Podcast
Questions and Answers
What is the diameter threshold for abdominal aortic aneurysms?
What is the diameter threshold for abdominal aortic aneurysms?
- 5 cm
- 4 cm
- 2 cm
- 3 cm (correct)
Which of the following statements about the coeliac trunk is accurate?
Which of the following statements about the coeliac trunk is accurate?
- It gives rise to the splenic artery. (correct)
- It is primarily responsible for blood drainage from the pancreas.
- It supplies exclusively the lower part of the esophagus.
- It supplies only the stomach.
Which artery is NOT associated with the abdominal blood supply?
Which artery is NOT associated with the abdominal blood supply?
- Superior mesenteric artery
- Iliac artery (correct)
- Splenic artery
- Common hepatic artery
What condition can commonly coexist with abdominal aortic aneurysms?
What condition can commonly coexist with abdominal aortic aneurysms?
What is the main drainage vessel for the organs supplied by the superior mesenteric artery?
What is the main drainage vessel for the organs supplied by the superior mesenteric artery?
Which of the following is NOT a risk factor for abdominal aortic aneurysms?
Which of the following is NOT a risk factor for abdominal aortic aneurysms?
Which artery is associated with the blood supply to the jejunum and ileum?
Which artery is associated with the blood supply to the jejunum and ileum?
Which set of arteries provides anastomoses around the stomach?
Which set of arteries provides anastomoses around the stomach?
Which artery supplies the last third of the transverse colon?
Which artery supplies the last third of the transverse colon?
What is the primary drainage vein for the sigmoid colon?
What is the primary drainage vein for the sigmoid colon?
What defines the difference between the portal system and caval system?
What defines the difference between the portal system and caval system?
Which vein is NOT a tributary of the hepatic portal vein?
Which vein is NOT a tributary of the hepatic portal vein?
The left testicular vein drains into which vein?
The left testicular vein drains into which vein?
Which anatomical feature is involved in referred pain?
Which anatomical feature is involved in referred pain?
What anatomical structure does the superior rectal artery drain into?
What anatomical structure does the superior rectal artery drain into?
Which of the following statements regarding the inferior vena cava (IVC) is incorrect?
Which of the following statements regarding the inferior vena cava (IVC) is incorrect?
Which of the following describes the role of the right suprarenal vein?
Which of the following describes the role of the right suprarenal vein?
Which feature is NOT associated with the portal-caval anastomosis?
Which feature is NOT associated with the portal-caval anastomosis?
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Study Notes
Abdominal Aorta Aneurysms
- Diameter greater than 3cm
- Different types
- Associated with thoracic aorta and popliteal aneurysms
- Risk factors: male, smoking, high blood pressure, family history
Arterial Supply
- Gut
- Single unpaired branches
- Abdominal wall & other structures
- Paired branches
Foregut
- Lower part of oesophagus, stomach, 2/3rds duodenum
- Includes: liver, spleen, gallbladder, pancreas
- Supplied by coeliac trunk
- Drained by splenic artery
- Note anastomosis around stomach: left and right gastric arteries and left and right gastroomental arteries
Coeliac Trunk
- Left gastric artery
- Splenic artery
- Left gastroomental artery, short gastric arteries
- Common hepatic artery
- Proper hepatic artery
- Cystic artery; left and right hepatic arteries
- Right gastric artery
- Gastroduodenal artery
- Supraduodenal artery
- Right gastroomental artery
- Superior pancreaticoduodenal artery
- Proper hepatic artery
Midgut
- Last 1/3rd of duodenum, jejenum, ileum, cecum & appendix, ascending colon, 1st 2/3rd of tv colon
- Supplied by superior mesenteric artery
- Drained by superior mesenteric vein
Superior Mesenteric Artery
- Jejenual and ileal branches
- Ileocolic artery
- Appendicular branch
- Right colic artery
- Middle colic artery
Hindgut
- Last 1/3rd of tv colon, descending colon, sigmoid colon, rectum
- Supplied by inferior mesenteric artery
- Drained by inferior mesenteric vein
Inferior Mesenteric Artery
- Left colic artery
- Sigmoidal branches
- Superior rectal artery
Anastomosis: Foregut - Midgut
- Anastomosis between the coeliac trunk and the superior mesenteric artery
Anastomosis: Midgut - Hindgut
- Anastomosis between the superior mesenteric artery and the inferior mesenteric artery
Venous Drainage
- IVC (Caval System)
- Drains the limbs, abdominal wall and paired structures
- Common iliac veins - from lower limbs and gluteal region
- Lumbar veins – from posterior abdominal wall
- Renal veins – from kidneys, left adrenal gland and left testis/ovary. Right testicular/ovarian vein from right testes or ovary
- Right suprarenal vein
Venous Drainage: IVC
- Note:
- Left testicular/ovarian vein drains into the left renal vein
- Left adrenal vein drains into left renal vein
- No tributaries from spleen, pancreas, gallbladder drain into portal system
Venous Drainage: Portal Hepatic Vein
- Forms GIT
- Formed by union of splenic vein and inferior mesenteric vein
- Posterior to head of pancreas on L2
- Tributaries:
- Inferior mesenteric vein
- Gastric veins
- Cystic veins
Portal System vs Caval System
- Portal System
- Hepatic portal vein
- Drains nutrient rich deoxygenated blood
- From GIT
- Into IVC via hepatic veins inside liver
- Caval System
- IVC
- Drains nutrient poor deoxygenated blood
- From limbs, abdominal wall and paired structures
- Directly into the right atrium
Portocaval Anastomosis
- Butt (rectal)
- Gut (Oesophageal & retroperitoneal)
- Caput (paraumbilical)
- A: Oesophagal
- Caval: azygos system
- Portal: Left gastric v
- B: Rectal
- Caval: Middle & Inferior rectal vv to internal iliac v
- Portal: Superior rectal vein to IMV
- C: Paraumbilical
- Caval: inferior epigastric vein
- Portal: Paraumbilical vv
- D: Retroperitoneal
- Caval: Lumbar vv
- Portal: Inferior mesenteric
Blockage of IVC below kidneys
- Can cause swelling in the legs
Portal Hypertension
- High blood pressure in the portal vein
- Can cause varicose veins in the oesophagus, stomach, rectum and abdomen
Innervation: Abdominal Wall
- T6-L1
Innervation: Autonomic Involvement
- Foregut
- Supplied by coeliac trunk
- sympathetic: greater splanchnic nerve
- parasympathetic: vagus nerve
- Midgut
- Supplied by superior mesenteric artery
- sympathetic: lesser splanchnic nerve
- parasympathetic: vagus nerve
- Hindgut
- Supplied by inferior mesenteric artery
- sympathetic: least splanchnic nerve
- parasympathetic: pelvic splanchnic nerves
Innervation: Peritoneum
- Parietal peritoneum
- innervated by somatic nerves
- Visceral peritoneum
- innervated by autonomic nerves
Referred Pain
- Pain perceived at a location other than the site of the painful stimulus
- Primarily due to convergence of sensory neurons in spinal cord
- Pain from injury, inflammation activate sensory neurons relaying info to spinal cord
- Due to convergence, pain signals may also activate sensory neurons from a different body region
- Brain is unable to differentiate between the two sources, perceives the pain as originating from the region represented by the activated sensory neurons
Examples of Referred Pain
- Pain from the appendix may be felt in the right lower quadrant of the abdomen
- Pain from the gallbladder may be felt in the right upper quadrant of the abdomen
- Pain from the heart may be felt in the left arm, jaw, or neck
- Pain from the kidneys may be felt in the back or loin
- Pain from the uterus may be felt in the lower abdomen or back
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