Artery Supply of the GUT

ARTERIAL SUPPLY OF THE GUT

Prof.Dr. Alaa Jamel
Facs, Cabs, mrcsi, mbchb

1- CAELIAC TRUNK;

Its artery of the forgut (stomach,liver spleen &upper half of duod)
Origin;
From abdominal oarta at the level of upper border of L1
Course;
Its ½ inch length pass forword infront of aorta above head of pancreas then divided to 3 main branches; lf gastric ,splenic and hepatic

Relations;

on each side 1- caeliac ganglia and caeliac plexus of autonomic nerve.
2-caeliac group of l.n
3- rt crus of diaphragm and caudate process of the liver ( on the rt side)
4-Lf crus of diaphragm and cardiac end of stomach on the lf side

Anterioly ;

cavity of lesser sac of pertonium ,seperating it from pertonium
Superioly
median arcute ligament of diaphragm
Inferioly
omental tubrosity of pancreas

Branches ;

1- lf gastric artery it pass upward to reach rt lower end of esophagus, then cuve down word to anastomose with rt gastric artery in the middle of lesser curvature.
Branches;
1- esophageal br.
2- gastric branches to the surfaces of the stomach.

Splenic artery

Largest branches of coeliac art.
Course and relations;
It runs in a tortuous course to the lf along the sup. border of pancreases and in front of lf kidney and suprarenal gland and enter the lieno renal ligament.
Divided into 5-6 terminal branches which enter the hilum

Branches;

1- pancreatic bra.—to the body and tail of pancreas.
2- short gastric arts. 5-7 small branches supply fundus of stomach runs along the gastosplenic ligament
3- lf gastroepiploic art.it arise near the hilum of spleen then enter the gastrosplenic lig. ,run downward along the upper 1/3 of greater curvature ,end by anastomosing with rt gastro epiploic art.
4- terminal splenic branches 5-6 to the spleen

Causes of tortuosity of splenic artery;

1- to accommodate the enlargement of spleen
2- accommodate its movement with respiration
3- to slow the circulation allowing blood to pass in the branches to supply pancreas.
Other tortious arteries in the body are;
*fascial *lingual *internal carotid art *post.sup cerebellar art. Uterine art.

Hepatic artery

Course and relation; it pass forward behind lesser sac to reach 1st part of duod.it pass to the liver in front of epiploic foramen in free margin of lesser omentum
Portal vein behind it and common bile duct on its rt side it end by dividing to rt &lf hepatic art.

Branches;

1- gastroduod.art.behind 1st part of duod.it gives
A- rt gastro epiploic a.
B-sup pancreatico duod.a.
2-rt gastric art.it end by anastemosis with lf gastric art.
3-supraduod.art.small supply upper part of duod.

4-rt terminal hepatic art

5-lf terminal hepatic art.
6- cystic art.it arise from rt terminal hepatic art.pass behind cystic duct and common hepatic duct

Sup.mesentric art.

Its artery of mid gut down to the rt 2l3 of transverse colon
Origin front of abd.aorta at lower border of L1
Course and relation;it arise behind the body of pancreas between splenic vein and lf renal vein
Sup mesentric vein lie on its rt side
Termination in rt iliac fosa by anastemosis with the ilial branches of the iliocolic artery

Branches;

1-inf.pancreatico art. lower 1l2 of duod. part of the head of pancreas
2-juj.and ilial branches— except terminal part of ilium
3-iliocolic art. Start from terminal part of ilium
4-rt colic art.
Middle colic art it arise just below the pancreas it divided to
1- rt branch anastomosis with ascending bran.of rt colic art.
2-lf branch ============ of lf colic art.

Inf.mesentric art.

Its art. of hind gut (lower 1/3 of trans.colon to the rectum)
It srises infront of abdominal aorta at level of L3
Course;it lie behind 3rd part of duod,
It enter the pelvis by crossing the lf common iliac art. where it end by becoming sup rectal artery.


Branches ;
1- sup.lf colic artery pass to the lf behind pertonium of post abd.wall
Divided to ascending branch and descending branch.

It supply lf 1/3 of trans.colon and upper part of descending colon.

2-inf.lf colic(segmoid ) art.2-3 bra.
They supply lower part of descending colon + sigmoid colon
They anastomose with descending branch of sup. Lf colic art. and with the sup rectal art.
3- sup. rectal art. continuation of inf. mes.art.

Anastemosis;

Sup.pancreaticoduod.(coeliac)anastemose with inf.pancreaticduod.art(sup.mes.aert)
Middle colic art.(sup.mese.art) with sup.lf colic art.(inf.mes.art.

