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Home Anatomy

Anatomy of Abdominal vasculature in a Nutshell

siva guru by siva guru
June 5, 2021
in Anatomy, Pre-Clinical
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Abdominal arteries:

Aorta terminates as bifurcation into R and L iliac arteries.  3 unpaired branches come off of aorta on its path from diaphragm to bifurcation.

  • Celiac artery (celiac trunk):  this supplied the foregut in embryo (stomach, duodenum, esophagus). Has 3 major branches:
    • Left gastric artery: lesser curvature of stomach.
    • Splenic artery: Runs behind stomach to supply spleen.
    • Common Hepatic artery.  Splits into gastroduodenal artery and propery hepatic artery.
  • Superior mesenteric artery (more inferior): supplies small intestine and most of large intestine.  Forms intestinal branches.
    • Ileocolic (ileocecal) supplies terminal part of ilum, cecum, and appendix.
    • Right colic artery: supplies  ascending colon.
    • Middle colic artery: supplies transverse colon.
    • Inferior pancreaticoduodenal artery: inferior supply to pancreas / duodenum.
    • All of these arteries are interconnected by the marginal artery of Drummond. This connection is important for collateral circulation.  Connects branches of both superior mesenteric and inferior mesenteric arteries.
  • Inferior mesentery artery (most inferior): supplies last portion of large intestine and part of rectum.
    • Left colic artery: majority of descending colon.
    • Sigmoidal artery: supplies sigmoidal colon.
    • Superior rectal artery: supplies rectum.  Always furthest to the right.
  • “Mesentery” arteries travel within the mesentery.

Hepatic portal venous system:

  • Begins at the venous ends of capillaries in the organs of the GI tract and ends at the venous sinusoids in the liver.
  • The portal vein is formed by the joining of the splenic vein within the superior mesenteric vein.  The inferior mesenteric vein usually joins the splenic vein.
    • Superior mesenteric vein
    • Inferior mesenteric vein.
    • Splenic vein
  • Splenic vein joins with inferior mesenteric veinà then joined by superior mesenteric vein to become the portal vein.

Portal hypertension:

  • Occurs when portal circulation through liver is obstructed by liver disease (cirrhosis) or tumor.
  • Portal veins do not have valves, thus allowing flow in each direction.
  • The high portal pressure promotes the enlargement (varices) of alternate pathways to the caval system. Result is varicose veins (enlarged veins).  4 spots where these occur: at portal-systemic anastomoses:
    • Esophageal varices: between esophageal branch of left gastric portal vein and esophageal branches to azygous (systemic veins).
    • Hemorrhoids: between superior rectal branch of inferior mesenteric vein (portal) and the middle / inferior rectal vein to the internal iliac (systemic).
    • Caput medusae: between paraumbilical (in falciform ligament) branch of portan and the superior / inferior epigastric veins (systemic).
    • Retroperitoneal varices (veins of Retzius): between colic / duodenal / pancreatic veins and the lumbar / renal veins to the inferior vena cava (systemic).

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