Abdomen: Visceral Vasculature

Abdomen > Visceral Vasculature > Study Aims
STUDY AIMS
At the end of your study, you should be able to:
Know the unpaired branches of the abdominal aorta
Know the major branches of the celiac trunk, superior mesenteric artery, and inferior mesenteric artery
Know the unpaired branches of the abdominal aorta and their distribution of blood
Understand the two types of venous drainage from the abdomen
Describe the formation of the hepatic portal vein from the splenic and superior mesenteric veins
Know the tributaries of the splenic and superior mesenteric veins
Describe the lymphatic drainage of the abdomen

Abdomen > Visceral Vasculature > Guides
GUIDE

4-6: Abdomen: Visceral Vasculature
    Arterial supply: Unpaired branches of the abdominal aorta (Plate 300) (Plate 301, Plate 306 and Plate 307) (Section 4-2: AbdomenBody Wall)
  • Celiac trunk
    • Arises at T12
    • Supplies
      • Lower one third of esophagus
      • Stomach
      • First and second parts of duodenum
      • Pancreas
      • Spleen
      • Liver
      • Biliary system
    • Branches
      • Left gastric artery
      • Common hepatic artery
      • Splenic artery
    • Left gastric artery
      • Supplies distal esophagus and lesser curvature of stomach
      • Anastomosis with right gastric artery
    • Splenic artery
      • Supplies body of pancreas and spleen directly
      • Branches:
        1. Left gastroepiploic: supplies left side of greater curvature of stomach, anastomoses with right gastroepiploic
        2. Short gastric arteries: supply fundus of stomach
    • Common hepatic artery
      • Extends retroperitoneally to the right to reach hepatoduodenal ligament
      • Divides into gastroduodenal and proper hepatic arteries
      • Gastroduodenal artery branches:
        1. Superior pancreaticoduodenal supplying the head of pancreas and proximal duodenum
        2. Right gastroepiploic artery supplying right side of greater curvature of stomach
      • Proper hepatic branches:
        1. Right and left hepatic arteries to right and left lobes of liver
        2. Right gastric artery to right portion of lesser curvature of stomach
        3. Cystic artery usually from the right hepatic artery supplies the gallbladder and cystic duct
  • Superior mesenteric artery (SMA)
    • Arises at L1
    • Supplies the gut from the second part of duodenum as far as the distal one third of the transverse colon
    • Major branches include:
      • Inferior pancreaticoduodenal
        1. Supplies duodenum (distal to entry of bile duct), pancreas, and spleen;
        2. Anastomosis with superior pancreaticoduodenal
      • Jejunal and ileal branches
        1. Form anastomotic loops (arterial arcades)
          Fewer large loops in jejunum
          Many shorter loops in ileum
        2. Loops give off vasa recta (straight arteries)
          Longer in jejunum
          Shorter in ileum
      • Ileocolic artery:
        1. Supplies caecum and some of the ascending colon
        2. Supplies appendix via appendicular branch
      • Right colic artery: supplies ascending colon and proximal transverse colon
      • Middle colic artery: supplies proximal two thirds of transverse colon
  • Inferior mesenteric artery (IMA)
    • Arises at L3
    • Supplies distal one third of the transverse colon → proximal rectum
    • Branches include:
      • Left colic artery: supplies distal transverse, descending and sigmoid colon
      • Superior sigmoid artery(ies): supplies sigmoid colon
      • Superior rectal artery (terminal branch of inferior mesenteric): supplies proximal rectum
  • Median sacral artery
    • Arises from posterior aspect of aorta just above bifurcation
    • Descends to supply lower lumbar vertebrae, sacrum and coccyx
    Arterial supply: Paired branches of the abdominal aorta
  • Inferior phrenic arteries
    • First branches of abdominal aorta (or from celiac trunk)
    • Supply inferior surface of diaphragm
    • Give rise to six to eight superior suprarenal arteries on either side
  • Middle suprarenal arteries
    • One or more on either side
    • Originate from aorta near origin of celiac trunk
  • Renal arteries
    • Arise at level of L1/L2 intervertebral disc
