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GastroIntestinal > Blood and Nerve Supply to Abdominal Organs Lecture (Test 1) > Flashcards

Blood and Nerve Supply to Abdominal Organs Lecture (Test 1) Flashcards

1
Q

Abdominal Aorta

A
  • The Abdominal Aorta begins at T12
  • It enters the abdomen through the AORTIC HIATUS which is formed by the Left and Right CRUS of DIAPHRAGM
  • RETROPERITONEAL!!!!!
  • Anterior to Vertebral Bodies
  • TERMINATES at L4
  • At L4 it BIFURCATES into Left and Right Common Iliac Arteries
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2
Q

Relationships of the Abdominal Aorta

A
  • The INFERIOR VENA CAVA lies to the RIGHT of the Aorta
  • The LEFT RENAL VEIN crosses ANTERIOR to the Aorta
  • The ANTERIOR LONGITUDINAL LIGAMENT and VERTEBRAL BODIES are POSTERIOR
  • THORACIC DUCT and CISTERNA CHYLI is to the RIGHT

Note: Thoracic Duct drains into he LEFT SUBCLAVIAN VEIN

  • Duodenum, Pancreas, and Root of Mesentery all cross the ANTERIOR SURFACE of the Aorta
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3
Q

Branches of Abdominal Aorta

A
  • Arteries supplying GI Structures Branch ANTERIORLY and are UNPAIRED
  • Arteries supply NON-GI Structures Branch LATERALLY and are PAIRED
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4
Q

Abdominal Aortic Aneurysm (AAA)

A
  • Baloon- like DILATION of the ABDOMINAL AORTA
  • Usually arises BELOW the RENAL ARTERIES and ABOVE the AORTIC BIFURCATION
  • Primarily due to ATHEROSCLEROSIS
  • Presents as Pulsatile Abdominal MASS that grows with time
  • Aorta should be no Larger than 3cm on Palpation
  • Major Complication is RUPTURE (Especially when > 5cm)
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5
Q

Celiac Trunk (Artery)

A
  • Branches from Aorta at T12- L1
  • Immediately INFERIOR to AORTIC HIATUS
  • Very Short (~ 1 cm) before Braching

3 Branches:

1) LEFT GASTRIC Artery
2) SPLENIC Artery
3) COMMON HEPATIC Artery

  • Base of Artery surrounded by CELIAC PLEXUS and GANGLION
  • Branches supply derivatives of Foregut and Spleen
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6
Q

Left Gastric Artery

A
  • Gives off ESOPHAGEAL BRANCHES
  • Will follow Lesser Curvature of Stomach
  • ANASTOMOSES with RIGHT GASTRIC Artery along the LESSER CURVATURE
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7
Q

Splenic Artery

A
  • Runs POSTER to Stomach and SUPERIOR to Pancreas
  • VERY TORTUOUS!!!!!!!!!
  • Within SPENORENAL LIGAMENT!!!!!!!
  • Ends as several Splenic Arteries (Do not Anastomose)

Branches:

1) SHORT GASTRIC:
- Upper part of the GREATER CURVATURE
- Within GASTROSPLENIC Ligament
- Poor Anastomoses

2) LEFT GASTRO- OMENTAL Artery:
- Greater Curvature of Stomach
- Anastomoses with RIGHT GASTRO-OMENTAL Artery

3) PANCREATIC BRACHES
a) Dorsal Pancreatic Artery
b) Inferior Pancreatic Artery

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8
Q

Common Hepatic Artery Branches into 2 Main Arteries

A

1) PROPER HEPATIC Artery (Superior)
- RIGHT GASTRIC Artery: Anastomoses with LEFT GASTRIC Artery along the Lesser Curvature of the Stomach

  • Ends as Right and Left HEPATIC Arteries
  • CYSTIC Artery is usually a Branch of the RIGHT HEPATIC Artery

2) GASTRO- DUODENAL Artery (Inferior)
- May give off SUPRADUODENAL Artery

  • Runs POSTERIOR to Duodenum
  • BIFURCATES into RIGHT GASTRO-OMENTAL Artery and SUPERIOR PANCREATICODUODENAL Artery
  • Superior PANCREATICODUODENAL Bifurcates into ANTERIOR SUPERIOR PANCREATICODUODENAL Artery and POSTERIOR SUPERIOR PANCREATICODUODENAL Artery
  • If Abdominal Aorta is blocked between CELIAC TRUNK and SUPERIOR MESENTERIC Artery, SUPERIOR PANCREATICODUODENAL Artery INFERIOR PANCREATICODUODNEAL (SMA) COmpensate
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9
Q

