Anatomy: GI Arteries, Veins, Lymphatics & Nerves

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Lymphatics: General GI

* Foregut = CELIAC NODE branches
* Midgut = SUPERIOR MESENTERIC NODE branches
* Hindgut = INFERIOR MESENTERIC NODE branches EXCEPT upper/lower rectum [right & left common illiac nodes --> lumbar chain nodes --> thoracic duct]

Innervation: General GI

* Foregut:
> Para = vagus
> Symp = Greater Thoracic Splanchnic nn. (T6-T10)

* Midgut:
> Para = vagus
> Symp = Lesser Thoracic Splanchnic nn. (T9-T11,L1)

* Hindgut:
> Para = Pelvic Splanchnic nn. (S2-S4)
> Symp = Upper Lumbar Splanchnic (L1-L2)

Esophagus: Arteries

* upper 1/3 = esophageal branch of inferior thyroid artery
* middle 1/3 = esophageal branch of thoracic aorta
* lower 1/3 = inferior phrenic artery & esophageal branch of left gastric artery

Esophagus: Veins

* upper 1/3 = inferior thyroid vein [--> drains into superior vena cava]
* middle 1/3 = azygous vein
* lower 1/3 = LEFT GASTRIC [--> portal circulation--> liver] & LEFT PHRENIC veins

Esophagus: Lymphatics

* upper 1/3 = paraesophageal nodes --> DEEP CERVICAL lymph nodes --> jugular trunk --> junction of left/right subclavian & internal jugular

* middle 1/3 = paraesophageal nodes --> BRONCHO-MEDIASTINAL TRUNK --> jugular trunk --> junction of left/right subclavian & internal jugular

* lower 1/3 = LEFT GASTRIC lymph nodes --> CELIAC --> cisterna chyli --> thoracic duct

Esophagus: Innervation

* para = rt & left vagus --> esophageal plexus + recurrent laryngeal

* symp = sympathetic trunk --> thoracic ganglia 2-4

Stomach: Lymphatics

* lesser curvature = RIGHT & LEFT GASTRIC lymph nodes --> CELIAC --> intestinal trunk --> cisterna chyli --> thoracic duct

* pylorus = PYLORIC nodes --> [CELIAC]--> intestinal trunks --> cisternae chyli --> thor.duct

* greater curvature = RIGHT & LEFT GASTRO-OMENTAL --> [SPLENIC lymph nodes] --> [CELIAC]--> intestinal trunks --> cisterna chyli --> thoracic duct

Stomach: Innervation

* symp: GREATER.LESSER SPLANCHNIC --> celiac plexus w/ vagal nerves

* para:
1. * posterior vagal trunk --> celiac branches --> celiac plexus w/ symp. nerves
2. * posterior vagal trunk --> gastric + pyloric branches
3. * anterior vagal trunk --> gastric + pyloric branches

Stomach: Arteries

* Lesser Curvature:
* celiac trunk --> LEFT GASTRIC
* celiac trunk --> common hepatic --> RIGHT GASTRIC

* Greater Curvature:
* celiac trunk --> splenic --> LEFT GASTRO-OMENTAL
* celiac trunk --> common hepatic --> gastroduodenal --> RIGHT GASTRO-OMENTAL

* Fundus =
* celiac trunk --> splenic --> SHORT GASTRIC ARTERIES

Stomach: Veins

* Lesser Curvature: LEFT GASTRIC VEIN + RIGHT GASTRIC VEIN --> Portal

Greater Curvature: LEFT + RIGHT GASTRO-OMENTAL --> SUPERIOR MESENTERIC* --> Portal

* Pylorus = PREPYLORIC VEIN --> Portal

* Fundus = SHORT GASTRIC VEINS --> Portal

Duodenum: Arteries

* CELIAC PLEXUS --> common hepatic --> gastroduodenal --> anterior/posterior SUPERIOR PANCREATICODUODENAL arteries

* SUPERIOR MESENTERIC --> inferior pancreatico-duodenal artery --> anterio/posterior INFERIOR PANCREATICODUODENALl arteries

Duodenum: Veins

* Proximal structures = Post & Ant. Superior Pancreaticoduodenal veins --> portal vein

* Distal structures= SUPERIOR MESENTERIC VEIN --> portal vein

Duodenum: Lymphatics

* superior/inferior pancreatic lymph nodes --> [SUPERIOR MESENTERIC lymph nodes] --> intestinal trunk --> cisterna chyli --> thoracic duct

* superior/inferior pancreaticoduodenal lymph nodes --> [CELIAC lymph nodes] --> intestinal trunks --> cisternal chyli --> thoracic duct

Duodenum: Innervation:

Para: * KNOW POSTERIOR VAGAL TRUNK --> celiac ganglia/plexus w/ symp

* Symp:
* greater/lesser splanchnic --> celiac ganglia --> celiac plexus
* greater/lesser splanchnic --> superior mesenteric ganglion --> superior mesentaric plexus

Jejunum & Ileum: Arteries

* superioer mesenteric --> jejunal + ileal branches --> anatomic loops [ARCADES] --> straight aa [vasa recta]

