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Block 3; Week 1 > Hulka Abdominal Blood Supply > Flashcards

Hulka Abdominal Blood Supply Flashcards

1
Q

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

A

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

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2
Q

What is the first branch off the aorta? What do these supply?

A

phrenic arteries

the diaphragm & the adrenal arteries

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3
Q

What is the first mesenteric branch off the aorta? What vertebral level does this arise from? What are its 3 branches?

A

celiac trunk
T12 vertebral level
3 branches: left gastric, common hepatic, Splenic

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4
Q

What is the journey of the left gastric artery off the celiac trunk?

A

it goes off toward the left & then goes toward the stomach
supplies:
lower esophagus
lesser curvature of the stomach

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5
Q

What branches off of the left gastric artery?

A

esophageal branches

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6
Q

What is the journey of the common hepatic artery?

A

exits the celiac trunk & goes to the right
goes behind the stomach to the liver
provides blood supply to lower stomach, liver, & duodenum

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7
Q

What are the 2 branches of the common hepatic artery & where do they go?

A

Common Hepatic Artery–>Gastroduodenal artery + proper hepatic artery
Gastroduodenal goes to duodenum & pancreas
Proper hepatic artery supplies the liver

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8
Q

The splenic artery that came off of the celiac trunk…where does that go?

A

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

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9
Q

What are the 3 branches of the splenic artery?

A

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

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10
Q

What is the second mesenteric branch of the abdominal aorta?

A

SMA
@ L1 level
behind the pancreas

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11
Q

What are the branches off the SMA?

A 
inferior pancreaticoduodenal
jejunal & ileal
ileocolic
right colic
middle colic
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12
Q

What’s the deal w/ the inferior pancreaticoduodenal artery?

A

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

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13
Q

How many branches are there off of the jejunal & ileal arteries? Where are they found?

A

15-18 branches
found in the mesentery of the bowel
provide blood supply to the small bowel

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14
Q

What’s the deal w/ the ileocolic artery?

A

it’s the most distal branch of the SMA
found in the mesentery of the bowel
provides blood supply to the terminal ileum & cecum

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15
Q

What does the right colic artery provide a blood supply to?

A

the right colon

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16
Q

What does the middle colic artery supply?

A

the transverse colon

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17
Q

Where does the IMA arise?

A

it branches off of the abdominal aorta
it comes in @ the L3 level
it is inferior to the renal arteries

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18
Q

What are the branches off of the IMA?

A

Left colic artery
sigmoidal branches
superior rectal artery

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19
Q

What does the left colic artery supply?

A

provides blood supply to the left colon from the splenic flexure to the sigmoid colon

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20
Q

What do the sigmoid branches of the IMA supply?

A

the sigmoid colon

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21
Q

What does the superior rectal branch supply?

A

this gives the blood supply to the superior rectum

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22
Q

What is the collateral flow pathway b/w the celiac trunk & the SMA?

A

Common Hepatic Artery
Gastroduodenal Artery
Superior Pancreaticoduodenal artery
Inferior pancreaticoduodenal artery (SMA)

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23
Q

What is the collateral flow pathway that connects the SMA & IMA?

A 
SMA
Middle Colic Artery
Marginal Artery of Drummond
Arc of Riolan
Left Colic Artery (IMA)
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24
Q

What is the collateral flow pathway b/w the IMA & iliac arteries?

A

IMA
Superior Rectal Artery
Middle & Inferior Rectal Arteries (Iliac arteries)

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25
Q

Where do the renal branches come off of?

A

the abdominal aorta @ about L2, in b/w the SMA & IMA

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26
Q

Where do the gonadal arteries come off?

A

around L2 level off the abdominal aorta

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27
Q

What are the lumbar arteries? Where do they come off? What do they supply?

A

come off of each lumbar level
anterior & posterior types
supply musculature of the back & spinal cord

28
Q

What do the anterior branches of the lumbar arteries supply?

A

supply the anterior & lateral abdominal wall

collateralizes w/ the inferior epigastric artery

29
Q

What do the posterior branches of the lumbar arteries supply?

A

supply the spinal cord & erector spine muscles

branch into radicular arteries

30
Q

What do the radicular arteries supply?

A

they are spinal arteries that supply each nerve level, come off b/w T7-T11
largest one: Spinal Artery of Adamkiewicz

31
Q

What is the journey of the IVC?

