Vascular Supply, Retroperitoneal Viscera and Posterior Abdominal Wall Flashcards
Foregut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied
Celiac
Vagus
T12/L1
esophagus to upper duodenum
Hindgut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied
IMA
Pelvic splanchnic nerve
L3
Distal 1/3 of transverse colon to anal above pectinate line
Midgut: Artery, Parasympathetic innervation, Vertebral level, and Structures supplied
SMA
Vagus
L1
Lower duodenum to proximal 2/3 of transverse colon
Arteries supplying GI structures are ____
single and branch anteriorly
Compress transverse (third) portion of duodenum
Superior mesenteric artery syndrome
Two areas of colon that have dual blood supply from distal arterial branches (watershed regions) - susceptible in colonic ischemia
- Splenic flexure - SMA and IMA
2. Rectosigmoid junction - last sigmoid arterial branch from the IMA and superior rectal artery
Arises from the front of the abdominal aorta immediately below the aortic hiatus of the diaphragm, between the right and left crura.
Celiac Trunk
Branches of celiac trunk
left gastric artery,
splenic artery,
common hepatic arteries
Is the smallest branch of the celiac trunk
Runs upward and to the left toward the cardia, giving rise to __ and __ branches and then turns to the right and runs along the lesser curvature within the lesser omentum to anastomose with the right gastric artery
Left Gastric Artery
Esophageal and hepatic
Is the largest branch of the celiac trunk and runs a highly tortuous course along the superior border of the pancreas and enters the lienorenal ligament.
Splenic Artery
Branches of splenic artery
dorsal pancreatic artery short gastric arteries left gastroepiploic (gastro-omental) artery
Pass through the lienogastric ligament to reach the fundus of the stomach
short gastric arteries
Reaches the greater omentum through the lienogastric ligament and runs along the greater curvature of the stomach to distribute to the stomach and greater omentum
left gastroepiploic (gastro-omental) artery
Runs to the right along the upper border of the pancreas and divides into the proper hepatic artery, the gastroduodenal artery, and possibly the right gastric artery.
Common Hepatic Artery
Branches of Common Hepatic Artery
proper hepatic artery,
gastroduodenal artery, and possibly
right gastric artery
Ascends in the free edge of the lesser omentum and divides, near the porta hepatis, into the left and right hepatic arteries
Proper Hepatic Artery
Ascends in the free edge of the lesser omentum and divides, near the porta hepatis, into the left and right hepatic arteries
Proper Hepatic Artery
Gives rise, near its beginning, to the right gastric artery
Proper Hepatic Artery
What is the origin branch of cystic artery in the cystohepatic triangle of Calot?
right hepatic artery
Arises from the proper hepatic or common hepatic artery, runs to the pylorus and then along the lesser curvature of the stomach, and anastomoses with the left gastric artery.
Right Gastric Artery
Descends behind the first part of the duodenum, giving off the supraduodenal artery to its superior aspect and a few retroduodenal arteries to its inferior aspect.
Gastroduodenal Artery
Two major branches of Gastroduodenal Artery
right gastroepiploic (gastro-omental) artery superior pancreaticoduodenal artery
Runs to the left along the greater curvature of the stomach, supplying the stomach and the greater omentum.
right gastroepiploic (gastro-omental) artery
Passes between the duodenum and the head of the pancreas and further divides into the anterior-superior pancreaticoduodenal artery and the posterior-superior pancreaticoduodenal artery.
superior pancreaticoduodenal artery
It is a temporary cross-clamping (intermittent soft vascular clamping) of the hepatoduodenal ligament containing portal triads at the foramen of Winslow for control of hepatic bleeding during liver surgery or donor hepatectomy for living donor liver transplantation.
Pringle maneuver
- Arises from the aorta behind the neck of the pancreas.
- Descends across the uncinate process of the pancreas and the third part of the duodenum and then enters the root of the mesentery behind the transverse colon to run to the right iliac fossa.
Superior Mesenteric Artery
Passes to the right and divides into the anterior-inferior pancreaticoduodenal artery and the posterior-inferior pancreaticoduodenal artery, which anastomose with the corresponding branches of the superior pancreaticoduodenal artery.
Inferior Pancreaticoduodenal Artery
Branches of SMA
Inferior Pancreaticoduodenal Artery Middle Colic Artery Right Colic Artery Ileocolic Artery Intestinal Arteries
Enters the transverse mesocolon and divides into the right branch, which anastomoses with the right colic artery, and the left branch, which anastomoses with the ascending branch of the left colic artery. The branches of the mesenteric arteries form an anastomotic channel, the marginal artery, along the large intestine.
Middle Colic Artery
Arteries supplying non-GI structures are ______
paired and branch laterally and posteriorly
- Arises from the superior mesenteric artery or the ileocolic artery.
- Runs to the right behind the peritoneum and divides into ascending and descending branches, distributing to the ascending colon
Right Colic Artery
• Descends behind the peritoneum toward the right iliac fossa and ends by dividing into the ascending colic artery, which anastomoses with the right colic artery, anterior and posterior cecal arteries, the appendicular artery, and ileal branches.
Ileocolic Artery
- Are 12 to 15 in number and supply the jejunum and ileum.
* Branch and anastomose to form a series of arcades in the mesentery.
Intestinal Arteries
It is caused by a thrombus, an embolus, atherosclerosis, an aortic aneurysm, a tumor in the uncinate process of the pancreas, compression by the third part of the duodenum, or surgical scar tissue.
Superior mesenteric artery obstruction
• Passes to the left behind the peritoneum and distributes to the descending and sigmoid colons and the upper portion of the rectum.
