Updated: 9/29/2018

Aorta and Branches

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aorta and branches
Overview
  • Celiac trunk
  • Superior mesenteric artery (SMA) 
    • branches
      • inferior pancreaticoduodenal artery
        • supplies distal portion of duodenum and head of pancreas
      • middle colic artery
        • supplies proximal 2/3 of transverse colon
      • right colic artery
        • supplies ascending colon
    • can cause SMA syndrome
      • SMA compresses the transverse portion of the duodenum => obstruction
  • Inferior mesenteric artery (IMA)
    • branches
      • left colic artery
        • supplies distal 1/3 of transverse and descending colon
      • sigmoid artery 
        • supplies descending and sigmoid colon
      • superior rectal artery
        • supplies upper portion of rectum
  • Renal arteries 
    • supplies kidneys and contribute to blood supply to adrenal glands
  • Gonadal (testicular/ovarian) arteries
    • testicular artery accompanies vas deferens into scrotum and supplies spermatic cord, epididymis, and testis
    • ovarian artery enters the suspensory ligament of the ovary and supplies ovary
      • anastomoses with the ovarian branch of uterine artery
  • Common iliac arteries
    • divides into the internal and external iliac arteries that supply pelvis  
 

GI Blood Supply and Innervation


Embryonic Gut Region
Artery
Parasympathetic Innervation
Vertebral Level
Structures Supplied
Foregut
Celiac Trunk
Vagus
T12
  • Stomach to proximal duodenum
  • Liver, gallbladder, pancreas, and spleen (mesoderm)
Midgut
SMA
Vagus
L1
  • Distal duodenum to proximal 2/3 of transverse colon
Hindgut
IMA
Pelvic
L3
  • Distal 1/3 of transverse colon to upper portion of rectum
  • Splenic flexure is a watershed region

 
Collateral Circulation
  • Collateral circulation
    • overview
      • arterial anastomoses compensate for blockage of abdominal aorta
    • external iliac artery and subclavian artery
      • superior epigastric artery
        • arises from the internal thoracic artery (internal mammary artery), a branch of the subclavian artery
      • inferior epigastric artery 
        • arises from the external iliac artery
      • superior epigastric artery and inferior epigastric artery anastomose, providing collateral circulation between the subclavian and external iliac arteries
    • celiac trunk and SMA
      • superior pancreaticoduodenal artery (celiac trunk) anastamoses with the inferior pancreaticoduodenal artery (SMA)
    • SMA and IMA
      • middle colic artery anastamoses with the left colic artery (IMA)
    • IMA and internal iliac artery
      • superior rectal artery (IMA) anastamoses with the middle rectal artery (internal iliac artery)
Watershed Areas
  • Watershed areas and collateral circulation
    • right colon
      • marginal artery of Drummond supplies right colon though it is poorly developed in many patients
    • splenic flexure
      • marginal artery of Drummond is poorly developed in this area
      • in hypotension and blood loss, this area can become ischemic
    • rectosigmoid junction
      • excellent collateral circulation above this point (left colic artery supplying marginal artery of Drummond) and below (superior and inferior rectal arteries supply the rectum) yet weak collateral circulation at this point
    • collateral vessels to know in the colon (high yield)
      • The marginal artery of Drummond
        • anastomosis between the right, middle, and left colic arteries
      • The arc of Riolan (meandering mesenteric artery)
        • proximal anastomosis between the left and middle colic artery
 

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Questions (3)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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