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GIT blood supply

The document summarizes the blood supply of the gastrointestinal tract in three parts: 1) The arterial supply comes from branches off the abdominal aorta including the celiac trunk, superior mesenteric artery, and inferior mesenteric artery. 2) Venous drainage occurs through the portal vein, which is formed by the superior mesenteric vein and splenic vein. It drains into the liver. 3) The hepatic portion describes the hepatic arteries, portal vein branches in the liver, hepatic lobules, and hepatic veins draining into the inferior vena cava.

Health & Medicine◦
Blood Supply of GIT Dr. Komal Parmar Total Number of Slides: 45
Aims and Objectives • Understanding the three dimensional topography of vascular system inside the abdominopelvic cavity. • Detailed description of the blood supply of gastrointestinal tract. • Clinical and pathological correlation. 2
Blood Supply of Oropharynx 3
Blood Supply of Oesophagus 4
Entry into the Abdominal Cavity • T8: Caval Opening • IVC • Right Phrenic Nerve • T10: Esophageal Hiatus • Esophagus • Vagal Trunks • Esophageal Vessels • T12: Aortic Hiatus • Aorta • Thoracic Duct • Azygous Vein 5 Thoracoabdominal Interface
6
General Arrangement of Abdominopelvic Vascular Supply: Arterial Supply 7
Venous System 8
9 Portal Venous System
Arterial Supply 10
Abdominal Aorta • Begins at Aortic hiatus of Diaphragm: T12 • Bifurcates into two common iliac arteries at L4/5 intervertebral disc. • Mean diameter= • 19-21mm in males • 16-18mm in females • Relations: • Anterior= Coeliac trunk, Autonomic nerve plexuses, lymphatics, pancreas, 3rd part of duodenum, root of mesentry • Posterior: Vertebrae, I/V disc and ligaments, Lumbar Arteries • Right: Thoracic Duct, Azygous Vein, Right Crus of Diaphragm, IVC, Right Coeliac Ganglion. • Left: Left Crus of Diaphragm, Left Coeliac Ganglion, 4th part of Duodenum, Left Sympathetic Trunk, Inferior mesenteric Vein. 11
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Branches of Abdominal Aorta • Anterior group (unpaired) • Coeliac Trunk • Superior Mesenteric A • Inferior Mesenteric A • Lateral Group • Middle Suprarenal A • Renal A (R>L) • Gonadal A • Dorsal Group • Inferior Phrenic A • Lumbar A (4) (*** Artery of Adamkewicz) • Median Sacral A (1) 13
Coeliac Trunk • T12 • 1-3 cm long. • Trifucration and ramification • Related to respective crus of diaphragm and coeliac ganglion on each side. 14
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Splenic Artery • Tortous. 8-32cm long. • Largest branch of the coeliac trunk. • Runs along the upper border of pancreas. • Branches • Pancreatic • Short Gastric • Left Gastroepiploic 16
Common Hepatic Artery 17
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Superior Mesenteric Artery • Originates 1 cm below the Coeliac trunk • Lower border of L1, Transpyloric plane. • Posterior relations: uncinate process of Pancreas, 3rd part of Duodenum, left renal vein, IVC, right ureter, right psoas. • Anterior Relations: Splenic vein and Body of Pancreas. • ***Marginal Artery 19
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Inferior Mesenteric Artery • Arises behind the inferior border of 3rd part of Duodenum. • 3-4 cm above the aortic bifurcation 21
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Rectal Arteries 23
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26 Veins
Mesenteric Veins Inferior Mesenteric • Begins as Superior Rectal Vein. • Receives • Sigmoidal Veins and • Left Colic Veins • Drains into Splenic Vein eventually. Superior Mesenteric • Tributaries • Right Gastroepiploic V • Inferior Pancreaticoduodenal V • Middle colic V • Right Colic V • Ileocolic V • Ileal V • Jejunal V • Drains into: Portal Vein 27
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Splenic Vein • Tributaries • Short Gastric • Left Gastroepiploic • Pancreatic Veins • Inferior Mesenteric 29
Portal Venous Circulation 30
Portal Vein • Formed behind the neck of Pancreas at the level of L1/2 intervertebral disc. • Superior mesenteric Vein + Splenic vein • 8cm • Ascends behind the 1st part of Duodenum, CBD and gastroduodenal artery. • Enters the right border of Lesser Omentum and reaches the right end of Porta hepatis behind CBD and Hepatic Artery. • Divides into R and L branches which accompany the corresponding Hepatic Artery. • Tributaries: Left gastric and Posterior Superior Pancreaticoduodenal. Cystic veins, Para Umbilical veins. 31
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34 Hepatic Lobule
Hepatic Veins • The hepatic veins are divided into upper and lower groups • The upper three drain the central veins from the right, middle, and left regions of the liver and are larger than the lower group of veins. • The lower group of from six to twenty smaller hepatic veins come from the right lobe and the caudate lobe, are in contact with the hepatic tissue, and are valveless. All the veins empty into the inferior vena cava at the back of the liver. 35 Hepatic veins draining into IVC
Inferior Vena Cava 36
IVC • Formed by the junction of the common iliac veins anterior to the 5th lumbar vertebral body. • Tributaries • Lumbar veins • Right Gonadal vein • Renal veins (L>R) • Right Suprarenal vein • Inferior phrenic veins • Hepatic Veins 37
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• Portosystemic Shunt: Occur at the sites of Porto- Caval Anastamoses 39 Clinical Correlates
Aortic Aneurysm 40
Gastrointertinal Bleeding 41
Mesenteric Ishchemia 42
Intestinal Resection and Anastomoses 43
Conclusions • Arterial system and Venous system do not follow an exactly parallel system. • Importance of Portal Venous system and Liver as the focal site of metabolism. • Correlation of anatomical intricacies with the Clinical requirements. • Tip for consolidating the information: Look at the figures and approach it conceptually. 44
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