Arterial supply of the abdomen aorta.ppt

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  • 1. 1BITEW M./bitewm@gmail.com
  • 2.  The abdominal aorta begins at the aortichiatus of the diaphragm, anterior to thelower border of vertebra TXII. It descends through the abdomen, anteriorto the vertebral bodies, and by the time itends at the level of vertebra LIV it is slightlyto the left of midline. The terminal branches of the abdominalaorta are the two common iliac arteries.2BITEW M./bitewm@gmail.com
  • 3. The abdominal aorta hasanterior, lateral, and posteriorbranches as it passes through theabdominal cavity. The three anterior branches supply thegastrointestinal viscera:the celiac trunk the superior mesenteric andthe inferior mesentericarteries. 3BITEW M./bitewm@gmail.com
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  • 6. A. foregut,B. midgut, andC. hindgut regions. The boundaries of these regions are directlyrelated to the areas of distribution of the threeanterior branches of the abdominal aorta.6BITEW M./bitewm@gmail.com
  • 7. Divisions of thegastrointestinaltract intoforegut, midgut,andhindgut, summarizing the primaryarterial supply toeach segment.7BITEW M./bitewm@gmail.com
  • 8. The foregut begins with the abdominalesophagus and ends just inferior to themajor duodenal papilla, midway along thedescending part of the duodenum.It includes the abdominalesophagus, stomach, duodenum (superiorto the major papilla), liver, pancreas, andgallbladder.The spleen also develops in relation tothe foregut region. The foregut issupplied by the celiac trunk.8BITEW M./bitewm@gmail.com
  • 9. Divisions of thegastrointestinaltract intoforegut, midgut,andhindgut, summarizing the primaryarterial supply toeach segment.9BITEW M./bitewm@gmail.com
  • 10.  The midgut begins just inferior to the majorduodenal papilla, in the descending part of theduodenum, and ends at the junction betweenthe proximal two-thirds and distal one-third ofthe transverse colon. It includes the duodenum (inferior to themajor duodenalpapilla), jejunum, ileum, cecum, appendix, ascending colon, and the right two-thirds of thetransverse colon. The midgut is supplied by the superiormesenteric artery.10BITEW M./bitewm@gmail.com
  • 11. Divisions of thegastrointestinaltract intoforegut, midgut,andhindgut, summarizing the primaryarterial supply toeach segment.11BITEW M./bitewm@gmail.com
  • 12.  The hindgut begins just before the left colicflexure (the junction between the proximaltwo-thirds and distal one-third of thetransverse colon) and ends midway throughthe anal canal. It includes the left one-third of the transversecolon, descending colon, sigmoidcolon, rectum, and upper part of the analcanal. The hindgut is supplied by the inferiormesenteric artery12BITEW M./bitewm@gmail.com
  • 13. Divisions of thegastrointestinaltract intoforegut, midgut,andhindgut, summarizing the primaryarterial supply toeach segment.13BITEW M./bitewm@gmail.com
  • 14.  The celiac trunk is the anterior branch of theabdominal aorta supplying the foregut. It arises from the abdominal aortaimmediately below the aortic hiatus of thediaphragm, anterior to the upper part ofvertebra LI. It immediately divides into the:A. left gastric,B. splenic, andC. common hepatic arteries.14BITEW M./bitewm@gmail.com
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  • 20.  The left gastric artery is the smallest branch ofthe celiac trunk. It ascends to the cardioesophageal junction andsends esophageal branches upward to theabdominal part of the esophagus. Some of these branches continue through theesophageal hiatus of the diaphragm andanastomose with esophageal branches from thethoracic aorta. The left gastric artery itself turns to the right anddescends along the lesser curvature of thestomach in the lesser omentum. It supplies both surfaces of the stomach in thisarea and anastomoses with the right gastric artery.20BITEW M./bitewm@gmail.com
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  • 23.  The splenic artery, the largest branch of theceliac trunk, takes a tortuous course to theleft along the superior border of thepancreas. It travels in the splenorenal ligament anddivides into numerous branches, which enterthe hilum of the spleen. As the splenic artery passes along thesuperior border of the pancreas, it gives offnumerous small branches to supply theneck, body, and tail of the pancreas.23BITEW M./bitewm@gmail.com
  • 24.  Approaching the spleen, the splenic artery givesoff short gastric arteries, which pass throughthe gastrosplenic ligament to supply the fundusof the stomach. It also gives off the left gastro-omentalartery, which runs to the right along the greatercurvature of the stomach, and anastomoses withthe right gastro-omental artery.24BITEW M./bitewm@gmail.com
