Blood supply and drainage of the gastrointestinal system

Dr.khaled omer
MB BS Honors - Medicine
& Surgery – SIU University
SUDAN
[MSc] in Human Clinical
Anatomy
National College- Sudan
khaledshora13@gmail.com
+249 912608457

National College for Medical and
Technical Studies
Department of Graduate Education
[MSc] in Human Clinical Anatomy
15/2/2014

Blood supply, lymphatic drainage and
nerves of the Gastrointestinal
system
Presented by Dr KHALID OMER

:OBJECTIVES
To define, describe and outline
vertebral level of origin, course and branches of distribution of the
celiac trunk, superior mesenteric and inferior mesenteric
pattern of blood supply to the small and large intestines, especially
the formation of arcades, and the marginal artery
venous drainage of the various organs of the gastro-intestinal tract
and relate this to the embryonic origin.
lymph node groups in the abdomen, and understand which organs
they drain
vagus and splanchnic nerves; and sacral parasympathetic outflow
to the organs of the gastro-intestinal tract.

The abdominal aorta
The abdominal aorta begins at the aortic hiatus of
the diaphragm, anterior to the lower border of
vertebra TXII.
It descends through the abdomen, anterior to the
vertebral bodies, and by the time it ends at the
level of vertebra LIV it is slightly to the left of
midline.
The terminal branches of the abdominal aorta are
the two common iliac arteries.

Anterior branches of the
abdominal aorta
The abdominal aorta has anterior, lateral, and
posterior branches as it passes through the
abdominal cavity.
The three anterior branches supply the
gastrointestinal viscera:
the celiac trunk
the superior mesenteric and
the inferior mesenteric arteries.

The primitive gut tube can be divided into :
foregut,
midgut, and
hindgut regions.
The boundaries of these regions are directly
related to the areas of distribution of the three
anterior branches of the abdominal aorta.
a

Divisions of the
gastrointestinal
tract into foregut,
midgut, and
hindgut,
summarizing the
primary arterial
supply to each
segment.
12 BITEW M./bitewm@gmail.com

The foregut
The foregut begins with the abdominal
esophagus and ends just inferior to the
major duodenal papilla, midway along the
descending part of the duodenum.
It includes the abdominal esophagus,
stomach, duodenum (superior to the major
papilla), liver, pancreas, and gallbladder.
The spleen also develops in relation to the
foregut region. The foregut is supplied by
the celiac trunk.

The midgut
The midgut begins just inferior to the major
duodenal papilla, in the descending part of
the duodenum, and ends at the junction
between the proximal two-thirds and distal
one-third of the transverse colon.
It includes the duodenum (inferior to the
major duodenal papilla), jejunum, ileum,
cecum, appendix, ascending colon, and the
right two-thirds of the transverse colon.
The midgut is supplied by the superior
mesenteric artery.

The hindgut
The hindgut begins just before the left colic
flexure (the junction between the proximal
two-thirds and distal one-third of the
transverse colon) and ends midway through
the anal canal.
It includes the left one-third of the transverse
colon, descending colon, sigmoid colon,
rectum, and upper part of the anal canal.
The hindgut is supplied by the inferior
mesenteric artery

Celiac trunk
The celiac trunk is the anterior branch of the
abdominal aorta supplying the foregut.
It arises from the abdominal aorta immediately
below the aortic hiatus of the diaphragm, anterior
to the upper part of vertebra LI.
:It immediately divides into the
1-left gastric
2-spelinc
3-common hepatic arteries

1. Left gastric artery
The left gastric artery is the smallest branch of the
celiac trunk.
It ascends to the cardioesophageal junction and sends
esophageal branches upward to the abdominal part
of the esophagus.
Some of these branches continue through the
esophageal hiatus of the diaphragm and anastomose
with esophageal branches from the thoracic aorta.
The left gastric artery itself turns to the right and
descends along the lesser curvature of the stomach in
the lesser omentum.
It supplies both surfaces of the stomach in this area and
anastomoses with the right gastric artery.

