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GI personal > Blood and Nerve Supply to Abdominal Organs > Flashcards

Blood and Nerve Supply to Abdominal Organs Flashcards

1
Q

Which branch of the abdominal aorta is the primary supply to foregut derivatives? What are these derivatives?

A

Celiac trunk

Supplies:
Liver and bile ducts
Distal esophagus
Stomach
Duodenum - proximal to common bile duct
Pancreas
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2
Q

Which branch of the abdominal aorta is the primary supply to midgut derivatives? What are these derivatives?

A

Superior mesenteric artery

Supplies:
Duodenum - distal to common bile duct
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Transverse colon - proximal 2/3
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3
Q

Which branch of the abdominal aorta is the primary supply to hindgut derivatives? What are these derivatives?

A

Inferior mesenteric artery

Supplies:
Transverse colon - distal 1/3
Descending colon
Sigmoid colon
Rectum - proximal 1/3
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4
Q

Vertebral level of celiac trunk

A

T12

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5
Q

Vertebral level of superior mesenteric a.

A

L1

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6
Q

Vertebral level of inferior mesenteric a.

A

L3

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7
Q

Vertebral level of bifurcation of abdominal aorta

A

L4

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8
Q

What is superior mesenteric artery syndrome?

A

Compression of 3rd part of duodenum by SMA

More common in females; age range 10-39

Results in chronic or intermittent duodenal obstruction, which can be complete or partial

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9
Q

There is an arterial anastomoses between the branches of the SMA and the IMA, predominantly one artery called the ______

What is its significance?

A

Marginal artery of drummond

Depending on the health of these vessels, and the speed at which obstruction occurs, they could help prevent intestinal ischemia by providing collateral circulation

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10
Q

what is considered to be the ANS master controller?

A

Hypothalamus

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11
Q

What nerve plexus is considered to be the “second brain” in terms of controlling activity in the stomach, small intestine, and large intestine?

A

Enteric nervous system (ENS)

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12
Q

Main ENS functions

A

Controls digestive tract motility

Regulates fluid exchange and local blood flow

Regulates secretions of pancreas and stomach - enzymes and HCl

Regulates hormone production: gastric and intestinal hormones

Mounts defensive reactions against viruses and some bacteria

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13
Q

Autonomic motor (efferent) neurons include:

____ neurons which decrease GI activity by constricting arteries supplying GI tract

_____ neurons which increase GI activity by synapsing with postsynaptic neurons in the ENS, thereby enhancing their activity

A

Sympathetic postsynaptic

Parasympathetic presynaptic

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14
Q

Visceral sensory (afferent) neurons in the stomach, small intestine, andlarge intestine detect what types of sensations?

A

Distention (fullness)
Discomfort
Nausea
Pain

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15
Q

Afferent neurons for pain from the proximal GI tract (including organs proximal to splenic flexure) travel to the ______ spinal sensory ganglia and then to spinal cord

A

Thoracolumbar

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16
Q

Afferent fibers conveying reflex information from proximal GI tract, including organs proximal to splenic flexure, travel with the ____ nerve

A

Vagus

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17
Q

Afferent fibers for pain and reflex information from distal GI tract (including organs distal to splenic flexure) travel to spinal sensory ganglia S2-S4 via ______ nerves

A

Pelvic splanchnic

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18
Q

Which spinal segments correspond to greater, lesser, and least splanchnic nerves?

A

Greater = T5-9

Lesser = T10-11

Least = T12

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19
Q

Which spinal cord segments correspond to lumbar and sacral splanchnic nn?

A

L1-L2 for both

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20
Q

3 unpaired visceral branches of aorta

A

Celiac (T12)
Superior mesenteric a. (L1)
Inferior mesenteric a. (L3)

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21
Q

3 paired visceral branches from aorta

A

Suprarenal a. (L1)

Renal (L1/L2)

Gonadal (L2)

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22
Q

3 paired parietal branches from aorta

A

Inferior phrenic a. (T12)

Subcostal a. (T12)

Lumbar (L1-4)

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23
Q

Parasympathetic innervation of foregut, midgut, and hindgut

A

Foregut: vagus n.

