Large Blood Vessels of the Gut

Question 1

Coeliac Trunk - Origin and length

Answer 1

Ventral branch of the abdominal aorta, the coeliac trunk is the artery of the foregut.
It is about 1.25 cm long and immediately gives off its 3 terminal branches (left gastric, common hepatic and splenic artery.
It arises from the ventral part of anterior abdominal aorta just below the aortic opening at the level of the disc between T12 and L1.

Question 2

Coeliac Trunk - Relations

Answer 2

It is surrounded by the coeliac plexus
Ant - Lesser sac and lesser omentum
Right - Right crus of diaphragm, right coeliac ganglion and caudate process of lover.
Left - Left crus of diaphragm, left coeliac ganglion and cardiac end of stomach
Inf - Body of pancreas and splenic vein

Question 3

Name the Branches of the coeliac trunk (Along with its branches)

Answer 3

Left gastric artery -
:gives off 2-3 oesophageal branches
:numerous gastric branches

Common hepatic artery-
:Gastroduodenal artery (after which common hepatic is called proper hepatic) which furthur gives superior pancreaticoduodenal artery and right gastroepiploic artery.
:Right gastric artery
:Cystic artery

Splenic Artery -
: Numerous Pancreatic Branches ( Special mentions - Arteria Pancreatica magna , Arteria caudae pancreatis )
: Short Gastric arteries
: Left gastroepiploic artery

Question 4

Left Gastric Artery

Answer 4

Smallest branch of the coeliac trunk.

Course- runs upwards to the left behind the lesser sac to reach the cardiac end of the stomach where it turns forwards and enters the lesser omentum to run downwards along the lesser curvature of stomach. Ends by anastomosing with right gastric artery.

Branches -
:2-3 Oesophageal branches that are given out at the cardiac end of the stomach
:Numerous Gastric branches along the lesser curvature.

Question 5

Common hepatic artery - Course and name its branches

Answer 5

Runs downwards, forwards and to the right, behind the lesser sac to reach the upper border of the first part of the duodenum where it enters the lesser omentum. Here it gives off the gastroduodenal branch and then continues upwards as the proper hepatic artery along the free margin of the lesser omentum, in front of the portal vein and left of the bile duct where it reaches porta hepatis. Upon reaching porta hepatis, it branches into left and right hepatic artery.

Branches -
:Gastroduodenal artery which furthur gives superior pancreaticoduodenal artery and right gastroepiploic artery.
:Right gastric artery
:Cystic artery

Question 6

Branches of hepatic artery

Answer 6

1. Gastroduodenal Branch - large branch arising at the upper border of the first part of the duodenum. It runs downwards behind the first part of the duodenum into the right gastroepiploic artery and the superior pancreaticoduodenal artery.
   The superior pancreaticoduodenal artery (usually having an anterior and posterior branch) runs downwards in the pancreaticoduodenal groove and ends by anastomosing with the inferior pancreaticoduodenal artery.
   The right gastroepiploic artery enters the greater omentum following the greater curvature and anastomoses with the left gastroepiploic artery. It supplies the omentum and the greater curvature of the stomach.
2. Right gastric artery - small branch arising from the proper hepatic artery close to the gastroduodenal branch. It takes a turn and runs towards the left along the lesser curvature and ends by anastomosing with the left gastric artery.
3. Cystic artery - Branch of right hepatic artery but can show variation from coming directly from common hepatic artery. It passes behind the common hepatic and cystic ducts to reach the upper surface of the neck of the gall bladder where it divides into superficial and deep branches for the inferior and superior surfaces respectively.

Question 7

Splenic artery - Course and name the branches

Answer 7

The splenic artery is the largest branch of the coeliac trunk and is tortuous . Runs horizontally to the left along the upper border of the pancreas behind the lesser sac. It crosses the left suprarenal gland and the upper part of the left kidney to enter the lienorenal ligament through which it enters the hilum of the spleen where it terminates by dividing into 5-7 splenic segmental branches.

Branches -
: Numerous Pancreatic Branches ( Special mentions - Arteria Pancreatica magna , Arteria caudae pancreatis )
: Short Gastric arteries
: Left gastroepiploic artery

Question 8

Splenic artery - Branches

Answer 8

1. Numerous Pancreatic branches - Supply the tail and body of the pancreas. One of the branches to the body is large and is called arteria pancreatica magna and another large branch of the tail is known as arteria caudae pancreatis. These large arteries anastomose with the left branch of the dorsal artery
2. 5-7 short gastric arteries - arise from the terminal part of the splenic artery runs in the gastrosplenic ligament and supplies the fundus of the stomach
3. Left gastroepiploic artery - Arise from the terminal part of the splenic artery runs downwards in the greater omentum following the greater curvature of the stomach and ends by anastomosing with the right gastroepiploic artery. Supplies the stomach and greater omentum.

Question 9

Superior Mesenteric artery - Origin, course and termination

Answer 9

Artery of the midgut

Course - Ventral branch of the aorta that arises at level of L1 behind the body of the pancreas 1cm below the coeliac trunk. It runs downwards and to the right forming a curve with its convexity towards the left.
At its origin it, it first lies behind body of pancreas and then in front of the uncinate process to then cross the third part of the duodenum. Here it enters the root of mesentery and runs between its two layers and terminates in the right iliac fossa by anastomosing with a branch of the ileocolic artery

Question 10

Superior Mesenteric Artery - Relations

Answer 10

Above the root of mesentery -
Ant- Body of pancreas and splenic vein
Post - Abdominal aorta, left renal vein, uncinate process and third part of duodenum

Within root of mesentery
It crosses the IVC and right psoas
Along its course, superior mesenteric vein is on its right and the artery is surrounded by the superior mesenteric plexus

Question 11

Name the branches of Superior Mesenteric Artery

Answer 11

5 sets of branches 
Right side -
1.Inferior Pancreaticoduodenal 
2.Right Colic 
3.Middle Colic
4.Ileocolic 
Left side 
5. 12-15 jejunal and ileal branches

Question 12

Inferior Pancreaticoduodenal artery

Answer 12

A right branch of the superior mesenteric artery that arises at the upper border of the 3rd part of the duodenum and divide into anterior and posterior branches which run in the pancreaticoduodenal groove
Supplies the head of pancreas and the duodenum and terminates by anastomosing with the superior pancreaticoduodenal artery

Question 13

Middle Colic artery

Answer 13

A right side branch of the Superior Mesenteric Artery it arises just below the pancreas runs downwards and forwards in the transverse mesocolon
It divides into two branches the right branch which anastomoses with the ascending branch of the right colic artery, and the left branch which anastomoses with the ascending branch of the left colic artery.
Further branches arise from these to form arcades that supply mesocolon

Question 14

Right Colic Artery

Answer 14

A right sided branch of the Superior Mesenteric Artery which arises from the middle of the Superior mesenteric artery’s concavity.
It passes to the right behind the peritoneum and at the upper part of the ascending colon divides into an ascending branch which anastomoses with the right branch of the middle colic artery and a descending branch which anastomoses with the ascending colic artery of the ileocolic artery.
Supplied the upper 2/3rd of the ascending colon and the right colic flexure