Trunk: neurovascular and lymph Flashcards
where does abdominal aorta start:
- below diaphragm
- T12 aortic hiatus
bifurcation of aorta and into
L4
- common iliacs
common iliacs supply:
- lower limb via external iliac
- pelvis, perineum via internal
ascending aorta: branches
- R and L coronary aa
ascending aorta: R coronary aa
- R marginal
- post interventricular
ascending aorta: L coronary aa
- ant interventricular
- circumflex
ascending aorta: supplies
- R side heart
- R ventricle
- L ventricle
- ant RV LV septum L atrium
arch of aorta: branches
- R brachiocephalic trunk
- L common carotid
- L subclavian aa
arch of aorta: brachiocephalic trunk
- R common carotid
- R subclavian aa
arch of aorta: L subclavian aa
- with R subclavian aa
- internal thoracic aa -> 6 paired ant intercostal aa
- vertebral aa
arch of aorta: internal thoracic aa become:
superior epigastric aa and musculophrenic
arch of aorta: supplies
- head and neck
- upper limb
- ant thoracic wall
- cervical vertebrae and fuse to form basilar aa in brain
- sup abdominal wall
thoracic aorta: name 7 branches
- pericardial
- bronchial
- oesophageal
- mediastinal
- intercostal
- subcostal
- superior phrenic
ant intercostal aa: branches
- lateral branches of int thoracic aa (branches of subclavian aa)
- internal thoracic aa
ant intercostal aa: lateral branches of internal thoracic aa features
- first 6 intercostal spaces
- anastomoses w post ICA
ant intercostal aa: internal thoracic aa branches
- superior epigastric aa
- musculophrenic aa (gives ant intercostal aa for lower 6 ICS)
abdominal aorta: branches
- celiac plexus
- renal aa
- superior mesenteric
- inferior mesenteric
- gonadal
- common iliac aa
- median sacral
- lumbar
abdominal aorta: paired/ unpaired- name ant midline branches
- celiac trunk T12
- sup mesenteric L1
- inf mesenteric L3
unpaired
abdominal aorta: paired/ unpaired- lateral visceral
- suprarenal L1
- renal L1
- gonadal L2
paired
abdominal aorta: paired/ unpaired- lateral parietal
- inf phrenic
- 5 lumbar L1-4
paired - median sacral L4 (unpaired)
abdominal aorta: paired/ unpaired- R and L common iliac
- L4
- internal iliac -> internal pudendal
- external iliac -> inf epigastric
abdominal aorta: paired/ unpaired- at inguinal lig
ext iliac -> femoral aa
celiac trunk: branches
- L gastric
- hepatic
- splenic
celiac trunk: L gastric
- supply abdominal oesophagus and stomach
- runs lesser curvatures -> anastomose w R gastric aa
celiac trunk: common hepatic
- forward to porta hepatis -> L and R hepatic before entering liver
celiac trunk: common hepatic branches
- R gastric
- gastroduodenal
- R gastro-omental (epiploic)
- superior pancreaticoduodenal
celiac trunk: splenic
- horizontal to post border of pancreas
celiac trunk: splenic branches
- pancreatic aa
- short gastric
- L gastro-omental (epiploic)
superior mesenteric artery: features
- supplies small intestine (exc sup part of duodenum)
- cecum, ascending colon, half transverse colon
- crosses uncinate process of pancrease
superior mesenteric artery: branches
- inferior pancreaticoduodenal
- jejunal and ileal branches
- middle colic
- iliocolic
- R colic
inferior mesenteric artery: features
- supplies L half of transverse colon, descending colon, iliac and sigmoid, greater part of rectum
inferior mesenteric artery: branches
- L colic
- sigmoid
- superior rectal aa
pelvic arteries: pathway branches
abdominal aorta - R/L common iliac - (R) ext/ int iliac - (int) post/ ant trunk
pelvic arteries: ext iliac branches
- deep circumflex
- inf epigastric
pelvic arteries: post trunk branches
- iliolumbar
- lateral sacral aa
- superior gluteal
pelvic arteries: ant trunk
- sup/inf vesical
- middle rectal
- vaginal
- obturator
- uterine
- int pudendal
- inf gluteal
azygos vein: structures related
- hemiazygos v
