cunninghams-manual-of-practical-anatomy-volume-2-84

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156
Th
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of the liver. In the lesser omentum, the proper 
hepatic artery may give the supraduodenal art-
ery to the superior part of the duodenum. The 
right hepatic artery gives the cystic artery which 
runs along the cystic duct to supply the gallbladder 
[Fig. 11.18]. The right gastric branch of the proper 
hepatic artery passes to the left on the duodenum, 
pylorus, and the lesser curvature of the stomach. It 
supplies these structures and anastomoses with the 
left gastric artery [Figs. 11.17, 11.18].
The gastroduodenal branch of the common 
hepatic artery descends posterior to the first part 
of the duodenum and divides into the superior 
pancreaticoduodenal artery and the right gastro-
epiploic artery [Figs. 11.18, 11.19].
The superior pancreaticoduodenal artery 
divides into two branches which form arcades on 
the anterior and posterior surfaces of the head of 
the pancreas. Each arcade sends branches to the 
duodenum and the pancreas. These arcades anas-
tomose with the inferior pancreaticoduodenal 
branches of the superior mesenteric artery.
The right gastro-epiploic artery runs to the 
left between the layers of the greater omentum. It 
curvature, and sends small twigs into the greater 
omentum [Fig. 11.18].
The corresponding veins drain into the splenic 
vein. The splenic vein lies inferior to the splenic 
artery and runs to the right, posterior to the pan-
creas [Figs. 11.20, 11.21]. It unites with the superior 
mesenteric vein to form the portal vein.
Common hepatic artery and 
corresponding veins
The common hepatic artery passes to the right 
along the superior border of the pancreas up to the 
first part of the duodenum. Here it divides into the 
proper hepatic artery and the gastroduodenal artery.
The proper hepatic artery turns forwards on 
the duodenum, gives off the right gastric artery, 
and ascends in the free margin of the lesser omen-
tum to the porta hepatis [Figs. 11.18, 11.19]. In the 
free margin of the lesser omentum, the proper he-
patic artery lies anterior to the portal vein and to 
the left of the bile duct [Fig. 11.11]. Inferior to the 
porta hepatis, it divides into the right and left he-
patic arteries which enter the corresponding lobes 
Diaphragm
Spleen
Stomach
Left suprarenal gland
Lesser omentum
Left kidney
Pancreas
Coeliac trunk
Greater omentum
Transverse mesocolon
First part of duodenum
Fundus of gallbladder
Liver
Fig. 11.23 Structures posterior to the stomach.
157
St
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The convex, posterolateral diaphragmatic 
surface lies against the diaphragm, parallel to the 
ninth to eleventh left ribs. It is separated from the 
ribs by the diaphragm, pleural cavity, and lung. 
This surface meets the gastric surface at the rela-
tively sharp superior margin. The superior mar-
gin is notched near its anterior end. The notches 
may be palpated through the anterior abdominal 
wall when a grossly enlarged spleen projects below 
the left costal margin.
The spleen develops in the dorsal mesogastrium 
as a number of separate masses, each with its own 
blood supply. These masses fuse together but re-
tain their separate circulations, with little or no 
anastomosis. % Thus blockage of a branch of the 
splenic artery leads to death (infarction) of a seg-
ment of the spleen. Accessory splenic nodules may 
be found in the gastrosplenic ligament.
Abdominal part of the oesophagus
The oesophagus pierces the right crus of the dia-
phragm, posterior to the central tendon, 2–3 cm 
to the left of the median plane. It is accompanied 
by the anterior and posterior vagal trunks, the oe-
sophageal branches of the left gastric artery, and the 
corresponding veins. It grooves the left lobe of the 
liver and almost immediately enters the stomach, 
in line with the lesser curvature. The oesophagus 
makes an acute angle—the cardiac notch—with 
the fundus of the stomach [Figs. 11.10, 11.24].
Replace the stomach and the left lobe of the liver 
if it has been removed. Review the shape and posi-
tion of the stomach.
Stomach
The stomach is the most distensible part of the gut 
tube and lies between the oesophagus and small 
intestine. It is arbitrarily divided into a fundus, 
body, and pylorus [Fig. 11.10].
It has two surfaces—an anterior and a posterior 
surface—and two openings, or orifices—the car-
diac orifice and the pyloric orifice. The cardiac, 
or oesophageal orifice lies approximately 10 cm 
posterior to the seventh left costal cartilage, 2–3 
cm from the median plane. It lies between the liver 
ant eriorly and the diaphragm posteriorly.
anastomoses with the left gastro-epiploic artery 
and sends branches to the superior part of the 
duodenum, the right part of the stomach, and the 
greater omentum [Figs. 11.17, 11.18].
Variations in the arrangements of the branches 
of the common hepatic artery are frequent. Occa-
sionally, the entire artery may arise from the super-
ior mesenteric artery through enlargement of the 
pancreaticoduodenal arcade.
Veins draining the area supplied by the com-
mon hepatic artery enter the portal vein or one 
of its tributaries. The cystic vein enters the right 
branch of the portal vein [Figs. 11.17, 11.21]. The 
pancreaticoduodenal vein enters the portal vein. 
The right gastro-epiploic vein usually enters 
the superior mesenteric vein. The right gastric 
vein enters the portal vein and is united to the 
right gastro-epiploic vein by the prepyloric vein. 
The prepyloric vein crosses the front of the pylorus 
and is a landmark for the surgeon.
Spleen
The spleen lies deep in the left hypochondrium, 
wedged obliquely between the diaphragm, stom-
ach, and left kidney [Fig. 11.22]. It is the largest 
single mass of lymphoid tissue in the body. 
It has a superolateral diaphragmatic surface 
and an inferomedial visceral surface, a supe-
rior and an inferior margin or border, and an 
anterior and a posterior extremity. The spleen 
is covered by peritoneum, except at the long, linear 
hilus on its concave visceral surface. The gas-
trosplenic and lienorenal ligaments are attached 
at the hilus of the spleen. Multiple branches of 
the splenic artery and tributaries of the splenic 
vein pierce the surface of the spleen at the hilus. 
The tip of the tail of the pancreas may reach it 
through the lienorenal ligament [Fig. 11.23].
The visceral surface is marked by the impres-
sion of the left kidney, the left colic flexure, and 
the stomach. The left colic flexure is applied to the 
anterior extremity of the visceral surface. The 
renal surface is in contact with the lateral part of 
the upper half of the left kidney. It faces inferome-
dially and meets the diaphragmatic surface at the 
blunt inferior margin, and the gastric surface at 
a low ridge (the intermediate margin) close to the 
hilus. The gastric surface lies adjacent to the supe-
rior border [Fig. 11.22].