Jejunum & Ileum: Veins

* superior mesenteric --> portal

Jejunum & Ileum: Lymphatics

** KNOW JUXTA-INTESTINAL lymph nodes --> MESENTERIC --> SUPERIOR CENTRAL-> Superior mesenteric --> Intestinal --> chyli cystern --> Lymphatic (Thoracic) duct

Spleen: Arteries, Innervation & Lymphatics

* Artery = Splenic

* Innervation = Celiac Nerve Plexus

* Lymphatics = PANCREATICOSPLENIC lymph nodes

Pancreas: Arteries

** KNOW
* Head = [SMC & celiac]:
superior anterior/posterior pancreaticoduodenal + inferior anterior/posterior pancreatoduodenal

Body & Tail = gastroduodenal, splenic, Superior Mesenteric

Pancreas: Veins

Head = superior anterior/posterior pancreaticododenal vein --> portal
* inferior anterior/posterior pancreaticoduodenal vein --> SMV

Body & Tail = splenic vein --> portal

Pancreas: Lymphatics

[same as duodenum]:
* superior/inferior pancreatic lymph nodes --> [SUPERIOR MESENTERIC lymph nodes] --> intestinal trunk --> cisterna chyli --> thoracic duct

* superior/inferior pancreaticoduodenal lymph nodes --> [CELIAC lymph nodes] --> intestinal trunks --> cisternal chyli --> thoracic duct

Pancreas: Innervation

[same as duodenum]
Para: * KNOW POSTERIOR VAGAL TRUNK --> celiac ganglia/plexus w/ symp

* Symp:
* greater/lesser splanchnic --> celiac ganglia --> celiac plexus
* greater/lesser splanchnic --> superior mesenteric ganglion --> superior mesentaric plexus

Large Intestine: Lymphatics

PARACOLIC lymph nodes--> RIGHT/LEFT/MIDDLE/ILIOCOLIC --> INFERIOR MESENTERIC lymph nodes -->LATERAL AORTIC--> celiac

Rectum: Innervation

* symp = LUMBAR & SACRAL SPLANCHNIC nerves

* para = PELVIC SPLANCHNIC

* symp + para mix --> innervate INFERIOR HYPOGASTRIC/RECTAL PLEXUS

* Sensory Innervation: Mucosa - sensitive only to stretch (via hypogastric plexuses)

Anal Canal: Innervation

* Internal Anal Sphincter (the fibers from the INFERIOR HYPOGSASTRIC PLEXUS)

* External Anal sphincter (voluntary- INFERIOR RECTAL nerves/PUDENDAL Nerves S2-S4)

Liver: Blood Supply

* Portal vein [80% = nutrients, prenchymal tissue]
* Hepatic artery [20% = O2, non-parenchymal tissue]

** PORTAL VEIN= formed by Superior Mesenteric Vein + Splenic [+ inferior mesenteric]

Liver: Venous Return

* portal triads --> teritary branches [to hepatocytes]--> COLLECTING veins --> CENTRAL veins --> right/middle/left HEPATIC veins --> IVC

** KNOW provide structural support; liver "hangs" on IVC

Liver: Lymphatics

* Bare Area = MEDIASTINAL lymph nodes --> thoracic duct

* Visceral area = FORAMINAL + CYSTIC + HEPATIC lymph nodes --> [celiac lymph nodes] --> intestinal trunk --> [joins w/ splenic lymph nodes] --> cisterna chyli --> thoracic duct

Liver: Innervation

* symp = GREATER/LESSER SPLANCHNIC --> celiac ganglia --> HEPATIC PLEXUS joins w/ para

* para = vagus --> vagus trunks --> hepatic branches --> HEPATIC PLEXUS [w/ symp]

* also both symp & para go to the splenic plexus

Common Bile Duct: Arteries

**KNOW
* proximal = CYSTIC artery [fr.right hepatic]

* middle = RIGHT HEPATIC

* retroduodenal = POSTERIOR SUPERIOR PANCREATICODUODENAL [fr. gastroduodenal]

Common Bile Duct: Veins

* POSTERIOR & ANTERIOR CYSTIC veins --> POSTERIOR SUPERIOR PACREATICODUODENAL vein --> Portal vein

* most SMALLER VEINS enter the liver directly from the body of gallbladder

* REMEMBER = gallbladder drains directly into liver tissue

Common Bile Duct: Lymphatics

* CYSTIC lymph nodes --> hepatic --> celiac

Gallbladder: Arteries

* CYSTIC artery [fr. right hepatic]

Gallbladder: Veins

* REMEMBER = directly drains into liver

* CYSTIC veins [anterior + posterior] --> SUPERIOR POSTERIOR PANCREATICODUODENAL vein [portal]

Gallbladder: Lymphatics

* cystic --> hepatic --> celiac lymph nodes

Gallbladder: Innervation

* para = vagus

* symp = sympathetic and visceral afferent

* ALSO somatic innervation = RIGHT PHRENIC --> pain in right shoulder

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