lecture 17-abdominal circulation

as it passes through the aortic hiatus at T12 level

where does the abdominal aorta begin?

just below L4 level

where does the abdominal aorta bifurcate into the R and L common iliac aa?

transumbilical (L3/L4 level, bifurcation at L4)

the level at which the abdominal aorta bifurcates into the common iliac aa is just below what plane?

parietal branches and visceral branches

what branches does the abdominal aorta give rise to?

musculature of the abdominal wall

what do the parietal branches from the abdominal aorta supply?

organs (v)

what do the visceral branches from the abdominal aorta supply?

organs (u)

where do all unpaired aa go?

inferior phrenic aa and 4 pairs of lumbar aa

what are the parietal branches of the abdominal aorta?

inferior phrenic aa

what parietal branches of the abdominal aorta supply the diaphragm?

wall of abdomen

what do the 4 pairs of lumbar aa from the abdominal aorta supply?

paired

all arterial vessels emanating from the lateral aspect of the aorta will be...

unpaired

all arterial vessels emanating from the anterior aspect of the aorta will be...

celiac trunk, superior mesenteric, and inferior mesenteric aa

what are the three major visceral aa that supply the splanchnic circulation?

splanchnic circulation

what supplies the GI tract and accessory organs?

gastric, small intestinal, colonic, pancreatic, hepatic, and splenic circulations

what circulations make up the splanchnic circulation?

smaller aa that form anastomoses

the three major visceral aa that supply splanchnic circulation (celiac trunk, superior mesenteric and inferior mesenteric aa) give rise to...

other visceral branches

what supplies non-GI tube related organs?

to supply embryologically derived parts of the gut tube

how are the visceral branches organized?

foregut

what does the celiac trunk supply?

midgut

what does the superior mesenteric a supply?

hindgut

what does the inferior mesenteric a supply?

esophagus, stomach, liver, gallbladder, pancreas, duodenum, and spleen

what viscera does the celiac a supply?

at the T12 level just below the median arcuate ligament

where does the celiac trunk branch from anterior surface of aorta?

left gastric a, common hepatic a, splenic a

the celiac branch spans only a few mm before it divides into...

esophageal branches

what does the L gastric a (from celiac trunk) give rise to?

R and L hepatic a (terminal branches), cystic a, gastroduodenal a (gives rise to R gastro-omental a), R gastric a

what does the hepatic a (from celiac trunk) give rise to?

R gastro-omental a

what does the gastroduodenal a give rise to?

pancreatic a, left gastro-omental a, short gastric a

what does the splenic a from the celiac trunk give rise to?

L1 level

where does the superior mesenteric a branch from the anterior surface of the aorta?

jejunum, ileum, cecum, vermiform appendix, ascending and transverse colon (proximal portion)

what viscera does the superior mesenteric a supply?

jejunal and ileal aa, ileocolic a, R colic a, middle colic a, inferior pancreaticoduodenal a

what branches does the superior mesenteric a give rise to?

few arterial arcades but very long vasa recta

describe jejunal aa from superior mesenteric a

jejunal aa

does the jejunal aa or ileal aa have a higher degree of vascularity?

more levels of arterial arcades that are closer to ileum resulting in shorter vasa recta

describe ileal aa from superior mesenteric a

L3 level on an oblique course down toward left ASIS

where and how does the inferior mesenteric a branch from the anterior aspect of the aorta?

distal portion of transverse colon, descending colon, sigmoid colon, and proximal portion of rectum

what viscera does the inferior mesenteric a supply?

L colic a, sigmoid a, superior rectal a

what branches does the inferior mesenteric a give rise to?

paracolic anastomoses and marginal a

what makes up the collateral blood supply of the colon?

between L1 and L2

where do the renal aa branch from the lateral aspect of the aorta?

renal aa

what supplies the kidneys?

R renal a is longer than left

compare the lengths of the R and L renal aa

testicular and ovarian

what are the gonadal aa?

at the level of L2 but course inferolaterally

where and how do the gonadal aa branch from the aorta?

R and L common iliac aa and median sacral a

what are the terminal branches of the aorta?

parietal branches of the aorta in the abdomen and the paired visceral aa

what will often have like named veins that course alongside them?

L gonadal v

parietal branches of the aorta in the abdomen and the paired visceral aa often have like named veins that course alongside them. what is the major exception?

no

is venous blood from the main visceral branches drained through the veins that lie with the arterial supply?

hepatic portal vein

what drains blood from the gut tube?

7-8cm

the hepatic portal vein is approximately how long?

hepatoduodenal ligament

what is the hepatic portal v embedded within?

collects poorly oxygenated, nutrient rich blood from the GI tract and carries it to the liver

what is the function of the hepatic portal vein?

superior mesenteric v, splenic v which receives inferior mesenteric v

what are the tributaries of the hepatic portal v?

in to

blood flow ___ the liver is maintained relatively constant

out of

blood flow ___ the liver cannot be readily compensated

pressure increases in the portal venous system (portal hypertension)

what happens if obstruction of the portal venous system occurs?

veins of the portal venous system have no valves

why does elevated pressure in the tributaries of the portal venous system occur?

dilation and varicosities

portal hypertension causes what to happen to the veins?

anastomoses

the hepatic portal system communicated with the systemic venous system in specific locations via...

esophageal vv draining to L gastric v, superior rectal v, paraumbilical v, colic v, splenic v

list portal veins involved in anastomoses with systemic veins

esophageal veins draining to azygous v, inferior rectal v, epigastric vv, retroperitoneal vv, L renal v

list systemic veins involved in anastomoses with portal veins

esophageal vv draining to azygous v (systemic v)

the esophageal vv draining to L gastric vein (portal vein) forms an anastomosis with...

inferior rectal v (systemic v)

the superior rectal v (portal vein) forms an anastomosis with...

epigastric vv (systemic v)

the paraumbilical v (portal vein) forms an anastomosis with...

retroperitoneal vv (systemic v)

the colic v (portal vein) forms an anastomosis with...

L renal v (systemic v)

the splenic v (portal vein) forms an anastomosis with...

obstruction of hepatic vv or portal vv due to tumor or thrombus, cirrhosis/sarcoidosis/lymphoma, congestive heart failure

list the causes of portal HTN

esophageal varices, hemorrhoids, and caput medusae

list the symptoms of portal HTN