Blood Supply to the Liver

A

1) PORTAL VEIN:
- Brings DEOXYGENATED NUTRIENT RICH Blood from GI tract to the Liver

  • Drains LOWER 1/3 of Esophagus, Stomach, Small Intestine, Large Intestine, and upper 1/2 of Anal Canal
  • Formed by the UNION of Splenic and Superior Mesenteric Veins
  • Most POSTEIRIOR Structure of the TRIAD

Note: Liver is drained by HEPATIC VEINS

2) PROPER HEPATIC Artery
- Supplies Oxygenated Blood

  • Divides into LEFT and RIGHT HEPATIC Arteries
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10
Q

Hepatoduodenal Ligament

A
  • The Heaptoduodenal Ligament is a part of the LESSER OMENTUM. It Surrounds and Encloses the structure of the PORTAL TRIAD:
    a) Hepatic Artery
    b) Portal Vein
    c) Bile Duct
  • The remaining part of the LESSER OMENTUM is the HEPATOGASTRIC LIGAMENT
  • The CELIAC TRUNK is located Posterior to the HEPATOGASTRIC LIGAMENT within the LESSER PERITONEAL SAC

**Portal Triad is WITHIN the HEPATODUODENAL LIGAMENT

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11
Q

Relationship of the Portal Triad

A

“Typical” Arrangement:

1) Proper Hepatic Artery (Left)
2) Portal Vein (Posterior)
3) Bile Duct (Right)

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12
Q

Cholecystectomy

A
  • Dissection is through HEPATODUODENAL LIGAMENT to reach the CYSTIC Artery which must be LIGATED before REMOVING the GALL BLADDER

CARLOT’S TRIANGLE:

  • MEDIALLY: Common Hepatic Duct
  • LATERALLY: Cystic Duct
  • SUPERIORLY: Edge of Liver
  • Cystic Artery crosses the middle of the Triangle
  • CARLOT’S NODE: Main bought of Lymphatic drainage of GALLBLADDER
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13
Q

Portal Triad

A

BILE DUCT:

- Formed by CYSTIC DUCT (Gallbladder) and COMMON HEPATIC DUCT (Liver)

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14
Q

Superior Mesenteric Artery

A
  • 1cm INFERIOR to Celiac Trunk

- Emerges from Aorta POSTERIOR to the NECK of the PANCREAS

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15
Q

Blood Supply of the Pancreas and Duodenum

A
  • The Pancreas receives Branches from BOTH the CELIAC and SUPERIOR MESENTERIC Arteries

1) CELIAC: SUPERIOR PANCREATICODUODENAL
- A Branch of the Gastroduodenal
- Anterior Superior Pancreaticoduodenal Artery
- Posterior Superior Pancreaticoduodenal Artery

2) SUPERIOR MESENTERIC
- Usually the FIRST BRANCH of the Superior Mesenteric Artery is an INFERIOR PANCREATICODUODENAL
a) Anterior Inferior Pacreaticoduodenal Artery
b) Posterior Inferior Pancreaticoduodenal Artery

  • The Branches from the Superior Mesenteric Artery meet the Branches fro the Gastroduodenal, forming ANASTOMOSING ARCADES on the ANTERIOR and POSTERIOR SURFACES of the Head of the Pancreas!!!!!!
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16
Q

Superior Mesenteric Artery

A
  • The Superior Mesenteric Artery supplies Branches to the “free” Small Intestine and part of the Large Intestine (midgut derivatives)
  • It emerges from the Aorta POSTERIOR TO THE NECK OF THE PANCREAS
17
Q

Superior Mesenteric Artery

BRANCHES TO SMALL INTESTINE

A

Braches to Small Intestine:
1) INFERIOR PANCREATICODUODENAL Artery

2) JEJUNAL Arteries
- SIMPLE ARCADES, LONG VASA RECTA

  • Jejunum WELL VASCULARIZED
    a) TALL, CLOSE PLICAE CIRCULARES

3) ILEAL Arteries:
- COMPLEX ARCADES, SHORT VASA RECTA

  • These Arteries all Branch to the LEFT from the Superior Mesenteric Artery
  • Ileum is LESS VASCULARIZED
  • PLICAE CIRCULARES are FEWER and SHORTER or ABSENT
18
Q

