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GI2 > abdominal vessels + nerves > Flashcards

abdominal vessels + nerves Flashcards

1
Q

What three main branches come off of the abdominal aorta?

A

Celiac Trunk
SMA
IMA

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2
Q

Where does the celiac trunk come off of the abdominal aorta?

When does the SMA branch off the abdominal aorta?

IMA?

A

right after the aortic hiatus (after the diaphragm)

T12/ Upper L1

Lower L1

L3

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3
Q

What structures correspond to the foregut? (what organs too?)

midgut?

hindgut?

A

above the major duodenal papilla… includes spleen, liver, pancreas, gallbladder

papilla to the proximal half of the transverse colon

other half to midway through anal canal

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4
Q

What are the three things that come off of the celiac trunk (which comes off at the abdominal aorta?

A

Left Gastric A.
Splenic A.
Common Hepatic A.

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5
Q

What does the Left Gastric A. do?

A

supplies the superior border of the lesser curvature of the stomach, and also gives off an esophageal branch.

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6
Q

What does the Splenic A. do?

A

This is a tortuous artery that goes along the superior border of the pancreas, giving off pancreatic branches as it goes along. it then gives off 3 branches…

  1. Short Gastric A. which supplies the cardia and funds portion
  2. splenic branches going to the spleen.
  3. Left Gastroomental A. (serving the left superior border of the greater curvature of the stomach)
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7
Q

What does the Common Hepatic A. initially split to?

A

The common hepatic splits off into 3 branches

  1. Proper hepatic which goes up and splits into 2 arteries, the Right Hepatic A. and Left Hepatic A., which supplies the right and left liver. the Cystic A comes off of the Right hepatic A.!
  2. Gastroduodenal A., which gives off 3 branches:, the supraduodenal A, the Superior Pancreaticoduodenal A. (which splits into anterior and posterior branches), and the right gastroomental A. (which supplies the right inferior greater curvature of the stomach)
  3. Right Gastric A. which supplies the right inferior portion of the lesser curvature of the stomach
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8
Q

What are the three anastomoses of the stomach?

A

Right and Left Gastric As.

Right and Left Gastroomental As.

Superior and Inferior Pancreaticoduodenal As.

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9
Q

What creates the anastomoses from Pancreaticoduodenal As?

A

Superior Pancreaticoduodenal comes from the gastroduodenal artery (which came from common hepatic)

Inferior Pancreaticoduodenal comes from the SMA.

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10
Q

What are the branches of the SMA?

A
  1. Inferior Pancreaticoduodenal A.
  2. Middle Colic A.
  3. Jejunal A.
  4. Right Colic A.
  5. Ileal A.
  6. Ileocolic A.
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11
Q

What does the middle colic A. supply?

Right colic?

Ileocolic A?

A

Transverse Colon

Ascending Colon

Ascending colon + Appendix through Cecal branches and Appendicular Branch

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12
Q

What’s the difference between the ileal and jejunal arteries?

A

ileal A.s are S + S, small arcades and short vasa recta (but lots of them)

Jejunal A.s are L + L, large arcades and long vasa recta (but few)

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13
Q

What are the anastomoses points of the large intestine?

A

Ileocolic anastomoses with right colic, which also anastomoses with the middle colic, which also anastomoses with left colic, sigmoidal arteries, and finally superior rectal A.

it’s one big circle

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14
Q

What artery is supplied by the anastomoses and what feeds into this anastomoses?

A

Marginal A.

Ileocolic, Right Colic, Left Colic, Middle Colic, and superior Sigmoidal arteries (according to Moores for the last one)

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15
Q

What is common at this marginal artery and why is it called what it is?

A

bowel ischemia is common.

it’s called the watershed area because lots of stuff are draining here.

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16
Q

What does the Inferior Mesenteric Artery give off?

A

Left colic A.

Sigmoid Arteries

Superior Rectal A.

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17
Q

What is the rectosigmoid junction anastomoses?

A

between the superior rectal and the sigmoid artery.

this is also a watershed area

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18
Q

Nutcracker syndrome?

A

The SMA passes anterior to the left renal V., and 3rd part of the duodenum, and the uncinate process of the pancreas.

downward traction of the SMA can cause compression of the left renal v. (and in severe cases, also the 3rd part of the duodenum)

present with hematuria, proteinuria, n/v (with bile), and left testicular pain

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19
Q

2 main players that drains blood from below the thorax, what are they?

A

Hepatic Portal Vein

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20
Q

What forms the hepatic portal vein?

A

formed by the splenic V and SMV form together.

