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Arteries of stomach, liver and spleen

Arteries which supply the stomach, liver and spleen.

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Transcript

Hi everyone! This is Megan from Kenhub, and welcome to another anatomy tutorial. In today's tutorial, we're going to be looking at the arteries of the stomach, the liver and the spleen. In the following image, we can see an anterior view of the abdominal cavity. Here we can see the right lobe of the liver, the left lobe of the liver, the gallbladder, the stomach, and the spleen. Before we discuss the arterial branches that supply these organs, I would just like to remind you of a few introductory points about these organs.

As you may remember from your embryology courses, the primitive gut tube can be divided into three regions, namely, the foregut, the midgut, and the hindgut regions. The boundaries of these three regions are directly related to the areas of distribution of three anterior branches of the abdominal aorta, a part of which is seen here highlighted in green.

The first of these regions – the foregut – begins with the abdominal part of the esophagus and ends at the level of the major duodenal papilla at the midpoint of the descending part of the duodenum. Therefore, the foregut includes the abdominal esophagus, the stomach, the duodenum superior to the major papilla, the liver, the pancreas, and the gallbladder. The spleen, although it is not part of the gut tube, is directly related to the foregut and, therefore, it is described together with these organs.

All of these organs that are part of the foregut are supplied by a very important branch of the abdominal aorta which is known as the celiac trunk. The celiac trunk that is now clearly seen in this image, because we've moved away the stomach and the pancreas, is an unpaired branch that arises from the anterior surface of the abdominal aorta immediately below the aortic hiatus of the diaphragm. If we zoom into this image, we can clearly see that the celiac trunk is a very short branch of the abdominal aorta. Immediately after arising from the abdominal aorta, the celiac trunk gives off three branches namely the gastric artery, the splenic artery, and the common hepatic artery.

As you can imagine, these three arteries are very important from a clinical point of view since they supply vital organs. So, next, we are going to describe the three branches of the celiac trunk and I hope that by the end of this tutorial, you will be able to identify these branches and know their distribution.

So, let's begin with the smallest branch of the celiac trunk which is the left gastric artery. As we can see here, the artery ascends slightly until it reaches the lesser curvature of the stomach. It then descends the lesser curvature of the stomach within the lesser omentum. It gives off several small branches which supply both surfaces of the stomach. Finally, at about the midpoint of the lesser curvature, it meets and anastomosis with the right gastric artery which we are going to describe later on in this tutorial.

Here at the cardioesophageal junction, the left gastric artery gives off some branches that supply the abdominal part of the esophagus. These branches are known as the esophageal branches of the left gastric artery. These branches are more clearly visible in this image. As you can see, some of these branches continue through the esophageal hiatus at the diaphragma and anastomose with the esophageal branches from the thoracic aorta.

The second branch of the celiac trunk is this long artery that you see now highlighted in green which is the splenic artery. This is the largest branch of the celiac trunk and it takes a tortuous course to the left along the superior border of the pancreas, finally giving off numerous small branches which enter the hilum of the spleen. As indicated by the green arrow, the splenic artery, as it passes the superior border of the pancreas, gives off some small branches like this one here in order to supply the neck, the body and the tail of the pancreas. In the next image, we can see this again but the stomach has been removed.

As the terminal branches of the splenic artery approach the hilum of the spleen, they give off a couple of short branches known as the short gastric arteries. These branches pass through the gastrosplenic ligament to mainly supply the fundus of the stomach. In addition to the short gastric arteries, the splenic artery, before it enters the spleen, also gives off another important branch – this one here – which is known as the left gastroomental artery. This artery runs to the right along the greater curvature of the stomach. An important thing about this branch is that it anastomosis with the opposite corresponding artery – the right gastroomental artery. We will cover the right gastroomental artery later on in this tutorial.

So up until now, we've described two of the three branches of the celiac trunk, namely, the left gastric artery and the splenic artery. The third and final branch of the celiac trunk which is the trickiest of the three is this one that you see now highlighted in green. It is known as the common hepatic artery. As you can see, this is a medium-sized branch that runs to the right all the way to the inferior surface of the liver. As it ascends towards the porta hepatis, it bifurcates into two terminal branches – the proper hepatic artery and the gastroduodenal artery. So, let's first look at the proper hepatic artery.

The proper hepatic artery which is clearly seen here where we've removed part of the stomach and pancreas ascends towards the liver just anterior to the portal vein. This artery gives off several branches that we're going to see in the following slides. At its very first segment, the proper hepatic artery gives off this large branch, the right gastric artery. This branch descends to the pyloric antrum of the stomach and passes from right to left along the lesser curvature of the stomach supplying the stomach with many branches and anastomosing with its counterpart, the left gastric artery.