Superior Mesenteric Artery

BRANCHES TO LARGE INTESTINE

A

Branches to Large Intestine

1) ILEOCOLIC Artery
- Ileal Branche (s)
- Colic Branch
- Anterior and Posterior Cecal branches
- Appendicular Branch

2) RIGHT COLIC Artery
- To ASCENDING COLON
- To RIGHT COLIC FLEXURE

3) MIDDLE COLIC Artery
- Supplies RIGHT COLIC FLEXURE and TRANSVERSE COLON

  • *MARGINAL Artery:
  • A CONTINUOUS ANASTOMOSES
19
Q

ILEOCOLIC Artery

A
  • Posterior Cecal Branch
  • Anterior Cecal branch
  • Ileal Branch (es)
  • Appendicular Branch
  • Ascending Colic Branch
20
Q

Superior Mesenteric veins

A
  • Superior Mesenteric Vein PARALLELS the Superior Mesenteric Artery to the RIGHT
  • Tributaries DRAIN the SAME PARTS of the Small and Large Intestine supplied by Branches of the SUPERIOR MESENTERIC Artery
  • Joins the SPLENIC VEIN to form the PORTAL VEIN POSTERIOR to the NECK of the PANCREAS
21
Q

Inferior Mesenteric Artery

A
  • Supplies derivatives of HINDGUT

Branches

1) LEFT COLIC Artery
- Ascending Branch
- Descending Branch

2) SIGMOID Arteries
3) SUPERIOR RECTAL Artery
4) MARGINAL Artery

22
Q

Inferior Mesenteric Vein

A
  • Tributaries drain the SAMME PARTS of the Large Intestine that were supplied by Branches of the Inferior Mesenteric Artery
  • Branches of the Inferior Mesenteric Vein DO NOT PARALLEL the Tributaries of the Artery
  • The SUPERIOR RECTAL VEIN drains SUPERIORLY to JOIN Branches of the LEFT COLIC VEINS and form the Inferior Mesenteric Vein
  • The Inferior Mesenteric Vein joins the SPLENIC or the SUPERIOR MESENTERIC VEIN to for the PORTAL VEIN
23
Q

Rectal Arteries and Veins

A

1) SUPERIOR RECTAL Arteries and Veins (Drain to Inferior Mesenteric Vein)
2) MIDDLE RECTAL Arteries and Veins (Drain to Internal Iliac Veins)
3) INFERIOR RECTAL Arteries and Veins (Drain to INTERNAL PUDENDAL VEINS)
- Anastomose within the wall of the Rectum and Anus

24
Q

Lymphatics of the GI System

A

** Chyle Cisterna

***Intestinal Lymphatic Trunk

25
Q

Nerve Plexi

A
  • Several Nerve Plexi Ganglia located on the ANTERIOR and LATERAL surfaces of the Aorta
    a) The Ganglia are PREVERTEBRAL SYMPATHETIC GANGLIA
  • Named for nearest branch of the Aorta or their location on the Aorta (Celiac, Superior Mesenteric, Inferior Mesenteric, Renal)
  • Each Plexus is a mix of SYMPATHETIC (Fibers and Cells), PARASYMPATHETIC Fibers, and AFFERENT Fibers
  • SYMPATHETIC TRUNKSA RE LATERAL TO AORTA
26
Q

Nerve Plexi

Sympathetic Innervation

A
  • PREGANGLIONIC Fibers drive at T5- L1, and they travel in respective SPLANCHNIC NERVES, Synapse in PREVERTEBRAL SYMPATHETIC Ganglia
  • POSTGANGLIONIC Fibers travel from Ganglia to Abdominal Organs
27
Q

Nerve Plexi

Parasympathetic Innervation

A
  • PREGANGLIONIC Fibers travel through CELIAC PLEXUS but DO NOT SYNAPSE
  • They Synapse in Nerve Plexi of ENTERIC (Intrinsic) NERVOUS SYSTEM contained in Gut Wall
  • Supplied by VAGUS and PELVIC Nerves
  • VAGUS Innervates the FORGUT and MIDGUT (Stomach to Proximal 2/3rd of Transverse Colon)
  • PELVIC Nerves arise at S2-S4; Innervate HINDGUT (Distal 1/3rd Transverse Colon to Proximal Rectum)
28
Q

Enteric Nervous System

A
  • Composed of a series of Ganglionic Nerve Plexi contained within the Gut Wall

Two Principle Components:

1) MYETERIC (Auerbach’s) Plexus:
- Between Outer Longitudinal and Inner Circular Muscle Layers
- MOTILITY!!!!!

