00:01
So now let's have a look at the vasculature
and innovation of the stomach. So here we can
see the stomach and it's principally supplied
by the celiac trunk. Now remember that the
stomach is a derivative of the 4 gut and all
4 gut derivatives is supplied by 1 of 3
unpaired blood vessels that come from the
abdominal aorta. And the 4 gut we're talking
about here is the stomach therefore it's
supplied by the celiac trunk. It leaves the
abdominal aorta rounded by the 12th thoracic
vertebra. Some textbooks may say the lower
border of 12th, the upper border of L1 but
approximately around the 12th thoracic
level. The celiac trunk is principally around
supplying the stomach, esophagus, and parts
of the duodenum. Here we can see the celiac
trunk. It is a short blood vessel, 1-2 cm
long, but it gives rise to 3 very important
branches.
00:57
Here we can see the celiac trunk and it's
giving rise to one of its main branches which
is the left gastric artery. As its name
implies, the left gastric artery is going to
supply parts of the stomach. Here we have the
left gastric artery. We also have the common
hepatic artery which is the 2nd of 3 branches
coming from the celiac trunk. And then
finally we have the splenic artery, which you
can see here. It's been faded out because
it's running posterior to the stomach.
Remember the spleen was on the posterior
aspect of the stomach so it makes sense for
the splenic artery to run posteriorly towards
the spleen behind the stomach. What we have
here is a really important anastomotic
network around both the lesser curvature and
the greater curvature of the stomach. Here
we're just going to concentrate on the lesser
curvature. So here we can see the lesser
curvature is supplied by the left gastric
artery which runs up, it supplies a bit of
the abdominal esophagus and then it runs
down along the lesser curvature where it's
met by the right gastric artery.
02:04
Now the right gastric artery completes this
anastomotic loop that's coming off the celiac
trunk by coming from the common hepatic
artery.
02:14
So here we can see quite a complicated
anastomotic loop around the lesser curvature
of the stomach. Celiac trunk, left gastric,
anastomosis with the right gastric that comes
from the common hepatic that comes from the
celiac trunk. And this is an important
anastomotic ring all the way around the
lesser curvature. We have a second
anastomotic ring that runs around the greater
curvature of the stomach by gastro-omental
arteries. Here we can see the splenic artery
as we seen before passing posterior to the
stomach towards the left-hand side and it's
giving rise to the left gastro-omental
artery. The left gastro-omental artery is
running down the greater curvature where it's
going to be met by the right gastro-omental
artery. Some textbooks may call this
gastroepiploic. It matters not. This is the
left gastro-omental artery coming from the
splenic artery and it will anastomose with
the right gastro-omental artery. The right
gastro-omental artery is coming from the
gastro-duodenal artery. Now the
gastro-duodenal artery comes from the hepatic
artery and we can see the hepatic artery has
been coming again from the celiac trunk. So
now we have this second anastomotic ring
around the greater curvature. We have the
gastric arteries giving rise to the
anastomotic ring around the lesser curvature
and now we have the splenic artery giving
rise to the left gastro-omental anastomosing
with the right gastro-omental that's coming
from the gastro-duodenal which itself comes
from the hepatic which comes from the celiac
trunk. Yes, it is a little bit complicated
but draw it out for yourselves originating
from the celiac trunk and follow celiac
trunk, left gastric, right gastric, common
hepatic, celiac trunk. Then for the greater
curvature, celiac trunk, splenic artery,
left gastro-omental, right gastro-omental,
gastroduodenal, hepatic, celiac trunk.
04:27
Later on in this series we have a nice
schematic that shows all of these together.
04:31
The final blood vessels here we can see are
passing superiorly up towards the fundus of
the stomach. These are coming from the
splenic artery and these are the short
gastric arteries. So a complicated
anastomotic ring around both the lesser and
greater curvatures of the stomach. Finally,
just to wrap up briefly around the innovation
because again we have another video that
brings this altogether nicely. But just for
simplicity, the stomach is innovated by
what's called a celiac plexus. The celiac
plexus is a plexus of nerves that surround
the celiac trunk. Passing into the celiac
plexus is going to be both sympathetic and
parasympathetic branches and from the celiac
plexus those parasympathetic and sympathetic
branches coming from the sympathetic chain,
sympathetic or from the vagus nerve,
parasympathetic, the left and right vagal
trunks form the celiac plexus and from here
passing around the arteries periarterial
plexuses coming from the various blood
vessels they piggyback on those blood vessels
to supply the stomach with its neural
innovation. Here we can see passing down
towards that by passing through the
esophageal hiatus is both the anterior and
posterior vagal trunks analogous with the
left and right vagus nerves and they pass
down, they form part of the celiac plexus but
they are the main parasympathetic
contribution and again they will pass out
over the surface of the stomach giving the
parasympathetic innovation.