Superior mesenteric artery, topography, branches. Blood supply to the small intestine. Superior mesenteric artery. Topography of the superior mesenteric artery. Bowel arcades Superior mesenteric artery

Superior mesenteric artery, a mesenteric superior. Unpaired branch of the abdominal aorta. It starts about 1 cm below the celiac trunk, first lies behind the pancreas, then passes in front of the uncinate process. Its branches continue into the mesentery of the small and transverse colon. Rice. A, B.
Inferior pancreatoduodenal artery pancreaticoduodenalis inferior. It departs at the level of the upper edge of the horizontal part of the duodenum. Its branches lie in front and behind the head of the pancreas. Rice. A. 2a Anterior branch, ramus anterior. Anastomoses with the anterior superior pancreatoduodenal artery. Rice. AT.
Jejunal arteries, aajejunales. Goes to the jejunum in her mesentery. Rice. BUT.
The ileal arteries, aa ileales. They approach the ileum between the two sheets of its mesentery. Rice. BUT.
Ileocolic artery, a. ileocolica. In the mesentery of the small intestine goes down and to the right to the iliocecal angle. Rice. BUT.
Colon branch, ramus colicus. Goes to the ascending colon. Anastomoses with the right colonic artery. Rice. BUT.
Anterior caecum artery, a. caecalis (cecalis) anterior. In the caecal fold, it approaches the anterior surface of the caecum. Rice. BUT.
Posterior caecum artery, a. caecalis (cecalis) posterior. Heads behind the terminal ileum to the posterior surface of the caecum. Rice. BUT.
Artery of the appendix, a. appendicularis. It crosses behind the ileum and lies along the free edge of the mesentery of the appendix. The place of origin of the artery is unstable, it can be double. Rice. A. 9a Ileal branch, ramus ile: alis. It goes to the ileum and anastomoses with one of the small intestinal arteries. Rice. BUT.
Right colonic artery, a. colic dextra. Anastomoses with the ascending branch of the ileocolic and middle colonic arteries. Rice. A. 10a Artery of the right flexure of the colon, aflexura dextra. Rice. BUT.
Middle colonic artery, a. colica media. It is located in the mesentery of the transverse colon. Rice. A. Pa Regional colonic artery, a. marginalis coli[]. Anastomosis of the left colic and sigmoid arteries. Rice. B.
Inferior mesenteric artery, and tesenterica inferior. Departs from the abdominal part of the aorta at the level of L3 - L4. Heads to the left and supplies the left third of the transverse colon, descending, sigmoid colon, as well as most of the rectum. Rice. B. 12a Ascending [intermesenteric] artery, a ascendeus. Anastomoses with the left colonic and middle colonic arteries. Rice. A, B.
Left colonic artery, a. colic sinistra. Retroperitoneally goes to the descending colon. Rice. B.
Sigmoid intestinal arteries, aa. sigmoideae. Goes obliquely down to the wall of the sigmoid colon. Rice. B.
Superior rectal artery, a. rectalis superior. Behind the rectum, it enters the small pelvis, where it is divided into right and left branches, which, perforating the muscle layer, supply the intestinal mucosa with blood to the anal flaps. Rice. B.
Middle adrenal artery, and suprarenalis (adrenalis) media. It departs from the abdominal part of the aorta and supplies the adrenal gland with blood. Rice. AT.
Renal artery, a. renalis. It starts from the aorta at the level of L 1 and divides into several branches that go to the hilum of the kidney. Rice. C, D. 17a Capsular arteries, aaxapsulares (perirenales). Rice. AT.
Inferior adrenal artery, a. suprarenalis inferior. Participates in the blood supply to the adrenal gland. Rice. AT.
Anterior branch, ramus anterior. Blood supply to the upper, anterior and lower segments of the kidney. Rice. V, G.
Upper segment artery, a. segment superioris. Spreads to the posterior surface of the kidney. Rice. AT.
Artery of the upper anterior segment, a.segmenti anterioris superioris. Rice. AT.
Artery of the lower anterior segment, a segmenti anterioris inferioris. Branch to the anteroinferior segment of the kidney. Rice. AT.
Artery of the lower segment, a. segmenti inferioris. It spreads to the back surface of the organ. Rice. AT.
Posterior branch, ramus posterior. Heads to the posterior, largest segment of the kidney. Rice. V, G.
Artery of the posterior segment, a. segmenti posterioris. Branches in the corresponding segment of the kidney. Rice. G.
Ureteric branches, rami ureterici. Branches to the ureter. Rice. AT.

Superior mesenteric artery, a. mesenterica superior, is a large vessel that starts from the anterior superficial aorta, slightly lower (1-3 cm) of the celiac trunk, behind the pancreas. Coming out from under the lower edge of the gland, the superior mesenteric artery goes down and to the right. Together with the superior mesenteric vein located to its right, it lies on the anterior surface of the horizontal (or ascending) part of the duodenum, crosses it across, immediately to the right of the flexura duodenojejunalis. Having reached the root of the mesentery of the small intestines, the superior mesenteric artery penetrates between the sheets of the latter, forming an arc with a bulge to the left, and reaches the right iliac fossa. In its course, the superior mesenteric artery gives off the following branches: to the small intestine (with the exception of the upper part of the duodenum) , a cecum with a appendix, ascending and partially to the transverse colon. The following arteries depart from the superior mesenteric artery.

Inferior pancreatoduodenal artery, a. pancreatico-duodenalis inferior (sometimes non-single), originates from the right edge of the initial section of the superior mesenteric artery, goes down and to the right along the anterior surface of the pancreas, bending around its head along the border with the duodenum. The inferior pancreatoduodenal artery gives off branches to the pancreas and
Intestinal arteries up to 15 depart sequentially one after the other from the convex part of the arch of the superior mesenteric artery. The intestinal arteries are sent between the sheets of the mesentery to the loops of the jejunum and ileum - these are the jejunal arteries and the ileal arteries, aa .. jejunales et aa. ilei. On its way, each branch divides into two trunks, which anastomose with the same trunks formed from the division of neighboring intestinal arteries. Such anastomoses look like arcs or arcades. New branches depart from these arcs, which also divide, forming arcs of the second order, of a somewhat smaller size. From the arcs of the second order, arteries again depart, which, dividing, form arcs of the third order, and so on. From the last, most distal, series of arcs, straight branches extend directly to the walls of the loops of the small intestines. In addition to intestinal loops, these arcs give small branches that supply blood to the mesenteric lymph nodes.
Iliocolic artery, a. ileocolica, departs from the cranial half of the superior mesenteric artery, to the right of the root of the mesentery of the small intestine. Heading to the right and down under the parietal peritoneum of the posterior abdominal wall to the end of the ileum and to the caecum, the ileocolic artery divides into two branches that supply the caecum, the beginning of the colon and the terminal ileum.

Anterior and posterior caecal arteries, aa .. cecales anterior et posterior, heading to the corresponding surfaces of the caecum.
The ileal branch is a continuation of a. ileocolica, goes down to the ileocecal angle, where, connecting with the terminal branches of aa .. ilei, it forms an arc, from which branches extend to the terminal ileum.
The branch of the colon goes to the right to the ascending colon. Before reaching the medial edge of this colon, it is divided into two branches, of which one is the ascending branch, g. ascendens, rises along the medial edge of the ascending colon and anastomoses (forms an arc) with a. colica dextra; the other branch descends along the medial edge of the colon and anastomoses (forms an arc) with a. ileocolica. Branches depart from these arcs, supplying the ascending colon and caecum, as well as the appendix through the artery of the appendix, a. appendicularis.

