L5.2 Vessels

Question 1

Arteriole supply in the 3 vascular plane?

Answer 1

1. Unpaired midline viscera
2. Paired Lateral viscera
   
   • Suprarenal A (SUP/MID/INF)
   • MID has own branch from aorta
   • Renal A (L/R)
3. Ab wall
   
   • INF phrenic
     
     • Branch of aorta
   • Supply diaphragm from INF
   • Also gives off SUP suprerenal A

Question 2

Unpaired midline supply: Celiac trunk: L gastric A

Answer 2

• Celiac trunk:
  
  • Comes off aortia hiatus
• Branches:
• Shortest = L gastric A (travels along lesser curvature)
  
  • → esophagus

Question 3

Unpaired mindline supply: Celiac trunk: Splenic A

Answer 3

• Longest = Splenic A (along pancreas → on gastrosplenic lig)
  
  • → L gastro-omental A (along G curvature)
  • → Short gastric A (SUP side)

Question 4

Unpaired midline supply: Common hepatic A

Answer 4

• Common hepatic A
  
  • → Hepatic A proper (larger - travels in free edge of L omentum)
  • → Gastro-duodenal A
    
    • → R gastro-omental A
    • → SUP Pancreaticoduodenal A

Question 5

Unpaired midline supply: SMA

Answer 5

• From distal body of L1

1. INF pancreaticoduodenal A
2. Main vessels on the L:
   
   • Jejunal A
   • Ileal A
     
     • Forms arcades → vasa recta comes off arcades
3. Ileocecal A
   
   • → appendicular A
4. R colic A (A colon)
   
   • Colic A travels through the fusion fascia
5. Middle colic A (T colon)

Question 6

Unpaired midline supply: IMA

Answer 6

• Comes off L3
• L colic A (D colon)
• Sigmoid A (Sig colon)
• SUP rectal A

Question 7

End arteries

Answer 7

• Found in these structures (i.e. appendicular A)
• Clinically significant → blocked → ischemia

Question 8

End organs

Answer 8

• Receiving BS from end A
• Able to be separated and surgically resected

Question 9

Systemic venous drainage

Answer 9

• IVC (on the R of the aorta)
  
  • Contacts SVC along ANT wall
• Azygous system = lumbar + A lumbar V
  
  • Subcostal V drain into A lumbar
  • A lumbar/lumbar V have branches draining into IVC
• R-renal V & R gonadal V drains directly into IVC
• R suprarenal also drains directly into IVC
• L renal V = L kidney + L gonadal
• L suprarenal → drains into L renal V → into IVC

Question 10

Hepatic portal system

Answer 10

• Hepatic portal V → systemic venous drainage for the liver
  
  • = Splenic V + IMV + SMV
• Travels in free edge of L omentum
• Drainage of ab viscera → drains into hepatic sinusoids (capillaries in liver) → allows nutrient exchange → back into systemic venous system

Question 11

Portosystemic anastomoses

Answer 11

• Contact b/w portal & systemic systems
• In liver: Blockage of sinusoids → causes backflow (no valves in trunk V) → dilation of systemic V (Varices)

Question 12

Esophageal & Short gastric V (portosystemic anastomoses)

Answer 12

• Esophageal V meets short gastric V at distal esophageal end (portosystemic anastomoses)
  
  • Dilated → hemorrhage

Question 13

SUP & INF rectal (portosystemic anastomoses)

Answer 13

• SUP rectal meet INF rectal (PS anastomoses)
  
  • Dilated → hemorrhage

Question 14

Paraumbilical V (Portosystemic anastomoses)

Answer 14

• Paraumbilical V → connects portal system (liver) with systemic system (via epigastric V in ANT wall)
  
  • Surrounds umbilical V (is degenerated)
  • Dilated → “head of medusa” - visible along umbilicus region → shows portohypertension

Question 15

Lymph vessels in skin

Answer 15

• Travels with Superficial V → Deep V
• Lymph from skin → travels to axillary & inguinal lymph nodes

Question 16

Lymph vessels in GIT

Answer 16

• lymph vessels are within visceral (lacteals)
• No deep lymph vessels or nodes
• Have paraaortic lymph nodes → pick up lymph from either side of body
• Have preaortic lymph nodes → on aorta (middle)
• Celiac + SM + IM lymph nodes (Cannot be palpated) → travels with A blood → Cisterna Chyli → Supraclavicular lymph nodes → drains into L brachiocephalic V → Heart

Question 17

Supraclavicular lymph node

Answer 17

• Last sentinel lymph node → able to be palpated to check for abdominal cancer (since Celiac/SM/IM cannot be palpated)

Question 18

NS to viscera

Answer 18

• ANS
  
  • Visceral efferent (motor)
    
    • SNS - inhibitory in GIT
    • PNS - stimulant in GIT

Question 19

Sympathetic trunk

Answer 19

• (T6-L2)
• Thoracolumbar outflow
• Presomatic fibres (no synpase within trunk) → meets preaortic ganglia (on aorta) & synapse → post sym fibres then sends to viscera → travels in N plexus along with maj A

Question 20

Splanchnic N

Answer 20

• Presomatic fibres travel in splanic N
  
  • Thoracic splanchnic: Supplies the celiac trunk & SMA
    
    • Greater (T5-9)
    • Lesser (T10-11)
    • Least (T12)
  • Lumbar splanchnic (L1-3) Supplies IMA

Question 21

PNS trunk

Answer 21

• Cranio(vagus)sacral outflow
• L (ANT); R (POS) vagal trunk (position relative to esophagus)
  
  • Gives out PS fibres
  • No synapses in ganglia → direct to viscera (synapse on/within viscera)
• Supplies foregut & midgut
  
  • Hindgut supplied by pelvic splanchnic N

Question 22

Referred pain in GIT (pathway it travels

Answer 22

• Travels from anal end to caudal end
  
  • Travel with SNS only up to sigmoid colon
  • Travel with PNS from sigmoid colon downwards
  • Midsigmoid region downwards → refer pain to perineal region (Dermatomes S2-4)