Abdominal Visceral Circulation and Collateral Circulation Flashcards
What gi tract organs obtain blood from the celiac trunk?
Esophagus Stomach Duodenum (1 and 2) Liver and Gallbladder Pancrease Spleen
What gi tract organs obtain blood from the superior mesentery artery?
Duodenum (2, 3, 4) Pancrease (head only) Jejunum Ileum Cecum and appendix Ascending colon transverse colon
What gi tract organs obtain blood from the inferior mesentery artery?
Transverse colon
Descending colon
Sigmoid colon
Rectum
Where is the aortic hiatus? Where does the celiac trunk come off? What happens if it comes off too high?
- T12
- T12.5
- Gets compressed by the aortic hiatus
What are the branches of the celiac trunk?
- Left gastric artery: supplies the lesser curvature of the stomach.
1a. On its way to lesser curvature, Left gastric artery provides esophagial branch as well
What arteries from the inferior mesenteric artery anatamose to make marginal artery (of Drummond)?
Ileocolic A. Right Colic A. Middle Colic A. Left Colic A. Sigmoid A.
Which two arteries foster anatomosis between inferior and superior mesenteric artery? What do they supply? How good is the anatomosis?
Middle colic and left colic a. (which supply distal transverse colon) And it is not good/reliable. Most common site for ischemic bowl disease = splenic flexure.
What veins drain into the inferior vena cava?
- Left and right iliac veins (pelvis + lower limb)
- Common iliac vein
- lumbar vein (abdominal wall)
- gonadal vein
- Renal vein (kkidney)
- Hepatic vein
- Inferior Phrenic vein (diaphragm)
What make the Portal Vein? What is its job? What drians into the splenic vein?
Carries venous blood to the liver. Formed by junction (right behind neck of pancrease) of splenic vein and superior mesenteric vein. Inferior mesenteric vein drains into splenic vein.
What is a portal vein? Why does it not take blood back to the heart instead? What is job of hepatic vein?
Communicates between 2 capillary beds. This one carries blood back to liver mostly from organs of the gi tract. The deoxy blood has a bunch of stuff absorbed from the gut. Needs to detoxify it first. Hepatic vein then takes liver blood back to heart.
Why does spleen go to liver?
Embryology..embryo has organs draining periotoneal and organs draining retroperitoneal. Organs retroperitoneal in embryo drainis intpo veina cava. Otherwise, it drains into portal if peritoneal. Primary retroperitineal = vana cava. Peritineal and secondarily retro peritoneal organs drain into portal. Spleen drains into portal because it is a peritoneal organ.
Where are the portal venal anatamoses?
Located in area around rectum and area around esophagus.
Which branches do superior rectal, middle rectal, and inferior rectal veins drain into? What do these veins do in the rectal wall? How do you capitalize on the anastamoses?
Superior rectal: portal
Middle rectal and Inferior rectal: caval
All 3 anastamose with each other in the rectal wall. Essentially, this is your link between portal and vana cava system. Anastamoses only works in cases of higher pressure pushing the blood in opposite direction AND the nonexistence of valves (portal veins do not have valves). Will see increased volumes of blood in rectal veins, and they will enlarge. Noticeable since veins are close to lumen (mucosa into lumen) (aka internal hemorrhoids)
Describe anatamoses between esophogeal branch + left gastric vein (these are portal drained) and azygos vein + esophageal vein (these are vana cava drained). Why is esophageal varices dangerous? What is special bout paraumbilical veins?
Direction of blood flow in esophagous vein and left gastric vein reverses towards the esophageal vein when the liver is backed up. Veins will bulge into esophagus (hemeroids for th eesophagus = esophageal varicis?). You eat, and this food abrazes the esophagus. Can lead to vomiting blood. Para umbilical (runs in ligamentum teres) veins anatamose (3rd sight) at superficial epigastric veins (caput medussae). which drain down and up through ilac and subclavian veins, respectively. You can see these, but not early in portal hypertension.
What is difference between splenorenal shunt and portlcaval shunt? What is the prefered method for curing?
Not important. Both had high fatalities. Preferred method is Transjugular Intrahepatic Portasystemic Shunt (TIPS). Use internal jugular vein, runs through brachiocephalic vein, goes to superior then inferior vena cava. Then gets to hepatic vein, then to liver. Burrow way through liver to get to portal vein. Then slide a stent call it a day.