Right colic artery, a. colica dextra, departs from the right side of the superior mesenteric artery in its upper third, at the level of the root of the mesentery of the transverse colon, and goes almost transversely to the right, to the medial edge of the ascending colon. At some distance from the ascending colon, the right colic artery divides into ascending and descending branches. The descending branch connects to branch a. ileocolica, and the ascending branch anastomoses with the right branch of a. colica media. From the arcs formed by these anastomoses, branches depart to the wall of the ascending colon, to the flexura
Middle colic artery, a. colica media, departs from the initial section of the superior mesenteric artery, heading forward and to the right between the sheets of the mesentery of the transverse colon, and is divided into two branches: right and left

The portal vein has the following tributaries.

425. Scheme of the portal vein.

2-r. sinister v. portae;

3-v. gastric sinistra;

4-v. gastrica dextra;

6-v. gastroepiploica sinistra;

7-v. mesenterica inferior;

8-v. colica sinistra;

9-vv. sigmoideae;

10-v. rectalis superior;

11-vv. rectales mediae;

12-vv. rectal inferiores;

13-v. iliocolica;

14-vv. jejunales;

15-v. mesenterica superior;

16-vv. paraumbilical;

17-r. dexter v. portae;

18 - venous capillaries of the liver;

19-vv. hepaticae;

20-v. cava inferior.

1. The superior mesenteric vein (v. mesenterica superior) is single, located at the root of the mesentery of the small intestine, next to the superior mesenteric artery, collects blood from the small intestine (vv. jejunales et ilei), appendix and caecum (vv. ileocolicae), ascending colon (v. colica dextra), transverse colon (v. colica media), head of the pancreas and duodenum (vv. pancreaticoduodenales superior et inferior), greater curvature of the stomach and transverse colon (v. gastroepiploica dextra).

2. The splenic vein (v. lienalis) is single, collects blood from the spleen, fundus and body of the stomach along the greater curvature (v. gastroepiploica sinistra, vv. gastricae breves) and pancreas (vv. pancreaticae). The splenic vein joins behind the head of the pancreas and the upper horizontal part of the duodenum with the superior mesenteric vein into the portal vein.

3. The inferior mesenteric vein (v. mesenterica inferior) collects blood from the descending colon (v. colica sinistra), sigmoid (vv. sigmoideae) and the upper part of the rectum (v. rectalis superior) intestine. The inferior mesenteric vein joins the splenic vein in the middle of the body of the pancreas or flows into the angle of the junction of the superior mesenteric and splenic veins.

4. The cystic vein (v. cystica), paraumbilical veins (vv. paraumbilicales) located in the lig. teres hepatis, left and right gastric veins (vv. gastricae sinistra et dextra), prepyloric vein (v. prepylorica).

The portal vein from the place of formation (behind the head of the pancreas) from the gate of the liver has a length of 4-5 cm and a diameter of 15-20 mm. It lies in lig. hepatoduodenale, where the ductus choledochus passes to the right of it, and a. hepatica propria. At the hilum of the liver, the portal vein divides into two large lobar branches, which in turn branch into 8 segmental veins. Segmental veins are divided into interlobular and septal veins, which end in sinusoids (capillaries) of the lobules. The capillaries are radially oriented between the hepatic ducts towards the center of the lobule. In the center of the lobules, the central veins (vv. centrales) are formed from the capillaries, representing the initial vessels for the hepatic veins flowing into the inferior vena cava. Thus, venous blood from the internal organs of the abdominal cavity, before entering the inferior vena cava, passes through the liver, where it is cleared of toxic metabolic products.

Portal Vein: Blood Pathways, Diseases, Diagnosis and Treatment Methods

The main task assigned to the portal vein is the well-established removal of venous blood from unpaired organs, with the exception of the liver. The circulatory system is associated primarily with the gastrointestinal tract and its major glands.

Portal tributaries

The portal vein system is characterized by the presence of branches that act as connecting links between individual unpaired internal organs. There are several main tributaries of the portal system of blood vessels, which are assigned separate functions.

splenic vein

The splenic vein is located along the upper border of the pancreas, behind the splenic artery. The vein intersects with the aorta, running in the direction from left to right.

In the dorsal part of the pancreas, the blood vessels of the splenic vein merge with another tributary of the portal vein, the mesenteric circulatory pathway. In turn, short gastric, omental and pancreatic vessels act as tributaries of the splenic vein.

The main function of the splenic vein is to ensure the outflow and movement of blood from the spleen, individual sections of the stomach.

Superior mesenteric vein

The mesenteric vein runs from the base of the mesentery of the small intestine, located on the right in relation to the blood artery of the same name. The veins of the ileum and jejunum, the middle and right colic veins act as tributaries of this blood path.

The blood vessels of the mesenteric vein mentioned above carry blood from the transverse colon, ileum, jejunum, and also the appendix. In general, the system of the superior mesenteric vein is responsible for stable blood flow in the region of the stomach, greater omentum and duodenum.

Inferior mesenteric vein

It is formed by the confluence of the sigmoid, left colonic and superior rectal veins. It is located in close proximity to the left colic artery. Passes the blood path behind the pancreas, after which it connects to the splenic vein.

The inferior mesenteric vein is responsible for collecting and draining blood from the walls of the rectum, colon, and sigmoid colon.

Portal vein - the norm of blood flow

Portal blood flow in the liver is unstable. Its distribution is possible with a predominance in one of the lobes of the liver. As a result, the flow of venous blood between the lobar branches of individual systems can be observed in the human body.

The optimal pressure in the portal vein is close to 7 mmHg. At the same time, the blood flow here is more laminar than turbulent.

Portal vein: dimensions

The dimensions of the portal vein correspond to the distance over which venous blood drains, starting from the vestibule of the liver and ending with the gastrointestinal tract. The portal vein is on average 8 to 10 cm long and about 1.5 cm wide.

Circulatory disturbance of the portal vein

In the presence of disturbances in the stable outflow of blood in the portal vein, regardless of their nature, portal blood begins to outflow into the central blood pathways with a noticeable expansion of venous collaterals. The collaterals connected with the lumbar veins can increase significantly in size. Disturbed distribution of the outflowing blood flow to the tributaries of the portal vein can lead to thrombosis and varicose veins in the lower layers of the stomach and esophagus.

Thrombosis

The portal vein, subject to acute thrombosis, causes pathological changes, followed by frequent severe pain in the abdominal cavity. The consequences of circulatory disorders in the system of this pathway can be:

progressive drop in blood pressure;

Quite quickly, against the background of impaired blood circulation in the portal vein system in acute thrombosis, liver abscesses, intestinal infarctions, jaundice, and cirrhosis are formed.

Chronic thrombosis of the portal vein can be caused by portal hypertension, varicose veins of the esophagus. Complications in the initial stages of the development of chronic thrombosis are usually gastrointestinal bleeding. There are frequent cases of impaired functioning and even rupture of the spleen.

Circulation diagnostics

Indications for diagnosis for the presence of diseases associated with disorders in the portal vein may be symptoms inherent in portal hypertension.

