B5-102 Abdominal Vasculature Flashcards
1
Q
the aorta enters the diaphragm at what vertebral level?
A
T12
2
Q
the aorta bifurcates at what vertebral level?
A
L4
bifourcation
3
Q
is the aorta intraperitoneal or retroperitoneal?
A
retro
4
Q
unpaired visceral branches of aorta
3
A
- Celiac (T12)
- SMA (L1)
- IMA (L3)
5
Q
paired visceral branches of aorta
3
A
- suprarenal (L1)
- renal (L1/L2)
- gonadal (L2)
6
Q
paired parietal branches of the aorta
3
A
- inferior phrenic (T12)
- subcostal (T12)
- Lumbar (L1-4)
7
Q
foregut structures are supplied by what artery?
A
celiac
8
Q
midgut structures are supplied by what artery?
A
SMA
9
Q
hindgut structures are supplied by what artery?
A
IMA
10
Q
foregut structures
5
A
- esophagus
- stomach
- liver/pancreas
- billiary apparatus
- proximal duodenum
11
Q
midgut structures
4
A
- small intestine
- cecum/appendix
- ascending colon
- right half of transverse colon
12
Q
hindgut structures
5
A
- left half of transverse colon
- descending colon
- sigmoid colon
- rectum
- superior anal canal
13
Q
3 branches of celiac trunk
A
- left gastric a.
- splenic a.
- common hepatic a.
14
Q
blood supply to liver
5
A
- common hepatic
- hepatic artery proper
- right hepatic artery
- cystic artery
- left hepatic artery
15
Q
90% of the time, the hepatic artery is located […] to the portal vein
ant/post
A
anterior
16
Q
sustains the liver parenchyma
hepatocytes
A
portal vein
17
Q
sustains non-parenchymal structures in liver
intrahepatic bile ducts
A
hepatic artery
18
Q
dual blood supply of liver is made up of what two structures?
A
portal vein
hepatic artery
19
Q
supplies blood to gallbladder
A
cystic artery
20
Q
located in the cystohepatic triangle (of Calot)
A
cystic artery
21
Q
boundaries of triangle of Calot
A
- cystic duct
- common hepatic duct
- visceral surface of liver
22
Q
the left gastric artery anastamoses with the right gastric artery on the [….] of the stomach
A
lesser curvature
23
Q
gives rise to the right gastro-omental artery
A
gastroduodenal artery
24
Q
gives rise to left gastro-omental artery
A
splenic artery
25
the left gastro-omental artery anastomoses with the right gastro-omental artery on the [...] of the stomach
greater curvature
26
supply fundus of stomach
short gastric vessels
27
what arteries are of concern during a splenectomy?
short gastrics
28
the gastroduodenal artery runs [...] to duodenum
| ant/post
posterior
29
supplies head of pancreas and antrum of stomach
gastroduodenal artery
30
gives rise to anterior and posterior superior pancreaticoduodenal arteries
gastroduodenal
31
supplies ancinate process of pancreas
anterior and posterior superior pancreaticoduodenal arteries
32
supplies neck, body, and tail of pancreas
splenic artery
33
what vessel is located at L1
SMA
34
SMA is located [...] to the pancreas
| ant/post
posterior
| problem in pancreatic cancer
35
supplies transverse colon
middle colic artery
36
supplies ascending colon
right colic a.
37
supplies ileum, cecum, and ascending colon
ileocolic
38
long vasa recta
few, but very large arcades
jejunal branches
39
short vasa recta
more, smaller arcades
ileal branches
40
common variations in SMA
* common trunk for right and middle colic arteries
* common trunk for right and ileocolic arteries
* absent right colic artery
41
SMA compresses left renal and 3rd part of duodenum
Nutcracker syndrome
42
* blood/protein in urine
* left flank pain
* nausea/vomiting
* left testicular pain
* may form varicocele
Nutcracker syndrome
43
artery located at L3
IMA
44
branches of IMA
| 4
* left colic
* sigmoid
* superior rectal
* marginal artery
45
supply descending colon
left colic branches
46
anastomotic connection between left colic and middle colic
marginal artery (of Drummond)
47
anastomotic connection between SMA, IMA, and middle colic
arc of Riolan
48
gives rise to superior rectal artery
IMA
49
gives rise to middle rectal artery
internal iliacs
50
gives rise to internal pudendal arteries
inferior rectal artery
51
drains into inferior mesenteric vein, eventually into portal drainage
| venous drainage of rectum
superior rectal vein
52
drain into common iliac vein and eventually IVC
| 2, venous drainage of rectum
middle and inferior rectal veins
53
blood drained by the IVC is called the [...] system
caval
54
blood drained via the liver is the [...] system
portal
55
# clinical correlation
* internal prolapse of rectal mucosa that contains normally dilated veins of internal venous plexus
* bleeding is bright red
* NOT painful because they are above pectinate line
internal hemmorrhoids
56
* thromboses or blood clots in veins of external venous plexus
* covered by skin
* painful because below pectinate line
external hemorrhoids
57
* begins anterior to L5
* lies to the right of aorta
IVC
58
the IVC passes through the caval opening of the diaphragm at what vertebral level?