2) Submucosal (Meissner’s) Plexus
- SECRETIONS, Blood Flow, Absorption

29
Q

Nerves of the Superior Mesenteric Plexus

A
  • SYMPATHETIC Fibers from the Greater, Lesser, and Lowest SPLANCHNIC NERVES Synapse in the Superior Mesenteric Ganglia
  • POSTGANGLIONIC Fibers follow Branches of the Superior Mesenteric Artery to TARGET ORGANS.
  • ****GVA PAIN Fibers follow SYMPATHETICS!!!!!!!!
  • PARASYMPATHETIC are fro the VAGUS NERVE. They follow Branches of the Superior Mesenteric Artery to Synapse i the Wall son the TARGET ORGAN
  • **Accompanied by GVA Fibers for VISCERAL REFLEXES!!!!!
30
Q

Nerves of the Inferior Mesenteric Plexus

A
  • The part of the Large Intestine PROXIMAL to the SPLENIC FLEXURE is derived from the MIDGUT. It is supplied by PARASYMPATHETICS from the VAGUS NERVE (+ GVA Reflex Fibers)
  • The part of the Large Intestine DISTAL to the SPLENIC FLEXURE is derived from HINDGUT and its PARASYMPATHTICS are from Sacral Levels S2-S4
  • SYMPATHETIC Nerves follow the Superior to Inferior Mesenteric Arteries from AORTIC PLEXI or form SACRAL SPLANCHNIC Nerves (+GVA PAIN FIBERS)

**GVA PAIN comes from SYMPATHETICS!!!!!!

*****VISCERAL REFLEXES comes from PARASYMPATHETICS!!!!!!

31
Q

Nerves of the Large Intestine: Sensory Supply

A

Liver: T6-9

Stomach: T6-9

Spleen: T6-8

SupreRenal Gland: T6-L2

Kidneys: T10-L1

Pancreas: T6-9

Ascending Colon: T10

Transverse Colon: T11

Descending Colon: T12-L1

Small Intestine: T8-10

Sigmoid Colon: L2 (3)

Rectum: S2

Anus: S4

32
Q

Foregut

A

Artery:
- Celiac Artery

Parasympathetic Innervation:
- Vagus Nerve

Sympathetic Innervation:

  • T5 - T9
  • Greater Splanchnic Nerve

Vertebral Level:
- T12-L1

Structures Supplied:

  • Stomach
  • Gallbladder
  • 1st and 2nd par of Duodenum
  • Liver
  • Pancreas
  • Spleen (Mesoderm)
33
Q

Midgut

A

Artery:
- Superior Mesenteric Artery

Parasympathetic Innervation:
- Vagus Nerve

Sympathetic Innervation:

  • T10 - T11
  • Lesser Splanchnic Nerve

Vertebral Level:
- L1

Structures Supplied:
- 3rd and 4th part of Duodenum to Proximal 2/3 of Transverse Colon

34
Q

Hindgut

A

Artery:
- Inferior Mesenteric Artery

Parasympathetic Innervation:
- Pelvic Splanchnic Nerve

Sympathetic Innervation:

  • T12-L2
  • Least Splanchnic Nerve

Vertebral Level:
- L3

Structures Supplied:
- Distal 1/3 of Transverse Colon to Upper portion of Rectum

35
Q

Ischemic Colitis

A

Risk Factors:
- Advanced Age, Clotting Abnormalities, Hypercholesterolemia, Severe Hypotension, Adhesions, Marathons

Etiology:
- Atherosclerosis, Severe Hypotension, Blood clot or Venous Thrombosis, Lupus or Sickle Cell, COCAINE

Complications:
- Tissue Death —> Perforation, or Bowel Obstruction

36
Q

Hirschsprung Disease

A
  • Failure of NEURAL CREST CELLS to Migrate during Intestinal development
  • No MYETERIC PLEXUS (When you biopsy you must take some of the Muscular Mucosa)
  • Neural Crest cells become the ENTERIC GANGLION Cells
  • No Parasympathetics so the gut cannot relax, causing CONSTRICTION and MEGACOLON of the Proximal Colon Segments
  • Most cases occur in the RECTOSIGMOID JUNCTION
  • DOWN SYNDROME babies have HIGHER RISK
37
Q

Chagas Disease

A
  • MEGACOLON

- T. cruz destroys Autonomic Nervous System MIANLY MYETERIC PLEXUS!!!!!!!

GastroIntestinal (21 decks)

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