L5 GI Vascular Supply & Innervation

Question 1

Name the vascular supply of the foregut, midgut & hindgut

Answer 1

Celiac trunk, superior mesenteric artery, inferior mesenteric artery

Question 2

Embryonic foregut becomes which adult organs

Answer 2

lower esophagus

stomach

duodenum (middle & descending)

liver

gallbladder

pancreas

Question 3

Branches of the celiac trunk that supply derivatives of the embryonic foregut are:

Answer 3

left gastric artery, splenic artery, common hepatic artery

Question 4

The left gastric artery supplies:

Answer 4

lower esophagus & stomach

Question 5

Splenic artery supplies the:

Answer 5

pancreas, spleen & stomach

Question 6

Branches of the common hepatic artery are:

Answer 6

gastroduodenal artery & proper hepatic artery

Question 7

Gastroduodenal artery supplies:

Answer 7

stomach, head of pancreas, duodenum.

posterior surface ulcer that bleeds comes from this artery.

celiac trunk–>common hepatic artery–>gastroduodenal artery

Question 8

Proper hepatic artery supplies the:

Answer 8

liver, gallbladder & stomach

The stomach receives vasculature from all three branches of the celiac trunk.

Question 9

Posterior duodenal ulcers erode directly which arteries?

Answer 9

gastroduodenal artery or posterior superior pancreaticoduodenal artery ( branch of gastroduodenal a)

Anterior duodenal ulcers erode into peritoneal cavity leading to peritonitis.

Question 10

The embryonic midgut forms the adult​:

Answer 10

• Duodenum (distal to its union with the bile and pancreatic ducts)​
• Jejunum & ileum​
• Cecum & appendix​
• Ascending colon​
• Transverse colon​

Ascending & transverse colon are proximal to splenic flexure

Question 11

Branches of the superior mesenteric artery:

Answer 11

• inferior pancreaticoduodenal a.
• intestinal branches to jejunum & ileum (jejunal & ileal a.)
• middle colic a.
• right colic a.
• ileocolic a.

Question 12

Embryonic hindgut forms the adult:

Answer 12

• Descending colon​
• Sigmoid colon​
• Rectum and anal canal​

Question 13

Branches of the inferior mesenteric artery:

Answer 13

• left colic a.
• sigmoid a.
• superior rectal a.

Question 14

what is the marginal artery

Answer 14

anastomoses of inferior & superior mesenteric arteries

function: prevent infarction if there is a bowel obstruction or a need to ligate.

Question 15

Hepatic portal vein is formed by

Answer 15

• splenic v.
• superior mesenteric v.
• inferior mesenteric v.

Venous blood from the GI goes to the liver (carrying nutrients) via hepatic portal vein

consequence: cancer of the GI may metastasize to the liver

Question 16

Describe the portal-systemic anastomoses:

Answer 16

hepatic portal vein anastomoses with tributaries of the systemic venous system

resistance to portal blood flow (portal hypertension) may cause dilation

Question 17

What are the manifestations of portal hypertension (dilation of the portacava anastomoses)?

Answer 17

• blood w/emesis (esophageal varices)
• hemorrhoids
• caput medusae

Question 18

Define lymphoma.

Answer 18

Enlarged lymph nodes.

(certain infections and metastatic malignant spread of certain cancers e.g colon cancer. May need surgical resection)

Question 19

Lymph nodes & vessels are associated with which abdominal structures?

Answer 19

• Aorta
• IVC
• Iliac vessels

Question 20

Which nodes make up the para-aortic nodes (lymphatic drainage of the abdominal viscera)?

Answer 20

right and left lateral aortic (lumbar nodes)

Question 21

Which nodes make up the pre-aortic nodes (lymphatic drainage of the abdominal viscera)?

Answer 21

• superior mesenteric
• inferior mesenteric
• celiac

Question 22

Para-aortic nodes (lumbar) drain which structures of the abdominal viscera?

Answer 22

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

(collect to form right and left lumbar trunks)

Question 23

Where is the cisterna chyli located? What is it?

Answer 23

• right side of abdominal aorta (LV1 & LV2)
• confluence of all trunks (saccular dilation)

Question 24

Name the pre-vertebral ganglia that provide sympathetic innervation to the abdominal organs.

Answer 24

• celiac ganglia
• superior mesenteric ganglia
• inferior mesenteric ganglia
• aorticorenal ganglia

(run w/blood vessels, the pre-synaptic nerve fibers meet these ganglia through splanchnic nerves *except aorticorenal)

Question 25

Thoracic splanchnic (preganglionic) nerves supply which ergions?

Answer 25

* foregut are (celiac trunk) * midgut (superior mesenteric artery)

Question 26

Which region(s) do the lumbar (preganglionic) splanchnic nerves supply?

Answer 26

hindgut (inferior mesenteric artery)

Question 27

Celiac ganglia supplies which structures?

Answer 27

foregut derivatives (follows the celiac trunk blood vessels)

Question 28

Superior mesenteric ganglia supplies which regions?

Answer 28

midgut derivatives

Question 29

Inferior mesenteric ganglia supplies which structures?

Answer 29

hindgut derivatives

Question 30

Vagus nerve supplies which structures?

Answer 30

foregut and midgut derivatives

Question 31

pelvic splanchnic nerves supply which structures?

Answer 31

hindgut derivatives

Question 32

Pelvic splanchnic nerves leave the spinal cord through which rami and level?

Answer 32

​ * anterior rami * S2-S4

Question 33

Where does pain from the liver, gallbladder or duodenum refer to?

Answer 33

right upper should (trap area) (irritation of the diaphragm is also referred here)

Question 34

Where is pain from the spleen referred to?

Answer 34

left hypochondric region

Question 35

Where is pain from the stomach referred to?

Answer 35

* between the scapulae * epigastric region

Question 36

Where is pain from the gallbladder referred to?

Answer 36

right upper shoulder near inferior angle fo the scapula right hypochondriac region

Question 37

Where is pain from the liver referred to?

Answer 37

right lower back (just under ribs) right upper shoulder right flank

Question 38

Where is pain from the small intestine referred to?

Answer 38

umbilical region

Question 39

Where is pain from the cecum, sigmoid colon and ascending colon referred to?

Answer 39

hypogastric region

Question 40

Where is pain from the kidney & ureter referred to?

Answer 40

Left groin Left lower back (over QL)