L7 Part 2: Blood Supply of GIT PDF

The peritoneum & blood supply of GIT Mo'men khashashneh Jana Huneidi  Systemic Module GIT “Anatomy” Blood Supply of GIT Dr. Aym...

The peritoneum & blood supply of GIT Mo'men khashashneh Jana Huneidi  Systemic Module GIT “Anatomy” Blood Supply of GIT Dr. Ayman Alzubi Faculty of Medicine, Yarmouk University The blood supply for GIT and accessory organs are from the abdominal aorta Abdominal aorta is a countinuation of thoracic aorta at aortic hiatus(at level of T12) and dessend anterior to the vertebral column at the left side of inferior vena cava and ends at L4(at level of L4 give the right and left common iliac arteries) Abdominal Aorta It begins at the aortic hiatus of the diaphragm, at T12. Descends in front of lumbar vertebrae (slightly to the left of midline) and ends at L4. The terminal branches of the abdominal aorta are the two common iliac arteries.  Branches of Abdominal Aorta Visceral Branches Parietal Branches  Celiac Trunk.  Inferior Phrenics. anterior‫بطلعو من ال‬  Superior Mesenteric. wall of abdominal  Lumbars. aorta  Inferior Mesenteric.  Middle Sacral.  Middle Suprarenals.  Renals.  Gonadal. Anterior Branches of The Abdominal Aorta blood‫ عن ال‬+‫مسؤول‬ supply of GIT and Three Branches: accessory organs in  Celiac Artery. abdomin  Superior Mesenteric Artery.  Inferior Mesenteric Artery.  These three anterior branches supply the gastrointestinal viscera.  Organs derived from foregut: Organs derived from midgut: Organs derived from hindgut: jejunum,ileum ,cecum,assending Distal1/3 of transverse colon Lower part of esophagus, colon,lower part of duodenum, Descending colon Stomach,spleen,pancreas,liver, Proximal 2/3 of transverse colon and Sigmoid colon gallbladder and first part of Rectum,urogenital sinus appendix duodenum Upper ansl canal Basic Concept The celiac trunk supplies all organ derived from the foregut. The superior mesenteric supplies all organ derived from the midgut. The Inferior mesenteric supplies all organ derived from the hindgut.  Celiac Trunk It arises from the abdominal aorta immediately below the aortic hiatus of the diaphragm at the level of T12-L1. It immediately divides into the:  Left gastric artery.  Splenic artery. The largest  Common hepatic artery. Left Gastric Artery It is the smallest branch. lower part of esophgus‫بغذي ال‬ It ascends upward to the left to the gastroesophageal junction, sends esophageal branches to the abdominal part of esophgus. It turns to the right and descend along the lesser curvature of the stomach. Here, it anastomoses with the right gastric artery. Splenic Artery The largest branch, travels to the left, running posterior to the stomach and along the superior margin of the pancreas, enters hilum of spleen and gives into five terminal branches which supply the segments of the spleen. Branches: 1. Left gastroepiploic: supplies the greater curvature of the stomach. It anastomoses with the right gastroepiploic artery. 2. Short gastrics: 5-7 small branches supplying the fundus of the stomach. 3. Pancreatic branches: supply the body and tail of the pancreas. Common Hepatic Artery Travel to the right, as it passes superior to the duodenum, it divides into its two terminal branches – the proper hepatic and gastroduodenal arteries. Proper Hepatic Artery: common bile duct‫ وال‬portal vein‫وهو طالع للكبد بمشي معه ال‬ Ascends through the lesser omentum towards the liver (portal triad ??). Give rises to:  Right gastric: supplies the pylorus and lesser curvature of the stomach. left gastric‫ مع ال‬anastomoses ‫بعمل‬  Right and left hepatic: divide inferior to the porta hepatis and supply their respective lobes of the liver. hilum‫هذا التفرع بصير عند ال‬  N.B. The cystic artery is branch of the right hepatic artery supplies the gall bladder. Contd. ‫ لهيك (ا تصير ال‬ulcer ‫ هو اكثر مكان ممكن يصير فيه‬cap‫ال‬ Gastroduodenal Artery: bleeding ‫ هذا هو اكثر شريان ممكن يتأثر ويصير‬ulcer Descends posterior to the first part of the duodenum. Cap Give rises to:  Right gastroepiploic: supplies the greater curvature of the stomach. Found between the layers of the greater omentum. ‫ وبعملو‬left gastroepiploic‫بلتقي مع ال‬ anastomoses  Superior pancreaticoduodenal: divides into an anterior and posterior branch, which supplies the duodenum and head of the pancreas.  