B5-102 Abdominal Vasculature Flashcards

1
Q

the aorta enters the diaphragm at what vertebral level?

A

T12

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2
Q

the aorta bifurcates at what vertebral level?

A

L4

bifourcation

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3
Q

is the aorta intraperitoneal or retroperitoneal?

A

retro

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4
Q

unpaired visceral branches of aorta

3

A
  1. Celiac (T12)
  2. SMA (L1)
  3. IMA (L3)
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5
Q

paired visceral branches of aorta

3

A
  1. suprarenal (L1)
  2. renal (L1/L2)
  3. gonadal (L2)
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6
Q

paired parietal branches of the aorta

3

A
  1. inferior phrenic (T12)
  2. subcostal (T12)
  3. Lumbar (L1-4)
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7
Q

foregut structures are supplied by what artery?

A

celiac

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8
Q

midgut structures are supplied by what artery?

A

SMA

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9
Q

hindgut structures are supplied by what artery?

A

IMA

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10
Q

foregut structures

5

A
  • esophagus
  • stomach
  • liver/pancreas
  • billiary apparatus
  • proximal duodenum
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11
Q

midgut structures

4

A
  • small intestine
  • cecum/appendix
  • ascending colon
  • right half of transverse colon
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12
Q

hindgut structures

5

A
  • left half of transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • superior anal canal
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13
Q

3 branches of celiac trunk

A
  • left gastric a.
  • splenic a.
  • common hepatic a.
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14
Q

blood supply to liver

5

A
  • common hepatic
  • hepatic artery proper
  • right hepatic artery
  • cystic artery
  • left hepatic artery
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15
Q

90% of the time, the hepatic artery is located […] to the portal vein

ant/post

A

anterior

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16
Q

sustains the liver parenchyma

hepatocytes

A

portal vein

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17
Q

sustains non-parenchymal structures in liver

intrahepatic bile ducts

A

hepatic artery

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18
Q

dual blood supply of liver is made up of what two structures?

A

portal vein
hepatic artery

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19
Q

supplies blood to gallbladder

A

cystic artery

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20
Q

located in the cystohepatic triangle (of Calot)

A

cystic artery

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21
Q

boundaries of triangle of Calot

A
  • cystic duct
  • common hepatic duct
  • visceral surface of liver
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22
Q

the left gastric artery anastamoses with the right gastric artery on the [….] of the stomach

A

lesser curvature

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23
Q

gives rise to the right gastro-omental artery

A

gastroduodenal artery

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24
Q

gives rise to left gastro-omental artery

A

splenic artery

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25
Q

the left gastro-omental artery anastomoses with the right gastro-omental artery on the […] of the stomach

A

greater curvature

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26
Q

supply fundus of stomach

A

short gastric vessels

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27
Q

what arteries are of concern during a splenectomy?

A

short gastrics

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28
Q

the gastroduodenal artery runs […] to duodenum

ant/post

A

posterior

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29
Q

supplies head of pancreas and antrum of stomach

A

gastroduodenal artery

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30
Q

gives rise to anterior and posterior superior pancreaticoduodenal arteries

A

gastroduodenal

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31
Q

supplies ancinate process of pancreas

A

anterior and posterior superior pancreaticoduodenal arteries

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32
Q

supplies neck, body, and tail of pancreas

A

splenic artery

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33
Q

what vessel is located at L1

A

SMA

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34
Q

SMA is located […] to the pancreas

ant/post

A

posterior

problem in pancreatic cancer

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35
Q

supplies transverse colon

A

middle colic artery

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36
Q

supplies ascending colon

A

right colic a.

