G09B: Arteries, Veins and Lymphatics of the GI System GI AVL.ppt.pdfCeliac Arteriogram Common...

G09B: Arteries, Veins andG09B: Arteries, Veins and

Lymphatics of the GI SystemLymphatics of the GI System

Unit II, p15Unit II, p15

Celiac TrunkCeliac Trunk

Unit II, p15Unit II, p15

Celiac TrunkCeliac Trunk

Celiac TrunkCeliac Trunk

Celiac ArteriogramCeliac Arteriogram

CommonCommonhepatichepaticarteryartery

RightRightgastricgastricarteryartery

Rt Rt and Ltand Lthepatichepaticarteriesarteries

SplenicSplenicarteryartery

LeftLeftgastro-gastro-epiploicepiploicarteryartery

LeftLeftgastricgastricarteryartery

Gastroduodenal arteryGastroduodenal artery Right gastroepiploic arteryRight gastroepiploic arteryCatheterCatheter

Celiac ArteryCeliac Artery

Superior Mesenteric ArterySuperior Mesenteric Artery

Unit II, p15Unit II, p15

SMA and Left Renal VeinSMA and Left Renal Vein

Unit II, p15Unit II, p15

Midgut - OverviewMidgut - Overview•• Parts: Duodenum (distal half), jejunum,Parts: Duodenum (distal half), jejunum,

ileum, appendix, ileum, appendix, cecumcecum, colon (2/3rds), colon (2/3rds)•• Arterial supply: superior mesentericArterial supply: superior mesenteric

artery (also celiac trunk, foregut)artery (also celiac trunk, foregut)•• JejunalJejunal, , ilealileal, middle colic, right colic,, middle colic, right colic,

ileocolic ileocolic (appendicular)(appendicular)•• Venous drainage: superior and inferiorVenous drainage: superior and inferior

mesenteric veins to portal veinmesenteric veins to portal vein•• Innervation: autonomicsInnervation: autonomics•• Lymphatic drainage: organ nodesLymphatic drainage: organ nodes

Superior Mesenteric ArterySuperior Mesenteric Artery

Unit II, p15Unit II, p15

Superior Mesenteric ArterySuperior Mesenteric Artery

Hindgut - OverviewHindgut - Overview•• Parts: Descending colon, rectum, anusParts: Descending colon, rectum, anus•• Arterial supply: inferior mesentericArterial supply: inferior mesenteric

artery (also SMA, midgut)artery (also SMA, midgut)•• Left colic, Left colic, sigmoidalsigmoidal, superior rectal,, superior rectal,

marginal artery (of Drummond)marginal artery (of Drummond)•• Venous drainage: inferior and superiorVenous drainage: inferior and superior

mesenteric veins to portal veinmesenteric veins to portal vein•• Innervation: autonomicsInnervation: autonomics•• Lymphatic drainage: organ nodesLymphatic drainage: organ nodes

Inferior Mesenteric ArteryInferior Mesenteric Artery

Unit II, p16Unit II, p16

Inferior Mesenteric ArteryInferior Mesenteric Artery

Midgut-Hindgut Midgut-Hindgut AnastomosesAnastomoses

Arterial Supply to the RectumArterial Supply to the Rectum

Unit II, p16Unit II, p16

A patient presents with diffuse abdomen pain that

localizes a few hours later around the umbilicus.

The patient's pain is referred from an inflamed organ.

Portal Venous SystemPortal Venous System

p17p17

Portal-Caval Portal-Caval AnastomosesAnastomoses

Unit II, p18Unit II, p18

Portal Venous SystemPortal Venous System

p18p18Fig 4.106Fig 4.106

Portal-Caval Portal-Caval AnastomosesAnastomoses

•• No valvesNo valves

•• Flow can be in any direction,Flow can be in any direction,

depending solely on the pressuredepending solely on the pressure

gradientgradient

Portal HypertensionPortal Hypertension

•• High blood pressure in the portal veinHigh blood pressure in the portal vein

and its branches.and its branches.

•• Results from liver disease (cirrhosis,Results from liver disease (cirrhosis,

schistosomiasis schistosomiasis etcetc……))

Caput Medusae

Splenomegaly

Portal HypertensionPortal Hypertension

Distal Distal splenorenal splenorenal shunt (DSRS)shunt (DSRS)

•• Surgical procedureSurgical procedure that connectsthat connects

the the splenic splenic vein and left renal vein.vein and left renal vein.

Portal HypertensionPortal Hypertension

Distal Distal splenorenal splenorenal shunt (DSRS)shunt (DSRS)

•• Surgical procedureSurgical procedure that connectsthat connects

the the splenic splenic vein and left renal vein.vein and left renal vein.

Lymphatic SystemLymphatic System

•• Lymph is a filtrate of plasmaLymph is a filtrate of plasma

•• Lymph returns interstitial protein andLymph returns interstitial protein and

water to the circulationwater to the circulation

•• In the GIIn the GI system lymph also returnssystem lymph also returns

fat to the circulationfat to the circulation

•• Lymph may also serve as transportLymph may also serve as transport

for cancer cells (metastasis)for cancer cells (metastasis)

Lymphatic Drainage - A RuleLymphatic Drainage - A Rule

•• Lymph is drained to lymph nodes thatLymph is drained to lymph nodes that

surround each organsurround each organ

•• Typically, this means that an organTypically, this means that an organ’’ss

lymph nodes are congregated along thelymph nodes are congregated along the

arterial supply to that organarterial supply to that organ

•• Typically, the next set of lymph nodes isTypically, the next set of lymph nodes is

located at the origin of the artery to anlocated at the origin of the artery to an

organ (i.e., aorta)organ (i.e., aorta)

Lymphatic Drainage of the GutLymphatic Drainage of the Gut

Unit II, p19Unit II, p19

•• Postnodal Postnodal lymphlymph

drains to thedrains to the

thoracic duct (viathoracic duct (via

the the cisternacisterna

chylichyli))

Unit II, p19Unit II, p19

Lymphatic Drainage of the RectumLymphatic Drainage of the Rectum

•• Upper partUpper part

•• Inferior mesenteric lymph nodesInferior mesenteric lymph nodes

•• Path of the superior rectal aPath of the superior rectal a

•• Middle partMiddle part

•• Internal iliac lymph nodesInternal iliac lymph nodes

•• Path of the middle rectal aPath of the middle rectal a

•• Lower partLower part

•• Inguinal lymph nodesInguinal lymph nodes

•• Path of the inferior rectal aPath of the inferior rectal a

Arterial Supply to the RectumArterial Supply to the Rectum

Unit II, p16Unit II, p16