N.B. The gastroduodenal artery may give off the supraduodenal artery before descending posterior to the superior part of the duodenum.  Arterial Supply of Gastroduodenal Area Celiac Trunk: Artery of the Foregut Celiac Trunk Short Proper Gastric A. Hepatic A. Common Hepatic A. Left Gastric A. Splenic A. Gastroduodenal A. Right Gastric A. splenic artery‫فرع من ال‬ greater‫بمشي مع ال‬ omentum Right and Left Gastro-omental A. epiploic‫اله اسم ثاني وهو ال‬ artery R. Gastro-omental A. Superior Pancreaticoduodenal A. (Anterior/Posterior) Gastroduodenal A. Superior Mesenteric Artery (SMA): Artery of the Midgut; supplies Inferior Pancreaticoduodenal A. (Ant/Post) The stomach is the only organ to receive arterial supply from all three branches of the coeliac trunk. This is achieved through a system of anastomoses along the greater (gastroepiploic arteries) and lesser (gastric arteries) curvatures.  neck of pancreas‫ خلف ال‬L1 ‫بتكون عند‬ ‫ وامامه‬left renal vein‫بمشي خلفه ال‬ splenic vein‫ال‬ Superior Mesenteric Artery It arises from the abdominal aorta immediately 1cm below the celiac trunk at the level of L1. (neck of pancreas‫)خلف ال‬ It supplies arterial blood to the organs of the midgut – which spans from the major duodenal papilla (of the duodenum) to the proximal 2/3 of the transverse colon. Anatomical relations:  Posterior to the artery: the left renal vein, the uncinate process of the pancreas, and the 3rd part of the duodenum.  Anterior to the artery: the pyloric part of the stomach, the splenic vein and neck of the pancreas. ‫ عن طريق التقاء‬neck of pancreas‫ بتكون خلف ال‬portal vein‫ال‬ superior mesenteric vein‫ مع ال‬splenic vein‫ال‬ posterior to (superior mesentric vessels) ‫ بتكون‬extension of pancreas ‫اال‬ Branches of Superior Mesenteric Artery Inferior pancreaticoduodenal artery (forms anterior and posterior vessels) Jejunal and ileal arteries proximal two thirds of‫بغذي ال‬ Middle colic artery assending colon‫بتغذي ال‬ transvers colon ascending‫بغذي ال‬ Ileocolic‫ وال‬assending colon‫ وال‬secum‫هذول بغذو ال‬ proximal teo‫بغذي ال‬ colon Right colic artery thirds of transvers colon transverse colon‫ من ال‬two thirds ‫بتغذي‬ Ileocolic artery (Gives off appendicular A.) terminal part of‫بتغذي ال‬ illum and the secum and appendix  Middle colic a. Superior Mesenteric v. Inf. pancreaticodudenal a. Superior Right colic a. mesenteric a. Ileocolic a. Jejunal and ileal br. Appendicular a. The jejunal and ileal arteries pass between the layers of the mesentery and form anastomotic arcades – from which smaller, straight arteries (known as the “vasa recta”) arise to supply the organs The jejunal blood supply is characterized by a smaller number of arterial arcades, but longer vasa recta. In contrast, the ileal blood supply is marked by more arterial arcades with shorter vasa recta.  Inferior Mesenteric Artery It is the smallest of the three anterior branches of the abdominal aorta and arises at the level of L3 (at the level of lower border of 3rd part of duodenum). It supplies arterial blood to the organs of the hindgut – the distal 1/3 of the transverse colon, splenic flexure, descending colon, sigmoid colon and rectum. And anal canal Initially, the inferior mesenteric artery descends anteriorly to the aorta and then passes to the left as it continues inferiorly.  Branches of Inferior Mesenteric Artery destaldistal partthirdof‫ال‬ of the‫بغذي‬ ‫بغذي ال‬ transverse colon and the entire descending colon Left colic artery descending colon Several sigmoid arteries 3_4 arteries Superior rectal artery. segmoid colon‫بغذو ال‬ Marginal artery (of Drummond) Inferior mesenteric v. Inferior mesenteric a. Left colic a. Sigmoid a. Superior rectal a.  IMV IMA Arterial Supply of Rectum and Anal Canal. Median sacral artery (Aorta) Superior rectal artery (IMA) lower part of rectum‫بغذي ال‬ Inferior rectal artery (Internal pudendal artery) rectum‫ الي بغذو ال‬arteries‫هذول ال‬  superior‫ الي بلتقي مع ال‬splenic vein‫بصب في ال‬ portal vein‫ عشان يعملو ال‬mesenteric vein Colic Marginal Artery (of Drummond) Marginal artery (of Drummond) –Forms a continuous arterial circle along the inner border of the colon.  Extends from the ileocecal junction to the rectosigmoid junction.  It is formed by the union of several branches: ileocolic, right colic and middle colic of the SMA and left colic and sigmoid branches of the IMA.  The vasa recta) arise from the artery to supply the colon.