Vasculature of the Abdominal Viscera Flashcards
Is the abdominal aorta retroperitoneal?
Yes
At which vertebra does the aorta terminate?
L4
Does the left renal vein cross posterior or anterior to the aorta?
anterior
What forms the aortic hiatus?
Lift and right crus of the diaphragm.
Is the anterior longitudinal ligament anterior or posterior of the aorta?
posterior
Where are the celiac, superior mesenteric, inferior mesenteric plexi, renal plexi, and autonomic nerves located in relation to the aorta?
anterior and lateral surfaces
Is the thoracic duct with the cisterna chyli to the right or left of the aorta?
right
True or False:
The pancreas, duodenum and root of the mesentery are anterior to the aorta.
True
What are the paired abdominal aorta branches?
- inferior phrenic aa.
- subcostal and lumbar aa.
- (middle) suprarenal aa.
- renal aa. (L2)
- gonadal aa. (testicular/ovarian)
What are the un-paired branches of the abdominal aorta and their approximate vertebral levels?
- celiac artery (T12, L1)
- superior mesenteric a. (L1)
- inferior mesenteric a. (L3)
- median (middle) sacral a. (L4)
What are the 3 major branches of the celiac trunk?
- left gastric a. (superior)
- common hepatic a. (right)
- splenic a. (left)
What are the branches off of the left gastric artery?
- esophageal branches
- branches to lesser curvature
Where do the branches to lesser curvature off of the left gastric artery anastomose?
Will anastomose with branches of the right gastric along the lesser curvature.
Which two arteries does the common hepatic artery off of the celiac trunk divide into?
- (proper) hepatic artery
- gastroduodenal artery
Where does the right gastric artery anastomose with the left gastric artery at?
along lesser curvature of stomach
What does the (proper) hepatic artery end as?
right and left hepatic arteries
Which artery is the cystic artery typically a branch off of?
right hepatic artery
What are the terminal branches of the gastroduodenal artery?
- right gastro-omental artery
- superior pancreaticoduodenal branches
What artery does the gastroduodenal artery sometimes give off?
supraduodenal artery
Where does the splenic artery run on its way to the spleen?
runs posterior to the stomach and superior to the pancreas
Does the splenic arteries that end at the spleen anastomose?
NO
What branches come off of the splenic artery?
- short gastric aa. (to upper part of greater curvature)
- left gastro-omental a. (anastomoses with right gastro-omental on the greater curvature of stomach)
What ligament contains the portal triad?
hepatoduodenal ligament
What is the typical arrangement of the portal triad?
- hepatic artery (left)
- portal vein (posterior)
- bile duct (right)
What does the portal vein do?
Brings deoxygenated, nutrient-rich blood from GI tract to the liver.
What does the hepatic artery (proper) do?/
Supplies oxygenated blood (a branch of common hepatic artery)
Do hepatic veins follow the branching patterns of portal veins, hepatic ducts, and hepatic artery?
NO
Where do the right and left hepatic veins drain into?
right and left sides of IVC
Where does the superior mesenteric artery emerge from the aorta?
Posterior to the neck of pancreas and 1 cm below celiac trunk.
What arteries supply blood to the pancreas?
Receives branches from both the celiac and superior mesenteric arteries.
Celiac - superior pancreaticoduodenal artery
- branch off of gastroduodenal
- anterior superior pancreacticoduodenal artery
- posterior superior pancreaticoduodenal artery
Superior Mesenteric - first branch off is inferior pancreaticoduodenal
- anterior inferior pancreaticoduodenal artery
- posterior inferior pancreaticoduodenal artery
True or False:
The branches from the superior mesenteric artery meet the branches from the gastroduodenal, forming anastomosing arcades on the anterior and posterior surfaces of the head of the pancreas.
True
Which branches of the superior mesenteric artery supply the small intestine?
- inferior pancreatico-duodenal a.
- jejunal arteries
> long vasa recta, simple arcades - ileal arteries
> complex arcades, short vasa recta
What are the 3 branches off of the superior mesenteric artery that supplies the large intestine?
- ileocolic artery > ileal branch(s) > colic branch - right colic artery - middle colic artery
You know that the ileocolic artery is a branch off of the superior mesenteric that supplies the large intestine. What are the 4 branches of the ileocolic artery?
- posterior cecal branch
- anterior cecal branch
- ileal branch(es)
- appendicular branch
What does the inferior mesenteric artery supply?
derivatives of hindgut
What are the branches of the inferior mesenteric artery?