Midgut: vagus n.

Hindgut: pelvic splanchnic nn.

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24
Q

Sympathetic innervation of foregut, midgut, and hindgut

A

Foregut: thoracic splanchnic nn. T5-9

Midgut: thoracic splanchnic nn. T8-12

Hindgut: Lumbar splanchnic nn. L1-2

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25
Q

The aorta enters the aortic hiatus at the diaphragm at ____ vertebral level. It ends at vertebral level ____ by dividing into right and left _____ arteries

A

T12; L4; common iliac

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26
Q

Is the aorta retroperitoneal or intraperitoneal?

A

Retroperitoneal

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27
Q

Name the most important anterior relationships of the abdominal aorta from superior to inferior

A 
Autonomic plexi and ganglia
Body of pancreas
Splenic v.
L renal v.
Horizontal part of duodenum
Coils of small intestine
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28
Q

Is the splenic a. intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Both; it is retroperitoneal until it travels through the splenorenal ligament to get to the spleen

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29
Q

What are the 5 branches of the splenic a. and what do they supply?

A

Posterior gastric a. (Sometimes not present)

Pancreatic branches (supply body and tail of pancreas)

Short gastric aa. (Supply fundus of stomach)

Splenic branches

L gastro-omental a.

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30
Q

Are the short gastric aa. (branches of splenic a.) intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Gastrosplenic ligament

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31
Q

Is the L gastro-omental a. (branch of splenic a.) intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Gastrocolic ligament
Greater omentum

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32
Q

2 primary branches of common hepatic a.

A

Proper hepatic a.

Gastroduodenal a.

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33
Q

Is the proper hepatic a. intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Hepatoduodenal ligament (with other parts of portal triad - portal v. and common bile duct)

Lesser omentum

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34
Q

Is the gastroduodenal a. intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Retroperitoneal

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35
Q

Branches of common hepatic a.

A

R gastric a.

R and L hepatic branches (cystic a. typically branches off R hepatic a.)

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36
Q

Branches of gastro-duodenal a.

A

Superior pancreaticoduodenal a. (anterior and posterior)

R gastro-omental a.

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37
Q

Is the R gastro-omental a. (branch of gastroduodenal a.) intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Gastrocolic ligament
Greater omentum

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38
Q

Is the superior pancreaticoduodenal a. (anterior and posterior branches of gastroduodenal a.) intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Retroperitoneal

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39
Q

The right hepatic a. typically comes off the common hepatic a., what is a common variation of this?

A

Right hepatic a. may come off superior mesenteric

40
Q

The L hepatic a. typically comes off the common hepatic, what is a common variation of this?

A

Left hepatic a. may come off L gastric a.

41
Q

T/F: proper hepatic a. is usually anterior to portal vein, but a possible variation is that it could be posterior

A

True

42
Q

Describe the dual blood supply of the liver

A

Hepatic portal v. carries relatively oxygenated blood to sustain liver parenchyma (75-80% of liver)

Hepatic a. sustains non-parenchymal structures like the intrahepatic bile ducts (20% of liver)

43
Q

How does blood flow through the liver relative to bile?

A

They flow in opposite directions

Blood enters liver from hepatic portal vein and artery toward the central vein

Bile flows from hepatocytes into bile canaliculi, to interlobular biliary ducts, and then to te bile duct in the extrahepatic portal triad

44
Q

Surgeons often use what anatomical landmark to find the cystic artery?

A

Cystohepatic triangle of Calot

45
Q

What 3 structures make up the cystohepatic triangle of Calot?

A

Common hepatic duct
Cystic duct
Visceral surface of liver

46
Q

What 3 important arterial anastomoses occur at the stomach and spleen?

A

L and R gastric aa.

L and R gastro-omental aa.

L gastric + R gastro-omental aa.

