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    Anatomy, Abdomen and Pelvis, Arteries and Veins

    The abdominopelvic cavity is confined superiorly by the diaphragm and extends inferiorly into the pelvis. This cavity houses most of the organs of the digestive system and parts of the urogenital system. The vasculature of the abdomen and pelvis supplies the various organs and layers of tissue across many planes; it is among the most complex vascular systems in the body. Physiologic variation among vessels exists to introduce diversity amongst patient populations. Understanding the vast anatomy and vasculature of the abdomen and pelvis is vital to clinical and surgical knowledge and aids decision-making in patients with a plethora of complaints.

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    Anatomy, Abdomen and Pelvis, Arteries and Veins

    Aaisha Shah; Yusuf S. Khan.

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    Last Update: July 31, 2021.

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    Introduction

    The abdominopelvic cavity is confined superiorly by the diaphragm and extends inferiorly into the pelvis. This cavity houses most of the organs of the digestive system and parts of the urogenital system. The vasculature of the abdomen and pelvis supplies the various organs and layers of tissue across many planes; it is among the most complex vascular systems in the body. Physiologic variation among vessels exists to introduce diversity amongst patient populations. Understanding the vast anatomy and vasculature of the abdomen and pelvis is vital to clinical and surgical knowledge and aids decision-making in patients with a plethora of complaints.

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    Structure and Function

    Arterial supply to the abdomen is by the branches of the abdominal aorta. The abdominal aorta is the furtherance of the thoracic aorta into the abdominal compartment by piercing the diaphragm close to the twelfth thoracic vertebra. The abdominal aorta bifurcates around the fourth and fifth lumbar vertebrae. It provides a vast network of paired and unpaired branches that supply the abdomen and later bifurcates to supply the pelvis and lower limbs.

    Venous drainage of the abdomen is by the inferior vena cava and its tributaries. The blood from the portal vein passes through the liver and finally drains into the inferior vena cava. The inferior vena cava forms at the level of the fifth lumbar vertebra by the joining of left with the right common iliac veins. It ascends anterior to the vertebral column, just right to the abdominal aorta. It pierces the diaphragm at the eighth thoracic vertebrae just before opening into the right atrium in the thorax.

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    Embryology

    The embryologic development of the cardiovascular system of the abdomen and pelvis is complex.[1] When the embryo folds, the paired dorsal aortae connecting the cranial end of the heart fold are ventral. Caudal to the aortic arches of the thorax, fusion of the dorsal aortae form a single dorsal aorta. This forms the ventral gut branches of the vitelline arteries, the retroperitoneal supplier known as lateral branches, and intersegmental arteries supplying the upper body, body wall, limbs, and vertebra.[2]

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    Blood Supply and Lymphatics

    Arterial Blood Supply to the Abdomen

    The abdominal arteries arise from the abdominal aorta, which enters the abdomen through the aortic hiatus of the diaphragm near T12 and descends, left to the inferior vena cava and anterior to the vertebral bodies. Before its bifurcation at L4 vertebra, the aorta gives off the renal arteries and the three major trunks which supply the alimentary organs.[3]

    Branches of the Abdominal Aorta

    The branches of the abdominal aorta include three major unpaired trunks (celiac trunk, superior mesenteric, inferior mesenteric arteries), six paired branches, and an unpaired median sacral artery.

    The other method of classifying the abdominal aorta branches are as follows:

    Coeliac trunk, superior mesenteric and inferior mesenteric arteries Inferior phrenic, middle suprarenal, renal and gonadal arteries Lumbar and median sacral arteries Right and left common iliac arteries

    The first branches off of the abdominal aorta are the paired inferior phrenic arteries, which further branch into superior suprarenal arteries.

    The second of the branches of the abdominal aorta is the unpaired celiac trunk. The celiac trunk (L1) supplies the foregut, which consists of the esophagus, stomach, proximal half of the duodenum, the gallbladder, superior portion of the pancreas and liver. The celiac trunk is found posterior to the stomach and lesser omentum. Three major branches of the celiac trunk include the common hepatic artery (further branches into the proper hepatic, right gastric, and gastroduodenal arteries), left gastric artery, and splenic artery.

    The third branches are the paired middle suprarenal arteries.

    The fourth branch is the unpaired superior mesenteric artery. The superior mesenteric artery provides oxygenated blood to the midgut; this includes the distal half of the duodenum, jejunum, and ileum, cecum, appendix, ascending colon, right colic flexure, and proximal two-thirds of the transverse colon.

