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gi exam 2 > Blood and Nerve Supply > Flashcards

Blood and Nerve Supply Flashcards

1
Q
  • The aorta enters the aortic hiatus at which spinal level?
  • At what spinal level does it bifurcate into left and right common iliac arteries?
  • The aorta is located _ and posterior to what structures?
A
  • T12
  • L4
  • Retroperitoneally
  • Pancreas, Splenic v., Left renal vein, 3rd part of duodenum, loops of small intestine
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2
Q
  • What are the unpaired visceral branches of the aorta and at which spinal levels are they located?
A
  • Celiac-T12
  • Superior Mesenteric-L1
  • Inferior Mesenteric-L3
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3
Q
  • What are the paired visceral branches of the abdominal aorta and at what spinal levels are they located?
A
  • Suprarenal-L1
  • Renal-L1/L2
  • Gonadal-L2
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4
Q
  • What are the paired parietal branches of the abdominal aorta and what spinal levels are they located?
A
  • Inferior phrenic A. (T12)
  • Subcostal A. (T12)
  • Lumbar A. (L1-L4)
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5
Q
  • Foregut structures:
  • Arterial Supply
  • Parasympathetic Innervation
  • Sympathetic Innervation
  • Referred Pain
A
  • Celiac A
  • Vagus N
  • Thoracic Splanchnic N (T5-9)
  • Epigastrium
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6
Q
  • Foregut derivatives
A
  • Esophagus
  • Stomach
  • Liver and Pancreas
  • Biliary Apparatus
  • Proximal Duodenum
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7
Q
  • Midgut Structures:
    • ​Arterial supply
    • Parasympathetic Innervation
    • Sympathetic Innervation
    • Referred Pain
A
  • Superior mesenteric a.
  • Vagus n.
  • Thoracic Splanchnic nerves (T8-12)
  • Umbilical region
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8
Q
  • Midgut derivatives
A
  • Small intestine
  • Cecum and veriform appendix
  • Ascending colon
  • Right half of transverse colon
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9
Q
  • Hindgut structures:
    • ​Arterial Supply
    • Parasymp
    • Symp
    • Referred Pain
A
  • Inferior mesenteric artery
  • Pelvic splanchnic nerves
  • Lumbar splanchnic nerves (L1-L2)
  • Hypogastrium
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10
Q
  • Hindgut Derivatives:
A
  • Left half of the transverse colon
  • Descending colon
  • Sigmoid Colon
  • Rectum
  • Superior anal canal
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11
Q
  • In general, what three arteries should come off of the celiac trunk?
A
  • Common hepatic a., Left gastric a., Splenic a.
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12
Q
  • What arteries will generally branch off of the Left Gastric A.?
  • What arteries will generally branch off of the Splenic A.?
  • What arteries will generally branch off of the Common Hepatic A.?
A
  • Left gastric a. has esophageal branch that runs to the esophagus
  • Common hepatic a. has right gastric a. branch, gastroduodenal branch, and after branching to right gastric a., will branch into proper hepatic artery with left and right hepatic a. (cystic a. supplying the gallbladder typically comes off of the right hepatic a.)
  • Splenic a. has pancreatic a.s that supply the uncinate process and head of the pancreas, and also branches into posterior gastric a., and left gastro-omental/gastro-epiploic as..
  • Splenic As also have short gastric as that supply stomach AND superior pole of the spleen
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13
Q
  • What are some common celiac trunk variations?
A
  • Right and left inferior phrenic arteries branching off of celiac trunk
  • Left hepatic artery branching off of the left gastric a.
  • All arteries coming off of the celiac trunk
  • Right hepatic artery coming off of the superior mesenteric a.
  • Common trunk of left gastric and splenic a.s
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14
Q

What are some common vascular variations of blood supply to the liver?