T8
59
right gonadal vein drains into
IVC
60
left gonadal vein drains into
left renal vein
61
take the processed blood from liver and puts it back into caval circulation
hepatic veins
62
if the IVC is compressed, the lumbar veins can drain into
the azygous vein
63
what two veins give rise to the hepatic portal vein?
superior mesenteric and splenic veins
| inf. mesenteric usually drains into superior
64
the portal vein is located [...] to IVC, and [...] to the pancreas
| anterior/posterior
anterior to IVC
posterior to pancreas
65
located in hepatoduodenal ligament
portal vein
66
left gastric + azygous vein anastomoses
esophageal
| esophageal varices
67
superior + inferior rectal vein anastomosis
rectal
| hemmorhoids
68
paraumbilical + epigastric vein anastomosis
paraumbilical
| caput medusae
69
colic veins + systemic retroperitoneal veins anastomosis
retroperitoneal
70
lymph drainage from foregut goes to what nodes?
celiac
71
lymph drainage from midgut goes to what nodes?
superior mesenteric
72
lymph from the hindgut goes to what nodes?
inferior mesenteric
73
from distal esophagus down to proximal half of 2nd part of duodenum
foregut
74
from distal half of 2nd part of duodenum down to proximal 2/3 of transverse colon
midgut
75
from distal 1/3 of trasverse colon to rectum
hindgut
76
supplies foregut
celiac
77
supplies midgut
SMA
78
supplies hindgut
IMA
79
most common source of bleeding the duodenum
gastroduodenal artery
80
post prandial abdominal pain
unintentional weight loss
food fear
chronic mesenteric ischemia
81
acute abdominal pain
worsens with time
bloody bowel movements
acute mesenteric ischemia
| due to thrombosis
82
* atrial fibrillations
* atrial/ventricular thrombus
* paroxysmal embolus of DVT (patent foramen ovale)
| are risk factors for
acute mesenteric ischemia
83
associated with shock due to pressors compromising perfusion to bowel
NOMI
| non-occlusive mesenteric ischemia
84
treatment for NOMI
supportive care- treat cause of shock
| sometimes anti-coags, surgery if bowel necroses
85
caused by thrombus or narrowing of portal vein or superior mesenteric vein
venous mesenteric ischemia
86
treatment for venous mesenteric ischemia
fluids, anticoagulants
| surgery if bowel necroses
87
aneurysm is a dilation of vessel greater than [...] times normal size
1.5
88
most common site of aortic aneurysm
infrarenal aorta
89
risk factors for aortic aneurysm
**family hx**
**male sex**
atherosclerotic disease
HTN
collagen vascular disease
**smoking**
90
any male smoker or former smoker over the age of 65 should be evaluated for
aortic aneurysm
| via aortic doppler
91
when should an aortic aneurysm be repaired surgically?
| differentiate male vs female
female: 5 cm
male: 5.5 cm
or
greater than 1 cm growth in one year
or
greater than .5 cm growth in 6 months
92
pelvic, gluteal, thigh, calf claudications
pain at rest
wounds
aortoiliac disease
93
refractory hypertension on multiple medications
| associated with..
renal artery stenosis
94
where does the plaque generally form in renal artery stenosis?