With the confluence of a whole complex of negative factors, the portal vein is prone to the development of acute thrombosis, which manifests itself in an increase in the diameter of the vein from 8-10 to 13 or more millimeters. However, with the development of chronic thrombosis, this symptom may not appear.

The most reliable method for diagnosing the state of the portal vein system is angiography. In recent years, the method of laparoscopy has been actively used and demonstrates excellent diagnostic results.

Treatment

The portal vein is restored using a whole complex of anticoagulants and fibrinolytics. Excellent treatment results are obtained by a combination of pharmacological preparations containing streptokinase, heparin and fibrinolysin.

Often, the restoration of normal blood flow in the portal vein system requires surgical intervention. Here, such proven methods of treatment as thrombectomy and surgical restoration of portal blood flow are widely used.

superior mesenteric vein

Russian-Italian medical dictionary with indexes of Russian and Latin terms. - M .: "Russo". C.C. Prokopovich. 2003 .

See what the "superior mesenteric vein" is in other dictionaries:

Superior mesenteric arteries (arteria mesenlerica superior), its branches - Front view. The transverse colon and the greater omentum are elevated. superior mesenteric artery; superior mesenteric vein; toshe intestinal arteries; arcades; loops of the small intestine; appendix; cecum; ascending colon; ... ... Atlas of human anatomy

portal vein - (v. portae) a large venous vessel that collects blood from unpaired abdominal organs (stomach, intestines, spleen, pancreas) and goes to the liver. Venous blood from these organs, before entering the system of the inferior vena cava, ... ... Dictionary of terms and concepts on human anatomy

The mesenteric part - the small intestine is located in the lower part of the abdominal cavity, its length is 4-6 m, and its diameter is 2-4 cm. / 5 and without visible boundaries ... ... Atlas of human anatomy

superior mesenteric vein - (v. mesenterica superior, PNA, BNA) see the list of anat. terms ... Big Medical Dictionary

The inferior mesenteric artery (arteria mesenterica inferior) and its branches - the transverse colon and the greater omentum are raised upwards. The loops of the small intestine are turned to the right. transverse colon; arterial anastomosis (riolan arch); inferior mesenteric vein; inferior mesenteric artery; abdominal aorta; right ... ... Atlas of human anatomy

Digestive system - provides the body with the absorption it needs as a source of energy, as well as for cell renewal and growth of nutrients. The human digestive apparatus is represented by a digestive tube, large digestive glands ... ... Atlas of Human Anatomy

Endocrine glands (endocrine glands) - Fig. 258. The position of the endocrine glands in the human body. Front view. I pituitary and epiphysis; 2 parathyroid glands; 3 thyroid gland; 4 adrenal glands; 5 pancreatic islets; 6 ovary; 7 testicle. Fig. 258. Position of the endocrine glands ... Atlas of human anatomy

The inferior vena cava system is formed by vessels that collect blood from the walls and organs of the abdominal cavity and pelvis, as well as from the lower extremities. The inferior vena cava (v. cava inferior) (Fig. 215, 233, 236, 237) begins at the level of the right anterolateral surface IV V ... ... Atlas of human anatomy

BLOOD VESSELS - BLOOD VESSELS. Contents: I. Embryology. 389 P. General anatomical sketch. 397 Arterial system. 397 Venous system. . 406 Table of arteries. 411 Table of veins. … … Big medical encyclopedia

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portal vein system

The portal vein (liver) occupies a special place among the veins that collect blood from the internal organs. This is not only the largest visceral vein (its length is 5-6 cm, diameter is mm), but it is also the afferent venous link of the so-called portal system of the liver. The portal vein of the liver is located in the thickness of the hepatoduodenal ligament behind the hepatic artery and common bile duct along with nerves, lymph nodes and vessels. It is formed from the veins of unpaired organs of the abdominal cavity: stomach, small and large intestine, except for the anus, spleen, pancreas. From these organs, venous blood flows through the portal vein to the liver, and from it through the hepatic veins to the inferior vena cava. The main tributaries of the portal vein are the superior mesenteric and splenic veins, as well as the inferior mesenteric vein, which merge with each other behind the head of the pancreas. Upon entering the hilum of the liver, the portal vein divides into a larger right branch and a left branch. Each of the branches, in turn, splits first into segmental, and then into branches of ever smaller diameter, which pass into the interlobular veins. Inside the lobules, they give off wide capillaries - the so-called sinusoidal vessels that flow into the central vein. The sublobular veins emerging from each lobule merge to form 34 hepatic veins. Thus, the blood flowing into the inferior vena cava through the hepatic veins passes on its way through two capillary networks: located in the wall of the digestive tract, where the tributaries of the portal vein originate, and formed in the liver parenchyma from the capillaries of its lobules. Before entering the portal of the liver (in the thickness of the hepatoduodenal ligament), the gallbladder vein (from the gallbladder), the right and left gastric veins and the prepyloric vein flow into the portal vein, delivering blood from the corresponding parts of the stomach. The left gastric vein anastomoses with the esophageal veins - tributaries of the unpaired vein from the system of the superior vena cava. In the thickness of the round ligament of the liver, the paraumbilical veins follow to the liver. They begin in the navel, where they anastomose with the superior epigastric veins - tributaries of the internal thoracic veins (from the system of the superior vena cava) and with the superficial and inferior epigastric veins - tributaries of the femoral and external iliac veins from the system of the inferior vena cava.

Portal tributaries

The superior mesenteric vein runs at the root of the mesentery of the small intestine to the right of the artery of the same name. Its tributaries are the veins of the jejunum and ileum, pancreatic veins, pancreatoduodenal veins, iliac-colic vein, right gastroepiploic vein, right and middle colon veins, vein of the appendix. In the superior mesenteric vein, these veins bring blood from the walls of the jejunum and ileum and the appendix, the ascending colon and transverse colon, partly from the stomach, duodenum and pancreas, and the greater omentum.

The splenic vein, located along the upper edge of the pancreas below the splenic artery, runs from left to right, crossing the aorta in front, and merges with the superior mesenteric vein behind the head of the pancreas. Its tributaries are the pancreatic veins, short gastric veins and the left gastroepiploic vein. The latter anastomoses along the greater curvature of the stomach with the right vein of the same name. The splenic vein collects blood from the spleen, part of the stomach, pancreas, and greater omentum.

The inferior mesenteric vein is formed by the fusion of the superior rectal vein, the left colic vein, and the sigmoid veins. Located next to the left colic artery, the inferior mesenteric vein goes up, passes under the pancreas and flows into the splenic vein (sometimes into the superior mesenteric vein). This vein collects blood from the walls of the upper rectum, sigmoid colon, and descending colon.

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portal vein system

Portal vein, v. portae hepatis, collects blood from unpaired abdominal organs.

It is formed behind the head of the pancreas as a result of the confluence of three veins: the inferior mesenteric vein, v. mesenterica inferior, superior mesenteric vein, v. mesenterica superior, and splenic vein, v. splenica.

The portal vein from the place of its formation goes up and to the right, passes behind the upper part of the duodenum and enters the hepatoduodenal ligament, passes between the sheets of the latter and reaches the gate of the liver.

In the thickness of the ligament, the portal vein is located with the common bile and cystic ducts, as well as with the common and proper hepatic arteries in such a way that the ducts occupy the extreme position on the right, to the left are the arteries, and behind the ducts and arteries and between them is the portal vein.

At the gates of the liver, the portal vein divides into two branches - the right and left, respectively, the right and left lobes of the liver.

