hi let's talk about the abdominal aorta and its branches so here we're looking at the abdominal
aorta and very many of its branches we can see the lateral borders of the abdominal aorta here
transitioning down at about L4 into the common iliac arteries
the abdominal aorta is a retroperitoneal structure that's found left lateral to the
inferior vena cava which we can see there there are several anteriorly facing important trunks
for viscera there's the celiac trunk there is the superior mesenteric artery
and down here is the inferior mesenteric artery we can also see some of the lateral branches
of the abdominal aorta so for instance here is the inferior phrenic artery you can see it
giving off the superior suprarenal arteries there is the middle suprarenal artery
coming more distally off the abdominal aorta we can see there's the renal artery
and the renal artery gives rise to the inferior supra renal arteries
here's an accessory renal artery and then we have gonadal arteries there's one going out of
artery and then there's the other gonadal artery and oftentimes folks will be more specific with
the gonadal artery for instance if it supplies a testis with blood they may call it the testicular
artery if it supplies an ovary with blood it may be called the ovarian artery or you may continue
to call it the gonadal artery let's take a look at some of the vessels supplying the duodenum
and the head of the pancreas with blood so we can start here that's the celiac trunk
and coming off of the celiac trunk along this way we have the common hepatic artery and that common
hepatic artery as you may recall has two terminal branches there's the hepatic artery proper
and then the gastro-duodenal artery it's that gastro-duodenal artery that's going to be
important for us here and we can see coming off of that gastroduodenal artery right here is a branch
and it's quite a mouthful it's called the anterior superior pancreaticoduodenal artery there's also
a posterior superior pancreaticoduodenal artery that we'll see on the next slide
and before we go there i'd like to point out here is the superior mesenteric artery or the sma
we can see it running just posterior to what would be the the neck of the pancreas there the the smv
is tucked away so we can't see it there but coming off of the sma is a branch called the inferior
pancreatico duodenal artery so here's the inferior and it is going to give rise to an anterior branch
and a posterior branch and we can see a little bit of that posterior branch there the anterior
branch is going to anastomose with the anterior superior pancreaticoduodenal artery that posterior
branch is also going to anastomose with the posterior superior pancreaticoduodenal artery
and let's take a look at that now so what you're looking at is the posterior aspect of the duodenum
and the head of the pancreas we can see along here that's the abdominal aorta and let me just
point out to you here's the inferior vena cava and we can see there's the left renal artery
heading out that way so that that's inferior vena cava here's the left renal vein sorry i
think i said artery my apologies there um there is the superior mesenteric artery so that's the
sma and what you're seeing here is kind of a rendition of what would be called the the Kocher
maneuver
the Kocher maneuver is when the peritoneum is incised and the duodenum and head of the pancreas
are reflected towards the midline now this is going to
give a surgeon access to the retroperitoneum access to the ivc and aorta and access to
elements of the duodenum and pancreas as well what this Kocher maneuver has allowed us to do
is to visualize all of those anastomoses on the posterior aspect of the head of the pancreas
and duodenum so here we can see that inferior pancreaticoduodenal artery so there's the inferior
pancreaticoduodenal artery inferior pda and then that would be the anterior branch
which is now occluded by the head of the pancreas and here's the posterior branch which we can see
coming up and lovely little branches heading off of it coming over here here is that
gastro duodenal artery it's a little oops a little torturous
um and then there's the anterior superior pancreaticoduodenal artery so that's
the ant. sup. PDA and we know that that's
heading over there to the anterior branch of the inferior pancreaticoduodenal artery
and here is that posterior this lovely posterior superior pancreaticoduodenal artery and we can
see that there is an open anastomosis there with the posterior branch of the inferior
pancreatico duodenal artery so this is just this is perfect um
the pancreas is more than just the uh the head and the neck however and the remainder of the
blood flow to the pancreas is going to come from another branch of the celiac trunk which i'm just
circling there called the splenic artery so let's highlight the splenic artery is a massive
torturous artery heading out to supply the spleen the stomach and of course the pancreas with blood
let's take a look at at some of the branches supplying the pancreas here so
one of the first major branches here is called the dorsal pancreatic artery
and that dorsal pancreatic artery as it continues is going to become the inferior
pancreatic artery that inferior pancreatic artery
may run the length of the body of the pancreas and head out toward the tail
so there is the dorsal pancreatic artery the next branch is the greater pancreatic artery
the greater pancreatic artery here you see is dividing into two branches and it may
and it does hear anastomos with the inferior pancreatic artery and then finally there's also
an artery to the tail of the pancreas and this is coming down and even anastomosing with that
inferior pancreatic artery and that inferior pancreatic artery can sometimes anastomose with
what's going on with the head of the the pancreas and duodenum and the body can also be supplied
by we can see here's the sma there uh jejunal arteries that they can be in the vicinity there
so we've discussed the uh the blood supply of the pancreas and the duodenum and we can we can
see how there are opportunities for anastomoses between the uh the branches of the celiac trunk
which supplies the foregut and the superior mesenteric artery which supplies the mid gut
and as the transition from four to mid gut occurs at the major duodenal papilla we can understand
why branches of both the celiac and sma
are going to be supplying these structures thank you very much for your time