal iliac arteries = hemorrhoids
Describe umbilicus - portosystemic anastomosis
Paraumbilical veins to anterior abd wall
Causes Caput medusae - distend stomach, engorged superficial epigastric veins
Describe portosystemic anastomosis - clinical Gen
Portal hypertension = varicoceles and hemorrhoids
Describe sympathetic innervation
T1-l2
Thoracic splanchnic = pass from sympathetic trunk in thorax to prevertebral plexus and ganglia, pass through diaphragm Cura
When want to reach organs-viscera…
Does not synapse, moves on and meets group
Compare para vs pre vertebral
Para = on each side
Pre = in front
Describe lumbar splanchnic nerves
2-4 splanchnic nerve
From lumbar portion of sympathetic trunk to aortic and superior hypogastric plexuses (prevertebral ganglia or plexus)
Describe prevertebral ganglia and plexus - Gen
Presynaptic neurons of thoracic splanchnic nerves synapse in prevertebral ganglia
Prevertebral plexus and ganglia associated to aortic branches
What are major ganglia (prevertebral ganglia and plexus)
Organization of cell bodies of postsynaptic neurons
Name and describe the 4 types of major ganglia (prevertebral ganglia and plexus)
Celiac= 2, associated with celiac trunk
Superior mesenteric = 1, associated with sma
Inferior mesenteric =1, associated with ima
Aorticorenal = 2, associated with renal arteries
Describe psns innervation - which types
Vagus - Cnx
Pelvic splanchnic
Describe vagus psns innervation
Through esophageal hiatus
Reach celiac and superior mesenteric regions
Will synapse in organs wall
Psns innervation to foregut and midgut
Describe pelvic splanchnics - psns
S2-s4
Enters inferior hypogastric plexus in pelvis
Ascend through hypogastric nerve
Reach inferior mesenteric region (superior hypogastric plexus and aortic plexus)
Describe what plexus means
Abdominal prevertebral plexus = v complex
Many ganglia around
Do not know if psns or sns
Collection of nerve fibers surrounding aorta and branches
Where do fibers of sns and psns synapse for plexuses
Sns = synapses in prevertebral ganglia
Psns = synapse in wall of target organ
Name the 3 kinds of plexuses
Celiac
Aortic
Superior hypogastric
Describe celiac plexus
Nerve fibers related to sma and celiac trunk
Psns =vagal trunk
Sns = greater and lesser splanchnics
Describe aortic plexus
Nerve fibers of anterior surface of abd aorta from sma to aortic bifurcation
Psns = pelvic splanchnic
Sns = lumbar splanchnic
Once bifurcation = now called superior hypogastric plexus
Describe superior hypogastric plexus
Same as aortic plexus but below aortic bifurcation
Connected to inferior hypogastric plexus via hypogastric nerve