Veins of the gut

The vein which stomch small&large intestin,spleen,pancreas,gall bladder drain to portal vein.
Portal vein
Origin; form behind neck of pancreas at level of L2 by union of 2 veins –splenic and sup.mesentric vein

Termination; in porta hepatis by dividing to rt & lf branch,

Length about 8 cm
Course and relation;
Has 2 part rtro and supra dud.
Retrodud.part;
Ascend up word and to the rt behind 2nd inch of 1st part of duod.

Relation ;post IVC

Ant. CBD &gastroduod art
Supraduod.part;
Ascending in the free margin of lesser omentum
Relation –post. epiploic foramen
Ant.1-CBD ant and to the rt
2-Hepatic art. Ant and to the lf

Terminal branches of the potal vein.

Rt shorter and wider why?
Lf longer and narrower
Relations ant rt & lf hepatic duct
Rt and lf branch of hepatic art.
Post ; IVC which separate it by caudate process of caudate lobe

2 lig.attach to the lf branch of portal vein

1-ligmantum teres (oblitration of umbl,vein
2- lig,venosum; oblitration ductus veinosum of the feotus which reach to the ivc.

Tributaries of portal vein

A- 2 main tributries *splenic & sup mes.vein
B- 2 vein from stomach lf gastric & rt gastric vein
C- vein drain in to the terminal branch
Cystic vein to the rt terminal bran.
Para umbl vein from ant,abdominal wall to the lf terminal branch.

Splenic vein

Begning; from hilum of spleen by uniting 5-6 veins
Course and relations;
It pass to the rt through the lino renal ligament accompanied splenic art and tail of pancreas. Then across the post,abd,wall behind body of pancreas.
End behind neck of pancreas by uniting with sup mes vein to form portal vein


Tributaries; like splenic art + inf mes.vein
Sup.mesentric vein;
Begning; in the lower root of mesentery.
Course and relation;on the rt side of mesnt.art,
End behind neck of pancreas
Tributeries;as sup.mesentric art +rt gastro epiploic vein.
The splenic vein strait un like splenic artey

Inf.mesentric vein

Begning; infront of the lf common iliac artery as acontinuation of the sup.rectal vein
Course and relation;
It ascend retropertnialy infront lf psoase m.&lat to the inf mes.art.
Upper end of its seperat from art and become behind DJ flexure then behind body of pancreas drain to splenic vein.
Tributries as inf mesentic art.

Portal circulation

Its venous drainge of GIT spleent pancreas GB to the live.
It differ from systemic circulation by
1- draining vein portal---IVC
2- organ drained GIT (except liver)---remining part of body + liver
3- begning network of capillaries in submucosa of elimentary trac ----capillaries in the wall of draind abdomin and pelvic organ


4- termination sinusidal cappiliraies in liver ----sys.inthe rt atrium
5- quality of blood de O BLOOD with product of GIT digestion no detoxification ----deO blood but detoxificat in the liver

Portosystemic anastemosis

Definition portal vein with S.V.C &IVC
Significance ; obstruction of portal vein tributaries ( liver cirrhosis)
Site of portosystemic anastemosis
At lower end of oesophagus; lf gastric with azugous vein tributaris ( oesoph.varices)
2-at anal canal ; sup.rectal with middle and inf rectal veins (internal piles)





3- around umblicus ; paraumblical vein ( portal) with epigastric veins of ant abdominal vein (caput medusae)
4- vein of ritzius ; sup .mes.vein ( portal) +IVC(systemic)
5- on post abdominal wall colic veins(portal) with renal and lumber veins
6- at the bar area of the liver --between twigs from the vein of the liver with phrenic vein of diaphragm

Appleid anatomy

Portal v.pressure 5-15 mmHg if increase up to 40 mmhg ---portal hypertension ( liver chirrhosis).

Suprarenal gland (adrenal)

2 gland 5 gm
Rt and lf gland
Site rt higher in position not reach the hilum of rt k. lf lower and reach ts hilum directed
up word while lf directed downward
Its vein very short and drain to IVC while lf longer and open into lf renal v

Post relation RT rt crus + upper part of ant.sur.of rt k. while LF lf k.

Medial relation ; RT rt coeliac ganglia + rt inf phrenic art. While LF same but lf
Ant.relation RT gland bare area of the liver + ivc while LF stomach and lesser sac + body of pancreas and splenic art.

Arterial supply ;3 art;

Sup .middle and inf.supra renal art. inf.phrenic –abdominal aorta & renal art correspondigly)
Veinous drainge ;one vein rt to ivc
Lf to the lf renal vein.

Thank you