2. Splenic artery
The splenic artery, the largest branch of the celiac
trunk, takes a tortuous course to the left along
the superior border of the pancreas.
It travels in the splenorenal ligament and divides
into numerous branches, which enter the hilum
of the spleen.
As the splenic artery passes along the superior
border of the pancreas, it gives off numerous
small branches to supply the neck, body, and tail
of the pancreas.

2. Splenic artery
Approaching the spleen, the splenic artery
gives off short gastric arteries, which pass
through the gastrosplenic ligament to
supply the fundus of the stomach.
It also gives off the left gastro-omental
artery, which runs to the right along the
greater curvature of the stomach, and
anastomoses with the right gastro-omental
artery.

Causes of tortusity of the Splenic artery

A-to accommodate for enlargement of the spleen
and its movement during respiration
B-to slow the circulation allowing blood to pass in
the branches supplying the pancreas
Other tortuous arteries in the body:
A-facial B-lingual C- int.carotid
D-uterine E-post.inf.cerbellar

3. Common hepatic artery
The common hepatic artery is a medium-sized
branch of the celiac trunk that runs to the
right and divides into its two terminal
branches, the hepatic artery proper and the
gastroduodenal artery.
The hepatic artery proper ascends towards
the liver in the free edge of the lesser
omentum.
It runs to the left of the bile duct and anterior
to the portal vein, and divides into the right
and left hepatic arteries near the porta
hepatis.

CONT’D
As the right hepatic artery nears the liver, it
gives off the cystic artery to the gallbladder.
The gastroduodenal artery may give off the
supraduodenal artery before descending
posterior to the superior part of the
duodenum.
Reaching the lower border of the superior
part of the duodenum, the gastroduodenal
artery divides into its terminal branches,
the right gastro-omental artery and the
superior pancreaticoduodenal artery

The right gastro-omental artery
passes to the left, along the greater curvature of the
stomach, eventually anastomosing with the left
gastro-omental artery from the splenic artery.
The right gastro-omental artery sends branches to both
surfaces of the stomach and additional branches
descend into the greater omentum.
The superior pancreaticoduodenal artery divides into
anterior and posterior branches as it descends and
supplies the head of the pancreas and the
duodenum.
These vessels eventually anastomose with anterior and
posterior branches of the inferior
pancreaticoduodenal artery.

Severance of the Cystic Artery
The cystic artery must be ligated or clamped and
then severed during cholecystectomy, removal of
the gallbladder. Sometimes, however, it is
accidentally severed before it has been
adequately ligated. The surgeon can control the
hemorrhage by compressing the hepatic artery
as it traverses the hepatoduodenal ligament. The
index finger is placed in the omental foramen
and the thumb on its anterior wall Alternate
compression and release of pressure on the
hepatic artery allows the surgeon to identify the
bleeding artery and clamp it.

Superior mesenteric
artery

Superior mesenteric artery
The superior mesenteric artery is the
anterior branch of the abdominal aorta
supplying the midgut.
It arises from the abdominal aorta
immediately below the celiac
artery,anterior to the lower part of
vertebra LI.

The superior mesenteric artery
is crossed anteriorly by the splenic vein and
the neck of pancreas. Posterior to the
artery are the left renal vein, the uncinate
process of the pancreas, and the inferior
part of the duodenum.
After giving off its first branch (the inferior
pancreaticoduodenal artery) the superior
mesenteric artery gives off jejunal and ileal
arteries on its left.

The superior mesenteric artery
Branching from the right side of the main
trunk of the superior mesenteric artery are
three vessels-
the middle colic,
right colic, and
ileocolic arteries-which supply the terminal
ileum, cecum, ascending colon, and two-
thirds of the transverse colon.