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  • 27.  The common hepatic artery is a medium-sized branch of the celiac trunk that runs tothe right and divides into its two terminalbranches, the hepatic artery proper and thegastroduodenal artery. The hepatic artery proper ascends towardsthe liver in the free edge of the lesseromentum. It runs to the left of the bile duct and anteriorto the portal vein, and divides into the rightand left hepatic arteries near the portahepatis.27BITEW M./bitewm@gmail.com
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  • 31.  As the right hepatic artery nears the liver, itgives off the cystic artery to the gallbladder. The gastroduodenal artery may give off thesupraduodenal artery before descendingposterior to the superior part of theduodenum. Reaching the lower border of the superiorpart of the duodenum, the gastroduodenalartery divides into its terminal branches, theright gastro-omental artery and the superiorpancreaticoduodenal artery31BITEW M./bitewm@gmail.com
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  • 35.  passes to the left, along the greater curvature ofthe stomach, eventually anastomosing with theleft gastro-omental artery from the splenic artery. The right gastro-omental artery sends branches toboth surfaces of the stomach and additionalbranches descend into the greater omentum. The superior pancreaticoduodenal artery dividesinto anterior and posterior branches as it descendsand supplies the head of the pancreas and theduodenum. These vessels eventually anastomose with anteriorand posterior branches of the inferiorpancreaticoduodenal artery.35BITEW M./bitewm@gmail.com
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  • 37.  The superior mesenteric artery is the anteriorbranch of the abdominal aorta supplying themidgut. It arises from the abdominal aortaimmediately below the celiac artery,anteriorto the lower part of vertebra LI.37BITEW M./bitewm@gmail.com
  • 38.  is crossed anteriorly by the splenic vein and theneck of pancreas. Posterior to the artery are theleft renal vein, the uncinate process of thepancreas, and the inferior part of theduodenum. After giving off its first branch (the inferiorpancreaticoduodenal artery) the superiormesenteric artery gives off jejunal and ilealarteries on its left.38BITEW M./bitewm@gmail.com
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  • 40. Branching from the right side of themain trunk of the superior mesentericartery are three vessels-A. the middle colic,B. right colic, andC. ileocolic arteries-which supply theterminal ileum, cecum, ascendingcolon, and two-thirds of thetransverse colon.40BITEW M./bitewm@gmail.com
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  • 45.  The inferior pancreaticoduodenal artery is thefirst branch of the superior mesenteric artery. It divides immediately into anterior andposterior branches, which ascend on thecorresponding sides of the head of thepancreas. Superiorly, these arteries anastomose withanterior and posterior superiorpancreaticoduodenal arteries. This arterial network supplies the head anduncinate process of the pancreas and theduodenum45BITEW M./bitewm@gmail.com
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  • 48.  Distal to the inferior pancreaticoduodenalartery, the superior mesenteric artery gives offnumerous branches. Arising on the left is a large number of jejunaland ileal arteries supplying the jejunum and mostof the ileum. These branches leave the main trunk of theartery, pass between two layers of themesentery, and form anastomosing arches orarcades as they pass outward to supply the smallintestine. The number of arterial arcades increases distallyalong the gut.48BITEW M./bitewm@gmail.com
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  • 51.  There may be single and then double arcades inthe area of the jejunum, with a continuedincrease in the number of arcades moving intoand through the area of the ileum. Extending from the terminal arcade are vasarecta (straight arteries), which provide the finaldirect vascular supply to the walls of the smallintestine. The vasa recta supplying the jejunum are usuallylong and close together, forming narrow windowsvisible in the mesentery. The vasa recta supplying the ileum are generallyshort and far apart, forming low broad windows.51BITEW M./bitewm@gmail.com
