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Blood supply of the 
gut 
Dr Kifayat khan 
Mphil Anatomy 
KMU Peshawer 
www.facebook.com/kaif71
OBJECTIVES 
• To define, describe and outline vertebral 
level of origin, course and branches of 
distribution of 
• celiac trunk 
• superior mesenteric 
• inferior mesenteric 
And pattern of blood supply to stomach, the small 
and large intestines.
Abdominal Aorta 
• The abdominal aorta begins at the aortic hiatus of 
the diaphragm, anterior to the lower border of 
vertebra T12. 
• It descends through the abdomen, anterior to the 
vertebral bodies, and by the time it ends at the 
level of vertebra L4 
• it is slightly to the left of midline. 
• The terminal branches of the abdominal aorta are 
the two common iliac arteries.
Abdominal aorta
• The abdominal aorta has anterior, lateral, 
and posterior branches as it passes through 
the abdominal cavity. The three anterior 
branches supply the gastrointestinal viscera: 
• The celiac trunk 
• The superior mesenteric 
• The inferior mesenteric arteries.
• Before going into detail of gut arterial 
supply we should know gut is divided into 
• A) Foregut 
• B) Midgut 
• C) Hindgut regions. 
– The boundaries of these regions are directly 
related to the areas of distribution of the three 
anterior branches of the abdominal aorta.
A) Fore gut 
• The foregut begins with the abdominal esophagus and ends 
just inferior to the major duodenal papilla, midway along 
the descending part of the duodenum. 
• It includes 
• abdominal esophagus 
• Stomach 
• duodenum (superior to the major papilla) 
• Liver 
• Pancreas 
• gallbladder. 
• The spleen also develops in relation to the foregut region. 
– The foregut is supplied by the celiac trunk.
Celiac trunk 
• The celiac trunk is the anterior branch of the 
abdominal aorta supplying the foregut. 
• It arises from the abdominal aorta immediately 
below the aortic hiatus of the diaphragm, anterior 
to the upper part of vertebra LI. 
• It immediately divides into 
– 1) left gastric 
• It sends esophageal branches upward to the abdominal part of 
the esophagus. 
• The left gastric artery itself turns to the right and descends 
along the lesser curvatureand anastomoses with the right 
gastric artery
– 2) Splenic artery 
• takes a tortuous course to the left along the superior border of 
the pancreas. supply the neck, body, and tail of the pancreas 
• It then travels in the splenorenal ligament and divides into 
numerous branches, which enter the hilum of the spleen. 
• gives off short gastric arteries, which pass through the 
gastrosplenic ligament to supply the fundus of the stomach 
• It also gives off the left gastro-omental artery, which runs to 
the right along the greater curvature of the stomach, and 
anastomoses with the right gastro-omental artery.
– 3) common hepatic arteries 
• It runs to the right and divides into its two terminal branches, 
• a) the hepatic artery proper 
– which gives right gastric artery,right and left hepatic arteries. As the right 
hepatic artery nears the liver, it gives off the cystic artery to the 
gallbladder 
• b) the gastroduodenal artery. 
– Gives off 
– i) the supraduodenal artery 
– ii) The right gastro-omental artery passes to the left, along the greater 
curvature of the stomach, eventually anastomosing with the left gastro-omental 
artery from the splenic artery. 
– iii) superior pancreaticoduodenal artery 
– The superior pancreaticoduodenal artery divides into anterior and 
posterior branches as it descends and supplies the head of the pancreas 
and the duodenum.
B) Mid gut 
• The midgut begins just inferior to the major duodenal 
papilla, in the descending part of the duodenum, and ends 
at the junction between the proximal two-thirds and distal 
one-third of the transverse colon. 
• It includes 
• The duodenum (inferior to the major duodenal papilla) 
• Jejunum 
• Ileum 
• Cecum 
• Appendix 
• Ascending colon 
• The right two-thirds of the transverse colon. 
– The midgut is supplied by the superior mesenteric artery.
Superior mesenteric artery 
• It is the anterior branch of the abdominal aorta supplying 
the midgut. 
• It arises from the abdominal aorta immediately below the 
celiac artery,anterior to the lower part of vertebra LI. 
• It gives following branches 
– 1) The inferior pancreaticoduodenal artery 
• arterial network supplies the head and uncinate process of the 
pancreas and the duodenum 
– 2) Jejunal and Ileal arteries on its left 
• Form single and double arcades in the area of the jejunum,nd more 
arcades in ileum. 