47
Q

An ulceration in the early portion of the duodenum would have the potential of compromising what blood vessel?

A

Gastroduodenal a.

48
Q

What vessel(s) supply the head of the pancreas as well as the 2nd and 3rd parts of the duodenum?

A

Gastroduodenal a. (+branches: anterior and posterior superior pancreaticoduodenal a.)

Superior mesenteric a. (+branches: anterior and posterior inferior pancreaticoduodenal a.)

49
Q

What vessel(s) supply the body, tail, and neck of the pancreas?

A

Pancreatic aa. (Which branch from splenic a.)

50
Q

The anastomoses of what blood vessels represents the transition from supplying the foregut to the midgut?

A

Anterior superior pancreaticoduodenal a. anastomoses with anterior inferior pancreaticoduodenal a.

[since superior comes from celiac trunk=foregut and inferior comes from SMA=midgut]

note that posterior branches also anastomose

51
Q

6 Branches of superior mesenteric a.

A

Inferior pancreaticoduodenal aa.

Ileocolic a. (Supplies cecum and lower part of ascending colon)

Right colic a. (mid to upper part of ascending colon)

Middle colic a. (transverse colon)

Jejunal a.

Ileal a.

52
Q

Compare/contrast vasa recta and vascular arcades of SMA in the jejunum vs. ileum

A

Jejunum: long vasa recta, few vascular arcades

Ileum: short vasa recta, many vascular arcades

53
Q

4 most common variations in SMA

A

Common trunk for right and middle colic aa.

Common trunk for right and ileocolic aa.

Absent middle colic, replaced by large branch from L colic

Absent right colic a.

54
Q

Nutcracker syndrome occurs when a loss of mesenteric fat causes the SMA to compress the 3rd part of the duodenum and the ______ vein

A

L renal

55
Q

Symptoms of nutcracker syndrome

A 
Proteinuria
Hematuria
Nausea
Vomiting (+bile)
L testicular pain in males 
Varicocele in males (engorged pampiniform plexus d/t backup of blood from L renal v.)
56
Q

3 major arteries supplying rectum and what they branched from

A

Superior rectal a. (from IMA)

Middle rectal a. (from internal iliacs)

Inferior rectal a (from internal pudendal a.)

57
Q

Describe venous drainage of the rectum

A 
Drainage occurs via:
Rectal venous plexus
Internal pudendal v.
Middle rectal v.
Superior rectal v.

The rectal venous plexus and superior rectal v. drain into inferior mesenteric v. and eventually into portal v. —> liver

The internal pudendal v. and the middle rectal v. are part of the systemic/caval system. They drain back into common iliac vv. then to the IVC —> heart

58
Q

Why are interal hemorrhoids not painful, while external hemorrhoids are?

A

Internal are not painful because they are above the pectinate line

External are below the pectinate line and are innervated by somatic sensory fibers (inferior anal nn.)

59
Q

Internal hemorrhoids are caused by prolapse of rectal mucosa that contains the normally dilated veins of the _____ venous plexus and typically bleed bright red.

External are due to thromboses or blood clots in the veins of the _____ venous plexus and are covered by skin.

A

Internal; external

60
Q

The IVC begins anterior to vertebral level _____, just to the right of midline (right side of aorta). It passes through the caval opening of the diaphragm at ______.

Is it longer or shorter than the aorta?

A

L5; T8

Longer

61
Q

Major branches of IVC

A

R and L common iliac vv.

Lumbar vv.

R and L renal vv.

R and L hepatic vv.

R gonadal v. (L gonadal typically goes to L renal v.)

62
Q

The ascending lumbar veins anastomose with what venous system?

A

Azygous

63
Q

What vein is found anterior to the IVC and posterior to the pancreas?

A

Portal v.

64
Q

Is the portal v. intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Hepatoduodenal ligament
Lesser omentum

65
Q

The portal v. is formed from the union of what 2 veins?

A

Splenic v.

Superior mesenteric v.

