Nerves & Vessels of the Abdomen Flashcards Preview

Anatomy (Karen) > Nerves & Vessels of the Abdomen > Flashcards

Flashcards in Nerves & Vessels of the Abdomen Deck (41):
1

The abdominal aorta divides into iliac arteries at

L4

2

Anterior branches of the abdominal aorta supply

GIT & derivatives

3

Lateral branches of the abdominal aorta supply

paired viscera (kidneys, adrenals, gonads)

4

Posterior branches of the abdominal aorta supply

paired posterior structures, diaphragm, and posterior abdominal wall

5

What are the 3 anterior (unpaired) branches of the AA?

celiac trunk (T12, upper border of pancreas)

superior mesenteric artery (L1, 1cm below celiac trunk)

inferior mesenteric artery (L3, inferior border of 3rd/hz part of duodenum)

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The coeliac trunk supplies

foregut derivatives:

abdominal oesophagus, stomach, liver, gallbladder, pancreas, spleen, duodenum up to major duodenal papilla

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7

What does the SMA supply?

midgut derivatives:

duodenum from major duodenal papilla, jejunum, ileum, appendix, caecum, ascending colon, most of the transverse colon up to near the splenic flexure

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8

What does the IMA supply?

hindgut derivatives:

transverse colon just proximal to splenic flexure, descending colon, sigmoid colon, rectum, and top of the anal canal

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9

What are the 3 branches of the celiac trunk?

splenic artery (L)

left gastric artery (L, superior and smaller than splenic)

common hepatic (R)

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10

What does the splenic artery supply?

main:

  • spleen
  • pancreas

gastric:

  • short gastric arteries (L fundus & greater curvature)
  • L gastroepiploic (greater curvature)

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11

What does the L gastric artery supply?

  • oesophageal branches to cardio-oesophageal junction (abdominal oesophagus)
  • lesser curvature of stomach

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12

What does the common hepatic artery supply?

  • divides into proper hepatic artery (liver via portal triad)
    • divides into R & L hepatic arteries to the respective functional halves of the liver
    • RHA (normally, or PHA) gives off cystic artery to the gallbladder
    • gives off right gastric artery to lesser curvature of stomach
  • and gastroduodenal artery
    • first part of duodenum (bleeds in peptic ulceration)
    • superior pancreaticoduodenal artery  to head of pancreas
    • right gastroepiploic artery to greater curvature of stomach

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13

The SMA supplies

  • inferior pancreaticoduodenal artery to distal duodenum

follows route of the mesentery (DJ flexure to ileocecal valve, across 3rd part of duodenum, aorta, IVC, lumbar VC, R psoas w/R ureter):

  • L branches to jejunum and ileum
    • create vascular arcades and vasa recta
    • jejunum - few arcades, long vasa recta
    • ileum - multiple arcades, short vasa recta
  • R branches to colon (colic arteries), contribute to marginal artery
    • iliocolic to beginning of colon
    • right colic to ascending colon
    • middle colic to transverse colon (up to where IMA takes over, just before splenic flexure)

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14

What does the IMA supply?

  • heads down and L to L iliac fossa (LLQ)
  • gives off colic branches:
    • left colic to rest of transverse colon & descending colon
    • sigmoid artery to the sigmoid colon
  • then becomes superior rectal artery before passing into the pelvis

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15

The portal venous system drains

GIT (pancreas, gallbladder, spleen)

SMV + splenic vein (w/ IMV)

everything supplied by the coeliac trunk, SMA, and IMA except the liver

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16

What comprises the (hepatic) portal vein?

IMV drains into splenic vein

splenic vein joins SMV @ L2

forms portal vein behind neck of pancreas

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17

Structures supplied by lateral branches of the AA drain into

(adrenals, kidneys, gonads)

IVC (caval system)

18

Structures supplied by the posterior branches of the AA drain into

(abdominal walls and diaphragm)

IVC/caval

19

What causes portal hypertension?

fibrosis of liver (alcohol) + shrinking of hepatic sinusoids

impedes portal venous drainage into liver

20

What are the five sites of portosystemic anastamoses?

  • lower/abdominal oesophagus @ cardiac orifice (can tear w/vomiting)
    • tributaries of L gastric vein (portal) & tributaries of azygous vein (caval/systemic)
  • inferior GIT/anus (haemorrhoids)
    • superior rectal veins (portal) & lower and inferior rectal veins (caval/systemic)
  • anterior abdominal wall (caput medusa)
    • cutaneous veins (cava/systemic) & tributaries of portal vein (portal)
  • posterior abdominal wall
    • retroperitoneal viscus (portal) w/back to posterior abdoiminal wall (caval/systemic)
  • bare area of liver
    • liver (caval) on diaphragm (portal)

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21

Abdominal viscera are innervated by

ANS

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22

Foregut derivatives are innervated by

T6-T9

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23

Midgut derivatives are innervated by

T8-T12

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24

Hindgut derivatives are innervated by

T12-L2

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25

Preganglionic sympathetic fibres to the abdominal viscera are derived from

T6-L2

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26

Sympathetic ganglion to the abdomen cluster around

unpaired branches of AA and renal arteries

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27

Parasympathetic innervtation to the abdomen comes from

vagus (foregut and midgut), pelvic splanchnics (hindgut)

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28

Parasympathetic innervation to the foregut and midgut is by

vagus

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29

Parasympathetic innervation to the hindgut comes from

pelvic splanchnics (S2-4)

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30

Post-ganglionic sympathetic fibres travel to abdominal viscera via

arterial branches

31

Visceral afferents of the abdomen run

  • same spinal cord segment as sympathetic innervation up to mid sigmoid colon
  • same spinal cord segment as parasympathetic innervation beyond the sigmoid colon

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32

What structures refer pain to the midline of the anterior abdominal wall (dermatomes T6-L2)?

afferent fibres from unpaired abdominal viscera proximal to the mid-sigmoid colon

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33

What structures refer pain to the perineal region (dermatomes S2-4)?

afferetn fibres from mid-sigmoid colon downward

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34

Lymphatics of deep structures below the diaphragm drain into

pre-aortic and para-aortic lymph nodes

35

Pre-aortic lymph nodes drain

anterior to the AA around the unpaired branches (celiac, SMA, IMA) and receive drainage from the structures they supply

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36

Para-aortic lymph nodes drain

R & L aorta, drain structures supplied by the sides and back of AA (posterior abdominal walls, kidneys, adrenals, gonads)

+ pelvis and lower limb

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37

What three lymphatics drain into the cisterna chyli?

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intestinal lymph trunk from pre-aortic LNs

R & L lumbar lymphatic trunks

38

Where is the cisterna chyli?

adjacent to the aortic hiatus @ T12

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39

What is the course of the thoracic duct?

  • cisterna chyli
  • traverse diaphragm w/AA thru crura @ T12
  • posterior to oesophagus
  • crosses L at T4-T5
  • empties at junction of left IJV and left subclavian vein

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40

The SMV drains

most of the gut from the 3rd part of the duodenum down to ~splenic flexure

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41

The IMV comes off the

splenic vein

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