ANATOMY OF THE STOMACH AND DUODENUM Blood supply

ANATOMY OF THE STOMACH AND DUODENUM Blood supply

Arteries The stomach has an arterial supply on both the lesser and greater curves ( Figure 67.1 ). On the lesser curve, the left gastric artery , a branch of the coeliac axis, forms an anastomotic arcade with the right gastric artery , which arises from the common hepatic artery . Branches of the left gastric artery pass up towards the cardia. The gastroduodenal artery , also a branch of the hepatic artery , passes behind the first part of the duodenum, which is highly relevant with respect to a bleeding duodenal ulcer. Here it divides into the superior pancreaticoduodenal artery and the right gastroepiploic artery . The superior pancreaticoduodenal artery supplies the duodenum and pancreatic head and forms an anastomosis with the inferior pancreaticoduodenal artery , a branch of the superior mesenteric artery . The right gastroepip loic artery runs along the greater curvature of the stomach, eventually forming an anastomosis with the left gastroepiploic artery , a branch of the splenic artery . This vascular arcade, important during construction of a gastric conduit in oesoph ageal resection (see Chapter 66 ), is often variably incomplete. The fundus of the stomach is supplied by the vasa brevia (or short gastric arteries), which arise from near the termination of the splenic artery . Veins In general, the veins accompany the arteries; those along the lesser curve drain into the portal vein and those on the greater curve drain into the splenic vein. On the lesser curve, the coronary vein is particularly important. It runs along the lesser curve towards the oesophagus and then passes left to right to join the portal vein. This vein becomes markedly dilated in portal hypertension.

To be able to: Decide on the most appropriate investigation of patients • with complaints relating to the stomach and duodenum Treat peptic ulcer disease and its complications • Recognise the presentation of gastric cancer and • understand the principles involved in treatment