Blood supply to the trunk

Question 1

Parts of the thoracic aorta

Answer 1

Ascending
Arch (front to back)
Descending

Question 2

Branches of the ascending aorta

Answer 2

Left and Right Coronary arteries

Question 3

Branches of the arch of the aorta

Answer 3

Brachiocephalic trunk
Left common carotid
Left subclavian

Question 4

What do the brachiocephalic trunk bifurcate into?

Answer 4

Right common carotid and right subclavian

Question 5

What do the common carotid arteries bifurcate into?

Answer 5

External and internal

Question 6

What do the paired subclavian arteries supply?

Answer 6

Upper limbs, head, neck (branches)

Question 7

When do the common carotid arteries bifurcate?

Answer 7

C3/C4 level into internal and external carotid arteries (Adam’s apple)

Question 8

What do the common carotid arteries supply?

Answer 8

Head and neck

Question 9

Which arteries supply the brain?

Answer 9

Vertebral artery (deep to carotid), subclavian branches, internal carotid (combine)

Question 10

Describe the position of the descending aorta

Answer 10

Loops back over the hilum of left lung into the posterior mediastinum

Question 11

What does the posterior mediastinum contain?

Answer 11

Oesophagus
Thoracic duct
Azygos Vein
L and R vagus nerves
L and R Sympathetic trunk

Question 12

What are the branches of the descending aorta and what do they supply?

Answer 12

3 bronchial arteries- lung walls (not pulmonary)
9 pairs of posterior intercostal arteries- rib cage
2 oesophageal arteries- oesophagus
Some branches to mediastinum, pericardium, diaphragm

Question 13

Describe the arrangement of intercostal arteries

Answer 13

Intercostal Neurovascular bundle- Vein- Artery- Nerve

(VAN)- superior to deep

Question 14

What are the intercostal arteries formed by?

Answer 14

Posterior= descending thoracic aorta
Anterior= L and R Internal thoracic arteries

Question 15

Where do the internal thoracic arteries come from?

Answer 15

Left and Right Subclavian arteries

Question 16

What are the two main routes for venous return to the heart?

Answer 16

Superior vena cava= head, neck, upper limbs
Inferior vena cava= Abdomen, pelvis, lower limbs
(Coronary sinus)
(Azygous system of the thorax)

Question 17

Describe the superior vena cava

Answer 17

Formed by unification of brachiocephalic veins
Receives azygous vein (drains thorax)
Carries deoxygenated blood back to right atrium

Question 18

What is the difference between the Left and Right brachiocephalic veins?

Answer 18

L= long and horizontal
R= short and vertical

Question 19

Describe the brachiocephalic veins

Answer 19

Formed by unification of subclavian and internal jugular veins on each side (draining blood from upper limbs and head and neck respectively)
Forms venous angle when they join- L shape

Question 20

Describe the azygos venous system

Answer 20

Receives blood from posterior thoracic wall (intercostal veins), bronchi, mediastinal viscera (organs)
Forms link between I. vena cava and S. vena cava
Drains into the SVC

Question 21

What are the veins of the azygos venous system?

Answer 21

Azygos vein
Hemiazygos vein
Accessory Hemiazygos vein

Question 22

What are the other features of the chest wall vasculature?

Answer 22

Thoracic duct (lymphatic vessel)
Descending aorta
Intercostal neurovascular bundle (VAN)
Internal thoracic artery

Question 23

Which major blood vessel gives rise to anterior intercostal arteries?

Answer 23

Internal thoracic artery

Question 24

Which major blood vessel gives rise to posterior intercostal arteries?

Answer 24

Thoracic aorta

Question 25

What are the vertebral levels to the arteries of the abdominal vasculature?

Answer 25

• Common Iliac= L4
• Left renal= L1
• Coeliac trunk= T12
• Superior mesenteric= L1
• Inferior mesenteric= L3
• Gonadal= L2

Question 26

Which vein does the left gonadal vein drain blood into?

Answer 26

Left renal vein

Question 27

Which vein does the right gonadal vein drain blood into?

Answer 27

Inferior vena cava

Question 28

At what vertebral level is the aortic hiatus?

Answer 28

T12

Question 29

At what vertebral level does the abdominal aorta bifurcate into the right and left common iliac arteries?

Answer 29

L4

Question 30

What are the three clinical consequences of portal hypertension?

Answer 30

Liver disease, varices, caput medusa, anorectal varices, oesophageal varices

Question 31

Describe what happens to the common iliac artery through bifurcation

Answer 31

• Forms at bifurcation of abdominal aorta
• Bifurcates into internal and external iliac arteries
• Internal iliac enters pelvis to supply majority of pelvic viscera
• External iliac exits cavity deep to the inguinal ligament to become femoral artery, to provide blood supply to regions of the lower limb

Question 32

At what point does the inferior mesenteric vein unite with other veins to form the hepatic portal vein and why does it not show up on angiograms?

Answer 32

• Typically unites with splenic vein prior to portal veins but variable- may also drain into superior mesenteric or point of formation for HPV
• I.M. vein drains the region which is supplied by the I.M. artery which is not filled with contrast agent so venous return does not contain agent

Question 33

Describe lymphatic drainage

Answer 33

• Lymphatic drainage of a region follows the arterial supply to that structure, but flowing in the opposite direction
• Lymph nodes are found at junction points- where the lower limb joins the trunk (inguinal) and where the upper body joins the trunk (axillary)
• They are also found along the blood vessels (internal and external iliac, para-aortic)
• Majority of lymph vessels from abdominal and lumbar regions converge to form the cisterna chyli in the upper abdomen
• Continues as thoracic duct in thorax to ultimately re-enter the venous system at the junction of the left subclavian vein and left jugular vein

Question 34

What are the primary lymphatic drainage systems?

Answer 34

• Cervical lymph nodes
• Infraclavicular nodes
• Thoracic duct
• Cisterna chyli
• Para-aortic nodes
• External iliac nodes
• Inguinal nodes