    The fifth branches are the paired renal arteries, which give rise to the inferior suprarenal arteries. The renal arteries arise around L1/L2 and supply the kidneys on either side. The renal artery further subdivides into anterior and posterior branches. The anterior branch further divides into four segmental arteries that supply renal tissue.

    The lumbar arteries follow the renal arteries, and the first through fourth are in pairs. There is also a set of paired testicular or ovarian arteries that supply the gonads in males and females, respectively.

    The third unpaired branch of the abdominal aorta is the inferior mesenteric artery. The inferior mesenteric artery arises around L3 and supplies the hindgut structures: the distal half of the transverse colon, the left colic flexure, the descending and sigmoid colons, rectum, and upper anal canal.

    Source : www.ncbi.nlm.nih.gov

    The Pelvic Veins

    The veins of the pelvis drain deoxygenated blood and return it to the heart. There are three major vessels involved in the venous drainage of the pelvis - the external iliac vein, internal iliac vein and common iliac vein (these correspond the major major pelvic arteries).

    Venous Drainage of the Pelvis

    based on 25 ratings

    Original Author(s): Wes ChannellLast updated: December 4, 2019Revisions: 29

    Contents

    The veins of the pelvis drain deoxygenated blood and return it to the heart. There are three major vessels involved in the venous drainage of the pelvis – the external iliac vein, internal iliac vein and common iliac vein (these correspond the major pelvic arteries).

    In this article, we shall look at the anatomy of the pelvic veins – their anatomical course, tributaries, and clinical correlations.

    Note: The ovarian/testicular vessels drain directly into the abdominal veins; into the inferior vena cava on the right and the renal vein on the left.

    External Iliac Vein

    The external iliac vein is a continuation of the femoral vein (the major vessel draining the lower limb), arising when the femoral vein crosses underneath the inguinal ligament. It ascends along the medial aspect of the external iliac artery, before joining with the internal iliac vein to form the common iliac vein.

    During its short course, the external iliac vein receives the inferior epigastric and deep circumflex iliac veins.

    By TeachMeSeries Ltd (2022)

    Fig 1 – Overview of the venous drainage of the pelvis. The internal iliac vein is responsible for the drainage of most of the pelvic organs. The external iliac vein carries venous return from the lower limb.

    Internal Iliac Vein

    The internal iliac vein is responsible the majority of pelvic venous drainage, and receives numerous tributaries from veins that drain the pelvic region. It is formed near the greater sciatic foramen, ascending anteriorly to the sacroiliac joint, before combining with the external iliac vein to form the common iliac vein.

    With the exception of the iliolumbar vein (which drains into the common iliac), the tributaries of the internal iliac vein correspond with the branches of the internal iliac artery. It receives venous blood from the:

    Superior and inferior gluteal veins – drains the buttock and upper thigh.Internal pudendal vein – drains the reproductive organs and part of the rectum (via the inferior rectal vein).Obturator veinLateral sacral veins – drains part of the sacrum.Middle rectal vein – drains the bladder, prostate (in males only), and part of the rectum.Vesical veins – drains the urinary bladder via the vesical venous plexus.Uterine and vaginal veins – drain the female reproductive organsvia the vaginal and uterine venous plexuses.

    Common Iliac Vein

    The common iliac vein is formed at the upper margin of the pubic symphysis by the union of the external and internal iliac veins. It receives two additional tributaries:

    Iliolumbar vein – drains the L4 and L5 vertebrae, and the iliopsoas muscle.Middle sacral veins – drain part of the sacrum.

    The left and right common iliac veins combine at L5 to become the inferior vena cava, which empties into the inferior aspect of the right atrium.

    Clinical Relevance - Pelvic Congestion Syndrome

    The veins in the pelvis, particularly the ovarian veins in women, are prone to valve failure that may cause them to become dilated and tortuous (similar to varicose veins of the leg). This can cause intense pain within the pelvis, known as pelvic congestion syndrome. The pelvis contains too many structures to successfully dissect out a vein, and so pelvic venous embolisation is performed instead.

    Using a venous catheter a guide wire is fed through, a contrast dye is used and affected vessels are embolised (blocked) with various substances, such as metal coils. Due to the rich venous anastomoses in the pelvis, one smaller vein can be tied off without compromising venous return.

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    Quiz

    Venous Drainage of the Pelvis

    Question 1 of 3

    Which structure does the left ovarian vein drain into?

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    Source : teachmeanatomy.info

    Homework: Chapter 14 and 15 Flashcards

    Start studying Homework: Chapter 14 and 15. Learn vocabulary, terms, and more with flashcards, games, and other study tools.

