Part 1

Okay, so this is a tutorial on the celiac artery. So I'm going to talk you through the various branches of the celiac artery in this tutorial.

 

I'm just going to get rid of the venous system and we'll just look at the arterial system. We'll focus in on the celiac artery.  we're looking now just at the arterial system and we're focusing on the abdominal section of the aorta.

The celiac trunk is the first anterior branch of the abdominal aorta, which supplies the foregut structures. It's just after the aorta perforates the diaphragm at the level of the upper border of the L1 vertebra.

 

I've just brought some other structures in for reference. You can see the aorta piercing the diaphragm and the celiac trunk just after this point. This is at the level of the upper border of lumber vertebra L1.

 

The celiac trunk has three branches. You've got the left gastric branch, which is this branch here going upwards. And then you've got the splenic branch, the splenic artery coming off going towards the spleen to the left. And you've got the common hepatic artery.  Those are the three branches that come off the celiac trunk.  the celiac artery, for some reason, on this model, it's in blue. I can't change that unfortunately, but it is meant to be red here, just try and ignore that.

 

If I zoom in a little further, you might be wondering what these two little arteries here are. These are actually the inferior phrenic arteries. Their origin is very variable.  They can arise above the celiac trunk or they can arise from a common trunk either above the origin of the celiac artery or from the celiac artery itself.  These are the inferior phrenic artery which supply the diaphragm and they have a variable origin.

 

Ignore these for this tutorial. We're just going to focus on the branches, the left gastric, the splenic and the common hepatic artery.

 

Now I'm just going to switch over to some nice diagram to illustrate the branching of these branches. Just to orientate a bit, we're looking at the abdominal aorta as it's just passed through the diaphragm and we've got the celiac trunk coming off immediately after that. And you can see it's three branches – the left gastric, the splenic and the common hepatic.

 

To the right, we've got a dissected liver.  we've got a little bit of the left lobe of the liver up here and the gallbladder is revealed because the liver has been pulled away. On the left, we've got the spleen and we've got the inferior vena cava system to the right of the aorta.

 

First, we'll talk about the left gastric artery.  we've got the celiac trunk here and the first artery coming off here is this artery called the left gastric. This artery ascends and it continues upwards here and gives off esophageal branches to the distal part of the esophagus.

 

And then you can see how the artery then sharply curves around like this. It runs along the lesser curvature of the stomach and it gives off these branches which supply the surface of the stomach.

 

The left gastric artery gives off this little branch here. And you can see these anastomoses with another branch here.

 

The word anastomose just means 'joins together'.  this artery another artery essentially, which comes off another part of the branch of the celiac artery.

 

You could probably guess the name of this artery. This is the right gastric artery and this anastomoses with the left gastric artery to form this nice little arch, which sits on the surface of the lesser curvature of the stomach and the right gastric artery comes off the common hepatic artery or the proper hepatic artery. It's fairly variable in its origin.

 

Fairly straightforward so far. The left gastric artery is the smallest branch and it ascends upwards and gives off esophageal branches, which supply the distal esophagus and then it curves around on the lesser curvature of the stomach and anastomoses with the right gastric artery, which comes off the common hepatic artery, which I'll come on to talk about.

 

I've shown you the vessels which run along the lesser curvature of the stomach, but you can also see that there's a vessel here which runs along the greater curvature of the stomach. So like the vessel, which runs along the lesser curvature, this vessel is composed of two vessels which anastomose.

 

The first vessel I'm going to talk about is the left gastroepiploic artery and this comes off the splenic artery, which is the next branch of the celiac trunk.

 

What I'm going to do is we're going to switch to another diagram now and we're going to flip the stomach up. We’re going to take the stomach and flip it over to the top and we're going to look at the splenic artery and we'll be able to see the pancreas below.

 

We’ve just flipped the stomach up and this is the posterior surface of the stomach. And just to orientate again, left gastric artery coming off and you can see its sharp curve round with this branch that runs along the lesser curvature anastomosing with the right gastric artery coming off the common hepatic or the proper hepatic.

 

And then we've got the splenic artery and it's got this long tortuous course.  You can see this vessel given off called the left gastroepiploic artery, which is what we saw in the previous diagram running along the greater curvature.  remember the stomach is flipped up so the greater curvature is up here.

 

Just like the left gastric and the right gastric artery which anastomose on the inferior curvature of the stomach, the left gastroepiploic artery anastomoses with the right gastroepiploic artery, which comes of the gastroduodenal branch, which I'll talk about soon. And hopefully, it will all come together and be clear.

 

The splenic artery is the largest branch of the celiac trunk. You can see it's got this long tortuous course and it runs along the top of the pancreas. And you can see these little branches given off to the pancreas. And these little branches supply the neck, the body and the tail of the pancreas. The head has a different supply, which I'll show you in a moment.

 

Just before the splenic artery enters the hilum of the spleen, it gives off some short vessels which are called the short gastric arteries. And this supplies the fundus of the stomach.  you can see these vessels coming off here and this area of the stomach, the fundus.

 

We've got the splenic artery with its branches supplying the neck, the body and the tail of the pancreas. And then just before it enters the hilum of the spleen, we've got the short gastric arteries, which supply the fundus of the stomach.

 

And then we've got this branch given off called the left gastroepiploic artery. And this anastomoses with the right gastroepiploic artery. It runs along the greater curvature of the stomach.