Right branch, r. dexter, wider than left; it enters through the gates of the liver into the thickness of the right lobe of the liver, where it is divided into anterior and posterior branches, r. anterior et r. posterior.

Left branch, r. sinister, longer than right; heading to the left side of the gate of the liver, it, in turn, divides along the way into a transverse part, pars transversa, giving branches to the caudate lobe - caudal branches, rr. caudati, and the umbilical part, pars umbilicalis, from which the lateral and medial branches depart, rr. laterales et mediales, into the parenchyma of the left lobe of the liver.

Three veins: inferior mesenteric, superior mesenteric and splenic, from which v. portae are called roots of the portal vein.

In addition, the portal vein receives the left and right gastric veins, vv. gastricae sinistra et dextra, prepyloric vein, v. prepylorica, paraumbilical veins, vv. paraumbilicales, and gallbladder vein, v. cystica.

1. Inferior mesenteric vein, v. mesenterica inferior, collects blood from the walls of the upper part of the straight, sigmoid colon and descending colon and with its branches corresponds to all branches of the inferior mesenteric artery.

It begins in the pelvic cavity as the superior rectal vein, v. rectalis superior, and in the wall of the rectum with its branches is connected with the rectal venous plexus, plexus venosus rectalis.

The superior rectal vein goes up, crosses the iliac vessels in front at the level of the left sacroiliac joint and receives the sigmoid intestinal veins, vv. sigmoideae, which follow from the wall of the sigmoid colon.

The inferior mesenteric vein is located retroperitoneally and, heading up, forms a small arc, facing the bulge to the left. Having taken the left colic vein, v. colica sinistra, the inferior mesenteric vein deviates to the right, passes immediately to the left of the duodenal-lean bend under the pancreas and most often connects with the splenic vein. Sometimes the inferior mesenteric vein flows directly into the portal vein.

2. Superior mesenteric vein, v. mesenterica superior, collects blood from the small intestine and its mesentery, caecum and appendix, ascending and transverse colon and from the mesenteric lymph nodes of these areas.

The trunk of the superior mesenteric vein is located to the right of the artery of the same name, and its branches accompany all the branches of this artery.

The superior mesenteric vein begins at the ileocecal angle, where it is called the ileocolic vein.

Ileococolic intestinal vein, v. ileocolica, collects blood from the terminal ileum, appendix (vein of the appendix, v. appendicularis) and the caecum. Heading up and to the left, the iliac-colon-intestinal vein continues directly into the superior mesenteric vein.

The superior mesenteric vein is located at the root of the mesentery of the small intestine and, forming an arc with a bulge to the left and down, receives a number of veins:

a) jejunal and ileo-intestinal veins, vv. jejunales et ileales, only 16 - 20, go to the mesentery of the small intestine, where they accompany the branches of the small intestinal arteries with their branches. Intestinal veins flow into the superior mesenteric vein on the left;

b) right colonic veins, vv. colicae dextrae, go retroperitoneally from the ascending colon and anastomose with the ileocolic-intestinal and middle colon-intestinal veins;

c) middle colic vein, v. colica media, located between the sheets of the mesentery of the transverse colon; it collects blood from the right flexure of the colon and the transverse colon. In the region of the left flexure of the colon, it anastomoses with the left colonic vein, v. colica sinistra, forming a large arcade;

d) right gastroepiploic vein, v. gastroepiploica dextra, accompanies the artery of the same name along the greater curvature of the stomach; collects blood from the stomach and greater omentum; at the level of the pylorus flows into the superior mesenteric vein. Before confluence, it takes pancreatic and pancreatoduodenal veins;

e) pancreatoduodenal veins, vv. pancreaticoduodenales, repeating the path of the arteries of the same name, collect blood from the head of the pancreas and duodenum;

e) pancreatic veins, vv. pancreaticae, depart from the parenchyma of the head of the pancreas, passing into the pancreatoduodenal veins.

3. Splenic vein, v. splenica, collects blood from the spleen, stomach, pancreas, and greater omentum.

It is formed in the region of the gate of the spleen from the numerous veins emerging from the substance of the spleen.

Here the splenic vein receives the left gastroepiploic vein, v. gastroepiploica sinistra, which accompanies the artery of the same name and collects blood from the stomach, greater omentum, and short gastric veins, vv. gastricae breves, which carry blood from the fundus of the stomach.

From the gate of the spleen, the splenic vein goes to the right along the upper edge of the pancreas, located below the artery of the same name. It crosses the anterior surface of the aorta just above the superior mesenteric artery and merges with the superior mesenteric vein to form the portal vein.

The splenic vein receives the pancreatic veins, vv. pancreaticae, mainly from the body and tail of the pancreas.

In addition to the indicated veins that form the portal vein, the following veins flow directly into its trunk:

a) prepyloric vein, v. prepylorica, begins in the pyloric region of the stomach and accompanies the right gastric artery;

b) gastric veins, left and right, v. gastrica sinistra et v. gastrica dextra, go along the lesser curvature of the stomach and accompany the gastric arteries. In the region of the pylorus, the veins of the pylorus flow into them, in the region of the cardial part of the stomach - the veins of the esophagus;

c) paraumbilical veins, vv. paraumbilicales (see Fig. 829, 841), begin in the anterior abdominal wall in the circumference of the umbilical ring, where they anastomose with the branches of the superficial and deep superior and inferior epigastric veins. Heading to the liver along the round ligament of the liver, the paraumbilical veins either connect into one trunk, or several branches flow into the portal vein;

d) gall bladder vein, v. cystica, flows into the portal vein directly into the substance of the liver.

In addition, in this area in v. portae hepatis, a number of small veins flow from the walls of the portal vein itself, the hepatic arteries and ducts of the liver, as well as the veins from the diaphragm, which reach the liver through the falciform ligament.

Superior mesenteric vein

Location: Root of the mesentery of the small intestine

Blood collection basin: small intestine, caecum, ascending colon, transverse colon, pancreas;

Location: lies in the retroperitoneal space

Blood collection pool: Descending colon, sigmoid colon, rectum (via superior rectal vein)

Location: lies along the upper edge of the pancreas

Blood collection pool: Spleen, stomach, pancreas

TRUCKS OF THE PORTAL VEIN

Blood collection pool: stomach

Anastomoses: esophageal veins (tributaries of the unpaired and semi-unpaired veins)

Paraumbilical veins (remnants of the fetal umbilical vein). They come from the umbilical ring in the thickness of the round ligament of the liver;

Anastomoses: Superior epigastric vein, inferior epigastric vein

Forms around the umbilical ring from the junction of the superior and inferior epigastric veins and paraumbilical veins

Outflow path from the superior epigastric veins: internal thoracic vein, brachiocephalic vein, superior vena cava;

Outflow tract from the inferior epigastric veins: external iliac vein, common iliac vein, inferior vena cava

Paraumbilical veins - Portal vein

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Portal vein: functions, structure of the portal circulatory system, diseases and diagnostics

The portal vein (BB, portal vein) is one of the largest vascular trunks in the human body. Without it, the normal functioning of the digestive system and adequate detoxification of the blood is impossible. The pathology of this vessel does not go unnoticed, causing serious consequences.

The portal vein system of the liver collects blood coming from the abdominal organs. The vessel is formed by connecting the superior and inferior mesenteric and splenic veins. In some people, the inferior mesenteric vein empties into the splenic vein, and then the connection between the superior mesenteric and splenic veins forms the trunk of the MV.

