Blood & Nerve Supply To Abdominal Organs-1/6/16 Flashcards
Define the relationships to the aorta:
A) IVC
B) Left renal vein
C) anterior longitudinal ligament and vertebral bodies
D) Thoracic duct & cisterna chyli
E) Duodenum, pancreas, and root of the mesentery
A) right B) anterior C) posterior D) right E) anterior
Where does a AAA usually arise?
Usually arises below the renal arteries and above the aortic bifurcation
The celiac trunk branches from the aorta at about ____ vertebral level
T12 or L1
List the following of the celiac trunk:
A) Parasympathetic innervation
B) Sympathetic innervation
C) Structures supplied
A) Vagus
B) T5-T9 Greater splanchnic n
C) Stomach, 1st and 2nd part of duodenum, liver, gallbladder, pancreas, spleen (mesoderm)
What are the 3 main branches coming off of the celiac trunk?
Left gastric a, Splenic a, Common hepatic a
Describe the Left gastric a. (Off of celiac trunk)
Gives off esophageal branches, will follow lesser curvature of stomach, anastomoses with Right Gastric a. Along lesser curvature
Describe the Splenic a. (Off of celiac trunk) and name its branches
Runs posterior to the stomach, VERY TORTUOUS, within splenorenal ligament, ends as several splenic aa. (Do no anastomose)
Gives off a Short Gastric aa.- upper part of greater curvature
Gives off Left Gastro-omental a. - greater curvature of stomach, anastomoses with Right Gastro-omental a.
Gives off Pancreatic branches- Dorsal pancreatic a. And Inferior pancreatic a.
Describe the Common Hepatic a. (Off of Celiac trunk) and name its branches
Gives off a Proper hepatic a (superior) which bifurcates into right and left hepatic arteries; Cystic a. Is usually a branch off of Right hepatic a.; It also gives off the Right gastric a which anastomoses with the Left gastric a.
Gives off Gastro-duodenal a (inferior) which runs posterior to duodenum and bifurcates into Right Gastro-omental a. And Superior Pancreaticoduodenal a. (Bifurcates into anterior and posterior)
This ligament surrounds the portal triad
Hepatoduodenal ligament
Before surgically removing the gall bladder (cholecystectomy), this artery must be ligated after dissecting through the hepatoduodenal ligament
Cystic a.
Define the borders of Calot’s Triangle (for gall bladder removal)
Medially-Common Hepatic Duct
Laterally-Cystic duct
Superiorly-Edge of liver
Cystic a. Crosses the middle of the triangle
Calot’s node- main route of lymphatic drainage of gallbladder
This vein is formed by the union of the splenic and superior mesenteric veins
Portal vein
Where does the SMA arise?
1 cm inferior to celiac trunk and emerges from aorta posterior to the neck of the pancreas
It is located to the left of the superior mesenteric v.
It enters THE mesentery and runs between the layers of THE mesentery with veins and lymphatic vessels
These abdominal organs receive anastomotic branches from both the celiac and SMA
Pancreas & Duodenum
Celiac gives rise to superior pancreaticoduodenal a
SMA branches anastomose with the branches of the celiac forming arcades on the anterior and posterior surfaces of the pancreas
List the branches to the small intestine off of the SMA
Inferior pancreatico-duodenal a.
Jejunal arteries–> long vasa recta, simple arcades
Ileal arteries –> complex arcades, short vasa recta
These all branch to the left from the SMA
List the branches to the large intestine off of the SMA
Ileocolic a. (Ileal branch, colic branch, anterior and posterior cecal branches, appendicular branch)
Right colic a.
Middle colic a.
Name the branches of the ileocolic a. (Off of SMA)
Ileal branches
Colic branches–> anterior cecal branch, posterior cecal branch, appendicular branch
Ascending colic branch
This main branch off of the SMA goes to the ascending colon as far as the hepatic flexure
Right colic a.
This main branch off of the SMA goes from the hepatic flexure to or near the splenic flexure
Middle colic a.
This artery off of the SMA is a more or less continuous artery that parallels the margin of the colon and is formed by anastomotic branches of the ileocolic, right colic, middle colic, and left colic arteries.
It is clinically important because it makes it possible to cut and remove parts of the colon and re-anastomose them while still maintaining their blood supply
Marginal a. (Of Drummond)
The superior mesenteric plexus (of nerves) contains:
1) Sympathetic fibers from greater, lesser, least splanchnic nerves
2) Sympathetic (prevertebral) ganglia
3) Parasympathetic fibers from the vagus n.
4) Afferent fibers –> General Visceral Afferent and Autonomic Visceral Afferent
The IMA supplies derivatives of the hindgut which include:
Left colic flexure (splenic flexure), descending colon, sigmoid colon, and rectum (superior)
List the main branches of the IMA
Left colic a (ascending and descending branch)
Sigmoid arteries
Superior rectal a.
*Marginal a.
This branch of the IMA supplies the left colic flexure (splenic) and part of descending colon
Ascending branch of left colic a.
This branch of the IMA supplies the descending colon and the upper sigmoid colon
Descending branch of the left colic a.
This main branch of the IMA has ~3-5 branches that supply the sigmoid colon
Sigmoid arteries
This IMA branch is clinically important because there is no anastomosis and blood supply must be preserved during surgery
Superior rectal a.
This vein helps to locate and define the paraduodenal fold and fossa. It can empty into the splenic v., superior mesenteric v., or into the junction of the splenic v and superior mesenteric v
Inferior mesenteric vein
Innervation to the hindgut is from:
A) sympathetics from greater, lesser, least splanchnic nerves–> synapse in inferior mesenteric ganglion or small individual aortic ganglia and follow branches of the IMA to their target organs; GVA pain fibers carried within sympathetics
B) Parasympathetics from S2-S4 which are the PELVIC SPLANCHNIC NERVES
What is the etiology of ischemic colitis?
Atherosclerosis, severe hypotension, blood clot or venous thrombosis, lupus or sickle cell, cocaine
Where does the superior rectal vein drain?
Where does the middle rectal vein drain?
Where does the inferior rectal vein drain?
To inferior mesenteric vein
To internal iliac vein
To internal pudendal vein
The intestinal lymphatic trunk and lumbar lymphatic trunk drain into the:
Cisterna chyli (chyle cistern)
The enteric NS is composed of a series of ganglionic nerve plexi contained within the gut wall. What are the 2 components?
1) Myenteric (Auerbach’s) plexus–> between outer longitudinal and inner circular muscle layers; Motility
2) Submucosal (Meissner’s) plexus –> Secretions, blood flow, absorption
This disease is characterized by a failure of neural crest cells to migrate during intestinal development and individuals do not have a myenteric plexus (biopsy must be taken from muscularis mucosa). There are no parasympathetics so the gut cannot relax, causing constriction and megacolon of the proximal colon segments.
Down syndrome babies are at higher risk
Hirschsprung disease
This disease is characterized by a Megacolon and the pathogen T. Cruzi which destroys the ANS, mainly the myenteric plexus
Chagas disease
Where does the abdominal aorta begin? Where does it terminate?
Begins at T12, ends at L4
