Neurovasculature of the Stomach

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.