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37
Q

supplies ileum, cecum, and ascending colon

A

ileocolic

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38
Q

long vasa recta
few, but very large arcades

A

jejunal branches

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39
Q

short vasa recta
more, smaller arcades

A

ileal branches

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40
Q

common variations in SMA

A
  • common trunk for right and middle colic arteries
  • common trunk for right and ileocolic arteries
  • absent right colic artery
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41
Q

SMA compresses left renal and 3rd part of duodenum

A

Nutcracker syndrome

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42
Q
  • blood/protein in urine
  • left flank pain
  • nausea/vomiting
  • left testicular pain
  • may form varicocele
A

Nutcracker syndrome

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43
Q

artery located at L3

A

IMA

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44
Q

branches of IMA

4

A
  • left colic
  • sigmoid
  • superior rectal
  • marginal artery
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45
Q

supply descending colon

A

left colic branches

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46
Q

anastomotic connection between left colic and middle colic

A

marginal artery (of Drummond)

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47
Q

anastomotic connection between SMA, IMA, and middle colic

A

arc of Riolan

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48
Q

gives rise to superior rectal artery

A

IMA

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49
Q

gives rise to middle rectal artery

A

internal iliacs

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50
Q

gives rise to internal pudendal arteries

A

inferior rectal artery

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51
Q

drains into inferior mesenteric vein, eventually into portal drainage

venous drainage of rectum

A

superior rectal vein

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52
Q

drain into common iliac vein and eventually IVC

2, venous drainage of rectum

A

middle and inferior rectal veins

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53
Q

blood drained by the IVC is called the […] system

A

caval

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54
Q

blood drained via the liver is the […] system

A

portal

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55
Q

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
A

internal hemmorrhoids

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56
Q
  • thromboses or blood clots in veins of external venous plexus
  • covered by skin
  • painful because below pectinate line
A

external hemorrhoids

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57
Q
  • begins anterior to L5
  • lies to the right of aorta
A

IVC

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58
Q

the IVC passes through the caval opening of the diaphragm at what vertebral level?

A

T8

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59
Q

right gonadal vein drains into

A

IVC

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60
Q

left gonadal vein drains into

A

left renal vein

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61
Q

take the processed blood from liver and puts it back into caval circulation

A

hepatic veins

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62
Q

if the IVC is compressed, the lumbar veins can drain into

A

the azygous vein

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63
Q

what two veins give rise to the hepatic portal vein?

A

superior mesenteric and splenic veins

inf. mesenteric usually drains into superior

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64
Q

the portal vein is located […] to IVC, and […] to the pancreas

anterior/posterior

A

anterior to IVC
posterior to pancreas

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65
Q

located in hepatoduodenal ligament

A

portal vein

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66
Q

left gastric + azygous vein anastomoses

A

esophageal

esophageal varices

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67
Q

superior + inferior rectal vein anastomosis

A

rectal

hemmorhoids

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68
Q

paraumbilical + epigastric vein anastomosis

A

paraumbilical

caput medusae

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69
Q

colic veins + systemic retroperitoneal veins anastomosis

A

retroperitoneal

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70
Q

lymph drainage from foregut goes to what nodes?

A

celiac

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71
Q

lymph drainage from midgut goes to what nodes?

A

superior mesenteric

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72
Q

lymph from the hindgut goes to what nodes?

A

inferior mesenteric

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73
Q

from distal esophagus down to proximal half of 2nd part of duodenum

A

foregut

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74
Q

from distal half of 2nd part of duodenum down to proximal 2/3 of transverse colon