 

Part 2

So obviously as you can see here, it's got these little branches, these gastric branches which is given off to both surfaces of the stomach. And it's also got omental branches which descend to supply the greater omentum.

 

I've switched back to this diagram with its stomach in its normal orientation.  You’ve got the splenic artery here. It's got this long tortuous course and it enters the hilum of the spleen. It gives out the little short gastric arteries to the fundus of the stomach. And it also gives off the left gastroepiploic artery.  Obviously this runs behind the stomach, but I'm just drawing on to illustrate.

 

And then you've got the little pancreatic branches here given off to the neck, body and tail of the pancreas.

 

You can see the left gastroepiploic artery running across here and the gastric branches supplying both surfaces of the stomach. You've got these vessels here which descend and supply the greater omentum.  If you remember in my peritoneal tutorial, the greater omentum hangs down in front of the small intestine.

 

Something worth mention is that I've been referring to this artery as the 'gastroepiploic', but you might see it referred to as the gastro-omental artery.  It’s worth bearing that in mind.

 

Now we're coming on to the final branch of the celiac trunk. This is the common hepatic artery. You can see it here. As it comes off the celiac trunk, it turns right. It has two terminal branches.  It gives off the proper hepatic artery, which goes to the liver (which I'm showing you here) and it's got the gastroduodenal artery, which descends to supply the duodenum and the head of the pancreas.  It also gives off a branch which supplies the surface of the stomach and we've seen this branch before. It's the right gastroepiploic artery.

 

It's called the gastroduodenal artery because it gives off a branch to the stomach, the gastro- part and it gives off a branch which supplies the duodenum, so the –duodenal part.  It’s the gastroduodenal artery.

 

If you've been listening carefully to this tutorial, you'll know what this branch is here. This is the right gastric artery, which anastomoses with the left gastric artery. The original of the right gastric artery is variable. It can come off the common hepatic artery or it can come off the proper hepatic artery. But what you need to know is that it comes off and it runs along the lesser curvature of the stomach and anastomoses with the left gastric artery.

 

The common hepatic splits into the proper hepatic and the gastroduodenal artery.

 

Let's follow the proper hepatic artery to the liver.  You can see here those two clear divisions and there are no prizes for guessing what these two are.  The one on the left is the left hepatic artery and the one on the right is the right hepatic artery. This division occurs just before it enters the porta hepatis.

 

You can also see this little vessel given off. This comes off the right hepatic artery and it's called the cystic artery. It supplies the gallbladder.  You can see the gallbladder, this little sac here.

 

Finally, we've got to take a look at this other branch of the common hepatic artery, the gastroduodenal artery.  There’s no duodenum in this picture, so I'm going to flick over to the other diagram I showed you.

 

We're looking at this descending branch here, the gastroduodenal artery. So before the gastroduodenal artery descends, it sometimes gives off a branch called the supraduodenal artery, which supplies the top part of the duodenum.  We go the pylorus here of the stomach and you've got the duodenum with its C-shape sitting around the head of the pancreas.

 

The first branch we'll look at is this one coming off here. You can see it curves around the greater curvature of the stomach.  Hopefully you will know what this is because we saw the other one before coming off the left of the splenic artery. That was the left gastroepiploic artery.  This branch coming off the gastroduodenal artery is the right gastroepiploic artery and it anastomoses with the left gastroepiploic artery.

 

The next branch of the gastroduodenal artery is the superior pancreaticoduodenal artery. It's quite a mouthful, but it is very descriptive of what the artery does and where it's located. It's 'superior' because there's also an inferior one and it's called 'pancreaticoduodenal' because it supplies the head of the pancreas and also, the duodenum.

 

There is an inferior pancreaticoduodenal artery, which comes off this superior mesenteric artery.  Like we've seen all these anastomosing vessels, we've seen the left gastric anastomosing with the right gastric on the lesser curvature of the stomach. We've seen the left gastroepiploic and the right gastroepiploic anastomosing on the greater curvature of the stomach. And now we're seeing an anastomosis between the superior pancreaticoduodenal artery and the inferior pancreaticoduodenal artery.

 

The superior pancreaticoduodenal artery comes off the gastroduodenal artery and it supplies the duodenum and the head of the pancreas. It anastomoses with the inferior pancreaticoduodenal artery which comes off the superior mesenteric artery.

 

Just to further confuse things, the superior pancreaticoduodenal artery and its inferior counterpart have anterior and posterior branches. It's not shown on this diagram, but I'm going to draw it on to illustrate it for you.

 

Here we've got the anterior superior pancreaticoduodenal artery because it lies anterior to the head of the pancreas, but also, the anterior superior pancreaticoduodenal artery also gives off a posterior branch which runs behind the pancreas. And then it joins up again with the inferior pancreaticoduodenal artery.

 

Just to recap things, you've got the celiac trunk. Then you've got the common hepatic artery, which gives off the proper hepatic artery, which sends off branches to the liver and the gallbladder. And then you've got the gastroduodenal artery, which sends off branches to supply the head of the pancreas and the duodenum as well as this branch supplies the surface of the stomach and anastomoses with the branch from the splenic artery.

 

The gastroduodenal artery gives off the right gastroepiploic artery and then it gives off the superior pancreaticoduodenal artery. And the superior pancreaticoduodenal artery gives off branches anteriorly and posteriorly. These branches unite inferiorly to form the inferior pancreaticoduodenal artery, which is given off by the superior mesenteric artery.

 

That’s the branches of the celiac trunk. I really hope that's cleared things up.