Anatomical features of blood circulation in the portal vein system

The anatomy of the portal vein system (portal system) is complex. This is a kind of additional circle of venous circulation, necessary to cleanse the plasma of toxins and unnecessary metabolites, without which they would immediately fall into the lower hollow, then into the heart and then into the pulmonary circle and the arterial part of the large.

The latter phenomenon is observed in lesions of the hepatic parenchyma, for example, in patients with cirrhosis. It is the absence of an additional "filter" on the path of venous blood from the digestive system that creates the prerequisites for severe intoxication with metabolic products.

Having studied the basics of anatomy at school, many remember that an artery enters most of the organs of our body, carrying blood rich in oxygen and nutrients, and a vein comes out, carrying “waste” blood to the right half of the heart and lungs.

The portal vein system is arranged somewhat differently; its peculiarity can be considered the fact that, in addition to the artery, the liver includes a venous vessel, the blood from which again enters the veins - the hepatic veins, having passed through the parenchyma of the organ. An additional blood flow is created, on the work of which the state of the whole organism depends.

The formation of the portal system occurs due to large venous trunks that merge with each other near the liver. The mesenteric veins transport blood from the intestinal loops, the splenic vein leaves the spleen and receives blood from the veins of the stomach and pancreas. Behind the head of the pancreas there is a connection of the venous "highways", giving rise to the portal system.

Between the sheets of the pancreatoduodenal ligament, the gastric, paraumbilical, and prepyloric veins flow into the EV. In this area, the EV is located behind the hepatic artery and common bile duct, together with which it follows to the gate of the liver.

At the gates of the liver, or not reaching them one and a half centimeters, there is a division into the right and left branches of the portal vein, which enter both hepatic lobes and there they break up into smaller venous vessels. Reaching the hepatic lobule, the venules braid it from the outside, enter inside, and after the blood is neutralized upon contact with hepatocytes, it enters the central veins emerging from the center of each lobule. The central veins gather into larger ones and form the hepatic veins, which carry blood from the liver and flow into the inferior vena cava.

A change in the size of the VV is of great diagnostic value and can indicate various pathologies - cirrhosis, venous thrombosis, pathology of the spleen and pancreas, etc. The normal length of the portal vein of the liver is approximately 6-8 cm, and the diameter of the lumen is up to one and a half centimeters.

The portal vein system does not exist in isolation from other vascular beds. Nature provides for the possibility of dumping "excess" blood into other veins if there is a violation of hemodynamics in this department. It is clear that the possibilities of such a discharge are limited and cannot last indefinitely, but they allow at least partially compensating the patient's condition in case of severe diseases of the hepatic parenchyma or thrombosis of the vein itself, although sometimes they themselves cause dangerous conditions (bleeding).

The connection between the portal vein and other venous collectors of the body is carried out through anastomoses, the localization of which is well known to surgeons, who quite often encounter acute bleeding from the anastomotic zones.

Anastomoses of the portal and caval veins in a healthy body are not expressed, since they do not bear any load. In pathology, when the flow of blood into the liver is difficult, the portal vein expands, the pressure in it increases, and the blood is forced to look for other ways of outflow, which become anastomoses.

These anastomoses are called portocaval, that is, the blood that was supposed to go to the vena cava goes to the vena cava through other vessels that unite both blood flow basins.

The most significant anastomoses of the portal vein include:

Connection of gastric and esophageal veins;
Anastomoses between the veins of the rectum;
Fistula of the veins of the anterior wall of the abdomen;
Anastomoses between the veins of the digestive organs with the veins of the retroperitoneal space.

In the clinic, the anastomosis between the gastric and esophageal vessels is of the greatest importance. If the movement of blood along the EV is disturbed, it is expanded, portal hypertension increases, then the blood rushes into the flowing vessels - the gastric veins. The latter have a system of collaterals with the esophagus, where the venous blood that has not gone to the liver is redirected.

Since the possibilities of dumping blood into the vena cava through the esophageal are limited, their overload with excess volume leads to varicose expansion with the likelihood of bleeding, often fatal. The longitudinally located veins of the lower and middle thirds of the esophagus do not have the ability to subside, but are at risk of injury when eating, gag reflex, reflux from the stomach. Bleeding from varicose veins of the esophagus and the initial part of the stomach is not uncommon in cirrhosis of the liver.

From the rectum, venous outflow occurs both into the BB system (upper third), and directly into the lower vena cava, bypassing the liver. With an increase in pressure in the portal system, stagnation inevitably develops in the veins of the upper part of the organ, from where it is discharged through collaterals into the middle vein of the rectum. Clinically, this is expressed in varicose veins of hemorrhoids - hemorrhoids develop.

The third junction of the two venous pools is the abdominal wall, where the veins of the umbilical region take on "excess" blood and expand towards the periphery. Figuratively, this phenomenon is called the “head of a jellyfish” because of some external resemblance to the head of the mythical Gorgon Medusa, which had writhing snakes instead of hair on its head.

Anastomoses between the veins of the retroperitoneal space and VV are not as pronounced as those described above, it is impossible to trace them by external signs, they are not prone to bleeding.

Video: lecture on the veins of the systemic circulation

Video: basic information about the portal vein from the abstract

Pathology of the portal system

Among the pathological conditions in which the BB system is involved, there are:

Thrombus formation (extra- and intrahepatic);
Portal hypertension syndrome (SPH) associated with liver pathology;
Cavernous transformation;
Purulent inflammatory process.

Portal vein thrombosis

Portal vein thrombosis (PVT) is a dangerous condition in which blood clots appear in the PV, preventing its movement towards the liver. This pathology is accompanied by an increase in pressure in the vessels - portal hypertension.

4 stages of portal vein thrombosis

According to statistics, in residents of developing regions, CPH is accompanied by thrombus formation in the ventricle in a third of cases. In more than half of patients who die of cirrhosis, thrombotic clots can be detected postmortem.

The causes of thrombosis are:

Cirrhosis of the liver;
Malignant tumors of the intestine;
Inflammation of the umbilical vein during catheterization in infants;
Inflammatory processes in the digestive organs - cholecystitis, pancreatitis, intestinal ulcers, colitis, etc.;
Injuries; surgical interventions (bypass surgery, removal of the spleen, gallbladder, liver transplant);
Blood clotting disorders, including some neoplasias (polycythemia, pancreatic cancer);
Some infections (tuberculosis of the portal lymph nodes, cytomegalovirus inflammation).

Pregnancy and long-term use of oral contraceptives are among the very rare causes of PVT, especially if the woman has crossed the age limit.

Symptoms of PVT consist of severe abdominal pain, nausea, dyspeptic disorders, and vomiting. An increase in body temperature, bleeding from hemorrhoids is possible.

Chronic progressive thrombosis, when blood circulation through the vessel is partially preserved, will be accompanied by an increase in the typical picture of SPH - fluid will accumulate in the abdomen, the spleen will increase, giving a characteristic heaviness or pain in the left hypochondrium, the veins of the esophagus will expand with a high risk of dangerous bleeding.

The main way to diagnose PVT is ultrasound, while the thrombus in the portal vein looks like a dense (hyperechoic) formation that fills both the lumen of the vein itself and its branches. If ultrasound is supplemented with dopplerometry, then there will be no blood flow in the affected area. Cavernous degeneration of vessels due to the expansion of small-caliber veins is also considered characteristic.

