Blood supply to stomach

Reading File

Finding Sources

Reading File

Loading Image

Excellent - I have a clear anatomical diagram and rich textbook content. Here is the full answer:

Blood Supply to the Stomach

The stomach is the most richly vascularized segment of the alimentary tract, with a dense intramural anastomotic network. Nearly all of its blood comes from branches of the celiac axis (celiac trunk), the first unpaired branch of the abdominal aorta.

Blood supply to the stomach and duodenum - Sabiston Textbook of Surgery, 21st ed.

Arterial Supply

1. Lesser Curvature Arcade

Artery	Origin	Course
Left gastric artery	Directly from celiac trunk	Runs right along lesser curvature; largest artery to the stomach
Right gastric artery	Proper hepatic artery (near pylorus)	Runs left along lesser curvature; anastomoses with left gastric

These two vessels form a continuous anastomotic arcade along the lesser curvature.

The left gastric is the largest gastric artery. In ~20% of people it gives off an aberrant left hepatic artery that travels in the gastrohepatic ligament - inadvertent ligation can cause hepatic ischemia.
In 90% of individuals the left gastric arises from the celiac axis; rarely it may arise from the common hepatic artery, splenic artery, or directly from the aorta.

2. Greater Curvature Arcade

Artery	Origin	Course
Right gastroepiploic artery	Gastroduodenal artery (behind 1st part of duodenum)	Runs left along greater curvature
Left gastroepiploic artery	Splenic artery	Runs right along greater curvature; anastomoses with right gastroepiploic

These form the gastroepiploic arcade along the greater curvature.

3. Fundus and Proximal Greater Curvature

Short gastric arteries (vasa brevia) - 4 to 6 branches from the splenic artery; travel in the gastrosplenic (gastrolienal) ligament to supply the fundus and proximal greater curvature.
Inferior phrenic artery - may contribute small branches to the proximal/fundic stomach.

Venous Drainage

Veins of the stomach generally parallel the arteries and all drain ultimately into the portal venous system.

Vein	Drains Into
Left gastric vein (coronary vein)	Portal vein
Right gastric vein	Portal vein
Right gastroepiploic vein	Superior mesenteric vein (forms part of Henle's trunk with right colic and anterior superior pancreaticoduodenal veins)
Left gastroepiploic vein	Splenic vein
Short gastric veins	Splenic vein

Clinical point - portal hypertension: Retrograde flow through the left gastric (coronary) vein leads to gastroesophageal varices. In splenic vein thrombosis (from pancreatitis or pancreatic tumour), isolated gastric varices form via the gastroepiploic channels - this is treated by splenectomy alone.

Microvascular Anatomy

Large arteries branch into submucosal arterioles
~70-80% of gastric blood flow goes to the mucosal capillary beds surrounding gastric glands
~20-30% supplies the muscle layers
Mucosal capillaries drain into submucosal venous plexuses
The "alkaline tide" - bicarbonate generated during acid secretion is secreted into capillaries and recycled to buffer surface mucosa

Clinical Significance

Remarkable resilience to ischemia: Because of rich anastomoses, the stomach survives ligation of 3 of 4 named arteries, provided the arcades are intact. This is exploited during esophagectomy (stomach pedicled on right gastric + right gastroepiploic) and sleeve gastrectomy.
Gastric variceal bleeding: Isolated fundal varices strongly suggest splenic vein thrombosis - splenectomy is curative.
Peptic ulcer bleeding: Posterior duodenal ulcers erode the gastroduodenal artery; posterior gastric ulcers can erode the splenic artery - both are surgical emergencies.
Gastric conduit for esophageal replacement: The stomach is pedicled on the right gastroepiploic artery (the second largest gastric vessel), with the left gastric, short gastric, and left gastroepiploic vessels all divided.

Sources: Yamada's Textbook of Gastroenterology, 7th ed. | Sabiston Textbook of Surgery, 21st ed. | Schwartz's Principles of Surgery, 11th ed.

This is a shared conversation. Sign in to Orris to start your own chat.