    Homework: Chapter 14 and 15

    19 studiers in the last hour

    Capillaries found in the kidneys, choroid plexuses of the ventricles in the brain, and most endocrine glands are most likely to be:

    Click card to see definition 👆

    fenestrated capillaries

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    The innermost layer of blood vessels is composed of:

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    simple squamous epithelium

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    1/50 Created by MEBreite

    Terms in this set (50)

    Capillaries found in the kidneys, choroid plexuses of the ventricles in the brain, and most endocrine glands are most likely to be:

    fenestrated capillaries

    The innermost layer of blood vessels is composed of:

    simple squamous epithelium

    What areas does the thoracic aorta supply:

    -pericardium -bronchi of lungs

    -superior and posterior surfaces of the diaphragm

    -esophagus

    Trace the flow of venous blood draining from the small intestine back to the heart.

    superior mesenteric vein, hepatic portal vein, liver, hepatic veins, inferior vena cava, heart

    What are the direct branches of the aortic arch?

    -left subclavian artery

    -left common carotid artery

    -brachiocephalic trunk

    At the base of the brain, the two vertebral arteries merge to form the _________ artery.

    basilar

    The abdominal aorta splits first into right and left _________ arteries.

    common iliac

    What are some veins that are located in the upper extremities?

    -basilica -cephalic -radial

    Which of the following accurately describe a true difference between arteries and veins?

    Veins are thin-walled whereas arteries are thick-walled

    The thoracic, shoulder, and muscles of the scapula and humerus receive blood directly from the...

    axillary artery

    What are some of the arties that are unpaired visceral branches of the abdominal aorta...

    -celiac trunk

    -superior mesenteric

    -inferior mesenteric

    The __________ directly supplies all organs of the gastrointestinal tract from the transverse colon to the rectum.

    inferior mesenteric artery

    Muscles of the thigh (quadriceps, adductors, and hamstrings) femur, and ligaments and tendons around the knee joint receive blood directly from the...

    femoral arteries

    The posterior and lateral muscle compartments of the leg, plantar muscles of the foot, tibia, fibula, tarsal, metatarsal, and phalangeal bones all receive blood directly from the...

    posterior tibial arteries

    All blood from the abdomen, pelvis, and lower limbs arrive in the heart via the...

    inferior vena cava

    Which vein of the head is the major drainage pathway from the brain?

    internal jugular veins

    Which vein of the head is the major drainage pathway from the deep muscles in the neck and cervical vertebrae?

    vertebral veins

    The integument and superficial muscles of the lateral aspect of the upper limb are drained directly by the...

    cephalic veins

    How is the azygos system related to the inferior vena cava?

    It receives blood from the lower limbs and abdomen and returns it to the hear via the superior vena cava

    The head, neck, upper limbs, mammary glands, and superior thorax are directly drained by the

    brachiocephalic veins

    What structures do the lumbar veins drain?

    posterior and lateral abdominal muscle wall, lumbar vertebrae, spinal cord

    What structures do the suprarenal veins drain?

    adrenal glands

    Which two veins unite to form the hepatic portal vein?

    superior mesenteric and splenic

    The hepatic portal system is important because blood reaching the liver...

    -converts glucose into glycogen for storage.

    -detoxifies harmful substances.

    -destroys bacteria.

    The layer(s) of an artery wall that is/are responsible for vasoconstriction and vasodilation is/are the...

    tunica media

    Blood flows through the following vessels in what order?

    1. arteriole 2. capillary

    3. thoroughfare channel

    4. metarteriole 5. venule

    arteriole>metarteriole>capillary>venule

    What is the correct route that a drop of blood would follow as it flows through the following vessels?

    1. inferior vena cava

    2. thoracic aorta 3. renal artery 4. abdominal aorta 5. renal vein

    thoracic aorta>abdominal aorta>renal aorta>renal vein>inferior vena cava

    What is the correct route that a drop of blood would follow as it flows through the following vessels?

    1. external iliac artery

    2. popliteal artery

    3. anterior tibial artery

    4. common iliac artery

    5. femoral artery

    6. dorsalis pedis (right dorsal artery of foot) artery

    common iliac artery> external iliac artery> femoral artery> popliteal artery> anterior tibial artery> dorsalis pedis artery

    What is the correct route that a drop of blood would follow as it flows through the following vessels?

    1. superior vena cava

    2. internal jugular vein

    3. sigmoid sinuses 4. subclavian vein

    5. brachiocephalic vein

    sigmoid sinuses> internal jugular vein> subclavian vein> brachiocephalic vein> superior vena cava

    What is the correct route that a drop of blood would follow as it flows through the following vessels?

    1. ulnar vein

    Source : quizlet.com

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