Blood & Nerve Supply To Abdominal Organs-1/6/16

Question 1

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

Answer 1

A) right 
B) anterior
C) posterior
D) right
E) anterior

Question 2

Where does a AAA usually arise?

Answer 2

Usually arises below the renal arteries and above the aortic bifurcation

Question 3

The celiac trunk branches from the aorta at about ____ vertebral level

Answer 3

T12 or L1

Question 4

List the following of the celiac trunk:
A) Parasympathetic innervation
B) Sympathetic innervation
C) Structures supplied

Answer 4

A) Vagus
B) T5-T9 Greater splanchnic n
C) Stomach, 1st and 2nd part of duodenum, liver, gallbladder, pancreas, spleen (mesoderm)

Question 5

What are the 3 main branches coming off of the celiac trunk?

Answer 5

Left gastric a, Splenic a, Common hepatic a

Question 6

Describe the Left gastric a. (Off of celiac trunk)

Answer 6

Gives off esophageal branches, will follow lesser curvature of stomach, anastomoses with Right Gastric a. Along lesser curvature

Question 7

Describe the Splenic a. (Off of celiac trunk) and name its branches

Answer 7

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.

Question 8

Describe the Common Hepatic a. (Off of Celiac trunk) and name its branches

Answer 8

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)

Question 9

This ligament surrounds the portal triad

Answer 9

Hepatoduodenal ligament

Question 10

Before surgically removing the gall bladder (cholecystectomy), this artery must be ligated after dissecting through the hepatoduodenal ligament

Answer 10

Cystic a.

Question 11

Define the borders of Calot’s Triangle (for gall bladder removal)

Answer 11

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

Question 12

This vein is formed by the union of the splenic and superior mesenteric veins

Answer 12

Portal vein

Question 13

Where does the SMA arise?

Answer 13

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

Question 14

These abdominal organs receive anastomotic branches from both the celiac and SMA

Answer 14

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

Question 15

List the branches to the small intestine off of the SMA

Answer 15

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

Question 16

List the branches to the large intestine off of the SMA

Answer 16

Ileocolic a. (Ileal branch, colic branch, anterior and posterior cecal branches, appendicular branch)
Right colic a.
Middle colic a.

Question 17

Name the branches of the ileocolic a. (Off of SMA)

Answer 17

Ileal branches
Colic branches–> anterior cecal branch, posterior cecal branch, appendicular branch
Ascending colic branch

Question 18

This main branch off of the SMA goes to the ascending colon as far as the hepatic flexure

Answer 18

Right colic a.

Question 19

This main branch off of the SMA goes from the hepatic flexure to or near the splenic flexure

Answer 19

Middle colic a.

Question 20

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

Answer 20

Marginal a. (Of Drummond)

Question 21

The superior mesenteric plexus (of nerves) contains:

Answer 21

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

Question 22

The IMA supplies derivatives of the hindgut which include:

Answer 22

Left colic flexure (splenic flexure), descending colon, sigmoid colon, and rectum (superior)

Question 23

List the main branches of the IMA

Answer 23

Left colic a (ascending and descending branch)
Sigmoid arteries
Superior rectal a.
*Marginal a.

Question 24

This branch of the IMA supplies the left colic flexure (splenic) and part of descending colon

Answer 24

Ascending branch of left colic a.

Question 25

This branch of the IMA supplies the descending colon and the upper sigmoid colon

Answer 25

Descending branch of the left colic a.

Question 26

This main branch of the IMA has ~3-5 branches that supply the sigmoid colon

Answer 26

Sigmoid arteries

Question 27

This IMA branch is clinically important because there is no anastomosis and blood supply must be preserved during surgery

Answer 27

Superior rectal a.

Question 28

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

Answer 28

Inferior mesenteric vein

Question 29

Innervation to the hindgut is from:

Answer 29

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

Question 30

What is the etiology of ischemic colitis?

Answer 30

Atherosclerosis, severe hypotension, blood clot or venous thrombosis, lupus or sickle cell, cocaine

Question 31

Where does the superior rectal vein drain?

Where does the middle rectal vein drain?

Where does the inferior rectal vein drain?

Answer 31

To inferior mesenteric vein

To internal iliac vein

To internal pudendal vein

Question 32

The intestinal lymphatic trunk and lumbar lymphatic trunk drain into the:

Answer 32

Cisterna chyli (chyle cistern)

Question 33

The enteric NS is composed of a series of ganglionic nerve plexi contained within the gut wall. What are the 2 components?

Answer 33

1) Myenteric (Auerbach’s) plexus–> between outer longitudinal and inner circular muscle layers; Motility
2) Submucosal (Meissner’s) plexus –> Secretions, blood flow, absorption

Question 34

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

Answer 34

Hirschsprung disease

Question 35

This disease is characterized by a Megacolon and the pathogen T. Cruzi which destroys the ANS, mainly the myenteric plexus

Answer 35

Chagas disease

Question 36

Where does the abdominal aorta begin? Where does it terminate?

Answer 36

Begins at T12, ends at L4