– 3) The middle colic, right colic, and ileocolic arteries 
• which supply the terminal ileum, cecum, appendix,ascending colon, 
and two- thirds of the transverse colon.
C) Hind gut 
• The hindgut begins just before the left colic 
flexure (the junction between the proximal two-thirds 
and distal one-third of the transverse colon) 
and ends midway through the anal canal. 
• It includes 
• The left one-third of the transverse colon 
• descending colon 
• sigmoid colon 
• Rectum 
• upper part of the anal canal. 
– The hindgut is supplied by the inferior mesenteric 
artery
Inferior mesenteric artery 
• It is the anterior branch of the abdominal aorta that 
supplies the hindgut. 
• arises anterior to the body of vertebra L3. 
• Its branches include 
– 1) left colic artery 
• Ascending branch supply the upper part of the descending 
colon and the distal part of the transverse colon, and 
anastomoses with branches of the middle colic artery; 
• the descending branch passes inferiorly, supplying the lower 
part of the descending colon and anastomoses with the first 
sigmoid artery.
– 2)Sigmoid arteries 
• supply the lowest part of the descending colon and 
the sigmoid colon. 
• Its branches anastomose superiorly with branches 
from the left colic artery and inferiorly with 
branches from the superior rectal artery. 
– 3) The superior rectal artery 
• its the terminal branch of the inferior mesenteric 
artery supplying rectum and upper portion of annal 
cannal.
Clinical anatomy 
1) The celiac axis syndrome: 
• This occurs when the celiac trunk is compressed by the diaphragmatic crura leading to 
reduced blood supply to the foregut structures. 
– It presents with pain in these structures 
2) Intestinal angina: 
– This may follow atherosclerosis or other narrowing of the mesenteric arteries causing ischemic 
pain in the intestines. It is worsened by eating and so victims tend to avoid eating. 
– The impaired absorption and food avoidance lead to wasting of the victims. 
3) Mesenteric artery thrombosis: 
• This is a rare condition that causes gut gangrene Water shed areas: The areas of the 
colon where branches of major arteries are vulnerable to ischemia. 
4) Superior mesenteric artery (SMA) syndrome 
• It is a very rare. 
– life-threatening gastro-vascular disorder characterized by a compression of the third portion of 
the duodenum by the abdominal aorta (AA) and the overlying superior mesenteric artery.
Arterial supply of gut

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Arterial supply of gut

  • 1. Blood supply of the gut Dr Kifayat khan Mphil Anatomy KMU Peshawer www.facebook.com/kaif71
  • 2. OBJECTIVES • To define, describe and outline vertebral level of origin, course and branches of distribution of • celiac trunk • superior mesenteric • inferior mesenteric And pattern of blood supply to stomach, the small and large intestines.
  • 3. Abdominal Aorta • The abdominal aorta begins at the aortic hiatus of the diaphragm, anterior to the lower border of vertebra T12. • It descends through the abdomen, anterior to the vertebral bodies, and by the time it ends at the level of vertebra L4 • it is slightly to the left of midline. • The terminal branches of the abdominal aorta are the two common iliac arteries.
  • 4.
  • 6. • The abdominal aorta has anterior, lateral, and posterior branches as it passes through the abdominal cavity. The three anterior branches supply the gastrointestinal viscera: • The celiac trunk • The superior mesenteric • The inferior mesenteric arteries.
  • 7. • Before going into detail of gut arterial supply we should know gut is divided into • A) Foregut • B) Midgut • C) Hindgut regions. – The boundaries of these regions are directly related to the areas of distribution of the three anterior branches of the abdominal aorta.
  • 8. A) Fore gut • The foregut begins with the abdominal esophagus and ends just inferior to the major duodenal papilla, midway along the descending part of the duodenum. • It includes • abdominal esophagus • Stomach • duodenum (superior to the major papilla) • Liver • Pancreas • gallbladder. • The spleen also develops in relation to the foregut region. – The foregut is supplied by the celiac trunk.
  • 9. Celiac trunk • The celiac trunk is the anterior branch of the abdominal aorta supplying the foregut. • It arises from the abdominal aorta immediately below the aortic hiatus of the diaphragm, anterior to the upper part of vertebra LI. • It immediately divides into – 1) left gastric • It sends esophageal branches upward to the abdominal part of the esophagus. • The left gastric artery itself turns to the right and descends along the lesser curvatureand anastomoses with the right gastric artery
  • 10.
