The Coeliac Trunk

Question 1

The coeliac trunk?

Answer 1

• The coeliac trunk is a major artery of the abdomen.
• It arises from the abdominal aorta, and supplies many of the gastrointestinal viscera.

Question 2

Anatomical Position?

Answer 2

• The coeliac trunk is the second branch of the abdominal aorta (the first branches are the paired inferior phrenic arteries).
• It arises from the anterior aspect of the aorta, at the aortic hiatus of the diaphragm (T12 level).

Question 3

Major Branches?

Answer 3

After emerging from the aorta, the coeliac trunk extends approximately 1cm before dividing into three major branches –

• left gastric,
• splenic and
• common hepatic arteries.

Question 4

Left Gastric Artery?

Answer 4

• The left gastric artery is the smallest of the three branches.
• It ascends across the diaphragm, giving rise to oesophageal branches, before continuing anteriorly along the lesser curvature of the stomach.
• Here, it anastomoses with the right gastric artery.

Question 5

Splenic Artery?

Answer 5

• The splenic artery arises from the coeliac trunk just inferior to the left gastric artery.
• It then travels left towards the spleen, running posterior to the stomach and along the superior margin of the pancreas.
• In addition to supplying the spleen, the splenic artery also gives rise to several important vessels:
• Left gastroepiploic: supplies the greater curvature of the stomach. Anastomoses with the right gastroepiploic artery.
• Short gastrics: 5-7 small branches supplying the fundus of the stomach.
• Pancreatic branches: supply the body and tail of the pancreas.

Question 6

Common Hepatic Artery?

Answer 6

The common hepatic artery supplies the liver

It divides into its two terminal branches:

• the proper hepatic and
• gastroduodenal arteries.

Proper Hepatic:

• The proper hepatic artery ascends through the lesser omentum towards the liver. It gives rise to:
• Right gastric: supplies the pylorus and lesser curvature of the stomach.
• Right and left hepatic: divide inferior to the porta hepatis and supply their respective lobes of the liver.
• Cystic: branch of the right hepatic artery – supplies the gall bladder.

Gastroduodenal:

The gastroduodenal artery branches are:

• Right gastroepiploic: supplies the greater curvature of the stomach. Found between the layers of the greater omentum, which it also supplies.
• Superior pancreaticoduodenal: divides into an anterior and posterior branch, which supplies the head of the pancreas.

Question 7

Anastomoses?

Answer 7

Stomach:

• Receives arterial supply from all three branches of the coeliac trunk.
• via a system of anastomoses along the greater (gastroepiploic arteries) and lesser (gastric arteries) curvatures.

Pancreas:

• The pancreaticoduodenal arcade is a network of arteries that surround and supply the head of the pancrea
• two main arteries – each has an anterior and posterior branch, that anastomose (e.g. anterior to anterior) forming a ring structure:
• Superior pancreaticoduodenal– a branch of the gastroduodenal artery.
• Inferior pancreaticoduodenal – branch of superior mesenteric artery (SMA).

Question 8

Coeliac axis?

Answer 8

The coeliac axis has three main branches.

• Left gastric
• Hepatic: branches-Right Gastric, Gastroduodenal, Right Gastroepiploic, Superior Pancreaticoduodenal, Cystic (occasionally).
• Splenic: branches- Pancreatic, Short Gastric, Left Gastroepiploic

Question 9

Relations?

Answer 9

Anteriorly Lesser omentum

Right Right coeliac ganglion and caudate process of liver

Left Left coeliac ganglion and gastric cardia

Inferiorly Upper border of pancreas and renal vein