Neurovascular of Abdomen & Portal System Flashcards
abdomina aorta
enters abdomen at T12 through aortic aperture descends along vertebral column, left to midline terminates at L4 where bifurcates into 2 common iliac A (2-2.5cm below umbilicus) paired parietal (posterior) paire visceral (lateral) unpaired visceral (anterior)
Paired parietal (posterior)
inferior phrenic: 1 pair, T12
lumbar arteries: 4 pairs (each level L1-L4)
paired visceral (lateral)
middle suprarenal: L1
renal: L1-L2
gonadal (testicular or ovarian) L2
unpaired
celiac trunk T12 superior mesenteric (L1) inferior mesenteric (L3)
inferior phrenic
1st branch from aorta, under aortic aperture
follows the inferior surface of diaphragm
gives superior suprarenal arteries
lumbar arteries
4 pairs for L1-L4
posterior aspect of abdominal aorta
like posterior intercostal: along vertebral body
vascularise spinal cord (segment) and posterior abdominal wall
Celiac trunk
arises on anterior surface of aorta, right below aortic aperture gives 3 branches: left gastric splenic common hepatic artery
celiac trunk: left gastric
uppermost branch of celiac trunk
follows lesser curvature of stomach
gives: oesophageal branches
vascularise lesser curvature of stomach, inferior portion of esophagus, lesser omentum
common hepatic artery:
large vessel directed to the right
gives 1 main branches: proper hepatic & gastroduodenal arteries
proper hepatic
goes up toward liver
gives: right gastric artery. for lesser curvature of stomach
will anastamose with left gastric
gastroduodenal artery
goes down towards pancreas& duodenum
gives 2 branches
right gastro-omental artery
superior pancreaticoduodenal arteries
splenic artery
large curled vessel directed to the left
passe posterior to stomach
gives: pancreatic arteries, left gastro-omental artery, short gastric artery
left gastro-omental artery
will anastomose with right gastro-omental artery
short gastric artery
vascularize the fundus of stomach
superior mesenteric artery
anterior surface of aorta
behind neck of pancreas, anterior to left renal vein
vascularize midgut
gives inferior pancreaticoduodenal arteries (anastomose with sup. pancreaticoduodenal)
all other branches for small intestine
inferior mesenteric artery
anterior surface of aorta
inferior of duodenum
vascularize hindgut
gives: left colic (will anastomose with middle colic via marginal colic branch) sigmoid & superior rectal
middle suprarenal
arise on each side of aorta, superior to renal arteries
vascularise suprarenal glands (superior pole of kidney
renal
large vessels arising on each side of aorta almost lateral to SMA
left renal artery is 1/2 shorter than right
right renal passes behind IVC
vascularize kidney: 1.2 L per minute
give inferior suprarenal arteries
gonadal arteries
arise inferior to the renal arteries on the anterolateral surface of aorta
directed inferiorly, cross over ureter, travel down on psoas.
male: in spermatic cord in inguinal cnal
female: to ovary in pelvis cavity
inferior vena cava
receives blood from retro peritoneal& pelvic organs , wall of abdomen & pelvis, & lower limbs
originate where 2 common iliac veins merge
ascends on the right side of vertebral column
passed post to liver
enters thoracic cavity through caval aperture (T8)
corresponds to arteries except for the unpaired branches.