- accessory hemiazygos v
lymphatic: lymph node collections divided into
- parietal
- visceral
lymphatic: parietal lymph nodes lie
- behind peritoneum (abdominal cavity), close association w large blood vessels
lymphatic: name parietal lymph nodes
- ext/ int iliac
- common iliac
- epigastric and circumflex
- lumbar
- sacral
- lateral aortic, preaortic, retroaortic
lymphatic: visceral lymph nodes lie
- closer to visceral vessels
- related to celiac trunk, SMA and IFA
lymphatic: what drains lateral aortic lymph nodes and deep lymph nodes of abdomen
2x lumbar trunk
lymphatic: what drains stomach, liver, pancreas and spleen
intestinal trunk
lymphatic: both lumbar and intestinal trunks drain into
cysterna chyli (dilation at diaphragmatic end of thoracic duct)
innervation: autonomic system innervates
- thoracic
- abdominal
- pelvic viscera
innervation: autonomic system made up of
- parasympathetic
- sympathetic divisions
- enteric nervous system
innervation: somatic supply to
- musculofascial wall
- peritoneum from spinal nerves
spinal nerves: how many pairs
- 31 pairs
spinal nerves: name pairs
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
spinal nerves: name plexuses
- cervical
- brachial
- lumbar
- sacral
intercostal nerves carry:
- somatic motor fibres for muscles
- somatic sensory to skin, parietal pleura, parietal peritoneum
- post ganglionic sympathetic fibres
innervation: anterolateral abdominal wall and pass btw
- ant rami of T7-12
- ant rami of L1 -> iliohypogastric, ilioinguinal
btw internal oblique and transversus abdominis
innervation: sympathetic in thorax
- cardiac
- pulmonary
- esophageal plexuses
innervation: sympathetic in abdomen
- celiac
- sup mesenteric
- inf mesenteric
innervation: sympathetic in pelvis
- hypogastric plexuses
innervation: name parasympathetic
- vagus
- pelvic splanchnic nn
innervation: parasympathetic vagus supplies
- thoracic and abdominal organs -> 2/3 of transverse colon
innervation: parasympathetic pelvic splanchnic nerves supply
- S2-4
- rest of colon, pelvic, perineum
enteric nervous system: features
- from autonomic nervous system
- walls of digestive organs
enteric nervous system: enteric neuron
- neurons cell body in ganglion within wall of digestive tract, biliary system or pancreas
enteric nervous system: names main parts
- myenteric plexus
- submucosal plexus
- intrinsic primary afferent neuron
enteric nervous system: myenteric plexus
- plexus of ganglia nerve fibre bundles
- btw longitudinal/ circular muscle layers
- forms continuous network from upper esophagus - internal anal sphincter
enteric nervous system: submucosal plexus
- small ganglia within submucosal layer
- btw ext musculature and mucosa of small/ large intestines
- continuous network from duodenum - internal anal sphincter
enteric nervous system: intrinsic primary afferent neuron
- neurons of ENS that detect states of digestive organs
- chemical entities within lumen of intestine
- tension in gut wall
- first neurons of intrinsic neural reflex circuits of intestine
referred pain: theory
- nociceptors from several locations converge on single ascending tract in spinal cord
- brain associates activation of pathway w pain in skin
eg. kidney vs skin
Hirschsprungs disease: symptoms in newborns/ infants
- difficulty w bowel movements
- infrequent but explosive stools
- jaundice
- poor feeding
- poor weight gain
- vomiting
Hirschsprungs disease: symptoms in older children
- constipation which gets worse gradually
- fecal impaction
- malnutrition
- slow growth
- swollen belly
Hirschsprungs disease: features
- congenital absence of ganglion cells in myenteric plexus of colon
- from rectum to variable distance proximally
- failure of peristalsis beyond transition zone
- colon proximal to transition zone dilated
