Abdominal Neurovasculature 2024 PDF

Abdominal Neurovasculature Dr Rex Barton-Smith BSc (Clin Sci), MHSc (Osteo), Grad.Cert.Tert.Ed 1  Learning Outcomes Compare and contrast the origins of arterial supply for unpaired and paired abdominal viscera, and the abdominal wall...

Abdominal Neurovasculature Dr Rex Barton-Smith BSc (Clin Sci), MHSc (Osteo), Grad.Cert.Tert.Ed 1  Learning Outcomes Compare and contrast the origins of arterial supply for unpaired and paired abdominal viscera, and the abdominal wall Identify the major three unpaired branches of the abdominal aorta and their subsequent branches to viscera Describe the pathway of arteries to viscera with reference to unique features (appearance, anatomical relationships with viscera and/or peritoneum) Identify and describe the major venous drainage of abdominal viscera via the portal system Describe potential portosystemic anastomoses and their significance Describe the autonomic innervation to the abdominal viscera Describe the basic lymphatic drainage of the abdominal viscera 2 Abdominal Aorta 3 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.98 Abdominal Aorta 4 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.98  Secondarily Retroperitoneal Development Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.6 5 Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.6 Abdominal Aorta 6 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.98  Abdominal Aorta - Unpaired Branches Three unpaired branches arising anteriorly from the abdominal aorta to supply unpaired viscera Celiac Trunk – supplies foregut Pancreaticoduodenal arteries Abdominal oesophagus, stomach, duodenum, pancreas, liver, gall bladder, spleen Superior Mesenteric Artery – supplies midgut Duodenum, pancreas, jejunum, ileum, caecum, appendix, Middle and left colic arteries ascending colon, transverse colon Inferior Mesenteric Artery – supplies hindgut Transverse colon, descending colon, sigmoid colon, rectum 7 Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.110  Celiac Trunk Arises at T12/L1 from abdominal aorta Splenic artery Classic tortuous appearance along pancreas superiorly Some branches will travel within splenorenal ligament and greater omental ligaments Supplies pancreas, stomach, spleen Common hepatic artery Pathway to liver within hepatoduodenal ligament (L.O) Supplies stomach, duodenum, pancreas, liver and gall bladder Left gastric artery Smaller branch, will travel within gastrohepatic ligament (L.O) Supplies stomach and abdominal oesophagus 8 Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.112  Common Celiac hepatic Left gastric Splenic Trunk Short gastric arteries Left hepatic Pancreatic branches directly off splenic Right hepatic and cystic Left gastro-omental Proper hepatic Right gastric Gastroduodenal Superior (anterior and posterior) pancreatico- duodenal arteries Right gastro-omental 9 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #290  Left hepatic Cystic and right hepatic Hepatic proper Right gastric Common Common hepatic Hepatic Supraduodenal Gastroduodenal Zoom Superior posterior pancreaticoduodenal Right gastroomental Superior anterior pancreaticoduodenal Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #290 10  Superior Mesenteric Artery (SMA) Arises at L1 from abdominal aorta Passes superoanteriorly to duodenum (3rd part) Anastomosis with celiac trunk – Inferior pancreaticoduodenal arteries →superior p-d arteries of the celiac trunk Supplying intra and retroperitoneal structures – Jejunum →→ transverse colon (first 2/3rd) Anastomosis with inferior mesenteric artery – Middle colic artery →left colic artery of the inferior mesenteric artery 11 Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.115  Inferior anterior and posterior pancreaticoduodenal SMA Zoom 12 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #295  SMALL INTESTINAL BRANCHES SMA Inferior anterior and posterior pancreaticoduodenal Compare and contrast their appearance Middle colic (cut) Jejunal Right colic Ileocolic Appendicular Ileal 13 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #295  Jejunum Ileum Arcades Vasa recta Longer vasa recta More prominent/layered arcades Greater vascular supply 14 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #272A Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #272B  SMALL INTESTINAL BRANCHES SMA Compare and contrast their appearance Jejunal Ileal 15 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #295  Inferior Mesenteric Artery (IMA) Arises at L4 from abdominal aorta Passes inferiorly to duodenum (3rd part) Anastomosis with superior mesenteric artery – Left colic artery →middle colic artery of the superior mesenteric artery Terminal branch – superior rectal artery 16 Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 3rd Ed. Churchill Livingstone Elsevier, 2015 Fig 4.102a SMA and