tributaries of IVC
inferior phrenic hepatic vein suprarenal renal gonadal ascending lumbar lumbar veins
inferior phrenic veins & lumbar veins
drain posterior wall & diaphragm
accompany arteries of same name
ascending lumbar
between lumbar veins
continuous with azygos system
function as a collateral pathway between IVC and SVC
veins of retroperitoneal organs: renal, suprarenal & gonadal veins
important variation between right & left
left gonadal & suprarenal veins drain into left renal vein not directly in IVC contrarily to right side
veins of intraperitoneal organ
hepatic veins: drain liver return blood to circulation after filtration
immediately inferior to caval aperture
portal vein system
nutrien-rich venous blood from capillary bed of the GI tract and associated organ to sinusoids of liver
treated blood return to systemic circulation
portosystemic pathway
GI capillary–> venule–> tributaries of portal vein–> 2nd capillary system (liver) –> venule–> hepatic vein–> IVC
portal vein tributaries
list: hepatic portal vein splenic vein superior mesenteric, inferior mesenteric small tributaries
hepatic portal vein
downstream vessel before liver passes post. to duodenum enters hepatoduodenal lig. major anatomical variation usually connection of splenic & superior mesenteric
splenic vein
drains spleen
receives short gastric, esophageal, left gastro-omental& sup. pancreaticoduodenal veins
superior mesenteric vein:
drains small intestine, & most of large intestine (same as SMA tibutaries)
receives right gastro-omental & inf. pancreaticoduodenal veins
inferior mesenteric vein
drains hindgut, (same as IMA tributaries)
left colic, sigmoidal, sup rectal (not middle +inf. rectal)
drains into splenic vein, but sometime directly into hepatic portal vein.
small tributaries
draining directly into portal vein (close to liver)
paraumbilical veins: associated with obliterated, umbilical veins, connected to anterior abdominal wall
right& left gastric veins: drain small curvature of stomach & abdominal portion of esophagus
cystic vein: drains gall bladder
portosystemic anastomosis
hepatic portal system drains abdominal visceral organs to liver
if high portal vein pressure (cirrhosis), less blood flows to the liver, but drains into systemic circulation through portosystemic anastomos
portosystemic anastomosis (different junction)
gastroesophageal junction: esophageal veins from left gastric vein –> azygos
reflux into esophageal veins = esophageal varice
anorectal junction: sup rectal veins –> middle & inf. rectal from internal iliac veins
causing: hemorrhoids
umbilicus: para-umbilical veins–> ant. abdominal wall
causing caput medusae
sympathetic system
arise from spinal cord of thoracic & lumbar level (T1-L2)
preganglionic fibres leave the spine with spinal nerve of corresponding level
enter sympathetic trunk
the use 3 different options to reach a sympathetic ganglion
2 groups of sympathetic ganglia:
sympathetic trunk: located on each side of the spine
are connected forming a chain
prevertebral ganglion: ganglion located in regard of main branches from the aorta
-coeliac
-SM
-IM
aorticorenal
prevertebral ganglia & plexus
organization of cell bodies of postsynaptic neurons
celiac: (2) associated with celiac trunk
superior mesenteric
inferior mesenteric
aorticorenal
thoracic splanchnic
pass from sympathetic trunk in thorax to prevertebral plexus & ganglia
pass through diaphragm crura
greater splanchnic nerve: T5-T9- celiac ganglion associated with celiac trunk
lesser splanchnic nerve: T10-T11–> to aorticorenal ganglion
least splanchnic nerve: T12
renal plexus
parasympathetic system
from brainstem and sacral spinal cord
from brain stem: 3,7, 9,10
sacral spinal nerve: S2,3,4
form pelvic splanchnic nerve
contribute to autonomic plexus in pelvis, abdomen
terminal synapse in parasympathetic ganglion that is always located near/ in the target organ
splanchnic nerves
visceral nerves carrying fibers of the autonomic nervous system
vagal trunks
reach celiac and superior mesenteric regions
parasympathetic innervation to foregut& midgut
pelvic splanchnics
enters inferior hypogastric plexus ascend through hypogastric nerve reach inferior mesnteric region (sup. hypogastric plexus & aortic plexus) parasympathetic innervation to hindgut
abdominal prevertebral plexus
collection of nerve fibres surrounding aorta & branches
fibres from:
sympathetic (postganglionic) &prevertebral ganglia
parasympathetic (preganglionic)
celiac plexus
celiac: nerve fibres related to celiac tunk and SMA
parasympathetic: vagal trunk
sympathetic: greater & lesser splanchnic
celiac + sup. mesenteric + aorticorenal ganglia
aortic plexus
nerve fibres of ant. surface of abd. aorta, from SMA to aortic bifurcation
parasympathetic: pelvic splanchnic
sympathetic: lumbar splanchnics
inf. mesenteric ganglion
superior hypogastric plexus
below aortic bifurcation
connected to inferior hypogastric plexus via hypogastic nerve
