Blood Supply and Lymphatics

• the abodminal aorta branches of to give the posterior surface of the median sacral artery
• Celiac Trunk at T12

  Branches to give off left gastric artery, splenic artery and common hepatic artery
• Splenic Artery supplies spleen (5-6 branches) pancreas and stomach ( 3 to 5 short gastric arteries as well as left gastroomental artery)
• Common hepatic artery

  1. Hepatic artery Proper: Right and Left hepatic and Right gastric artery
  2. Gastroduodenal Artery > Right gastroomental artery and anterior and posterior superior pancreaticoduodenal artery
• The gastroduodenal artery

  1. Right gastroomental artery - passes between two anterior layers of the greater omentum and participates in the arterial arch along the greature curvature
  2. Anterior and Posterior pancreaticoduodenal arteries
• Blood suppply to intestines

  SMA (L1) > Midgut

  Passes down behind the splenic vein and pancreatic neck which later on enters the uppermost part of the root of mesentery and continue.

  Ends near to the right iliac fossa by anastomosing with the ileocolic artery
• Brancges of SMA

  Common inferior pancreaticoduodenal artery

  12-15 Jejunal and ileal arteries > arise from the left side of SMA

  Course between the two layers of mesentery towards the intestinal wall to furm vascular arches (Arcades)
• SMA > Ileocolic artery > passes obliquely down to the right towards iliac fossa and divides into

  1. Superior branch: anastomoses with descending branch of colic artery
  2. Inferior branch anastomoses with the end of main stem of SMA to give off A. Anterior and Posterior cecal branches (cecum) B. Appendicular artery: sometimes it is a branch of posterior cecal artery C. Colic: branches to beginning of ascending colon D. Ileal branches to terminal part of ileum
• SMA

  1. right colic artery: middle of the ascending colon and divides into two branches (ascending and descending) > ascending anastomoses with the right branch of middle colic artery
  2. Middle colic artery: similar direction of the right colic flexure and divides into left and right branches
• IMA> L3 (4cm above bifurcation of aorta)

  from 1/3 of transverse colon to middle of anal canal

  runs downward and to the left and crosses left common iliac artery medially to the uretery

  Sigmoidal branches > superior rectal artery > descends in the base of the medial limb of the sigmoid mesocolon
• IMA branches

  1. left colic artery > towards descending colon and divides into ascending and descending branches (Descending branch anastomoses with the left branch of middle colic artery)
  2. Sigmoidal> 3-4 branches > sigmoid colon > highest sigmoidal artery anastomoses with descending branch of colic artery
  3. Superior rectal artery > direct continution > rectum and upper part of the anal canal
• Marginal Artery > anastomsis SMA and IMA

  1. Marginal artery of Drummond and it extends from ileocecal junction to where it ends by anastomosing with superior rectal artery
  2. The area of splenic flexure has a poor blood dsupply > avascular area of riolan > its okay to not ligate this area
• Arterial supply of rectum and anal canal

  1. Median sacral artery
  2. Superior rectal artery > inferior mesenteric
  3. Middle rectal artery > internal iliac (muscular wall only)
  4. Inferior rectal artery > internal pudendal
• Superior rectal artery > courses within the sigmoid mesocolon after it leaves S3 it gives of two lateral branches which lie on posterior rectal branches then pierce the muscular wall and supply everything including the mucus membran and later on continue submucosally into the anal canal > anastomoses with middle and inferior rectal arteries
• Middle rectal artery > internal iliac

  Only supplies blood to muscular wall

  It gives more branches to the prostate and seminal vesicles than to the rectum (in females it may be missing)
• Inferior rectal artery > internal pudendal artery > supplies lower part of the rectum and anal canal
• Portal Vein

  2inches behind the neck of the pancreas > made by superior mesenteric and splenic vein

  Ascends to liver behind the first part of duodenum > enters hepatoduodenal ligament
• Portal vien tributaries

  Inferior mesenteric ( to splenic vein)

  Left and right gastric (portal)

  Cystic veins (portal)

  Paraumbilical veins (left portal)
• Stomach vein

  1. left and right gastric vein > portal
  2. Left gastroomental and short gastric veins > splenic
  3. Right gastroomental vein > superior mesenteric
  4. Superior pancreaticoduodenal > portal
  5. Inferior pancreaticoduodenal > superior mesenteric
• Venous drainage of rectum and anal canal

  Superior rectal vein > inferior mesenteric vein > portal vein

  Middle and inferior rectal > internal iliac vein and internal pudendal veins > caval system
• Hemorrhids

  1. Internal ( Blood mucus and distension)
  2. External (Sever pain, mass)
• Portal system anastomosis

  Two main branches (tributaries) > sinusoids > central veins > hepatic veins
• Portal systemic anastomosis

  1. lower third of esophagus
  2. Anterior abdominal wall (caput medusae)
  3. Anal canal
  4. Retroperitoneally
• The lower third of the esophagus

  Esophageal tributaries of left gastric veins (portal system) > anastomose with the inferior phrenic (caval) and the veins draining the middle third into azygos vein
• Paraymbilical veins in the falciform ligament of the liver connect the left branch of portal vein with the superficial veins of anterior abdominal wall (inferior epigastric that drains into external iliac) around the umbilicus
• Halfway down the anal canal the superior rectal vein draining the upper half of anal canal > tributary of inferior mesenteric vein anastomoses with middle and inferior rectal veins > tribuatries of the internal iliac and internal pudendal veins
• Retroperitoneally

  1. veins of the bare area of the liver > anastomose with phernic and irght internal thoracic vein > caval system
  2. Tributates of the splenic and pancreatic veins > portal system > anastomose with the left renal vein > caval system
  3. Tributaries of the splenic and colic veins > portal system > anastomose with the lumber > caval system
• Lympathic drainage

  1. Stomach > left and right gastric nodes, gastroomental nodes and short gastric nodes > celiac nodes
  2. Duodenum > Upwards via pancreaticoduodneal nodes to the gastroduodneal nodes then celiac
  3. Duodenum > downards panctreaticoduodenal nodes to the mesenteric nodes
• Celiac nodes inferior and mesenteric nodes (preaortic lumph nodes lie infront of the aorta) which drains into the intestinal lymphatic trunk which will drain into cisterna chyle (L1 and L2) to thoracic duct in (T12) then to the veins in the neck