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  • 53.  The middle colic artery is the first of thethree branches from the right side of themain trunk of the superior mesenteric artery. Arising as the superior mesenteric arteryemerges from beneath the pancreas, themiddle colic artery enters the transversemesocolon and divides into right and leftbranches. The right branch anastomoses with the rightcolic artery while the left branchanastomoses with the left colic artery, whichis a branch of the inferior mesenteric artery.53BITEW M./bitewm@gmail.com
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  • 55.  Continuing distally along the main trunk of thesuperior mesenteric artery, the right colic arteryis the second of the three branches from theright side of the main trunk of the superiormesenteric artery. It is an inconsistent branch, and passes to theright in a retroperitoneal position to supply theascending colon. Nearing the colon, it divides into a descendingbranch, which anastomoses with the ileocolicartery, and an ascending branch, whichanastomoses with the middle colic artery.55BITEW M./bitewm@gmail.com
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  • 57.  The final branch arising from the right side ofthe superior mesenteric artery is the ileocolicartery. This passes downward and to the right towardsthe right iliac fossa where it divides into superiorand inferior branches: the superior branch passes upward alongthe ascending colon to anastomose withthe right colic artery; the inferior branch continues towards theileocolic junction dividing intocolic, cecal, appendicular, and ilealbranches.57BITEW M./bitewm@gmail.com
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  • 59.  The specific pattern of distribution and origin ofthese branches is variable:the colic branch crosses to the ascendingcolon and passes upward to supply the firstpart of the ascending colon;anterior and posterior cecal branches, eitherarising as a common trunk or as separatebranches, supply corresponding sides of thececum;the appendicular branch enters the freemargin of and supplies the mesoappendix andthe appendix;the ileal branch passes to the left and ascendsto supply the final part of the ileum beforeanastomosing with the superior mesentericartery.59BITEW M./bitewm@gmail.com
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  • 67.  The inferior mesenteric artery is the anteriorbranch of the abdominal aorta that suppliesthe hindgut. It is the smallest of the three anteriorbranches of the abdominal aorta and arisesanterior to the body of vertebra LIII. Initially, the inferior mesenteric arterydescends anteriorly to the aorta and thenpasses to the left as it continues inferiorly. Its branches include the left colicartery, several sigmoid arteries, and thesuperior rectal artery.67BITEW M./bitewm@gmail.com
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  • 72.  The left colic artery is the first branch of theinferior mesenteric artery. It ascends retroperitoneally, dividing into ascendingand descending branches: the ascending branch passes anteriorly to the leftkidney, then enters the transverse mesocolon, andpasses superiorly to supply the upper part of thedescending colon and the distal part of thetransverse colon, and anastomoses with branches ofthe middle colic artery; the descending branch passes inferiorly, supplyingthe lower part of the descending colon andanastomoses with the first sigmoid artery.72BITEW M./bitewm@gmail.com
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  • 74.  The sigmoid arteries consist of two to fourbranches, which descend to the left, in thesigmoid mesocolon, to supply the lowest part ofthe descending colon and the sigmoid colon. These branches anastomose superiorly withbranches from the left colic artery and inferiorlywith branches from the superior rectal artery.74BITEW M./bitewm@gmail.com
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  • 76.  The terminal branch of the inferior mesenteric arteryis the superior rectal artery. This vessel descends into the pelvic cavity in thesigmoid mesocolon, crossing the left common iliacvessels. Opposite vertebra SIII, the superior rectal arterydivides. The two terminal branches descend on eachside of the rectum, dividing into smaller branches inthe wall of the rectum. These smaller branches continue inferiorly to thelevel of the internal anal sphincter, anastomosingalong the way with branches from the middle rectalarteries (from the internal iliac artery) and theinferior rectal arteries (from the internal pudendalartery).76BITEW M./bitewm@gmail.com
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  • 78. Thank you for your attention78BITEW M./bitewm@gmail.com