Small thrombi in the portal system can be detected by endoscopic ultrasound, and CT and MRI can determine the exact causes and find possible complications of thrombus formation.

Video: incomplete portal vein thrombosis on ultrasound

portal hypertension syndrome

Portal hypertension is an increase in pressure in the portal vein system, which may be accompanied by local thrombosis and severe pathology of internal organs, primarily the liver.

Normally, the pressure in the BB is not more than ten mm Hg. st, if this indicator is exceeded by 2 units, we can already talk about LNG. In such cases, porto-caval anastomoses gradually turn on, and varicose expansion of the collateral outflow tract occurs.

Cirrhosis of the liver;
Budd-Chiari syndrome (liver vein thrombosis);
Hepatitis;
Severe heart defects;
Metabolic disorders - hemochromatosis, amyloidosis with irreversible damage to the liver tissue;
Thrombosis of the vein of the spleen;
Thrombosis of the portal vein.

Clinical signs of SPH are dyspeptic disorders, a feeling of heaviness in the right hypochondrium, jaundice, weight loss, and weakness. Splenomegaly, that is, an enlargement of the spleen, which experiences venous congestion on itself, since the blood is not able to leave the splenic vein, as well as ascites (fluid in the abdomen) and varicose veins of the lower esophagus (as a result of venous blood bypass) ).

Ultrasound of the abdominal cavity with LPH will show an increase in the volume of the liver, spleen, the presence of fluid. The width of the lumen of the vessels and the nature of the movement of blood is assessed by Doppler ultrasound: the BB is increased in diameter, the lumen of the superior mesenteric and spleen veins are dilated.

Cavernous transformation

With SPH, PVT, congenital malformations of the liver veins (narrowing, partial or complete absence), a so-called cavernous can often be detected in the region of the portal vein trunk. This zone of cavernous transformation is represented by many intertwining vessels of small diameter, which partially compensate for the lack of blood circulation in the portal system. Cavernous transformation has an outward resemblance to a tumor-like process, which is why it is called a cavernoma.

The detection of cavernoma in children may be an indirect sign of congenital anomalies of the vascular system of the liver; in adults, it often indicates the development of portal hypertension against the background of cirrhosis and hepatitis.

Inflammatory processes

an example of the development of pylephlebitis due to a diverticulum of the sigmoid colon

Among the rare lesions of the portal vein include acute purulent inflammation - pylephlebitis, which has a distinct tendency to "develop" into thrombosis. The main culprit of pylephlebitis is acute appendicitis, and the consequence of the disease is abscessing in the liver tissue and the death of the patient.

The symptoms of inflammation in the VV are extremely nonspecific, so it is very difficult to suspect this process. More recently, the diagnosis was made mainly posthumously, but the possibility of using MRI has somewhat changed the quality of diagnosis for the better, and pylephlebitis can be detected during life.

Signs of pylephlebitis include fever, chills, severe intoxication, and abdominal pain. Purulent inflammation of the BB can cause an increase in pressure in the vessel and, accordingly, bleeding from the esophageal and gastric veins. When an infection enters the liver parenchyma and purulent cavities develop in it, jaundice will appear.

Laboratory examinations for pylephlebitis will show the presence of an acute inflammatory process (ESR will increase, leukocytes will increase), but ultrasound, dopplerometry, CT and MRI help to reliably judge the presence of pylephlebitis.

Diagnostics of the pathology of the portal vein

The main method for diagnosing changes in the portal vein is ultrasound, the advantages of which can be considered safety, low cost and high availability for a wide range of people. The study is painless, does not take much time, can be used for children, pregnant women and the elderly.

Doppler ultrasound is considered a modern addition to routine ultrasound, which allows you to assess the speed and direction of blood flow. BB on ultrasound is visible at the gates of the liver, where it bifurcates into horizontally located right and left branches. So the blood during dopplerometry is directed towards the liver. The norm on ultrasound is the diameter of the vessel within 13 mm.

With thrombus formation in a vein, hyperechoic content will be detected, heterogeneous, filling part of the diameter of the vessel or completely the entire lumen, leading to a total cessation of blood flow. Color Doppler imaging will show the absence of blood flow with complete obstruction by a thrombus or its parietal character near the blood clot.

With SPH on ultrasound, the doctor will detect an expansion of the lumen of the vessels, an increase in the volume of the liver, the accumulation of fluid in the abdominal cavity, and a decrease in blood flow velocity on color Doppler. An indirect sign of SPH will be the presence of cavernous changes that can be confirmed by dopplerometry.

In addition to ultrasound, contrast-enhanced CT is used to diagnose portal vein pathology. The advantages of MRI can be considered the ability to determine the causes of changes in the portal system, examination of the liver parenchyma, lymph nodes and other nearby formations. The disadvantage is the high cost and low availability, especially in small towns.

Angiography is one of the most accurate methods for diagnosing portal thrombosis. In case of portal hypertension, the examination necessarily includes FGDS to assess the state of porto-caval anastomoses in the esophagus, esophagoscopy, and possibly X-ray contrast examination of the esophagus and stomach.

The data of instrumental examination methods are supplemented by blood tests, in which deviations from the norm are detected (leukocytosis, an increase in liver enzymes, bilirubin, etc.), and patient complaints, after which the doctor can make an accurate diagnosis of damage to the portal system.

Pancreas (superior mesenteric vein)

The superior mesenteric vein is in contact with the gland for 1.5-2 cm. It is located in the incisura pancreatis and is almost completely surrounded by the tissue of the gland. Only on the left this groove is open, and here next to the vein is the superior mesenteric artery surrounded by periarterial tissue.

The posterior wall of the stomach is adjacent to the anterior surface of the body of the gland. Often, the body of the gland partially or completely protrudes above the lesser curvature of the stomach and comes into contact with the hepatogastric ligament, as well as the caudate lobe of the liver. At the upper edge of the body of the gland is the gastro-pancreatic ligament, between the leaves of which the left gastric artery passes, accompanied by the vein of the same name. To the right of this ligament, along the upper edge of the gland or somewhat posterior to it, lies the common hepatic artery. Along the lower edge of the gland (in rare cases on its front surface) is the root of the mesentery of the transverse colon.

The posterior surface of the body of the pancreas is in direct contact with the splenic vessels and the inferior mesenteric vein. The splenic artery is located behind the upper edge of the pancreas. Sometimes bends or loops form along its course. In such cases, in some areas, the artery may protrude above the upper edge of the gland or go downward, approaching the splenic vein or crossing it.

The splenic vein is located below the artery of the same name and, on the way to the portal vein, receives 15-20 short venous trunks coming from the gland. At the lower edge of the pancreas runs the inferior mesenteric vein, heading to the superior mesenteric, splenic or portal vein.

"Atlas of operations on the abdominal wall and abdominal organs" V.N. Voilenko, A.I. Medelyan, V.M. Omelchenko

The head of the pancreas is placed in the C-curve of the duodenum. At the top, it is adjacent to the lower and posterior surfaces of the upper part of the duodenum. In some cases, the glandular mass also partially covers the anterior or posterior surface of the descending part of the duodenum. The uncinate process is in contact with the lower part of the duodenum, its medial part is located behind the superior mesenteric and portal veins, ...