  • 11. – 2) Splenic artery • takes a tortuous course to the left along the superior border of the pancreas. supply the neck, body, and tail of the pancreas • It then travels in the splenorenal ligament and divides into numerous branches, which enter the hilum of the spleen. • gives off short gastric arteries, which pass through the gastrosplenic ligament to supply the fundus of the stomach • It also gives off the left gastro-omental artery, which runs to the right along the greater curvature of the stomach, and anastomoses with the right gastro-omental artery.
  • 12. – 3) common hepatic arteries • It runs to the right and divides into its two terminal branches, • a) the hepatic artery proper – which gives right gastric artery,right and left hepatic arteries. As the right hepatic artery nears the liver, it gives off the cystic artery to the gallbladder • b) the gastroduodenal artery. – Gives off – i) the supraduodenal artery – ii) The right gastro-omental artery passes to the left, along the greater curvature of the stomach, eventually anastomosing with the left gastro-omental artery from the splenic artery. – iii) superior pancreaticoduodenal artery – The superior pancreaticoduodenal artery divides into anterior and posterior branches as it descends and supplies the head of the pancreas and the duodenum.
  • 13. B) Mid gut • The midgut begins just inferior to the major duodenal papilla, in the descending part of the duodenum, and ends at the junction between the proximal two-thirds and distal one-third of the transverse colon. • It includes • The duodenum (inferior to the major duodenal papilla) • Jejunum • Ileum • Cecum • Appendix • Ascending colon • The right two-thirds of the transverse colon. – The midgut is supplied by the superior mesenteric artery.
  • 14. Superior mesenteric artery • It is the anterior branch of the abdominal aorta supplying the midgut. • It arises from the abdominal aorta immediately below the celiac artery,anterior to the lower part of vertebra LI. • It gives following branches – 1) The inferior pancreaticoduodenal artery • arterial network supplies the head and uncinate process of the pancreas and the duodenum – 2) Jejunal and Ileal arteries on its left • Form single and double arcades in the area of the jejunum,nd more arcades in ileum. – 3) The middle colic, right colic, and ileocolic arteries • which supply the terminal ileum, cecum, appendix,ascending colon, and two- thirds of the transverse colon.
  • 15.
  • 16. C) Hind gut • The hindgut begins just before the left colic flexure (the junction between the proximal two-thirds and distal one-third of the transverse colon) and ends midway through the anal canal. • It includes • The left one-third of the transverse colon • descending colon • sigmoid colon • Rectum • upper part of the anal canal. – The hindgut is supplied by the inferior mesenteric artery
  • 17. Inferior mesenteric artery • It is the anterior branch of the abdominal aorta that supplies the hindgut. • arises anterior to the body of vertebra L3. • Its branches include – 1) left colic artery • Ascending branch supply the upper part of the descending colon and the distal part of the transverse colon, and anastomoses with branches of the middle colic artery; • the descending branch passes inferiorly, supplying the lower part of the descending colon and anastomoses with the first sigmoid artery.
  • 18.
  • 19. – 2)Sigmoid arteries • supply the lowest part of the descending colon and the sigmoid colon. • Its branches anastomose superiorly with branches from the left colic artery and inferiorly with branches from the superior rectal artery. – 3) The superior rectal artery • its the terminal branch of the inferior mesenteric artery supplying rectum and upper portion of annal cannal.
  • 20. Clinical anatomy 1) The celiac axis syndrome: • This occurs when the celiac trunk is compressed by the diaphragmatic crura leading to reduced blood supply to the foregut structures. – It presents with pain in these structures 2) Intestinal angina: – This may follow atherosclerosis or other narrowing of the mesenteric arteries causing ischemic pain in the intestines. It is worsened by eating and so victims tend to avoid eating. – The impaired absorption and food avoidance lead to wasting of the victims. 3) Mesenteric artery thrombosis: • This is a rare condition that causes gut gangrene Water shed areas: The areas of the colon where branches of major arteries are vulnerable to ischemia. 4) Superior mesenteric artery (SMA) syndrome • It is a very rare. – life-threatening gastro-vascular disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta (AA) and the overlying superior mesenteric artery.