1/3 cases = iMV dumps directly into the HPV

more commonly 2/3 = IMV drains into the splenic V or SMV

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21
Q

Aorta enters the diaphragm at what level and descends until what level?

what happens then?

A

T12

L4 –> then bifurcates to common iliac

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22
Q

What is the aorta posterior to? (5 structures)

A

pancreas

splenic V

left renal V.

3rd part of the duodenum

loops of the small intestine

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23
Q

What are the unpaired visceral branches of the aorta? What are their corresponding spinal levels?

A

Celiac (T12), SMA (L1), IMA (L3)

24
Q

What are the paired visceral branches of the aorta?

A

Suprarenal (L1)

Renal (L1/L2)

Gonadal (L2)

25
Q

What are the paired parietal branches of the aorta?

A

Inferior Phrenic (T12)
Subcostal (T12)
Lumbar (L1-L4)

26
Q

posterior ulcer in the posterior wall of the 1st part of the duodenum.

what’s the artery that is ruptured?

where does this artery come from?

A

Gastroduodenal A.

common hepatic A.

27
Q

What is Gastroduodenal A.’s terminal branches?

A

Superior Pancreaticoduodenal A.

Right Gastroomental A.

28
Q

What artery runs along the superior border of the pancreas?

A

Splenic A.

29
Q

What organ is spared from ischemia in the presence of an occluded celiac trunk?

Why would each one not be the answer?

Pancreas
Liver
Spleen
Gallbladder
Stomach
A

Pancreas has branching from the SMA via the inferior pancreaticoduodenal a’s.!!

Stomach - Celiac trunk gives off everything for gastric A., splenic arteries, and pretty much the whole stomach

Spleen has splenic Arteries coming from the Celiac Trunk, no anastomoses

Gallbladder has the cystic artery coming from the right hepatic A.. no anastomoses

liver - has no anastomoses

30
Q

What is the blood supply to the liver?

A

common hepatic –> proper hepatic artery (in the hepatoduodenal ligament) –> right hepatic and left hepatic..

remember cystic comes off of right hepatic a. mostly

31
Q

What are the 2 vascular variations to the liver?

A

The left hepatic could go off of the celiac trunk by itself and the right hepatic comes off of the gastroduodenal A.

left hepatic could go off of the left gastric artery instead

32
Q

What are the possible relationships to the right hepatic artery and portal vein?

A

usually the right hepatic artery should be anterior to the hepatic portal vein, but in 9% of people it’s opposite

33
Q

What does the dual blood supply to the liver mean?

what does it supply?

A

Majority of the blood to the liver comes from the hepatic portal vein. This sustains the liver parenchyma (hepatocytes)

Hepatic artery is 20-25%. this sustains the non-parenchymal structures such as the intrahepatic bile ducts

34
Q

how does each segment of the liver survive if you cut one part off?

A

the right hepatic and left hepatic do right and left, but then there are secondary and tertiary branches to the different lobes and segments

35
Q

What do we see in the interlobar portal triad?

what about bile?

A

venous blood goes into the sinusoids from the portal vein and hepatic arteries.. this then goes into the central veins.

bile goes in the opposite direction into the bile duct in the extrahepatic portal triad

36
Q

Where does the blood leaving the liver go?

A

leave via the hepatic veins (right left and middle), which drain into the IVC superiorly.

37
Q

What is the blood supply to the gallbladder? where do we look for this clinically?

A

from the cystic artery coming off the right hepatic artery (usually)

you look for it in the cystohepatic triangle (triangle of Callot)

boundary is cystic duct, the common hepatic duct, and the inferior border of the liver.

38
Q

What are the other options of the cystic artery?

A

coming off of gastroduodenal
(2.8%)

coming off left gastric (6.2%)

coming off of proper hepatic but now ANTERIOR to common hepatic duct

39
Q

What is the blood supply to the stomach?

A

Left gastric and right gastric anastomosing off of the lesser curvature (left gastric from celiac trunk, right gastric off of the proper hepatic

right gastroomental from gastroduodenal + left gastroomental from the splenic A.

40
Q

if we ligate the celiac trunk, what happens to the stomach blood supply?

A

the stomach is cut off

41
Q

Splenic artery gives off what arteries?

A

branches to supply the spleen, left gastroomental A., and the short gastric arteries which supply the fundus/cardia region of the stomach.

short gastric also give some blood supply to the spleen too!! not just the cardia/fundus

42
Q

What supplies blood to the pancreas? (3)

why is one of these connections important?

