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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