A

midgut

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75
Q

from distal 1/3 of trasverse colon to rectum

A

hindgut

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76
Q

supplies foregut

A

celiac

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77
Q

supplies midgut

A

SMA

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78
Q

supplies hindgut

A

IMA

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79
Q

most common source of bleeding the duodenum

A

gastroduodenal artery

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80
Q

post prandial abdominal pain
unintentional weight loss
food fear

A

chronic mesenteric ischemia

81
Q

acute abdominal pain
worsens with time
bloody bowel movements

A

acute mesenteric ischemia

due to thrombosis

82
Q
  • atrial fibrillations
  • atrial/ventricular thrombus
  • paroxysmal embolus of DVT (patent foramen ovale)

are risk factors for

A

acute mesenteric ischemia

83
Q

associated with shock due to pressors compromising perfusion to bowel

A

NOMI

non-occlusive mesenteric ischemia

84
Q

treatment for NOMI

A

supportive care- treat cause of shock

sometimes anti-coags, surgery if bowel necroses

85
Q

caused by thrombus or narrowing of portal vein or superior mesenteric vein

A

venous mesenteric ischemia

86
Q

treatment for venous mesenteric ischemia

A

fluids, anticoagulants

surgery if bowel necroses

87
Q

aneurysm is a dilation of vessel greater than […] times normal size

A

1.5

88
Q

most common site of aortic aneurysm

A

infrarenal aorta

89
Q

risk factors for aortic aneurysm

A

family hx
male sex
atherosclerotic disease
HTN
collagen vascular disease
smoking

90
Q

any male smoker or former smoker over the age of 65 should be evaluated for

A

aortic aneurysm

via aortic doppler

91
Q

when should an aortic aneurysm be repaired surgically?

differentiate male vs female

A

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
Q

pelvic, gluteal, thigh, calf claudications
pain at rest
wounds

A

aortoiliac disease

93
Q

refractory hypertension on multiple medications

associated with..

A

renal artery stenosis

94
Q

where does the plaque generally form in renal artery stenosis?

A

renal artery ostium

95
Q
  • hypertrophy of media layer of aterial wall
  • string of beads appearance
  • causes renal artery stenosis
A

fibromuscular dysplasia

96
Q

IV anticoagulants

3

A

heparin
bivalirudin
argatroban

97
Q

IV anticoagulants are reversible with

A

protamine

98
Q

require monitoring with aPTT or antiXa levels

A

IV anticoagulants

99
Q

subcutaneous anticoagulant for DVT ppx

A

heparin

100
Q

subcutaneous anticoagulant that can be ppx or therapeutic

used to bridge warfarin at home

A

enoxaparin

101
Q

anticoagulant that is:
* oral
* cheap
* requires INR checks
* reversed with vitamin K

A

warfarin

102
Q
  • costly, novel oral anticoagulants
  • cannot be used in valvular disease
  • PCC for partial reversal
A

rivaroxaban
apixaban
dabigatran

103
Q
  • receive somatic innervation from the inferior rectal branch of the pudendal nerve
  • painful if thrombosed
A

external hemorrhoids

104
Q
  • abnormal distension of anal venous plexus
  • receive visceral innervation and are not painful
A

internal hemorrhoids

risk factors: older age, chronic constipation

105
Q
  • critical blockage of intestinal blood flow (usually SMA)
  • abdominal pain out of proportion to physical findings
  • may see red “currant jelly” stools

from FA pg 395

A

acute mesenteric ischemia

106
Q
  • intestinal angina
  • atherosclerosis of celialc artery, SMA, or IMA
  • associated with end stage renal disease, vWD, aortic stenosis

from FA pg 365

A

chronic mesenteric ischemia

107
Q

two “watershed” regions of the colon that are susceptible to colonic ischemia

FA pg 372

A

splenic flexure: SMA and IMA
rectosigmoid junction: sigmoid branch of IMA and rectal artery

108
Q
  • compression of left renal vein between SMA and aorta
  • flank pain, hematuria, left-side varicocele

FA pg 372

A

nutcracker syndrome

109
Q
  • intermittent intestinal obstruction symptoms (post prandial pain)
  • SMA and aorta compress 3rd portion of duodenum
  • associated with low body weight, malnutrition

FA pg 372

A

superior mesenteric artery syndrome

110
Q

3 vessels that constitute main supply of foregut

FA pg 373

A

common hepatic
splenic
left gastric

111
Q

2 areas of strong anastomoses arising from celiac trunk

FA pg 373

A
  • left and right gasto-omental (greater curvature)
  • left and right gastric (lesser curvature)
112
Q

provide the blood supply and innervation for:

Foregut
artery:
parasympathetic innervation:
verterbal level:

A

artery: celiac
parasympathetic innervation: vagus
verterbal level: T12/L1

113
Q

provide the blood supply and innervation for:

Midgut
artery:
parasympathetic innervation:
vertebral level:

A

artery: SMA
parasympathetic innervation: vagus
vertebral level: L1

114
Q

provide the blood supply and innervation for:

Hindgut
artery:
parasympathetic innervation:
vertebral level:

A

artery: IMA
parasympathetic innervation: pelvic
vertebral level: L3

115
Q

what artery descends immediately posterior to the first part of the duodenum?

