L5 GI Vascular Supply & Innervation Flashcards
Name the vascular supply of the foregut, midgut & hindgut
Celiac trunk, superior mesenteric artery, inferior mesenteric artery
Embryonic foregut becomes which adult organs
lower esophagus
stomach
duodenum (middle & descending)
liver
gallbladder
pancreas
Branches of the celiac trunk that supply derivatives of the embryonic foregut are:
left gastric artery, splenic artery, common hepatic artery
The left gastric artery supplies:
lower esophagus & stomach
Splenic artery supplies the:
pancreas, spleen & stomach
Branches of the common hepatic artery are:
gastroduodenal artery & proper hepatic artery
Gastroduodenal artery supplies:
stomach, head of pancreas, duodenum.
posterior surface ulcer that bleeds comes from this artery.
celiac trunk–>common hepatic artery–>gastroduodenal artery
Proper hepatic artery supplies the:
liver, gallbladder & stomach
The stomach receives vasculature from all three branches of the celiac trunk.
Posterior duodenal ulcers erode directly which arteries?
gastroduodenal artery or posterior superior pancreaticoduodenal artery ( branch of gastroduodenal a)
Anterior duodenal ulcers erode into peritoneal cavity leading to peritonitis.
The embryonic midgut forms the adult:
- Duodenum (distal to its union with the bile and pancreatic ducts)
- Jejunum & ileum
- Cecum & appendix
- Ascending colon
- Transverse colon
Ascending & transverse colon are proximal to splenic flexure
Branches of the superior mesenteric artery:
- inferior pancreaticoduodenal a.
- intestinal branches to jejunum & ileum (jejunal & ileal a.)
- middle colic a.
- right colic a.
- ileocolic a.
Embryonic hindgut forms the adult:
- Descending colon
- Sigmoid colon
- Rectum and anal canal
Branches of the inferior mesenteric artery:
- left colic a.
- sigmoid a.
- superior rectal a.
what is the marginal artery
anastomoses of inferior & superior mesenteric arteries
function: prevent infarction if there is a bowel obstruction or a need to ligate.
Hepatic portal vein is formed by
- splenic v.
- superior mesenteric v.
- inferior mesenteric v.
Venous blood from the GI goes to the liver (carrying nutrients) via hepatic portal vein
consequence: cancer of the GI may metastasize to the liver
Describe the portal-systemic anastomoses:
hepatic portal vein anastomoses with tributaries of the systemic venous system
resistance to portal blood flow (portal hypertension) may cause dilation
What are the manifestations of portal hypertension (dilation of the portacava anastomoses)?
- blood w/emesis (esophageal varices)
- hemorrhoids
- caput medusae
Define lymphoma.
Enlarged lymph nodes.
(certain infections and metastatic malignant spread of certain cancers e.g colon cancer. May need surgical resection)
Lymph nodes & vessels are associated with which abdominal structures?
- Aorta
- IVC
- Iliac vessels
Which nodes make up the para-aortic nodes (lymphatic drainage of the abdominal viscera)?
right and left lateral aortic (lumbar nodes)
Which nodes make up the pre-aortic nodes (lymphatic drainage of the abdominal viscera)?
- superior mesenteric
- inferior mesenteric
- celiac
Para-aortic nodes (lumbar) drain which structures of the abdominal viscera?
- body wall
- kidneys
- adrenal glands
- testes or ovaries
- uterus and uterine tubes
(collect to form right and left lumbar trunks)
Where is the cisterna chyli located? What is it?
- right side of abdominal aorta (LV1 & LV2)
- confluence of all trunks (saccular dilation)
Name the pre-vertebral ganglia that provide sympathetic innervation to the abdominal organs.
- celiac ganglia
- superior mesenteric ganglia
- inferior mesenteric ganglia
- aorticorenal ganglia
(run w/blood vessels, the pre-synaptic nerve fibers meet these ganglia through splanchnic nerves *except aorticorenal)
Thoracic splanchnic (preganglionic) nerves supply which ergions?
- foregut are (celiac trunk)
- midgut (superior mesenteric artery)
Which region(s) do the lumbar (preganglionic) splanchnic nerves supply?
hindgut (inferior mesenteric artery)
Celiac ganglia supplies which structures?
foregut derivatives
(follows the celiac trunk blood vessels)
Superior mesenteric ganglia supplies which regions?
midgut derivatives
Inferior mesenteric ganglia supplies which structures?
hindgut derivatives
Vagus nerve supplies which structures?
foregut and midgut derivatives
pelvic splanchnic nerves supply which structures?
hindgut derivatives
Pelvic splanchnic nerves leave the spinal cord through which rami and level?
- anterior rami
- S2-S4
Where does pain from the liver, gallbladder or duodenum refer to?
right upper should (trap area)
(irritation of the diaphragm is also referred here)
Where is pain from the spleen referred to?
left hypochondric region
Where is pain from the stomach referred to?
- between the scapulae
- epigastric region
Where is pain from the gallbladder referred to?
right upper shoulder
near inferior angle fo the scapula
right hypochondriac region
Where is pain from the liver referred to?
right lower back (just under ribs)
right upper shoulder
right flank
Where is pain from the small intestine referred to?
umbilical region
Where is pain from the cecum, sigmoid colon and ascending colon referred to?
hypogastric region
Where is pain from the kidney & ureter referred to?
Left groin
Left lower back (over QL)
