Neurovasculature of Foregut

Question 1

Describe the arterial supply of the stomach

Answer 1

The stomach is supplied by branches of coeliac trunk:
Left Gastric
Right Gastric
Left gastro-omental/ gastroepiploic
Right gastro-omental / gastroepiploic
Short gastric: Branches of splenic artery

Question 2

Describe the left and right gastric branches

Answer 2

Left Gastric
Branch of coeliac trunk
Runs along lesser curvature in lesser omentum
Also supplies lower oesophagus
Right Gastric
Branch of hepatic artery proper
Runs along lesser curvature in lesser omentum

Question 3

describe the left and right gastro-omental branches

Answer 3

Left gastro-omental/ gastroepiploic:
Branch of splenic artery
Runs along Greater curvature in greater omentum
Right gastro-omental / gastroepiploic:
Branch of gastroduodenal artery
Runs along greater curvature in greater omentum

Question 4

Label this

Answer 4

Question 5

Label this

Answer 5

Question 6

Describe the lympatics of the stomach

Answer 6

• Follow blood vessels
• All lymph eventually passes into coeliac nodes
• Important for cancer spread: gastrectomy

Question 7

Describe lymphatics of the duodenum

Answer 7

• Follows arteries superiorly from superior pancreaticoduodenal to gastroduodenal to coeliac nodes
• Follows arteries inferiorly from inferior pancreaticoduodenal to superior mesenteric nodes

Question 8

Describe Parasympathetic Innervation of Foregut

Answer 8

Parasympathetic: “Rest and Digest”. Controlled by the Vagus Nerve (CN X). It acts as the following:
Secretomotor to gastric glands
Innervates secretory cells
Motor to smooth muscular walls of GIT (peristalsis)
Relax pyloric sphincter

Question 9

Describe sympathetic innervation of the foregut

Answer 9

Sympathetic: “Fight and Flight”: Controlled by greater splanchnic nerve (T5 – T9). This acts to:
Vasoconstrict
Inhibits peristalsis
Motor to pyloric sphincter
Pain fibers (visceral afferent) hitchhike with splanchnic nerves.
Foregut pain is referred to epigastric region due to convergent nerve roots