Hulka Abdominal Blood Supply Flashcards
Where does the abdominal aorta begin? Where does it end?
Begins @ aortic hiatus as it gets thru the abdomen
thru the diaphragm @ the T12-L1 vertebral level
Ends @ the division into common iliac arteries
above the pelvis @ the L4-5 vertebral level
What is the first branch off the aorta? What do these supply?
phrenic arteries
the diaphragm & the adrenal arteries
What is the first mesenteric branch off the aorta? What vertebral level does this arise from? What are its 3 branches?
celiac trunk
T12 vertebral level
3 branches: left gastric, common hepatic, Splenic
What is the journey of the left gastric artery off the celiac trunk?
it goes off toward the left & then goes toward the stomach
supplies:
lower esophagus
lesser curvature of the stomach
What branches off of the left gastric artery?
esophageal branches
What is the journey of the common hepatic artery?
exits the celiac trunk & goes to the right
goes behind the stomach to the liver
provides blood supply to lower stomach, liver, & duodenum
What are the 2 branches of the common hepatic artery & where do they go?
Common Hepatic Artery–>Gastroduodenal artery + proper hepatic artery
Gastroduodenal goes to duodenum & pancreas
Proper hepatic artery supplies the liver
The splenic artery that came off of the celiac trunk…where does that go?
goes to the left after it goes off the celiac trunk
goes behind the stomach & along the pancreas to the spleen
Provides blood supply: upper stomach, pancreas, spleen
What are the 3 branches of the splenic artery?
pancreatic branches, supply the superior portion of the pancreas
short gastric branches, supply greater curvature of the stomach
left gastro-omental artery–supply greater curvature of the stomach
What is the second mesenteric branch of the abdominal aorta?
SMA
@ L1 level
behind the pancreas
What are the branches off the SMA?
inferior pancreaticoduodenal jejunal & ileal ileocolic right colic middle colic
What’s the deal w/ the inferior pancreaticoduodenal artery?
there are anterior & posterior arteries
it goes around the C-loop of the duodenum & the head of the pancreas
provides blood supply to duodenum & head of pancreas
How many branches are there off of the jejunal & ileal arteries? Where are they found?
15-18 branches
found in the mesentery of the bowel
provide blood supply to the small bowel
What’s the deal w/ the ileocolic artery?
it’s the most distal branch of the SMA
found in the mesentery of the bowel
provides blood supply to the terminal ileum & cecum
What does the right colic artery provide a blood supply to?
the right colon
What does the middle colic artery supply?
the transverse colon
Where does the IMA arise?
it branches off of the abdominal aorta
it comes in @ the L3 level
it is inferior to the renal arteries
What are the branches off of the IMA?
Left colic artery
sigmoidal branches
superior rectal artery
What does the left colic artery supply?
provides blood supply to the left colon from the splenic flexure to the sigmoid colon
What do the sigmoid branches of the IMA supply?
the sigmoid colon
What does the superior rectal branch supply?
this gives the blood supply to the superior rectum
What is the collateral flow pathway b/w the celiac trunk & the SMA?
Common Hepatic Artery
Gastroduodenal Artery
Superior Pancreaticoduodenal artery
Inferior pancreaticoduodenal artery (SMA)
What is the collateral flow pathway that connects the SMA & IMA?
SMA Middle Colic Artery Marginal Artery of Drummond Arc of Riolan Left Colic Artery (IMA)
What is the collateral flow pathway b/w the IMA & iliac arteries?
IMA
Superior Rectal Artery
Middle & Inferior Rectal Arteries (Iliac arteries)
Where do the renal branches come off of?
the abdominal aorta @ about L2, in b/w the SMA & IMA
Where do the gonadal arteries come off?
around L2 level off the abdominal aorta
What are the lumbar arteries? Where do they come off? What do they supply?
come off of each lumbar level
anterior & posterior types
supply musculature of the back & spinal cord
What do the anterior branches of the lumbar arteries supply?
supply the anterior & lateral abdominal wall
collateralizes w/ the inferior epigastric artery
What do the posterior branches of the lumbar arteries supply?
supply the spinal cord & erector spine muscles
branch into radicular arteries
What do the radicular arteries supply?
they are spinal arteries that supply each nerve level, come off b/w T7-T11
largest one: Spinal Artery of Adamkiewicz
What is the journey of the IVC?
Starts @ the confluence of the common iliac veins @ L5 level
ascends to the right of the abdominal aorta
runs behind the liver & thru the diaphragm & into the right atrium
Where do the renal veins drain into the IVC? Do they run anterior or posterior to the aorta?
