SN4
SHORT NOTE
5M
★ High-yield
Describe the coeliac trunk with its branches and distribution.
Definition
The coeliac trunk is the artery of the foregut, the first ventral branch of the abdominal aorta.
- Arises at the level of T12, just below the aortic opening of the diaphragm
- Only about 1.25 cm long, then divides into three branches
- Surrounded by the coeliac plexus of nerves and coeliac lymph nodes
Branches
| Branch | Course | Supplies |
|---|---|---|
| Left gastric | Runs to the cardia, then along the lesser curvature | Lower oesophagus and upper lesser curvature; the smallest branch |
| Splenic | Tortuous, along the upper border of the pancreas | Spleen, pancreas (via pancreatic branches), fundus (short gastric) and greater curvature (left gastroepiploic); the largest branch |
| Common hepatic | Runs right, then ascends in the lesser omentum | Liver, gall bladder (cystic), stomach (right gastric), duodenum and pancreas (gastroduodenal) |
Territory — the Foregut
- Supplies from the lower oesophagus to the second part of the duodenum, as far as the opening of the bile duct (the major duodenal papilla)
- Also the liver, gall bladder, pancreas and spleen, all foregut derivatives
- Pain from foregut structures is referred to the epigastrium
Comparison of the Three Gut Arteries
| Artery | Level | Gut region | Extent | Referred pain |
|---|---|---|---|---|
| Coeliac trunk | T12 | Foregut | Lower oesophagus to the opening of the bile duct | Epigastrium |
| Superior mesenteric | L1 | Midgut | Bile duct opening to the junction of the proximal two-thirds and distal third of the transverse colon | Umbilical region |
| Inferior mesenteric | L3 | Hindgut | Distal third of the transverse colon to the upper anal canal | Hypogastrium |
Applied Aspects
- The splenic artery is tortuous along the upper border of the pancreas, so a posterior gastric ulcer or pancreatitis may erode it and cause catastrophic haemorrhage; splenic artery aneurysm is the commonest visceral aneurysm
- The gastroduodenal artery lies behind the first part of the duodenum — a posterior duodenal ulcer erodes it and produces massive haematemesis and melaena
- Median arcuate ligament syndrome — compression of the coeliac trunk by the ligament, causing postprandial pain and weight loss
- Rich anastomoses between the coeliac and superior mesenteric territories through the pancreaticoduodenal arcades mean the coeliac trunk can be occluded slowly without infarction
- Coeliac plexus block is used for the intractable pain of carcinoma of the pancreas, since pain fibres run with the sympathetic through this plexus
All questions in Abdomen
- Q1Describe the layers of the anterior abdominal wall and the formation of the rectus sheath. Add a note on the inguinal canal. ★
- Q2Describe the stomach under parts, relations, blood supply, lymphatic drainage and nerve supply. Add a note on its applied anatomy. ★
- Q3Describe the liver under surfaces, lobes, ligaments and blood supply. Add a note on the porta hepatis and hepatic segments. ★
- Q4Describe the peritoneum with its folds, the lesser sac and the peritoneal spaces. Add a note on its nerve supply and applied anatomy. ★
- Q5Describe the kidney under position, coverings, relations and blood supply. Add a note on the ureter and its constrictions. ★
- SN1Describe the formation and tributaries of the portal vein. Add a note on portal hypertension and portosystemic anastomoses. ★
- SN2Describe the positions, blood supply and applied anatomy of the vermiform appendix. ★
- SN3Describe the spleen with its relations, blood supply and functions. Add a note on splenomegaly and splenectomy. ★
- SN4Describe the coeliac trunk with its branches and distribution. ★
- SN5Describe the extrahepatic biliary apparatus. Add a note on Calot's triangle and gallstones. ★
- SN6Describe the inguinal canal with its boundaries, contents and the mechanisms preventing herniation. ★
- SN7Describe the regions and planes of the abdomen. Add a note on the transpyloric plane and surface marking.