A
  • Left hepatic artery coming off of celiac a. and right hepatic artery coming off of SMA
  • Left hepatic a. coming off of left gastric a.
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15
Q
  • Blood supply to the pancreas
A
  • Gastroduodenal a.
    • Anterior superior pancreaticoduodenal a.
    • Posterior superior pancreaticoduodenal a.
  • SMA
    • Anterior inferior pancreaticoduodenal a.
    • Posterior inferior pancreaticoduodenal a.
  • Splenic a.
    • Pancreatic arteries
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16
Q
  • What arteries branch off of the SMA (in typical case)?
A
  • Middle colic a. (supplying transverse colon)
  • Right colic a. (supplying ascending colon)
  • Ileocolic a. (cecum and parts of ascending colon)
    • Appendicular a.
  • Also have:
    • Ileal a.s (More arcades (loops) and short vasa recta)
    • Jejunal as. (Less arcades (loops) and long vasa recta)
17
Q
  • Common variations in SMA
A
  • Common trunk for middle colic and right colic arteries
  • Absent middle colic replaced by a large branch from left colic a.
  • Common trunk for right colic and ileocolic arteries
  • Absent right colic artery
18
Q
  • SMA and Renal Vein Entrapment Syndrome
A
  • The left renal vein AND 3rd part of duodenum runs posterior to the SMA and anterior to the descending abdominal aorta
  • w/ loss of mesenteric fat, can compress these structures
  • Sx:
    • Left renal vein compression:
      • Proteunuria
      • Hematuria
      • Left flank pain
    • Duodenum compression:
      • Nausea
      • Bilious Vomit
19
Q
  • What are the common/typical branches off of the IMA
A
  • Left colic a. (ascending branch and descending branch supplying the descending colon)
  • Sigmoid arteries (2-5 of them supplying sigmoid colon)
  • Superior rectal a. (Over pelvic brim and to rectum)
20
Q
  • Where do the superior, middle, and inferior rectal arteries come from?
A
  • Superior-from IMA
  • Middle-from Internal Iliacs
  • Inferior-From Internal Pudendal
21
Q
  • How does venous drainage of the rectum work?
A
  • Rectal venous plexus drains into superior, middle, or inferior rectal veins
  • Middle and inferior rectal veins drain into the caval/systemic system-DIRECTLY into IVC
  • Superior rectal vein drains into PORTAL SYSTEM
22
Q
  • Branches of the IVC
A
23
Q
  • Commonly, the hepatic portal vein comes from the joining of what two veins?
  • Variations?
A
  • Splenic vein
  • Superior mesenteric vein

Variations:

  • Inferior mesenteric vein drains into superior mesenteric vein (which drains into hepatic portal vein)
  • Inferior mesenteric vein drains into portal vein along with superior mesenteric v. and splenic v.
24
Q
  • Portal Caval Anastamoses
    • ​What can portal HTN cause in each of these anastamoses?
A
  1. Esophageal (Left gastric/Azygous)
    1. Esophageal varices
  2. Rectal (Superior rectal w/ middle or inferior rectal veins)
    1. Hemorrhoids
  3. Paraumbilical (Paraumbilical and Epigastric veins)
    1. Caput Medusae
  4. Retroperitoneal
    1. Colic veins with systemic retroperitoneal veins
25
Q
  • Abdominal innervation:
    • Sympathetics
    • Parasympathetics
A
  • Sympathetics
    • Greater Splanchnic nerve (T5-T9)
    • Lesser Splanchnic nerve (T10-T11)
    • Least Splanchnic nerve (T12)
    • Lumbar Splanchnic nerves (L1-L3)
  • Parasympathetics
    • Vagus nerve
    • Pelvic Splanchnics (S2-S4)
26
Q
  • Parasympathetic innervation
A
  • Anterior and posterior vagal trunks
  • Pelvic splanchnic nerves (S2-S4)
  • Abdominal (para-aortic) autonomic plexuses and the peri-arterial plexuses (extensions of para-aortic autonomic plexuses)
  • Enteric parasympathetic ganglia (post-synaptic ganglia of parasympathetics)
27
Q
  • The vagus nerve conveys _ parasympathetic and _ afferent fibers to abdominal aortic plexuses and periarterial plexuses (extend along branches of aorta)
  • Pelvic splanchnics-what makes them different from other splanchnic nerves?
A
  • Presynaptic parasympathetics and visceral afferent
  • Pelvic splanchnics
    • Nothing to do with symopathetics
    • Derive from S2-S4 anterior rami
    • Convey PRE-synaptic PARAsympathetic fibers to inferior hypogastric plexus
28
Q
  • Abdominopelvic splanchnics summary
A
29
Q
  • Where are prevertebral ganglia located?
A
30
Q
  • Plexuses summary
A

gi exam 2 (14 decks)

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