Abdominal Vasculature

Question 1

What are the branches and levels of the abdominal aorta?

Answer 1

Inferior phrenic T12 - paired, parietal
Coeliac T12 - singular, visceral
Superior mesenteric L1- singular, visceral
Middle Suprarenal L1- paired, visceral
Renal L1-L2 - paired, visceral
Testicular (in men) Gonadal L2 - paired, visceral
Lumbar L1-L4 - paired, parietal
Inferior mesenteric L3 - singular, visceral
Median Sacral L4 - singular, parietal
Common iliac L4 - paired, terminal

Question 2

What are the surface markings of the transpyloric plane?

Answer 2

Halfway between the jugular notch and the upper border of the pubic symphysis

Question 3

Name different types of abdominal aortic aneurysms

Answer 3

True aneurysms (saccular) - one wall
True aneurysm (fusiform) - bilateral
False aneurysm
Dissection

Question 4

Define aneurysm

Answer 4

Abnormal dilatation of the wall of an artery

Question 5

What is the pathogenesis of an aneurysm

Answer 5

Cystic Medial necrosis (true aneurysm),
- collagen linking defects > deposition of basophilic ground substances > formation of cystic structures which weaken the artery wall

post traumatic (pseudoaneurysm)
- damage to the arterial wall leads to formation of a contained haematoma between the tunic media and adventitia

Question 6

What are the risk factors for AAA

Answer 6

HTN - secondary to atherosclerosis secondary to smoking
Marfan syndrome
Syphilis
Bicuspid aortic valve

Question 7

What is a dissecting aneurysm?

Answer 7

Results from a longuitudinal tear in the intima with subsequent extension of the intramural haemorrhage into the subadventitial place causing a focal sac like outpouching

Question 8

What are the complications of a dissecting aneurysm?

Answer 8

Haemorrhage due to rupture
Ascending aorta - acute MI
Arch of aorta - stroke

Question 9

What are the main branches of the coeliac axis?

Answer 9

Left gastric

Common hepatic
- gastroduodenal
- hepatic proper (gives right and left hepatic and right gastric)
- cystic occasionally

Splenic
- pancreatic (greater pancreatic and dorsal pancreatic)
- short gastric
- left gastroepiploic

Question 10

What are the IVC tributaries?

Answer 10

I Like to Rise So High

Iliacs
Lumbars
Testicular
Renal
Suprarenal
Hepatic veins

T8 - hepatic veins, inferior phrenic vein
L1 - suprarenal veins, renal vein
L2 - Gonadal veins
L1-L5 - Lumbar veins
L5 - Common iliac vein Formation of the IVC

Question 11

What are the anterior relations of the renal veins?

Answer 11

Right side
- 2nd part of the duodenum

Left side
- body of the pancreas
- SMA
- splenic vein