renal artery ostium
95
* hypertrophy of media layer of aterial wall
* string of beads appearance
* causes renal artery stenosis
fibromuscular dysplasia
96
IV anticoagulants
| 3
heparin
bivalirudin
argatroban
97
IV anticoagulants are reversible with
protamine
98
require monitoring with aPTT or antiXa levels
IV anticoagulants
99
subcutaneous anticoagulant for DVT ppx
heparin
100
subcutaneous anticoagulant that can be ppx or therapeutic
| used to bridge warfarin at home
enoxaparin
101
anticoagulant that is:
* oral
* cheap
* requires INR checks
* reversed with vitamin K
warfarin
102
* costly, novel oral anticoagulants
* cannot be used in valvular disease
* PCC for partial reversal
rivaroxaban
apixaban
dabigatran
103
* receive somatic innervation from the inferior rectal branch of the pudendal nerve
* painful if thrombosed
external hemorrhoids
104
* abnormal distension of anal venous plexus
* receive visceral innervation and are not painful
internal hemorrhoids
| risk factors: older age, chronic constipation
105
* critical blockage of intestinal blood flow (usually SMA)
* abdominal pain out of proportion to physical findings
* may see red "currant jelly" stools
## Footnote
from FA pg 395
acute mesenteric ischemia
106
* intestinal angina
* atherosclerosis of celialc artery, SMA, or IMA
* associated with end stage renal disease, vWD, aortic stenosis
## Footnote
from FA pg 365
chronic mesenteric ischemia
107
two "watershed" regions of the colon that are susceptible to colonic ischemia
## Footnote
FA pg 372
splenic flexure: SMA and IMA
rectosigmoid junction: sigmoid branch of IMA and rectal artery
108
* compression of left renal vein between SMA and aorta
* flank pain, hematuria, left-side varicocele
## Footnote
FA pg 372
nutcracker syndrome
109
* intermittent intestinal obstruction symptoms (post prandial pain)
* SMA and aorta compress 3rd portion of duodenum
* associated with low body weight, malnutrition
## Footnote
FA pg 372
superior mesenteric artery syndrome
110
3 vessels that constitute main supply of foregut
## Footnote
FA pg 373
common hepatic
splenic
left gastric
111
2 areas of strong anastomoses arising from celiac trunk
## Footnote
FA pg 373
* left and right gasto-omental (greater curvature)
* left and right gastric (lesser curvature)
112
# provide the blood supply and innervation for:
**Foregut**
artery:
parasympathetic innervation:
verterbal level:
artery: celiac
parasympathetic innervation: vagus
verterbal level: T12/L1
113
# provide the blood supply and innervation for:
**Midgut**
artery:
parasympathetic innervation:
vertebral level:
artery: SMA
parasympathetic innervation: vagus
vertebral level: L1
114
# provide the blood supply and innervation for:
**Hindgut**
artery:
parasympathetic innervation:
vertebral level:
artery: IMA
parasympathetic innervation: pelvic
vertebral level: L3
115
what artery descends immediately posterior to the first part of the duodenum?
gastrodeuodenal
116
gives rise to right gastro-omental and superior pancreaticoduodenal
gastroduodenal a.
117
supply the fundus of the stomach on its greater curvature
short gastrics
118
passes along greater curvature of the stomach and forms an anastomotic arc with the right gastro-omental
left gastro-omental
119
largest branch of the celiac trunk
splenic
120
* provides branches to pancreas, fundus, greater curvature of stomach, and greater omentum
* travels along superior border of pancreas and terminates at spleen
splenic a.
121
smallest branch of celiac trunk
left gastric
122
travels along lesser curvature of stomach to form and anastomotic connection with the right gastric artery
left gastric a
123
* runs along superior aspect of the pancreas
* enters the spleen through the splenorenal ligament and hilum of spleen
splenic a.
124
runs posterior to the first part of duodenum
gastroduodenal
| susceptible to perforating duodenal ulcers
125
descends behind neck of pancreas and divides into left and right branches to supply the pancreas
dorsal pancreatic a.
126
describe the collateral supply of the pancreas
* from celiac trunk via gastroduodenal a. and superior pancreaticoduodenal branches
* from the SMA via the inferior pancreaticoduodenal branches
127
the appendicular artery is a branch of the
ileocolic a.
128
branch from SMA that supplies transverse colon
middle colic
129
branch of SMA that supplies ascending colon
right colic
130
branch of IMA that supplies descending colon
left colic
131
bifurcations of the aorta
common iliac arteries
132
transverse colon recieves blood supply from the
middle colic
133
the descending colon is supplied by the
left colic artery
134
areas at risk for ischemia during AAA repair
Watershed areas
* splenic flexure
* rectosigmoid junction
135
receive lymphatic drainage from the descending colon, sigmoid colon and superior aspect of rectum
inferior mesenteric lymph nodes
136
lymph from the inferior aspect of the rectum drains into
internal iliac lymph nodes
137
receive lymphatic drainage from superior wall of the bladder and superior pelvic ureters
external iliac lymph nodes
138
receive lymphatic drainage from posterior abdominal wall, gonads, kidneys, ureters, uterus, and uterine tubes
lumbar
139
receive lymphatic drainage from the embryonic midgut
superior mesenteric nodes
140
if the IVC is obstructed, blood can bypass it by traveling
ascending lumbar veins to azygous and hemiazygous veins
| will then drain into SVC
141
what two structures join to form the portal vein?