Inferior pancreaticoduodenal artery
The inferior pancreaticoduodenal artery is the first
branch of the superior mesenteric artery.
It divides immediately into anterior and posterior
branches, which ascend on the corresponding
sides of the head of the pancreas.
Superiorly, these arteries anastomose with anterior
and posterior superior pancreaticoduodenal
arteries.
This arterial network supplies the head and uncinate
process of the pancreas and the duodenum

Jejunal and ileal arteries
There may be single and then double arcades in the
area of the jejunum, with a continued increase in
the number of arcades moving into and through the
area of the ileum.
Extending from the terminal arcade are vasa recta
(straight arteries), which provide the final direct
vascular supply to the walls of the small intestine.
The vasa recta supplying the jejunum are usually long
and close together, forming narrow windows visible
in the mesentery.
The vasa recta supplying the ileum are generally short
and far apart, forming low broad windows.

a.Middle colic artery
The middle colic artery is the first of the three
branches from the right side of the main trunk of
the superior mesenteric artery.
Arising as the superior mesenteric artery emerges
from beneath the pancreas, the middle colic
artery enters the transverse mesocolon and
divides into right and left branches.
The right branch anastomoses with the right colic
artery while the left branch anastomoses with
the left colic artery, which is a branch of the
inferior mesenteric artery.

b. Right colic artery
Continuing distally along the main trunk of the
superior mesenteric artery, the right colic
artery is the second of the three branches
from the right side of the main trunk of the
superior mesenteric artery.
It is an inconsistent branch, and passes to the
right in a retroperitoneal position to supply
the ascending colon.
Nearing the colon, it divides into a descending
branch, which anastomoses with the ileocolic
artery, and an ascending branch, which
anastomoses with the middle colic artery.

c. Ileocolic artery
The final branch arising from the right side of the
superior mesenteric artery is the ileocolic
artery.
This passes downward and to the right towards
the right iliac fossa where it divides into
superior and inferior branches:
the superior branch passes upward along the
ascending colon to anastomose with the right
colic artery;
the inferior branch continues towards the
ileocolic junction dividing into colic, cecal,
appendicular, and ileal branches.

The specific pattern of distribution and origin
of these branches is variable:
the colic branch crosses to the ascending colon and
passes upward to supply the first part of the
ascending colon;
anterior and posterior cecal branches, either arising
as a common trunk or as separate branches,
supply corresponding sides of the cecum;
the appendicular branch enters the free margin of
and supplies the mesoappendix and the
appendix;
the ileal branch passes to the left and ascends to
supply the final part of the ileum before
anastomosing with the superior mesenteric
artery.

Inferior mesenteric artery
The inferior mesenteric artery is the anterior branch
of the abdominal aorta that supplies the hindgut.
It is the smallest of the three anterior branches of
the abdominal aorta and arises anterior to the
body of vertebra LIII.
Initially, the inferior mesenteric artery descends
anteriorly to the aorta and then passes to the left
as it continues inferiorly.
Its branches include the left colic artery, several
sigmoid arteries, and the superior rectal artery.

Left colic artery
The left colic artery is the first branch of the inferior
mesenteric artery.
It ascends retroperitoneally, dividing into ascending
and descending branches:
the ascending branch passes anteriorly to the left
kidney, then enters the transverse mesocolon, and
passes superiorly to supply the upper part of the
descending colon and the distal part of the
transverse colon, and anastomoses with branches
of the middle colic artery;
the descending branch passes inferiorly, supplying
the lower part of the descending colon and
anastomoses with the first sigmoid artery.

Sigmoid arteries
The sigmoid arteries consist of two to four
branches, which descend to the left, in the
sigmoid mesocolon, to supply the lowest
part of the descending colon and the
sigmoid colon.
These branches anastomose superiorly with
branches from the left colic artery and
inferiorly with branches from the superior
rectal artery.

Superior rectal artery
The terminal branch of the inferior mesenteric artery is the
superior rectal artery.
This vessel descends into the pelvic cavity in the sigmoid
mesocolon, crossing the left common iliac vessels.
Opposite vertebra SIII, the superior rectal artery divides.
The two terminal branches descend on each side of the
rectum, dividing into smaller branches in the wall of the
rectum.
These smaller branches continue inferiorly to the level of
the internal anal sphincter, anastomosing along the way
with branches from the middle rectal arteries (from the
internal iliac artery) and the inferior rectal arteries (from
the internal pudendal artery).

:Clinical anatomy
The coelic axis syndrome: This occurs when the coeliac
trunk is compressed by the diaphragmatic crura
leading to reduced blood supply to the foregut
structures. It presents with pain in these structures
Intestinal angina: This may follow atherosclerosis or
other narrowing of the mesenteric arteries causing
ischaemic pain in the intestines. It is worsened by
eating and so victims tend to avoid eating. The
impaired absorption and food avoidance lead to
wasting of the victims.