66
Q

The portal vein is usually formed from the union of the splenic v. and superior messenteric v. The inferior mesenteric v. USUALLY empties into the splenic v. What are the 2 most common variations?

A

Inferior mesenteric v. may drain into superior mesenteric v.

Inferior mesenteric v. may drain directly into hepatic portal v.

67
Q

Portal-caval anastomoses form when blood flow is somehow obstructed in the liver and the portal system backs up. What are the 4 locations that these anastomoses might form?

A

Esophageal

Rectal

Paraumbilical

Retroperitoneal

68
Q

Describe esophageal portal caval anastomoses and the potential clinical implication associated with this

A

Left gastric v. anastomoses with azygous v.

May cause portal HTN and subsequent esophageal varices

69
Q

Describe rectal portal caval anastomoses and the potential clinical implication associated with this

A

Blood backflow through the inferior mesenteric vein into superior rectal vein causes rectal vein to anastomose with middle and/or inferior rectal veins which drain back into caval system

Clinical: hemorrhoids, bleeding

70
Q

Describe paraumbilical portal caval anastomoses and the potential clinical implication associated with this

A

Paraumbilical vv. anastomose with epigastric vv. (superior and inferior) which go back to caval system

Clinical: caput medusae

71
Q

Describe retroperitoneal portal caval anastomoses

A

Colic veins anastomose with systemic retroperitoneal veins (since descending colon is retroperitoneal)

72
Q

Esophageal varices can rupture and bleed into the stomach, which may be fatal. Histologically, where would esophageal varices be seen?

A

Submucosal layer

73
Q

What nerves contribute to the extrinsic sympathetic innervation of the abdomen, and what are their corresponding spinal levels?

A 
Greater splanchnic (T5-9)
Lesser splanchnic (T10-11)
Least splanchnic (T12)
Lumbar splanchnic (L1-2)
74
Q

What nerves contribute to the extrinsic parasympathetic innervation of the abdomen?

A

Vagus n. (CN X)

Plevic splanchnic nn. (S2-4)

75
Q

Parasympathetic innervation from anterior and posterior vagal trunks travel into the abdomen via the ______hiatus. Pelvic splanchnic nerves travel on ______ plexuses and their extensions, the _____ plexuses

A

Esophageal; abdominal (para-aortic); periarterial

76
Q

The vagus nerves convey _______ and ______ fibers (mainly for reflexes) to the abdominal aortic plexuses and the periarterial plexuses, which extend along the branches of the aorta

A

Presynaptic parasympathetic; visceral afferent

77
Q

What makes the pelvic splanchnic nerves distinct from other splanchnic nerves?

A

They have nothing to do with sympathetic trunks

They derive directly from anterior rami of spinal nn. S2-S4

Convey preganglionic presynaptic parasympthatic fibers to the inferior hypogastric (pelvic) plexus

78
Q

Where are the cell bodies of sympathetic nerves that innervate the abdomen?

A

Intermediolateral cell column of lateral horn of spinal cord

79
Q

Trace the path of a sympathetic nerve that innervates the abdomen from the cell body in the intermediolateral column of lateral horn of spinal cord to the abdominopelvic viscera

A
  1. Leaves IMC via anterior (ventral) root
  2. Travels via anterior (ventral) ramus
  3. Leaves via white rami communicantes
  4. Passes through paravertebral ganglion as abdominopelvic splanchnic nerve
  5. Synapses in prevertebral ganglion
  6. Postsynaptic fibers travel via periarterial plexus
  7. Synapses at abdominopelvic viscera
80
Q

Sympathetic abdominopelvic splanchnic nerves synapse in one of the prevertebral ganglia anterior to the aorta prior to travelling via periarterial plexuses to get to target organ. What are the pre-vertebral ganglia?

A

Celiac ganglion
Superior mesenteric ganglion
Inferior mesenteric ganglion
Aorticorenal ganglion

81
Q

What is the origin of the lumbar abdominopelvic splanchnic nerves (presynaptic sympathetic)?