A

from the gastroduodenal artery –> anterior and posterior superior pancreaticoduodenal A.

from the SMA –> Anterior and posterior inferior pancreaticoduodenal A.

pancreatic branches from the splenic A. (to the body and tail)

this is an anastomoses between the SMA and the Celiac Trunk

43
Q

If a surgeon wants to ligate an artery to remove the appendix, which artery would you remove? (assume collateral circulation is discounted)

A

probably the ileocolic artery, because it sets a branch off to the appendicular A.

It all depends on where you ligate, so right before the appendicular A.

44
Q

Girl hit a brick wall and has damage to the SMA immediately below the middle colic. What organs may become ischemic?

A

Ascending Colon

45
Q

What artery is ligated causing ischemia to the descending colon?

A

Left Colic A.

46
Q

Where does the SMA come off of?

what are the orders of branches coming off going to the right side of the body?

A

L1

Inferior Pancreaticoduodenals

Middle Colic

Right Colic

Ileocolic (to ileocecal junction)

47
Q

What are the coming from the left side of the body from the SMA?

A

Ileal + Jejunal arteries.

Remember Large and Long but little amount (jejunum)

Remember Short and Small and shit ton (Ileal)

48
Q

Where is the IMA coming off of?

What’s the first thing that’s coming off of it?

the next two?

A

comes off L3

Left colic, which gives off an ascending branch and a descending branch

Sigmoid arteries (usually 3)

the IMA becomes the superior rectal over the pelvic rim.

49
Q

What does the superior rectal artery (from the IMA) anastomose with in the rectum?

A

with Middle rectal artery (from internal iliac) and the inferior rectal artery (from internal pudendal)

50
Q

Where does the Rectal Venous plexus (in the submucosa) drain to? (2 possible regions)

What’s the difference between them?

A

Superior Rectal Vein –> then to the portal system (Hepatic portal vein –> liver –> IVC)

or blood flows from here to the inferior or middle rectal veins, which drain into the caval system (goes through common iliac veins or lumbar
–> directly to IVC)

middle or inferior rectal veins do not go through the liver!!

51
Q

What are the two possible hemorrhoid locations?

cover pain, what plexus is affected, and what type of bleeding

A

internal = above the pectinate line… they are dilated internal venous plexus lines. Bleeding is bright red and not painful!

external = below the pectinate line… thromboses or clots in veins of the external venous plexus lines. it’s painful!

52
Q

IVC begins where?

where does it go?

where does it sit?

A

L5 where the common iliac veins are coming together.

blood ascends and it exits the esophagus at the caval opening of the diaphragm at T8. It sits on the right side of the aorta.

53
Q

What are the superior most openings of the IVC before going into the diaphragm?

what is about 1/3 of the way down from the top?

2/3 down? what’s the difference between these?

A

left and right hepatic veins.

left and right renal veins

left and right gonadal veins

the right gonadal vein drains to the IVC, the left drains into the left renal.. hence why compression creates backed up blood in the testicle.

54
Q

The lumbar veins are found on each side, what do they come up and become?

A

they form the azygos vein, which goes through the aortal hiatus

on the left side is the hemiazymgous vein!

55
Q

if you ligate the IVC at approximately the 4th lumbar vein, how is blood going to get back to the heart?

A

Ascending lumbars

Inferior Epigastrics from the external iliac! it’ll anastomose with the superior epigastric

56
Q

What is the most common way for the portal vein to form?

2 other common ways?

A

most common is the SMV + Splenic vein coming together, then this goes to the liver.. usually the IMV drains into the splenic vein in this process

one way is the same as above but the IMV is draining into the SMV rather than the Splenic V

all three comes to one junction.

57
Q

if you get cirrhosis of the liver, anything that causes increased pressure in the liver, that blood from the ortal vein cannot get through the liver, so it flows backwards.

what are the 4 ways in which this corrects?

what is the pathway for each?

what clinical thing do you see in these?

A
  1. Esophageal - it goes backwards and goes through left gastric and it anastomoses left gastric V’s (specifically the esophageal veins) with the azygos vein. (causes esophageal varices)
  2. Rectal - flows backwards from IMV into the superior rectal vein and then it goes back into the middle or inferior rectal vein and then through the caval system (we’ll see hemorrhoids)
  3. Paraumbilical - if the disease process goes long enough, it can reopen the paraumbilical veins to anastomose with the epigastric veins (we see the Caput madusae)
  4. Retroperitoneal - veins from descending colon (colic veins) anastomose with the systemic retroperitoneal lumbar veins (caval system) (retroperitoneal varices can form but we can’t see them)

GI2 (20 decks)

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