Now, let's go back to the proper hepatic artery. Before entering the liver, it bifurcates into two branches – the right branch of the proper hepatic artery and the left branch of the proper hepatic artery. These two arteries are responsible for supplying the liver with oxygenated blood. Something important to remember here is that these two arteries may demonstrate significant anatomical variation. So, a misplaced right branch may arise from the superior mesenteric artery and a misplaced left branch may arise from the left gastric artery.

Before we move on to the gastroduodenal artery, I would just like to mention here that the right branch of the proper hepatic artery gives off a thin but important branch which is known as the cystic artery. The cystic artery supplies the gallbladder. Knowing the exact anatomical features of this artery as well as its main variations is essential when you want to perform a safe cholecystectomy or a gallbladder removal.

So now that we have looked at the branches of the proper hepatic artery, let's move on to the other terminal branch of the common hepatic artery which is the gastroduodenal artery. And just as a reminder, I want to reiterate that the common hepatic artery is the third and most complicated branch of the celiac trunk which gives two terminal branches – the proper hepatic artery and the gastroduodenal artery seen here.

The gastroduodenal artery passes behind the first part of the duodenum. Reaching the lower border of the superior part of the duodenum, the gastroduodenal artery gives off two terminal branches – the right gastroomental artery and the anterior superior pancreaticoduodenal artery.

The first terminal branch of the gastroduodenal artery – the right gastroomental artery – or the right gastroepiploic artery passes to the left along the greater curvature of the stomach and anastomosis – as you can see here – with the left gastroomental artery that we described previously which is a branch of the splenic artery. The right gastroomental artery supplies both the anterior and posterior surface of the stomach. In addition, it sends branches to the greater omentum, hence, the name gastroomental – gastro for the stomach branches and omental for the greater omentum.

The other terminal branch of the gastroduodenal artery is the anterior superior pancreaticoduodenal artery. This branch arises behind the duodenum and descends towards the pancreas here and, along with the posterior superior pancreaticoduodenal artery, it supplies the duodenum and the pancreas. In the next image, we can see this artery clearer.

Before we move on to look at some surrounding structures in relation to these arteries, I would just like to quickly go over the arteries we have discussed so far. As I said at the beginning of this tutorial, the foregut that we are talking about is supplied by the celiac trunk which is an unpaired branch of the abdominal aorta. So everything here starts at the celiac trunk.

The celiac trunk gives off three branches – the left gastric artery, the splenic artery, and the common hepatic artery. The left gastric artery gives off gastric branches for the stomach and esophageal branches for the abdominal part of the esophagus. The splenic artery gives off branches for the spleen and other branches to the body and tail of the pancreas. It also gives short gastric arteries for the fundus of the stomach and the left gastroomental artery. And, finally, the common hepatic artery bifurcates into two terminal branches – the gastroduodenal artery and the proper hepatic artery.

The gastroduodenal artery gives off two terminal branches – the right gastroomental artery and the superior anterior pancreaticoduodenal artery. The proper hepatic artery gives off the left branch of the proper hepatic artery, the right gastric artery which supplies the stomach, and the right branch of the proper hepatic artery. The left and right branches of the proper hepatic artery supply the liver but before they do this, the right branches off to give the cystic artery for the gallbladder. And this is a summary of the arteries that supply the foregut organs.

And now it's time to move on and look at some other vessels that are not arteries of the foregut but are visible in this image, and it's good to describe them and know their relation with the arteries that we saw previously. So, first, let's look at these two arteries – the left and right inferior phrenic arteries. These are paired branches that arise usually above the celiac trunk as you can see here, but very often these arteries demonstrate significant anatomical variations and it may arise from the celiac trunk, from the renal arteries, the left gastric artery or even the superior mesenteric artery. The inferior phrenic arteries mainly supply the diaphragm but also give off small branches to the liver, the esophagus and the suprarenal glands.

Another large vessel that we can see from this perspective is one that you can see now highlighted in green – the inferior vena cava. The inferior vena cava is the largest vein in the human body. It collects blood from the veins serving the tissues inferior to the heart and returns this blood to the right atrium of the heart. We are not going to describe this vessel in detail since it's not directly related to the arteries of the stomach, the liver and the spleen but it's good to know that it runs along the right side of the vertebral column with the aorta lying laterally on the left.

The last vessel that we're going to see in this tutorial is one that you can see now highlighted in green – the hepatic portal vein. This vessel carries nutrient-rich blood from the gastrointestinal tract and the spleen to the liver. One very important thing you have to remember is that the hepatic portal vein is not a true vein as it conducts blood to the liver and not directly to the heart. Blood from the gastrointestinal tract containing both nutrients and toxins from food arrives to the hepatic portal vein to the liver which is responsible for filtering the blood.

Now that you just completed this video tutorial, then it’s time for you to continue your learning experience by testing and also applying your knowledge. There are three ways you can do so here at Kenhub. The first one is by clicking on our “start training” button, the second one is by browsing through our related articles library, and the third one is by checking out our atlas.

Now, good luck everyone, and I will see you next time.

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