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36 terms

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