superior mesenteric vein
splenic vein
142
supplies body and tail of pancreas
splenic
143
supplies hindgut
IMA
144
supplies head of pancreas
pancreaticoduodenal
145
most appropriate first steps in management of hypovolumic shock
large bore IVs and administration of blood products
146
describe the changes to cardiac output, vascular resistance, and central venous pressure during hypovolumic shock
CO: decreased
TPR: increased
central venous pressure: decreased
147
buttock/thigh claudication is typically due to
aortoiliac disease
| one sided: left/right common iliac artery
148
calf claudication is typically due to
femoral artery disease
149
first line therapy for claudication
conservative management
| manage risk factors
150
young female with no atherosclerotic risk factors and uncontrolled hypertension despite aggressive management
fibromuscular dysplasia
151
string of beads
fibromuscular dysplasia
152
postprandial abdominal pain, weight loss, food fear
chronic mesenteric ischemia
153
sudden onset of constant abdominal pain out of proportion to exam findings
acute mesenteric ischemia
154
what is the most likely location of the arterial lesion responsible for chronic mesenteric ischemia?
SMA
155
best imaging modality for chronic mesenteric ischemia
CT angiogram
| or abdominal duplex US
156
best imaging modality for renal artery stenosis?
aortic/renal duplex US
| CT angiogram also works, but US is first line
157
two risk factors most important to development of ruptured AAA?
smoking, male sex
158
best imaging to diagnose AAA
| 2
CT angiogram
abdominal US
159
which anticoagulant is easily titrated, has a short half life, and easily reversible
Heparin
160
supplies to foregut
celiac
161
organs of the foregut
esophagus
stomach
liver
biliary apparatus
pancreas
proximal duodenum
162
supples midgut
SMA
163
organs of the midgut
small intestine
cecum
appendix
ascending colon
right half to 2/3 of transverse colon
164
supplies hindgut
IMA
165
organs of hindgut
left of transverse colon
descending colon
sigmoid colon
rectum
superior anal canal
166
supply posterior abdominal wall
lumbar arteries
167
supplies the fundus of stomach
| 2
short gastrics
posterior gastric
168
supplies the pylorus of the stomach, pancreas, first part of the duodenum, and distal bile duct
gastroduodenal
169
supplies the distal part of esophagus and lesser curvature of stomach
left gastric
170
supplies right side of lesser curvature of stomach
right gastric
171
supplies right side of greater curvature of the stomach
right gastro-omental
172
provides main blood supply to pancreas
splenic
173
anastomose together to supply the head of the pancreas
* anterior and posterior superior pancreaticduodenal arteries
* anterior and posterior inferior pancreaticduodenal arteries
174
supplies liver and gallbladder
proper hepatic
| branch of common hepatic
175
the right colic and ileocolic arteries supply the [...] colon
ascending
176
supplies the cecum and rectum
ileocolic a.
177
the left colic supplies the [...] colon
descending
178
the middle colic supplies the [...] colon
transverse
179
the sigmoid arteries supply the [...] colon and sigmoid
descending
180
the internal pudendal gives rise to the inferior rectal a. which supplies
| 2
inferior rectum and anal canal
181
supplies inferior rectum and anal canal
inferior rectal a.
| branch of internal pudendal
182
supplies middle rectum
middle rectal a.
| branch of internal iliac
183
supplies superior rectum
superior rectal artery
| branch of IMA
184
gives rise to inferior rectal artery
internal pudendal
185
gives rise to middle rectal a.
internal iliac
186
gives rise to superior rectal a.
IMA
187
gives rise to sigmoid artery
IMA
188
located at T12
| vessel
celiac trunk
189
vessel located at L1
SMA
190
vessels located at L1-L2
renal a.
191
vessel located at L2
gonadal a.
192
vessel located a L3
IMA
193
the bifurcation of the aorta is located at L[..]
L4
194
the left adrenal vein and left phrenic vein drain into the left [...] vein
renal
195
the right adrenal vein drains into
IVC
196
what two structures join to form the portal vein?
SMV and splenic vein
197
the inferior mesenteric vein usually drains into
splenic vein
| can contribute to portal vein
198
patients with GI bleeds may present with what symptoms
| 3
* melena
* hematochezia
* hematoemesis
199
where is the most common location in the aorta for an aneurysm to form?
infrarenal aortia
| turbulence due to iliac artery bifurcation