Inferior Mesenteric Artery
Branches of Inferior Mesenteric Artery
Left Colic Artery
Sigmoid Arteries
Superior Rectal Artery
Runs to the left behind the peritoneum toward the descending colon and divides into ascending and descending branches.
Left Colic Artery
Are two to three in number, run toward the sigmoid colon in its mesentery, and divide into ascending and descending branches.
Sigmoid Arteries
Is the termination of the inferior mesenteric artery, descends into the pelvis, divides into two branches that follow the sides of the rectum, and anastomoses with the middle and inferior rectal arteries.
Superior Rectal Artery
Arterial supply of right 2/3 of transverse colon
right and middle colic arteries of SMA
Arterial supply of left 1/3 of transverse colon
left colic artery from IMA
Venous drainage of transverse colon
veins of corresponding arterial supply
Arterial supply of rectum
Superior rectal artery - IMA
Middle rectal artery - internal iliac artery
Inferior rectal artery - internal pudendal artery
A system of vessels in which blood collected from one capillary bed (of intestine) passes through the portal vein and then through a second capillary network (liver sinusoids) before reaching the IVC (systemic circulation).
Hepatic Portal Venous System
Formed by the union of the splenic vein and the superior mesenteric vein posterior to the neck of the pancreas.
Portal Vein
Drains the abdominal part of the gut, spleen, pancreas, and gallbladder and is 8 cm (3.2 in.) long
Portal Vein
Carries three times as much blood as the hepatic artery and maintains a higher blood pressure than in the IVC
Portal Vein
It results from liver cirrhosis or thrombosis in the portal vein, forming esophageal varices, caput medusae, and hemorrhoids.
Portal hypertension
- Accompanies the superior mesenteric artery on its right side in the root of the mesentery
- Crosses the third part of the duodenum and the uncinate process of the pancreas and terminates posterior to the neck of the pancreas by joining the splenic vein, thereby forming the portal vein.
- Has tributaries that are some of the veins that accompany the branches of the superior mesenteric artery
Superior Mesenteric Vein
- Is formed by the union of tributaries from the spleen.
* Receives the short gastric, left gastroepiploic, and pancreatic veins.
Splenic Vein
Formed by the union of the superior rectal and sigmoid veins.
Inferior Mesenteric Vein
What does the inferior mesenteric vein receive?
Left colic vein
Where does inferior mesenteric vein drain?
Usually into the splenic vein
May drain into the superior mesenteric vein
Junction of superior mesenteric and splenic veins
Has esophageal tributaries that anastomose with the esophageal veins of the azygos system at the lower part of the esophagus and thereby enter the systemic venous system.
Left Gastric (Coronary) Vein
- Are found in the falciform ligament and are virtually closed; however, they dilate in portal hypertension
- Connect the left branch of the portal vein with the small subcutaneous veins in the region of the umbilicus, which are radicles of the superior epigastric, inferior epigastric, thoracoepigastric, and superficial epigastric veins.
Paraumbilical Veins
Important Portal-Caval (Systemic Anastomoses)
LGV & EVAS 1. The left gastric vein and the esophageal vein of the azygos system.
SRV & MIRV 2. The superior rectal vein and the middle and inferior rectal veins.
PUV & REV 3. The paraumbilical veins and radicles of the epigastric (superficial and inferior) veins.
• Spider angiomata - patients with liver cirrhosis
RV - RSG Veins4. The retroperitoneal veins draining the colon and twigs of the renal, suprarenal, and gonadal veins.
- Consist of the right, middle, and left hepatic veins that lie in the intersegmental planes and converge on the IVC.
- Have no valves, and the middle and left veins frequently unite before entering the vena cava.
Hepatic Veins
It is an occlusion of the hepatic veins and results in high pressure in the veins, causing hepatomegaly, upper right abdominal pain, ascites, mild jaundice, and eventually portal hypertension and liver failure.
Budd-Chiari syndrome
Retroperitoneal structures
SAD PUCKER Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd through 4th part) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (thoracic portion) Rectum (partially)
Remnant urachus
Median Umbilical Fold
Remnant of umbilical arteries
Medial Umbilical Fold
Lodges inferior epigastric arteries
Lateral Umbilical Fold
Is retroperitoneal and extends from T12 to L3 vertebrae in the erect position.
Kidney
Where is the right and left kidney related to?
right kidney - rib 12 posteriorly
left kidney - ribs 11 and 12 posteriorly
What invests and surrounds the kidney?
invested by a firm, fibrous renal capsule
surrounded by the renal fascia
Lies in the perinephric space between the renal capsule and renal fascia
perirenal (perinephric) fat
Lies external to the renal fascia
pararenal (paranephric) fat
Where does ureter, renal vessels, and nerves enter or leave the kidney?
hilus-on its medial border
What are the functional units of kidney?
Nephrons (1 to 2 million in each kidney)
What consists the nephron?
renal corpuscle (found only in the cortex),
proximal convoluted tubule,
Henle loop,
distal convoluted tubule.
What are the arterial segments in kidney with surgical importance?
superior, anterosuperior, anteroinferior, inferior, and posterior segments
Functions of kidney
Produce urine Excrete urine Regulate salt, ion (electrolyte), and water balance Produce erythropoietin Produces renin
What produces renin in the kidney?
juxtaglomerular cells
It increases blood pressure and volume and stimulates aldosterone production by the suprarenal cortex, thereby regulating the salt, ion, and water balance between the blood and urine.
angiotensin Il
Physiologic process involved in renin of the kidney
RAAS - renin, angiotensin, aldosterone system