IMA Peritoneal relationship Note the vasculature traversing through the layers of the mesentery for the transverse and sigmoid colon 17 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #296  Venous Return of Unpaired Abdominal Viscera Splenic vein Portal vein Inferior mesenteric vein Superior mesenteric vein 18 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.32 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #303 Venous Return – Liver to IVC Hepatic veins 19 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #280  Portal Hypertension Portal venous system has a low pressure and no valves in the portal vein and major tributaries Liver damage can affect internal vasculature and may lead to an increase in pressure or ‘portal hypertension’ The pressure can force blood in a retrograde flow to find other ways to eventually enter the inferior vena cava via the systemic venous circulation (porto-systemic anastomosis) Structures at risk are those closely associated with veins draining into the portal and systemic venous systems (next slide). Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #282A 20  Portosystemic Anastomoses Potential anastomoses of portal and systemic veins 1. Oesophagus – Left gastric → azygous 2. Umbilicus/anterior abdominal wall – Paraumbilical →epigastric 3. Secondarily Retroperitoneal Viscera + Liver – Bare areas of these viscera – Eg. left colic → lumbar 4. Rectum – Superior rectal →middle/inferior rectal 21 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.75  Umbilical Vein and Ductus Venosus FETAL CIRCULATION FIBROTIC REMNANTS Ligamentum venosum Ductus venosus Umbilical vein Round ligament 22 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.65 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #279  Lymphatic Supply Lymph runs with arteries via chains of nodes Unpaired viscera drainage – travel along arterial supply to pre-aortic nodes Paired viscera drainage – travel along arterial supply to para-aortic nodes These all drain into ‘cisterna chyli’ → Thoracic duct 23 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.50  Pre-Aortic Nodes 24 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #304A Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #305 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #306A  Abdominopelvic splanchnic nerves Innervation - Sympathetic Preganglionic fibres from T6-L2 Pass through sympathetic chain without synapsing – Leave sympathetic chain as ‘splanchnic’ nerves (greater, lesser, least and lumbar) Synapse at ganglion around arteries – Unpaired visceral ganglion near unpaired arteries (eg celiac ganglion) – Paired visceral ganglion near paired arteries (eg aorticorenal ganglion) Post ganglionic fibres travel to viscera with arteries Visceral afferents carrying pain signals travel with sympathetic nerves until mid sigmoid colon – Pain referred to T6-L2 dermatomes Focus on blue lines Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.90 25  Innervation - Sympathetic In general, the relationship of these nerves Greater splanchnic – foregut Lesser splanchnic – midgut Least splanchnic – renal Lumbar splanchnic - hindgut 26 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.90  Innervation - Sympathetic Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.88 27 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.90  Innervation - Parasympathetic Foregut and midgut – vagus nerve Anterior and posterior vagal trunks join abdominal aortic plexuses Hindgut – pelvic splanchnic nerves (S2-4) Join inferior hypogastric plexus Visceral afferents carrying pain signals travel with parasympathetic nerves after mid sigmoid colon Pain referred to S2-4 dermatomes Focus on red lines 28 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.90  Innervation - Parasympathetic 29 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.90 Moore KL, Dalley AF & Agur AMR. Clinically Oriented Anatomy. 7th Ed. Wolters Kluwer, 2014, Fig 2.89  Revision Suggestions Below are images and activities suggested for your revision When revising, consider what activities help you understand the content to be able to reproduce your knowledge 30  Practice labelling Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #290 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #292 31  Practice labelling Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #295 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #298 Netter, FH. Atlas of Human Anatomy. 3rd Ed. New Jersey, Icon Learning Systems Plate #301 32  Revision Suggestions What other activities can you try to help your efficiency of your learning and revision? How can you make your activities more active? Organise a study group in the museum? Record yourself (not in the museum!) discussing images and then rewatching them? Have flip cards that are unlabelled images/open ended prompts? 33