A

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

32
Q

Where do the renal veins drain into the IVC? Do they run anterior or posterior to the aorta?

A

@ the L2 level

run anterior to the aorta

33
Q

Where do the gonadal veins dump into the venous drainage/IVC?

A

@ L2 level

34
Q

Where does the left gonadal vein drain?

A

left gonadal vein drains into the left renal vein

35
Q

Where does the right gonadal vein drain?

A

right gonadal vein drains directly into the IVC

36
Q

Describe the hepatic veins that drain into the IVC.

A

3 branches, hepatic veins drain directly into the IVC

right, middle, & left hepatic veins

37
Q

What’s the deal w/ the lumbar veins?

A

there are 4-5 pairs of them coming off of each lumbar vertebral level
they unite into the R & L ascending lumbar veins

38
Q

What is the journey of the R ascending lumbar vein?

A

R ascending lumbar vein becomes the azygos vein

**it enters the thorax & goes into central circulation

39
Q

What is the journey of the L ascending lumbar vein?

A

L ascending lumbar vein becomes the hemiazygos vein

**enters the thorax & general circulation

40
Q

Where does the mesentery drain?

A

it drains into the hepatic system before entering the systemic circulation

41
Q

Describe the veins that empty into the portal vein.

A

IMV joins the splenic vein. The SMV joins the IMV/splenic vein.
this uniting forms the portal vein

42
Q

What does the IMV drain?

A

descending colon

sigmoid colon

43
Q

What does the SMV drain?

A

this drains the small bowel, right colon & transverse colon

44
Q

What drains the esophagus? What drains the stomach?

A

Esophagus–>esophageal veins

Stomach–>gastric veins

45
Q

How does portal HTN happen?

A

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.

46
Q

What is the cardiac orifice?

A

where the stomach begins, right after the gastro-esophageal junction

47
Q

Where is the fundus of the stomach?

A

superior portion of the stomach, above the cardiac orifice.

48
Q

Where is the body of the stomach?

A

b/w fundus & antrum

b/w cardiac orifice & vein of mayo

49
Q

Where is the antrum of the stomach?

A

where the vein of Mayo crosses the stomach, the lesser curvature angle–>pyloric canal
this is where all of the acid is produced!!

50
Q

Which part of the stomach controls gastric emptying?

A

the pylorus

51
Q

Before H2 blockers were discovered, what surgical interventions were performed for people w/ peptic ulcer disease?

A

cutting out the antrum of the stomach

cutting off the vagus nerves to the stomach–>side effect was difficulty w/ gastric emptying

52
Q

What do you do to treat pyloric stenosis in kids?

A

cutting the pyloric muscle to open the canal

53
Q

What is the area behind the stomach known as?

A

the lesser sac

54
Q

which part of the liver touches the stomach?

A

left lobe

55
Q

Which part of the stomach is next to the diaphragm & spleen?

A

fundus

56
Q

Where is the pancreas located w/ respect to the stomach?

A

it sits behind the stomach

57
Q

Describe the nerve supply to the stomach.

A

The L & R Vagus nerves provide motor stimulation to the stomach & also prompt the antrum to secrete acid.

58
Q

How does the R vagus innervate the stomach?

A

The R vagus becomes the posterior vagal trunk. It innervates the posterior wall of the stomach.

59
Q

How does the L vagus innervate the stomach?

A

The L vagus becomes the anterior vagal trunk. It innervates the anterior wall of the stomach & the liver & duodenum.

60
Q

Where are the pancreaticolineal lymph nodes located?

A

along the splenic artery

61
Q

What are the 5 main lymph nodes near the stomach & where do they drain to?

A 
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.
62
Q

The blood supply to the stomach comes from all angles of the celiac axis. Explain this.

A 
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
63
Q

Which of the arteries supplying the stomach enters @ the lesser curvature?

A

Right Gastric Artery

Left Gastric Artery

64
Q

Which of the arteries supplying the stomach enters @ the greater curvature?

A

Short Gastric Arteries
Left Gastro-omental artery
Right gastro-omental artery

65
Q

Which of the arteries supplying the stomach enters near the hepatogastric ligament?

A

Left Gastric Artery

Right Gastric Artery

66
Q

Which of the arteries supplying the stomach enters near the gastrolineal ligament?

A

Short Gastric Arteries

Left Gastro-omental Artery

67
Q

Describe the venous drainage of the stomach.

A

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.

Block 3; Week 1 (11 decks)

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