- left colic artery > ascending branch > descending branch - sigmoid arteries - superior rectal artery
Where does the superior rectal vein, which is a branch off of the inferior mesenteric vein, drain?
drain to inferior mesenteric vein
Where does the middle rectal vein, which is a branch off of the inferior mesenteric vein, drain?
drain to internal iliac veins
Where does the inferior rectal vein, which is a branch off of the inferior mesenteric vein, drain?
drain to external pudendal veins
What does the hepatic portal system begin and end as?
Begins as capillaries in the digestive system and ends as capillaries in the liver.
Where all does the hepatic portal system drain blood from?
From esophagus to upper anal canal.
Does the portal vein have valves?
NO
How long is the portal vein?
about 2 inches
What veins form the portal vein?
- splenic vein
- superior mesenteric vein
- inferior mesenteric vein, which enters either the superior mesenteric or splenic veins
Where does the hepatic portal system form?
posterior to the neck of the pancreas
What ligament does the hepatic portal system run through on its way to enter the liver at the porta hepatis?
hepatoduodenal ligament
What are the direct tributaries of the portal vein?
- (paraumbilical vv.) (anterior wall)
- cystic vein
- left gastric vein
- right gastric vein
Which veins drain into the splenic vein, which drains into the portal vein?
- splenic vv. (proper)
- short gastric vv.
- left gastro-omental v.
- pancreatic vv.
Which veins drain into the superior mesenteric vein, which drains into the portal vein?
- right gastro-omental v.
- pancreaticoduodenal vv.
- intestinal vv. (ileal and jejunal vv.)
- ileocolic v. (cecal and appendicular vv.)
- right colic v.
- middle colic v.
Which veins drain into the inferior mesenteric vein, which drains into the portal vein?
- superior rectal v.
- left colic v.
- sigmoid vv.
What is clinically important about the overlap between veins of the esophagus?
- blood can drain superiorly into the azygous system
- blood can drain inferiorly into the portal system
- NOTE: the submusous venous plexus in the esophagus.
Are hepatic veins intersegmental?
Yes
At what vertebral level does the common iliac veins join to form the IVC?
L5
Where is the IVC formation in regards to the bifurcation of the aorta?
posterior and inferior
Does the IVC pass through the liver?
Yes
Where does the IVC pierce the central tendon of the diaphragm?
T8
What does the IVC drain?
- posterior body wall muscles
- genitourinary system (internal iliac vv.)
- lower limbs (external iliac vv.)
What are the main tributaries to the IVC?
- common iliacs
- lumbar (segmental) veins
- renal veins
- hepatic veins
What are all of the tributaries to the IVC?
- R and L common iliac veins
- middle (median) sacral v.
- lumbar veins (paired, segmental)
- R and L renal vv.
- right gonadal v.
- right suprarenal v.
- hepatic vv.
- inferior phrenic vv.
NOTE: left suprarenal and gonadal veins enter left renal vein instead of IVC
What is unique about the left suprarenal and left gonadal veins?
They enter the left renal vein instead of emptying directly into the IVC.
True or False:
Veins from the gastrointestinal tract normally drain into the portal vein, either directly or indirectly, and veins from posterior structures, normally drain into the inferior vena cava.
True
When does the portal-caval anastomoses become important?
When the liver is blocked from diseases such as cirrhosis.
What happens if the liver is blocked from cirrhosis?
Blood flows back through the portal system and through the interconnections with the IVC to return to the heart.
How is it possible for blood to flow backwards through the portal system and back into the IVC to return to the heart if blood flow is blocked in the liver?
Because the portal system does NOT have valves.
True or False:
The back-up of blood in the caval system causes varicosities which are at risk for hemorrhage.
True
How many ways are there for blood to bypass the liver?
4
What are the 4 ways blood can bypass the liver?
1) Esophageal branches of left gastric vein connect with veins on lower thoracic esophagus.
> esophageal varicosities
> usually result from portal hypertension
2) Paraumbilical veins in the falciform ligament with subcutaneous veins around umbilicus in the anterior abdominal wall.
> paraumbilical veins run in the base of falciform ligament and drain umbilical area
> when the liver is blocked, paraumbilical veins dilate, blood flow toward caval system
> inferior epigastric and superficial epigastric veins of anterior abdominal wall empty into the external iliac and femoral veins
> form a “caput medusae”
3) Colic veins to retroperitoneal veins.
> veins draining the ascending colon (superior mesenteric vein) and descending colon (inferior mesenteric vein) connect with retroperitoneal veins that drain the posterior body wall (veins of Retzius) (lumbar)
> The veins of Retzius drain into lumbar veins which in turn drain into the inferior vena cava
4) Between superior rectal veins and middle and inferior rectal veins.
> the middle and inferior rectal veins empty into the internal iliac veins which in turn empty into the common iliac veins
> rectal varicosities/hemorrhoids