Mesenteric artery thrombosis: This is a rare
condition that causes gut gangrene
Water shed areas: The areas of the colon where
branches of major arteries are vulnerable to
ischaemia

Marginal artery
– Anastomosis of branches of colic arteries, forming continuous
channel along mesenteric border of large bowel
– Enables ligation of inferior mesenteric artery at origin
Importance of marginal artery:
•Marginal artery is of significant clinical importance
because it forms an important anastomosis between the
superior mesenteric artery and the inferior mesenteric
artery. It is sufficiently large to supply the oxygenated
blood those parts of large intestine which are supplied by
the inferior mesenteric artery. For this reason, the inferior
mesenteric artery doesn’t have to be re-implanted into
the repaired abdominal aorta in abdominal aortic
aneurysm repair.
a

The anastomosis of the colic arteries around the
concave margin of the large intestine forms a
single arterial trunk, known as the marginal
artery. It begins at the ileocecal junction, where
it anastomoses with the ileal branches of the
superior mesenteric artery and ends where it
anastomoses with the superior rectal artery.

Superior mesenteric artery (SMA) syndrome is a
very rare, life-threatening gastro-vascular
disorder characterized by a compression of the
third portion of the duodenum by the abdominal
aorta (AA) and the overlying superior mesenteric
artery. The syndrome is typically caused by an
angle of 6°-25° between the AA and the SMA, in
comparison to the normal range of 38°-56°, due
to a lack of retroperitoneal and visceral fat. In
addition, the aortomesenteric distance is 2-8
millimeters, as opposed to the typical 10-20

Venous Drainage of
Gastrointestinal Tract

Venous Drainage of Gastrointestinal
Tract
Veins of portal venous
system
Systemic veins
Blood from GIT enter the
liver via portal vein and
leave the liver via
hepatic veins to enter
the inferior vena cava

Venous Drainage of Gastrointestinal
Tract
Venous drainage of the
abdominal part of the
gastrointestinal tract,
spleen, pancreas and
gallbladder except for
the inferior part of the
rectum, is through the
portal system of veins.

Portal Vein
It is formed by the union of the
splenic vein and the
superior mesenteric vein
posterior to the neck of the
pancreas at the level of
vertebra L2.
It is the final common pathway
for the transport of venous
blood from the spleen,
pancreas, gallbladder, and
the abdominal part of the
gastrointestinal tract.

Ascending towards the liver, the portal vein passes
posterior to the superior part of the duodenum
and enters the right margin of the lesser
omentum. As it passes through this part of the
lesser omentum, it is anterior to the omental
foramen and posterior to both the bile duct,
which is slightly to its right, and the hepatic
artery proper, which is slightly to its left
Length : about 8 cm

Portal Vein
It divides into right and
left branches, which
enter the liver
parenchyma.

Tributaries to The Portal Vein
Right and left gastric veins draining the lesser
curvature of the stomach and abdominal
esophagus
Cystic veins from the gallbladder
The para-umbilical veins are associated with the
obliterated umbilical vein and connect to veins
on the anterior abdominal wall.

Splenic Vein
It forms from numerous
smaller vessels leaving
the hilum of the spleen.
It passes to the right,
passing through the
splenorenal ligament with
the splenic artery and the
tail of pancreas.
It crosses the posterior
abdominal wall.

Tributaries to The Splenic Vein
Short gastric veins from the fundus and left part
of the greater curvature of the stomach
Left gastro-omental vein from the greater
curvature of the stomach
Pancreatic veins draining the body and tail of
pancreas
Inferior mesenteric vein.

Superior Mesenteric Vein
It drains blood from the
small intestine, cecum,
ascending colon, and
transverse colon.
It begins in the RIF as veins
draining the terminal
ileum, cecum, and
appendix.
It ascends in the mesentery
to the right of the
superior mesenteric
artery.