The inferior vena cava is covered by a gland for 5-8 cm. Between the head of the gland and the inferior vena cava, as well as the renal vessels, there is a thin layer of retroperitoneal tissue. There are no tight adhesions here, and therefore, if necessary, for example, during pancreaticoduodenal resection, as well as when mobilizing the duodenum, the head of the gland, together with the descending part of the duodenum, can be completely free ...

In the retroperitoneal tissue posterior to the pancreas is the aorta, as well as branches extending from it: the celiac trunk and the superior mesenteric artery. The distance between these vessels at the place of their departure from the aorta in most cases does not exceed 0.5-3 cm, sometimes they depart in one common trunk. The celiac trunk is surrounded by the celiac nerve plexus, from which along the arterial ...

1 - ductus choledochus; 2-v. portae; 3-a. hepatica communis; 4 - ductus pancreaticus; 5 - pancreas; 6 - flexura duodenojejunalis; 7 - papilla duodeni major; 8 - ductus pancreaticus accessorius; 9 - papilla duodeni minor; 10 - duodenum. Blood supply. The pancreatic arteries are branches of the hepatic, splenic, and superior mesenteric arteries. Blood supply…

Blood supply to the head of the pancreas (front view). 1 - aorta abdominalis; 2 - truncus coeliacus; 3-a. gastric sinistra; 4-a. lienalis; 5-a. et v. colica media; 6-a. et v. mesenterica superior; 7-a. et v. pancreaticoduodenalis inferior anterior; 8 - caput pancreatis; 9 - duodenum; 10-a….

The information on the site is for informational purposes only and is not a guide for self-treatment.

Superior mesenteric vein

portal vein system

From unpaired organs of the abdominal cavity, except for the liver, blood is first collected in the portal vein system, through which it goes to the liver, and then through the hepatic veins to the inferior vena cava.

The portal vein (Fig. 96) is a large visceral vein (length 5-6 cm, diameter 11-18 mm), formed by connecting the inferior and superior mesenteric and splenic veins. The veins of the stomach, small and large intestine, spleen, pancreas and gallbladder flow into the portal vein. Then the portal vein goes to the gate of the liver and enters its parenchyma. In the liver, the portal vein is divided into two branches: the right and the left, each of which, in turn, is divided into segmental and smaller ones. Inside the lobules of the liver, they branch into wide capillaries (sinusoids) and flow into the central veins, which pass into the sublobular veins. The latter, connecting, form three or four hepatic veins. Thus, blood from the organs of the digestive tract passes through the liver, and then only enters the system of the inferior vena cava.

The superior mesenteric vein runs into the roots of the mesentery of the small intestine. Its tributaries are the veins of the jejunum and ileum, pancreatic, pancreatoduodenal, iliac-colic, right gastroepiploic, right and middle colic veins and the vein of the appendix. The superior mesenteric vein receives blood from the above organs.

Rice. 96. Portal vein system:

1 - superior mesenteric vein; 2 - stomach; 3 - left gastroepiploic vein; 4 - left gastric vein; 5- spleen; 6- tail of the pancreas; 7- splenic vein; 8- inferior mesenteric vein; 9 - descending colon; 10 - rectum; 11 - lower rectal vein; 12 - middle rectal vein; 13 - superior rectal vein; 14 - ileum; 15 - ascending colon; 16 - head of the pancreas; 17, 23 - right gastroepiploic vein; 18 - portal vein; 19 - gallbladder vein; 20 - gallbladder; 21 - duodenum; 22 - liver; 24- pyloric vein

The splenic vein collects blood from the spleen, stomach, pancreas, duodenum, and greater omentum. The tributaries of the splenic vein are the short gastric veins, the pancreatic vein, and the left gastroepiploic vein.

The inferior mesenteric vein is formed by the fusion of the superior rectal vein, left colic, and sigmoid veins; it collects blood from the walls of the upper rectum, sigmoid colon, and descending colon.

Superior mesenteric artery (a. mesenterica superior).

A. mesenterica superior, the superior mesenteric artery, departs from the anterior surface of the aorta immediately below the vermiform trunk, goes down and forward, into the gap between the lower edge of the pancreas in front and the horizontal part of the duodenum behind, enters the mesentery of the small intestine and descends to the right iliac fossa .

Branches, a. mesentericae superioris:

a) a. pancreatieoduodeiialis inferior goes to the right along the concave side of the duodeni towards aa. pancreaticoduodenales superiores;

b) aa. intestinales -- 10-16 branches that extend from a. mesenterica superior to the left side to the jejunum (aa. jejundles) and ileum (aa. ilei) intestine; along the way, they divide dichotomously and adjacent branches are connected to each other, which is why it turns out along aa. jejunales three rows of arcs, and along aa. ilei - two rows. Arcs are a functional device that provides blood flow to the intestines with any movements and positions of its loops. Many thin branches extend from the arcs, which encircle the intestinal tube in an annular fashion;

c) a. ileocolica departs from a.r mesenterica superior to the right, supplying with branches the lower part of the intestinum ileum and the caecum and sending to the appendix a. appendicularis, passing behind the final segment of the ileum;

d) a. colica dextra goes behind the peritoneum to the colon ascendens and near it is divided into two branches: ascending (going up towards a. colica media) and descending (descending towards a. ileocolica); branches depart from the resulting arcs to the adjacent sections of the large intestine;

e) a. colica media passes between the sheets of mesocolon transversum and, having reached the transverse colon, is divided into the right and left branches, which diverge in the respective directions and anastomose: the right branch -- with a. colica dextra, left - with a. colic sinistra

Inferior mesenteric artery (a. mesenterica inferior).

A. mesenterica inferior, the inferior mesenteric artery, leaves at the level of the lower edge of the III lumbar vertebra (one vertebra above the aortic division) and goes down and slightly to the left, located behind the peritoneum on the anterior surface of the left psoas muscle.

Branches of the inferior mesenteric artery:

a) a. colica sinistra is divided into two branches: ascending, which goes towards flexura coli sinistra towards a. colica media (from a. mesenterica superior), and descending, which connects to aa. sigmoideae;

b) aa. sigmoideae, usually two to colon sigmoideum, ascending branches anastomose with branches of a. colica sinistra, descending - with

c) a. rectalis superior. The latter is a continuation of a. mesenterica inferior, descends at the root of the mesentery colon sigmoideum into the small pelvis, crossing in front of a. iliaca communis sinistra, and splits into lateral branches towards the rectum, joining as with aa. sigmoideae, as well as with a. rectalis media (from a. iliaca interna).

Thanks to the interconnection of branches aa. colicae dextra, media et sinistra and aa. rectales from a. iliaca interna, the large intestine along its entire length is accompanied by a continuous chain of anastomoses connected to each other.

Paired visceral branches: renal artery (a. renalis), middle adrenal artery (a. suprarenalis media).

Paired visceral branches depart in the order of the location of the organs, due to their laying.

1. A. suprarenalis media, the middle adrenal artery, starts from the aorta near the beginning of a. mesenterica superior and goes to gl. suprarenalis.

2. A. renalis, the renal artery, departs from the aorta at the level of the II lumbar vertebra almost at a right angle and goes in the transverse direction to the gate of the corresponding kidney. In caliber, the renal artery is almost equal to the superior mesenteric, which is explained by the urinary function of the kidney, which requires a large blood flow. The renal artery sometimes departs from the aorta in two or three trunks and often enters the kidney with multiple trunks not only in the region of the gate, but also along the entire medial edge, which is important to consider when pre-ligating the arteries during the kidney removal operation. At the hilum of the kidney a. renalis is usually divided into three branches, which in turn break up into numerous branches in the renal sinus (see "Kidney").