A

gastrodeuodenal

116
Q

gives rise to right gastro-omental and superior pancreaticoduodenal

A

gastroduodenal a.

117
Q

supply the fundus of the stomach on its greater curvature

A

short gastrics

118
Q

passes along greater curvature of the stomach and forms an anastomotic arc with the right gastro-omental

A

left gastro-omental

119
Q

largest branch of the celiac trunk

A

splenic

120
Q
  • provides branches to pancreas, fundus, greater curvature of stomach, and greater omentum
  • travels along superior border of pancreas and terminates at spleen
A

splenic a.

121
Q

smallest branch of celiac trunk

A

left gastric

122
Q

travels along lesser curvature of stomach to form and anastomotic connection with the right gastric artery

A

left gastric a

123
Q
  • runs along superior aspect of the pancreas
  • enters the spleen through the splenorenal ligament and hilum of spleen
A

splenic a.

124
Q

runs posterior to the first part of duodenum

A

gastroduodenal

susceptible to perforating duodenal ulcers

125
Q

descends behind neck of pancreas and divides into left and right branches to supply the pancreas

A

dorsal pancreatic a.

126
Q

describe the collateral supply of the pancreas

A
  • from celiac trunk via gastroduodenal a. and superior pancreaticoduodenal branches
  • from the SMA via the inferior pancreaticoduodenal branches
127
Q

the appendicular artery is a branch of the

A

ileocolic a.

128
Q

branch from SMA that supplies transverse colon

A

middle colic

129
Q

branch of SMA that supplies ascending colon

A

right colic

130
Q

branch of IMA that supplies descending colon

A

left colic

131
Q

bifurcations of the aorta

A

common iliac arteries

132
Q

transverse colon recieves blood supply from the

A

middle colic

133
Q

the descending colon is supplied by the

A

left colic artery

134
Q

areas at risk for ischemia during AAA repair

A

Watershed areas
* splenic flexure
* rectosigmoid junction

135
Q

receive lymphatic drainage from the descending colon, sigmoid colon and superior aspect of rectum

A

inferior mesenteric lymph nodes

136
Q

lymph from the inferior aspect of the rectum drains into

A

internal iliac lymph nodes

137
Q

receive lymphatic drainage from superior wall of the bladder and superior pelvic ureters

A

external iliac lymph nodes

138
Q

receive lymphatic drainage from posterior abdominal wall, gonads, kidneys, ureters, uterus, and uterine tubes

A

lumbar

139
Q

receive lymphatic drainage from the embryonic midgut

A

superior mesenteric nodes

140
Q

if the IVC is obstructed, blood can bypass it by traveling

A

ascending lumbar veins to azygous and hemiazygous veins

will then drain into SVC

141
Q

what two structures join to form the portal vein?

A

superior mesenteric vein
splenic vein

142
Q

supplies body and tail of pancreas

A

splenic

143
Q

supplies hindgut

A

IMA

144
Q

supplies head of pancreas

A

pancreaticoduodenal

145
Q

most appropriate first steps in management of hypovolumic shock

A

large bore IVs and administration of blood products

146
Q

describe the changes to cardiac output, vascular resistance, and central venous pressure during hypovolumic shock

A

CO: decreased
TPR: increased
central venous pressure: decreased

147
Q

buttock/thigh claudication is typically due to

A

aortoiliac disease

one sided: left/right common iliac artery

148
Q

calf claudication is typically due to

A

femoral artery disease

149
Q

first line therapy for claudication

A

conservative management

manage risk factors

150
Q

young female with no atherosclerotic risk factors and uncontrolled hypertension despite aggressive management

A

fibromuscular dysplasia

151
Q

string of beads

A

fibromuscular dysplasia

152
Q

postprandial abdominal pain, weight loss, food fear

A

chronic mesenteric ischemia

153
Q

sudden onset of constant abdominal pain out of proportion to exam findings

A

acute mesenteric ischemia

154
Q

what is the most likely location of the arterial lesion responsible for chronic mesenteric ischemia?