Tributaries to The Superior Mesenteric
Vein
Right gastro-omental vein, draining the right part
of the greater curvature of the stomach;
Anterior and posterior inferior
pancreaticoduodenal veins
Anterior superior pancreaticoduodenal vein
usually empties into the right gastro-omental
vein, and the posterior superior pancreatico
duodenal vein usually empties directly into the
portal vein.

Inferior Mesenteric Vein
It drains blood from the
rectum, sigmoid colon,
descending colon, and
splenic flexure.
It begins as the superior
rectal vein and ascends,
receiving tributaries from
the sigmoid veins and the
left colic vein.
It joins the splenic vein
posterior to the body of
the pancreas

Sites of portacaval anastomosis
When the portal vein is obstructed or the blood-flow through the liver
impeded, the anastomoses between the portal and systemic veins
provide alternative routes known as a collateral circulation. The
following are the most important sites of portacaval anastomosis:
Lower oesophagus: between the oesophageal tributaries of the left gastric
vein and oesophageal veins joining the azygos system.
Anal canal: between the rectal venous plexus (portal drainage and the
middle and inferior rectal veins (systemic drainage)
Pelvis: between the rectal venous plexus (portal and systemic drainage)
and the other pelvic venous plexuses, such as the vesical and prostatic,
the uterine and vaginal (systemic)
Umbilicus: between epigastric veins (systemic) and the left branch of the
portal vein, along ligamentum teres.
Bare area of liver: between hepatic venules and veins of diaphragm and
thorax.
Intestine and spleen: between colic and splenic venous twigs (portal) and
renal or lumbar veins (systemic).

Portosystemic Anastomosis
Lower end of oesophagus
Upper part of anal canal
Umbilicus
Retroperitoneal
Bare area of liver

Clinical Applications
Hemorrhoids at the
anorectal junction
Esophageal varices at the
gastroesophageal
junction;
Caput medusae at the
umbilicus.

Portosystemic Anastomosis
The gastroesophageal junction around the cardia of the
stomach-where the left gastric vein and its
tributaries form a portosystemic anastomosis with
tributaries to the azygos system of veins of the caval
system.
The anus-the superior rectal vein of the portal system
anastomoses with the middle and inferior rectal
veins of the systemic venous system.
The anterior abdominal wall around the umbilicus-the
para-umbilical veins anastomose with veins on the
anterior abdominal wall.

The stomach
The stomach lymph vessels follow the arteries into the left and right gastric
nodes, the left and right gastroepiploic nodes, and the short gastric
nodes.
All lymph from the stomach eventually passes to the celiac nodes located
around the root of the celiac artery.
78

The duodenum
The duodenal lymph vessels follow the arteries and drain:
•Upward via pancreaticoduodenal nodes to the gastroduodenal nodes and
then to the celiac nodes.
•Downward via pancreaticoduodenal nodes to the superior mesenteric
nodes around the origin of the superior mesenteric artery.
79

The jejunum and the
ileum
The lymph vessels of the
jejunum and ileum pass
through many
intermediate mesenteric
nodes and finally reach
the superior mesenteric
nodes, which are situated
around the origin of the
superior mesenteric
artery.
80

The cecum
The lymph vessels
of the cecum pass
through several
mesenteric nodes
and finally reach
the superior
mesenteric nodes.
81

The appendix
Lymph vessels of the appendix drain into one or
two nodes lying in the mesoappendix and then
eventually into the superior mesenteric nodes.
82

The ascending colon
Lymph vessels of the
ascending colon drain
into lymph nodes
lying along the course
of the colic blood
vessels and
ultimately reach the
superior mesenteric
nodes.
83

Transverse Colon
The proximal two thirds drain into the middle colic nodes and then into the
superior mesenteric nodes;
The distal third drains into the colic nodes and then into the inferior
mesenteric nodes. 84

Descending Colon
The lymph from the descending colon is drained to the colic lymph nodes
and the inferior mesenteric nodes around the origin of the inferior
mesenteric artery.
85

The efferent vessels pass to the celiac nodes.
A few vessels pass from the bare area of the liver through the diaphragm
to the posterior mediastinal lymph nodes.
86
• Liver
• The liver produces a
large amount of
lymph—about one
third to one half of
all body lymph.
• The lymph vessels
leave the liver and
enter several lymph
nodes in the porta
hepatis.

