Editing Stomach (section)

== '''Arteries''' ==

* Rich anastomosis in mucosa,     submucosa, and intra-muscular layers
* Four main branches, mostly     from coeliac trunk:
** '''Left      gastric artery'''      (direct branch of coeliac trunk) supplies the proximal part of lesser      curvature. It ascends a short distance beneath the peritoneum to reach      the lesser curve at the gastro-oesophageal junction (accompanied by left      gastric (coronary) vein and the coeliac branch of the posterior vagus      nerve). To reach the stomach, it raises a fold of peritoneum called the      gastropancreatic fold, best seen from the lesser sac. This is the biggest      gastric artery normally. Gives off oesophageal branches, and usually      divides into anterior and posterior branches. 15-20% of patients have an      aberrant accessory left hepatic artery, originating from the left gastric      artery. 10% have an accessory left gastric artery from the splenic      artery.
** '''Right      gastric artery''' (branch      of hepatic artery or sometimes gastroduodenal artery) supplies the distal      part of lesser curvature
*** Arises from CHA before or       after GDA branch and descends towards pylorus, contained in leaves of       the lesser omentum
*** Can give off the small       artery above the pylorus, the supraduodenal artery
*** Small in size but adequate       to support a conduit
** '''Left      gastroepiploic artery''' (branch of splenic artery) supplies the proximal greater      curvature. Arises from splenic artery, and passes to stomach via      gastrosplenic ligament, to reach the greater curvature at about the level      of the inferior pole of spleen. It runs in greater omentum about 1cm from      greater curvature, as the gastro-omental arcade. This arcade runs between      the two layers of the greater omentum. Note that it only runs about      two-thirds of the way along the greater curvature, only as far superiorly      as its feeding vessel in the gastrosplenic ligament. Left omental branch.
** '''Right      gastroepiploic artery''' (branch of gastroduodenal artery) supplies the distal part of      greater curvature. Arises as one of the two terminal branches of GDA,      behind D1. Mirror image to the left gastro-epiploic.
* Additionally, the fundus and     upper left part of the great curvature receive about six '''short     gastric arteries'''     from the splenic artery in the gastrosplenic ligament, which supply fundus     normally, but can preserve a gastric pouch.
* Some supply to proximal     stomach can come from oesophageal arteries
* In most cases, the stomach     will survive if 3 out of the 4 arteries are ligated, provided the     anastomotic connections are preserved.
* 40-97% of patients have a     posterior gastric artery supplying the posterior portion of the gastric     fundus that arises from the middle splenic artery, which can preserve a     gastric pouch if care is taken to identify it. Could be conceptualised as     the most proximal of the short gastric arteries.

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