A

Abdominal sympathetic trunk

82
Q

The greater splanchnic nerves typically synapse with what abdominal prevertebral ganglia prior to traveling to their target organ?

A

Celiac ganglia

83
Q

The lesser splanchnic nerves typically synapse with what abdominal prevertebral ganglia prior to traveling to their target organ?

A

Aorticorenal ganglia

84
Q

The least splanchnic and lumbar splanchnic nerves typically synapse with what abdominal prevertebral ganglia prior to traveling to their target organ?

A

Superior and inferior mesenteric ganglia

And intermesenteric/hypogastric plexus

85
Q

Name the abdominal nerve plexuses

A 
Celiac plexus
Superior mesenteric plexus
Inferior mesenteric plexus 
Intermesenteric plexus
Superior hypogastric plexus
Inferior hypogastric plexus
86
Q

Describe the celiac nerve plexus.

Where is it located? What nerves contribute to it? Is it sympathetic, parasympathetic, or mixed?

A

Located superior or on sides of celiac trunk

Predominantly greater splanchnics, but may have some contributions from lesser splanchnics. Some contribution from vagus parasympathetics travelling through but they DO NOT synapse here

Mixed sympathetic and parasympathetic

87
Q

Describe the superior mesenteric nerve plexus.

Where is it located? What nerves contribute to it? Is it sympathetic, parasympathetic, or mixed?

A

Located above the superior mesenteric a., often fused with the celiac plexus

Contributions from lesser and least splanchnic nn, and sometimes lumbar splanchnics. Parasympathetics travel through but DO NOT synapse here.

Mixed sympathetic and parasympathetic.

88
Q

Describe the intermesenteric nerve plexus.

Where is it located? What does it supply? Is it sympathetic, parasympathetic, or mixed?

A

Located between superior mesenteric a. and inferior mesenteric a.

Sends supply to renal, gonads, and ureters.

Mixed sympathetic and parasympathetic

89
Q

Describe the superior hypogastric nerve plexus.

Where is it located? What nerves contribute to it? Is it sympathetic, parasympathetic, or mixed?

A

Located at bifurcation of aorta

Sympathetics only! The sympathetic nerves have already synapsed in inferior, superior, or maybe aorticorenal or celiac ganglia - so they are POSTGANGLIONIC only

R and L hypogastric nn. are the primary sympathetics coming out; they contribute to the inferior hypogastric plexus

90
Q

Describe the inferior hypogastric nerve plexus.

What nerves contribute to it? Is it sympathetic, parasympathetic, or mixed?

A

Contributions from pelvic splanchnics (parasympathetics) and hypogastric nn. (sympathetics)

So it is mixed

91
Q

Describe innervation of the rectum

A

Sympathetics from: lumbar splanchnics (L1, L2) which synapse in inferior mesenteric ganglia and travel to superior mesenteric plexus to R and L hypogastric nn. to get to inferior hypogastric plexus to get to recutm

Parasympathetics go through pelvic splanchnics to pelvic plexus and anything above pectinate line

[below pectinate line, there is somatic innervation via pudendal n. and branches that supply distal rectum]

92
Q

Visceral afferent pain fibers travel with sympathetics. What is the exception to this?

A

They travel with parasympathetics BELOW the pelvic pain line

The pelvic pain line corresponds to inferior limit of peritoneum; for GI tract this is the middle of the sigmoid colon

93
Q

Visceral reflexes travel with what nerve fibers?

A

Parasympathetics

94
Q

What branches off the L gastric a.? What does its branch anastomose with?

A

Esophageal branch - anastomosis with esophageal aa. in the thorax

95
Q

Is the L gastric a. intraperitoneal or retroperitoneal? If intraperitoneal, in which omenta, ligament, or mesentery is it located in?

A

Intraperitoneal

Hepatogastric ligament
Lesser omentum

96
Q

3 primary branches of celiac trunk

A

L gastric a.
Splenic a.
Common hepatic a.

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