dr kifayat khan

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.

5. Abdominal aorta

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

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.

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.

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.