GI Vascular Supply and Innervation

Question 1

The digestive system within the abdomen consists of derivatives of the embryonic gut supplied by unpaired ventral branches of the abdominal aorta with the…

Answer 1

foregut - celiac trunk

midgut- superior mesenteric artery

hindgut- inferior mesenteric artery

Question 2

Embryonic foregut forms..

Answer 2

Abdominal portion of the esophagus

Stomach

Duodenum (as far as its union with the common bile and pancreatic ducts)

Liver/gall bladder

Pancreas

Question 3

Branches of the celiac trunk supplying the foregut are

Answer 3

Left gastric artery

Splenic artery

Common hepatic artery

Question 4

Left gastric artery supplies what to structures of the GI tract?

Answer 4

stomach

lower esophagus

Question 5

Splenic artery supplies what structures of the GI tract?

Answer 5

neck, body, and tail of the pancreas and the spleen

-also sends some branches to stomach

Question 6

The common hepatic artery branches into 2 vessels. What are they and what do they supply?

Answer 6

Gastroduodenal artery- stomach, head of pancreas, and duodenum

Proper hepatic artery- liver, gallbladder, and sends a single branch to stomach

Question 7

Most of the ulcers in the stomach and duodenum are associated with what bacteria?

Answer 7

H. pylori

Question 8

In which part of the duodenum do ulcers typically occur?

Answer 8

Superior portion

Question 9

Should ulcers take place in the posterior duodenum they will erode directly into the?

Answer 9

Gastroduodenal artery

-“or more commonly a branch of the gastroduodenal artery known as the posterior superior pancreaticduodenal artery which can produce a massive, potentially fatal hemorrhage”

Question 10

Should uclers occur in the anterior duodenum they will erode into the peritoneal cavity causing..

Answer 10

Peritonitis thereby causing adhesion of the greater omentum

Question 11

The embryonic midgut forms what parts of the GI tract?

Answer 11

Duodenum

Jejunum/ileum

Cecum/appendix

Ascending colon

Transverse colon

Question 12

Branches of the superior mesenteric artery supplying derivatives of the embryonic midgut include the:

Answer 12

Inferior pancreaticoduodenal artery- head of the pancreas and the duodenum

Intestinal branches- jejunum/ileum

Middle colic artery- transverse colon

Right colic artery- ascending colon

Ileocolic artery- terminal ileum, cecum, and ascending colon

–>Appendiculara artery- appendix

Question 13

The embyonic hindgut forms the:

Answer 13

Descending colon

Sigmoid colon

Rectum/anal canal

Question 14

Branches of the inferior mesenteric artery supplying derivatives of the embryonic hindgut include the:

Answer 14

Left colic artery- Descending colon

Sigmoid artery- sigmoid colon

Superior rectal artery- Rectum/anal canal

Question 15

Branches of the superior and inferior mesenteric arteries anastomose to form what artery? Why is it important?

Answer 15

Marginal artery

–>serves as collateral circulation which can prevent infarction of a segment of colon if one of the branches is obstructed or has to be ligated

Question 16

Venous drainage from the abdominal GI tract and spleen enters the hepatic portal vein for transport to where?

Answer 16

the liver

Question 17

Unlike blood from everywhere else in the body, venous drainage travels directly to the liver. One potential consequence of this system would be..

Answer 17

Cancer from the GI tract often metastasizes to the liver

Question 18

The hepatic portal vein is formed posterior to the neck of the pancreas by the union of the:

Answer 18

Splenic vein

Superior Mesenteric vein

Inferior mesenteric vein

Question 19

Tributaries of the hepatic portal vein anastamose with those of the sytemic venous system (vena cavae) may become increasing dilated in what medical scenario?

Answer 19

If there is resistance to portal blood flow (e.g., in cirrhosis), increasing pressure within the portal vein (portal hypertension)

Question 20

In portal hypertension the portacaval anastomoses include:

Answer 20

Lower esophagus- esophageal varices

Anal canal- hemorrhoids

Paraumbilical region- varicose veins (caput medusae)

Question 21

In portal hypertension esophageal varices may be the source of what?

Answer 21

Fatal hemorrhage

–>secondary to cirrhosis of the liver

Question 22

What are the pre-aortic nodes and what do they drain / unite to form?

Answer 22

Celiac, superior, inferior, mesenteric

Drain GI tract/accessory GI organ

Unite to form intestinal trunk

Question 23

What are the para aortic nodes? What do they drain? What do they unite to form?

Answer 23

Lumbar

Drain body wall, kidneys, adrenal glands, testes or ovaries, uterus and uterine tubes

Unite to form right and left lumbar trunks

Question 24

Confluence or merging of all lymphatic trunks appears as saccular dilatation called:

Answer 24

Cisterna chyli

Question 25

The thoracic (preganglionic) splanchnic nerves generally supplt the foregut and midgut through which ganglia?

Answer 25

Celiac ganglia Superior mesentaric ganglion

Question 26

The lumbar (preganglionic) splanchnic nerves supplt the hind gut via what ganglia?

Answer 26

Inferior mesenteric ganglion

Question 27

Celiac ganglia supplies

Answer 27

stomach, proximal duodoenum, liver, gallbladder, pancreas

Question 28

Aorticorenal ganglia fibers supply

Answer 28

Kidneys and adrenal glands

Question 29

Superior mesenteric ganglia supply:

Answer 29

distal duodenum, jejunum and ileum, ascending and transverse colon

Question 30

Inferior mesenteric ganglia supply:

Answer 30

descending colon, sigmoid colon, rectum, and upper anal canal

Question 31

**Vagus** nerves provide parasympathetic innervation to the foregut and midgut derivatives:

Answer 31

**Distal esophagus** **Stomach** **Liver and gallbladder** **Pancreas** **Duodenum, jejunum, and ileum** **Ascending colon** **Transverse colon**

Question 32

**Pelvic splanchnic** nerves send **preganglionic parasympathetic** fibers to hindgut derivatives:

Answer 32

**Descending colon** **Sigmoid colon** **Rectum** **Upper anal canal**

Question 33

Visceral afferent nerve fibers (GVA) accompanying sympathetic nerves carry pain from abdominal viscera to spinal cord. Visceral pain (ischemia, sudden distention, muscle spasms) may be what kind of pain?

Answer 33

Referred pain --\> pain referred to other areas of the body that recieve somatic innervation (e.g., skin) from the same spinal cord segments

Question 34

Irritation of the **phrenic nerve** from **inflammation of the diaphragmatic pleura** (e.g., pleuritis) or peritoneum (e.g., cholecystitis, ruptured spleen) may cause **referred pain** to the:

Answer 34

**Ipsilateral shoulder** \*the pain is referred to the shoulder because afferent fibers of the phrenic nerve (C3,4,5) enter the same spinal cord segments as the supraclavicular nerves (C3,4), which supply cutaneous innervation to the shoulder