    • Right renal artery longer and passes posterior to inferior vena cava (IVC)
    • Divide close to hilum into five segmental end arteries
  • Gonadal arteries
    • Arise inferior to renal arteries but superior to inferior mesenteric
    • May arise at different levels on either side
    • Run anterior to ureters, cross origin of external iliac vessels in suspensory ligament of ovary and enter broad ligament
    • Divide into ovarian and tubal branches to supply ovary and uterine tube
    • Branches anastomoses with correspondingly names branches of uterine artery
  • Lumbar arteries
    • Usually four pairs
    • Given off from posterior aspect of aorta
    • Each gives off a dorsal branch
      • Supplies musculature of back
      • Gives off a spinal branch to vertebral column and spinal roots
    • Rest of artery supplies anterolateral abdominal wall
  • Common iliac arteries
    • Formed by bifurcation of aorta at level of iliac crest (slightly below level of umbilicus)
    • Follow medial borders of psoas muscle to pelvis brim
    • Bifurcate into internal and external iliac arteries at pelvic brim
    • Supply pelvic viscera and lower limb
    Venous Drainage (Section 4-2: AbdomenBody Wall)
  • Veins draining the abdominal viscera are tributaries of one of two venous systems (Plate 309 and Plate 310) (Plate 311)
    • Inferior vena cava
    • Portal vein
  • No vein equivalent to celiac trunk or gastroduodenal vein
  • Splenic vein and superior mesenteric vein unite to form the portal vein (Plate 312)
    • Tributaries of the splenic vein
      • Inferior mesenteric vein and its tributaries (left colic, sigmoid, superior rectal)
      • Pancreatic veins
      • Left gastroepiploic vein
      • Short gastric veins
    • Tributaries of the superior mesenteric vein
      • Inferior pancreaticoduodenal vein
      • Right gastroepiploic vein
      • Right colic vein
      • Ileocolic vein
      • Jejunal veins
      • Ileal veins
    • Veins draining directly into portal vein
      • Cystic vein
      • Superior pancreaticoduodenal
      • Left and right gastric veins also may
    • Tributaries of the IVC
      • Common iliac veins
      • Lumbar veins
        • Enter IVC in irregular pattern
        • Second lumbar vein may enter left renal vein
        • Anastomose with tributaries of epigastric veins
        • Are connected to each other on either side by a vertical anastomotic channel, the ascending lumbar vein
        • Ascending lumbar veins connect with azygos vein on the right and hemiazygos vein on the left
      • Right gonadal vein (left drains to left renal vein)
      • Right and left renal veins
      • Right suprarenal vein (left drains to left renal vein)
      • Right inferior phrenic vein (left drains to left renal vein)
      • Hepatic veins
        • Two to three in number
        • Empty into IVC just below diaphragm
      • Blood from the hepatic portal vein constitutes approximately 70% of the liver's blood supply
    Lymphatic Drainage
    (Section 4-2: AbdomenBody Wall and Section 4-4: AbdomenViscera (Gut) and 4-5: AbdomenViscera (Accessory Organs) for specific organs)
  • Lymphatics generally follow arteries
  • Drain to local, then regional lymph nodes (lumbar, celiac, superior, and inferior mesenteric nodes)
  • Main lymphatic ducts of abdomen from regional nodes
    • Intestinal lymphatic trunks (single or multiple)
    • Right and left lumbar lymphatic trunks
  • Thoracic duct
    • Begins with union of main lymphatic ducts of abdomen, unless cisterna chili is present
    • Ascends into thoracic through aortic hiatus in diaphragm
  • Cisterna chili
    • Thin walled sac or dilation at union of main lymphatic ducts of abdomen
    • Drains to thoracic duct
    • If present, occurs at the level of L1/2
    • Not seen in all individuals
    • Can vary in size and shape
Abdomen > Visceral Vasculature > Figures
FIGURES
Plate 300: Abdomen: Visceral Vasculature—Arteries of Stomach, Liver and Spleen
Plate 311: Abdomen: Visceral Vasculature—Veins of Large Intestine
Plate 312: Abdomen: Visceral Vasculature—Hepatic Portal Vein Tributaries: Portacaval Anastomoses
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