A

SMA

155
Q

best imaging modality for chronic mesenteric ischemia

A

CT angiogram

or abdominal duplex US

156
Q

best imaging modality for renal artery stenosis?

A

aortic/renal duplex US

CT angiogram also works, but US is first line

157
Q

two risk factors most important to development of ruptured AAA?

A

smoking, male sex

158
Q

best imaging to diagnose AAA

2

A

CT angiogram
abdominal US

159
Q

which anticoagulant is easily titrated, has a short half life, and easily reversible

A

Heparin

160
Q

supplies to foregut

A

celiac

161
Q

organs of the foregut

A

esophagus
stomach
liver
biliary apparatus
pancreas
proximal duodenum

162
Q

supples midgut

A

SMA

163
Q

organs of the midgut

A

small intestine
cecum
appendix
ascending colon
right half to 2/3 of transverse colon

164
Q

supplies hindgut

A

IMA

165
Q

organs of hindgut

A

left of transverse colon
descending colon
sigmoid colon
rectum
superior anal canal

166
Q

supply posterior abdominal wall

A

lumbar arteries

167
Q

supplies the fundus of stomach

2

A

short gastrics
posterior gastric

168
Q

supplies the pylorus of the stomach, pancreas, first part of the duodenum, and distal bile duct

A

gastroduodenal

169
Q

supplies the distal part of esophagus and lesser curvature of stomach

A

left gastric

170
Q

supplies right side of lesser curvature of stomach

A

right gastric

171
Q

supplies right side of greater curvature of the stomach

A

right gastro-omental

172
Q

provides main blood supply to pancreas

A

splenic

173
Q

anastomose together to supply the head of the pancreas

A
  • anterior and posterior superior pancreaticduodenal arteries
  • anterior and posterior inferior pancreaticduodenal arteries
174
Q

supplies liver and gallbladder

A

proper hepatic

branch of common hepatic

175
Q

the right colic and ileocolic arteries supply the […] colon

A

ascending

176
Q

supplies the cecum and rectum

A

ileocolic a.

177
Q

the left colic supplies the […] colon

A

descending

178
Q

the middle colic supplies the […] colon

A

transverse

179
Q

the sigmoid arteries supply the […] colon and sigmoid

A

descending

180
Q

the internal pudendal gives rise to the inferior rectal a. which supplies

2

A

inferior rectum and anal canal

181
Q

supplies inferior rectum and anal canal

A

inferior rectal a.

branch of internal pudendal

182
Q

supplies middle rectum

A

middle rectal a.

branch of internal iliac

183
Q

supplies superior rectum

A

superior rectal artery

branch of IMA

184
Q

gives rise to inferior rectal artery

A

internal pudendal

185
Q

gives rise to middle rectal a.

A

internal iliac

186
Q

gives rise to superior rectal a.

A

IMA

187
Q

gives rise to sigmoid artery

A

IMA

188
Q

located at T12

vessel

A

celiac trunk

189
Q

vessel located at L1

A

SMA

190
Q

vessels located at L1-L2

A

renal a.

191
Q

vessel located at L2

A

gonadal a.

192
Q

vessel located a L3

A

IMA

193
Q

the bifurcation of the aorta is located at L[..]

A

L4

194
Q

the left adrenal vein and left phrenic vein drain into the left […] vein

A

renal

195
Q

the right adrenal vein drains into

A

IVC

196
Q

what two structures join to form the portal vein?

A

SMV and splenic vein

197
Q

the inferior mesenteric vein usually drains into

A

splenic vein

can contribute to portal vein

198
Q

patients with GI bleeds may present with what symptoms

3

A
  • melena
  • hematochezia
  • hematoemesis
199
Q

where is the most common location in the aorta for an aneurysm to form?

A

infrarenal aortia

turbulence due to iliac artery bifurcation