@ the L2 level
run anterior to the aorta
Where do the gonadal veins dump into the venous drainage/IVC?
@ L2 level
Where does the left gonadal vein drain?
left gonadal vein drains into the left renal vein
Where does the right gonadal vein drain?
right gonadal vein drains directly into the IVC
Describe the hepatic veins that drain into the IVC.
3 branches, hepatic veins drain directly into the IVC
right, middle, & left hepatic veins
What’s the deal w/ the lumbar veins?
there are 4-5 pairs of them coming off of each lumbar vertebral level
they unite into the R & L ascending lumbar veins
What is the journey of the R ascending lumbar vein?
R ascending lumbar vein becomes the azygos vein
**it enters the thorax & goes into central circulation
What is the journey of the L ascending lumbar vein?
L ascending lumbar vein becomes the hemiazygos vein
**enters the thorax & general circulation
Where does the mesentery drain?
it drains into the hepatic system before entering the systemic circulation
Describe the veins that empty into the portal vein.
IMV joins the splenic vein. The SMV joins the IMV/splenic vein.
this uniting forms the portal vein
What does the IMV drain?
descending colon
sigmoid colon
What does the SMV drain?
this drains the small bowel, right colon & transverse colon
What drains the esophagus? What drains the stomach?
Esophagus–>esophageal veins
Stomach–>gastric veins
How does portal HTN happen?
cirrhosis to the liver causes so much scarring that hepatopedal flow is inhibited & there is increased venous pressure in the system. The venous system distends & the veins of the esophagus, stomach, spleen & intestines are engorged/enlarged.
What is the cardiac orifice?
where the stomach begins, right after the gastro-esophageal junction
Where is the fundus of the stomach?
superior portion of the stomach, above the cardiac orifice.
Where is the body of the stomach?
b/w fundus & antrum
b/w cardiac orifice & vein of mayo
Where is the antrum of the stomach?
where the vein of Mayo crosses the stomach, the lesser curvature angle–>pyloric canal
this is where all of the acid is produced!!
Which part of the stomach controls gastric emptying?
the pylorus
Before H2 blockers were discovered, what surgical interventions were performed for people w/ peptic ulcer disease?
cutting out the antrum of the stomach
cutting off the vagus nerves to the stomach–>side effect was difficulty w/ gastric emptying
What do you do to treat pyloric stenosis in kids?
cutting the pyloric muscle to open the canal
What is the area behind the stomach known as?
the lesser sac
which part of the liver touches the stomach?
left lobe
Which part of the stomach is next to the diaphragm & spleen?
fundus
Where is the pancreas located w/ respect to the stomach?
it sits behind the stomach
Describe the nerve supply to the stomach.
The L & R Vagus nerves provide motor stimulation to the stomach & also prompt the antrum to secrete acid.
How does the R vagus innervate the stomach?
The R vagus becomes the posterior vagal trunk. It innervates the posterior wall of the stomach.
How does the L vagus innervate the stomach?
The L vagus becomes the anterior vagal trunk. It innervates the anterior wall of the stomach & the liver & duodenum.
Where are the pancreaticolineal lymph nodes located?
along the splenic artery
What are the 5 main lymph nodes near the stomach & where do they drain to?
I. Left Gastric Lymph Nodes 2. Gastro-omental Lymph Nodes 3. Pyloric Lymph Nodes 4. Pancreaticolineal lymph nodes 5. Right Gastric Lymph Nodes All drain into celiac lymph nodes this drains into the cisterna chyle. This drains into the thoracic duct.
The blood supply to the stomach comes from all angles of the celiac axis. Explain this.
Abdominal Aorta Celiac Trunk Common Hepatic: -Gastroduodenal *Right Gastro-omental artery -Proper Hepatic *Right Gastric Artery Left Gastric Artery Splenic Artery: -Left Gastro-omental artery -Short Gastric Arteries
Which of the arteries supplying the stomach enters @ the lesser curvature?
Right Gastric Artery
Left Gastric Artery
Which of the arteries supplying the stomach enters @ the greater curvature?
Short Gastric Arteries
Left Gastro-omental artery
Right gastro-omental artery
Which of the arteries supplying the stomach enters near the hepatogastric ligament?
Left Gastric Artery
Right Gastric Artery
Which of the arteries supplying the stomach enters near the gastrolineal ligament?
Short Gastric Arteries
Left Gastro-omental Artery
Describe the venous drainage of the stomach.
The R & L gastric veins drain into the portal vein
The R gastro-omental vein drains into the SMV
The L gastro-omental vein drains into the splenic vein.