The right renal artery lies behind v. cava inferior, heads of the pancreas and pars descendens duodeni, left behind pancreas. V. renalis is located in front and slightly below the artery. From a. renalis extend upward to the lower part of the adrenal gland a. suprarenalis inferior, as well as a branch to the ureter.

3. A. testucularis (in women a. ovarica) is a thin long stem that starts from the aorta immediately below the beginning of a. renalis, sometimes from this latter. Such a high discharge of the artery that feeds the testicle is due to its laying in the lumbar region, where a. testicularis occurs at the shortest distance from the aorta. Later, when the testicle descends into the scrotum, along with it, a. testicularis, which by the time of birth descends along the anterior surface of m. psoas major, gives a branch to the ureter, approaches the inner ring of the inguinal canal and, together with the ductus deferens, reaches the testicle, which is why it is called a. testicularis. A woman has a corresponding artery, a. ovarica, does not go to the inguinal canal, but goes to the small pelvis and further as part of lig. suspensorium ovarii to the ovary.

Parietal branches of the abdominal aorta: lower phrenic artery (a. phrenica inferior), lumbar arteries (Aa. lumbales), median sacral artery (a. sacralis mediana).

1. A. phrenica inferior, inferior phrenic artery, supplies blood to the pars lumbalis of the diaphragm. She gives a small twig, a. suprarenalis superior, to the adrenal gland.

2. Ah. lumbales, lumbar arteries, usually four on each side (the fifth sometimes departs from a. sacralis mediana), correspond to the segmental intercostal arteries of the thoracic region. They supply blood to the corresponding vertebrae, spinal cord, muscles and skin of the lumbar region and abdomen.

3. A. sacralis mediana, median sacral artery, unpaired, represents the continuation of the aorta lagging behind in development (caudal aorta).

The superior and inferior mesenteric arteries are responsible for the blood supply to certain organs and depart from the main aorta. They have many branches that extend to different parts of the intestines, stomach and kidneys. Disturbances in the mesenteric arteries entail a lack of nutrition, which leads to the development of diseases.

The structure of the superior mesenteric vessel

A large vessel forms in the anterior part of the aorta. Place of origin of the superior mesenteric artery 1-3 cm under the celiac trunk. It goes behind the pancreas, from where it goes down to the right. Next to it - on the right side - is the mesenteric vein. Together they go along the first wall of the duodenum horizontally and across, moving away to the right side from the skinny fracture.

Further, the circulatory element reaches the root of the mesentery and passes between the layers of the small intestine, creating an arc convex to the left. Thus, it passes to the right iliac fossa and is divided into several branches. Arteries depart from it:

Inferior pancreatoduodenal. It starts at the starting point of the blood vessel and is divided into anterior and posterior. They go down and pass along the anterior wall of the pancreas, bypassing the head in the area of junction with the intestines. Small branches extend to the gland and duodenum, and then diverge from the upper pancreatoduodenal blood elements.
jejunum. In total, there are from 7 to 8 in the human body, and the blood elements depart one by one from the convex zone. They are sent through the mesentery to the jejunum. Each branch of the mesenteric artery is further divided into 2 trunks and intertwined with the vessels of the intestinal branches.
ileo-intestinal. Depart to the loops of the ileum. There are 5-6 of them in the body. Like the previous ones, the iliac blood elements are divided into 2 trunks and form arcs of the 2nd order (small size). Even smaller arteries depart from them again and go to the walls of the loops of the small intestine. They also form small branches that are responsible for feeding the lymph nodes of the mesenteric region.
ileocolic-intestinal. It starts in the zone of the cranial part of the mesenteric vessel and goes to the right side to the ileum along the posterior wall of the abdominal cavity. It is divided into additional branches that go to the caecum and colon, as well as to the ileum region of the intestine.
Right colon—intestinal. Forms a process on the right side of the main mesenteric artery, starts from the upper third. Goes to the edge of the colon.
Middle colon—intestinal. It originates in the upper part of the mesenteric artery, passes through the mesentery of the colonic area and is divided into 2 branches. The right one goes to the ascending vessel, and the left one forms a branch through the mesenteric edge of the intestine.

Several large branches are separated from the ileocolic vessel. The first is the ascending artery, which departs from the right to the colon and ascends to the blood branch emanating from this zone. In the same place, it forms an arc, from which the colonic branches are formed. They are responsible for supplying blood to the upper part of the cecum and the ascending part of the colon loop.

From the same blood branch, the caecal arteries depart back and forth, heading to the caecum. They form a vascular network that extends to the ileocecal angle, where they connect with the terminal arteries of the ileo-intestinal arch.

Another feeding element is the appendix, which is responsible for the blood supply to this area. These arteries pass through the mesentery of the appendix.

The superior mesenteric artery is not a separate blood vessel, but a whole system of descending branches with a slope to the right.

The structure of the inferior mesenteric branch

The lower part of the mesenteric vessel is located on the edge of the third vertebra, just above the aortic division. It goes down to the left and is located behind the abdominal wall on the surface of the psoas muscle. There are several branches in the anatomy of the inferior mesenteric artery:

colica constanta - ascending and descending pair;
sigmoideae - with several branches forming an arc;
rectalis superior - descends into the mesentery of the sigmoid colon and goes into the small pelvis, forming several lateral branches to the rectum.

The formation of vessels from these arteries form anastomoses along the entire length of the rectum.

Main functions

The superior and inferior mesenteric arteries are part of the circulatory system. Since these are rather large vessels, they are considered the main sources of nutrition for the abdominal organs, including all branches. The superior artery supplies blood to more than half of the intestines, as well as the entire pancreas.

Violation of the functions of the superior mesenteric vessel leads to a general deterioration in blood circulation. Because of this, the internal organs located in the peritoneum suffer, most often the large intestine.

Embolism of the circulatory mesentery

A common disease of the superior artery begins with acute pain in the abdomen, located in the umbilical zone. In some patients, symptoms begin in the lower right abdomen. The intensity of pain depends on many factors and can vary greatly.

On palpation, the doctor detects a too soft abdomen, as well as a slight tension in the muscles of the anterior wall. Pain during the examination is practically absent. In some cases, there is increased intestinal peristalsis.

Patients with embolism often suffer from vomiting, nausea, and diarrhea. At the same time, no functional disorders were detected during the examination. In the early stages, occult blood is detected in stool tests, but there are no visible impurities.

The presence of an embolism can be suspected by a combination of symptoms from the gastrointestinal tract, as well as the cardiovascular system. It is not uncommon for an embolism to develop in people who have recently had a heart attack or have rheumatic valve disease.

Features of treatment

Therapy of embolism is possible by conservative methods, but in the acute course of the disease, the best results are observed only after surgical intervention. The laparotomy method is used, in which the upper artery is opened and an embolectomy is performed.

As a result of the operation, blood flow is restored, and the condition of the small intestine is also determined. Sometimes during the procedure, necrosis of part of the tissues of this part of the intestine is detected. Then, during the operation, doctors remove damaged cells. After the operation, an additional autopsy is prescribed 24 hours later to ensure the viability of the intestine.