B5-102 Abdominal Vasculature Flashcards
the aorta enters the diaphragm at what vertebral level?
T12
the aorta bifurcates at what vertebral level?
L4
bifourcation
is the aorta intraperitoneal or retroperitoneal?
retro
unpaired visceral branches of aorta
3
- Celiac (T12)
- SMA (L1)
- IMA (L3)
paired visceral branches of aorta
3
- suprarenal (L1)
- renal (L1/L2)
- gonadal (L2)
paired parietal branches of the aorta
3
- inferior phrenic (T12)
- subcostal (T12)
- Lumbar (L1-4)
foregut structures are supplied by what artery?
celiac
midgut structures are supplied by what artery?
SMA
hindgut structures are supplied by what artery?
IMA
foregut structures
5
- esophagus
- stomach
- liver/pancreas
- billiary apparatus
- proximal duodenum
midgut structures
4
- small intestine
- cecum/appendix
- ascending colon
- right half of transverse colon
hindgut structures
5
- left half of transverse colon
- descending colon
- sigmoid colon
- rectum
- superior anal canal
3 branches of celiac trunk
- left gastric a.
- splenic a.
- common hepatic a.
blood supply to liver
5
- common hepatic
- hepatic artery proper
- right hepatic artery
- cystic artery
- left hepatic artery
90% of the time, the hepatic artery is located […] to the portal vein
ant/post
anterior
sustains the liver parenchyma
hepatocytes
portal vein
sustains non-parenchymal structures in liver
intrahepatic bile ducts
hepatic artery
dual blood supply of liver is made up of what two structures?
portal vein
hepatic artery
supplies blood to gallbladder
cystic artery
located in the cystohepatic triangle (of Calot)
cystic artery
boundaries of triangle of Calot
- cystic duct
- common hepatic duct
- visceral surface of liver
the left gastric artery anastamoses with the right gastric artery on the [….] of the stomach
lesser curvature
gives rise to the right gastro-omental artery
gastroduodenal artery
gives rise to left gastro-omental artery
splenic artery
the left gastro-omental artery anastomoses with the right gastro-omental artery on the […] of the stomach
greater curvature
supply fundus of stomach
short gastric vessels
what arteries are of concern during a splenectomy?
short gastrics
the gastroduodenal artery runs […] to duodenum
ant/post
posterior
supplies head of pancreas and antrum of stomach
gastroduodenal artery
gives rise to anterior and posterior superior pancreaticoduodenal arteries
gastroduodenal
supplies ancinate process of pancreas
anterior and posterior superior pancreaticoduodenal arteries
supplies neck, body, and tail of pancreas
splenic artery
what vessel is located at L1
SMA
SMA is located […] to the pancreas
ant/post
posterior
problem in pancreatic cancer
supplies transverse colon
middle colic artery
supplies ascending colon
right colic a.
supplies ileum, cecum, and ascending colon
ileocolic
long vasa recta
few, but very large arcades
jejunal branches
short vasa recta
more, smaller arcades
ileal branches
common variations in SMA
- common trunk for right and middle colic arteries
- common trunk for right and ileocolic arteries
- absent right colic artery
SMA compresses left renal and 3rd part of duodenum
Nutcracker syndrome
- blood/protein in urine
- left flank pain
- nausea/vomiting
- left testicular pain
- may form varicocele
Nutcracker syndrome
artery located at L3
IMA
branches of IMA
4
- left colic
- sigmoid
- superior rectal
- marginal artery
supply descending colon
left colic branches
anastomotic connection between left colic and middle colic
marginal artery (of Drummond)
anastomotic connection between SMA, IMA, and middle colic
arc of Riolan
gives rise to superior rectal artery
IMA
gives rise to middle rectal artery
internal iliacs
gives rise to internal pudendal arteries
inferior rectal artery
drains into inferior mesenteric vein, eventually into portal drainage
venous drainage of rectum
superior rectal vein
drain into common iliac vein and eventually IVC
2, venous drainage of rectum
middle and inferior rectal veins
blood drained by the IVC is called the […] system
caval
blood drained via the liver is the […] system
portal
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
- thromboses or blood clots in veins of external venous plexus
- covered by skin
- painful because below pectinate line
external hemorrhoids
- begins anterior to L5
- lies to the right of aorta
IVC
the IVC passes through the caval opening of the diaphragm at what vertebral level?
T8
right gonadal vein drains into
IVC
left gonadal vein drains into
left renal vein
take the processed blood from liver and puts it back into caval circulation
hepatic veins
if the IVC is compressed, the lumbar veins can drain into
the azygous vein
what two veins give rise to the hepatic portal vein?
superior mesenteric and splenic veins
inf. mesenteric usually drains into superior
the portal vein is located […] to IVC, and […] to the pancreas
anterior/posterior
anterior to IVC
posterior to pancreas
located in hepatoduodenal ligament
portal vein
left gastric + azygous vein anastomoses
esophageal
esophageal varices
superior + inferior rectal vein anastomosis
rectal
hemmorhoids
paraumbilical + epigastric vein anastomosis
paraumbilical
caput medusae
colic veins + systemic retroperitoneal veins anastomosis
retroperitoneal
lymph drainage from foregut goes to what nodes?
celiac
lymph drainage from midgut goes to what nodes?
superior mesenteric
lymph from the hindgut goes to what nodes?
inferior mesenteric
from distal esophagus down to proximal half of 2nd part of duodenum
foregut
from distal half of 2nd part of duodenum down to proximal 2/3 of transverse colon
midgut
from distal 1/3 of trasverse colon to rectum
hindgut
supplies foregut
celiac
supplies midgut
SMA
supplies hindgut
IMA
most common source of bleeding the duodenum
gastroduodenal artery