LO1 - Stomach

1. Describe the blood supply of the foregut, specifically abdominal viscera.

The celiac trunk is the main supply to the abdominal viscera derived from the foregut. The trunk branches from the abdominal aorta at approximately the level of T12, or just inferior to the aortic hiatus of the diaphragm. The trunk is very short and immediately branches into: L. gastric a., common hepatic a., and splenic a.

The L. gastric a. supplies small portions of the distal esophagus and liver and the lesser curvature of the stomach, where it anastomoses with the R. gastric a.

The common hepatic a. divides into the hepatic artery proper and gastroduodenal a. at approximately the level of the pylorus of the stomach (pyloroduodenal junction).

The hepatic artery proper (HAP) runs in the hepatoduodenal ligament and has three main branches. The R. gastric a. supplies the lesser curvature of the stomach and anastomoses with the L. gastric a. The other two branches are the R. & L. brs of HAP. the supply the liver parenchyma.

The gastroduodenal a. descends posterior to the duodenum. It has three main branches: anterior & posterior superior pancreaticoduodenal aa. (supplies the superoanterior and superoposterior portions of the duodenum and head of pancreas) & R. gastro-omental (-epiploic) a. (supplies greater curvature of stomach; anastomoses with L. gastro-omental a.).

The large and tortuous splenic a. runs posterior to the superior portion of the pancreas. There are multiple branches that supply the pancreas, and these will be discussed in another session. It also has branches supply the stomach and spleen. These include short gastric aa. (supply the fundus of the stomach), L. gastro-omental (-epiploic) a. (supply the greater curvature of the stomach; anastomose with the R. gastro-omental a.), and splenic brs. (supply the spleen).

Anastomoses of curvatures of the stomach:

    • Greater curvature of stomach:
      • R. gastro-omental (-epiploic) a. [branch of gastroduodenal a.]
      • L. gastro-omental (-epiploic) a. [branch of splenic a.]
    • Lesser curvature of stomach:
      • R. gastric a. [branch of hepatic artery proper]
      • L. gastric a. [direct branch of celiac trunk]