•Gall Bladder
•The lymph drains into a cystic lymph node situated near the neck of the
gallbladder.
•From here, the lymph vessels pass to the hepatic nodes along the course
of the hepatic artery and then to the celiac nodes.
87

The pancreatic lymph nodes are situated along the arteries that
supply the gland.
The efferent vessels ultimately drain into the celiac and superior
mesenteric lymph nodes.
88

Spleen
The lymph vessels of the spleen emerge from the hilum and pass through
a few lymph nodes along the course of the splenic artery and then drain
into the celiac nodes.
89

90
The lymph nodes are closely related to the aorta and form a preaortic
and a right and left lateral aortic (Para-aortic or lumbar) chain.

•The preaortic lymph
nodes lie around the
origins of the celiac,
superior & inferior
mesenteric arteries.
•They are referred to as
the celiac, superior, and
inferior mesenteric
lymph nodes,
respectively.
91

These nodes drain the
lymph from the
gastrointestinal tract,
extending from the
lower one third of the
esophagus to halfway
down the anal canal,
and from the spleen,
pancreas, gallbladder,
and greater part of the
liver.
92

The efferent
lymph vessels
from the
preaortic nodes
form the large
intestinal lymph
trunk.
93

•The thoracic
duct begins in
the abdomen as
an elongated
lymph sac, the
cisterna chyli.
•The cisterna
chyli lies just
below the
diaphragm in
front of the first
two lumbar
vertebrae and on
the right side of
the aorta.
94

The cisterna chyli receives the intestinal trunk, the right and left
lumbar trunks, and some small lymph vessels that descend from
the lower part of the thorax.
95

96
lymphatic duct
thoracic duct
left jugular trunk ：
converying lymph from the
left side of the head and neck
left subclavian trunk ：draining
lymph from the left upper limb
and part of the thorax on the
left side
left bronchomediastinal trunk ：
draining lymph from Left thoracic
cavity
intestinal trunk, ：draining most
of the lymph from the
abdominal part of the alimentary
canal, liver, pancreas and spleen
left and right 1umbar trunks ：
conveying lymph from the
lower limbs and the pelvic
viscera
left venous angle
thoracic
duct
cisterna
chyli

• IV. Clinical Considerations
• Surgeon may judge extent of metastases from a
malignancy by examining nodes draining the area
• For example, from sigmoid colon, first check for
nodes in sigmoid mesocolon, and then examine
inferior mesenteric group found at origin of
inferior mesenteric artery

106
Visceral sensory neurons
Monitor temperature, pain, irritation, chemical changes and
stretch in the visceral organs
Brain interprets as hunger, fullness, pain, nausea, well-being
Receptors widely scattered – localization poor (e.g. which part is
giving you the gas pain?)
Visceral sensory fibers run within autonomic nerves, especially
vagus and sympathetic nerves
Sympathetic nerves carry most pain fibers from visceral organs of body
trunk
Simplified pathway: sensory neurons to spinothalamic tract to
thalamus to cerebral cortex
Visceral pain is induced by stretching, infection and cramping of
internal organs but seldom by cutting (e.g. cutting off a colon
polyp) or scraping them

107
Referred pain: important to know
Pain in visceral organs
is often perceived to
be somatic in origin:
referred to somatic
regions of body that
receive innervation
from the same spinal
cord segments
Plus left shoulder,
from spleen
Anterior skin areas to which pain is referred
from certain visceral organs

108
Visceral sensory and autonomic neurons
participate in visceral reflex arcs
•Many are spinal reflexes such as defecation and
micturition
reflexes
•Some only
involve peripheral
neurons: spinal
cord not involved
(not shown)*
*e.g. “enteric” nervous system: 3 neuron reflex arcs entirely within the wall of the gut

Blood supply and drainage of the gastrointestinal system

Blood supply and drainage of the gastrointestinal system

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Blood supply and drainage of the gastrointestinal system

Similar to Blood supply and drainage of the gastrointestinal system (20)

Recently uploaded

Recently uploaded (20)

Blood supply and drainage of the gastrointestinal system